Atlanta, GA—The recommended use of two inactivated influenza vaccines has been changed for the upcoming flu season, according to public health officials.

The CDC announced recent labeling changes for two IIV4s, Afluria Quadrivalent and Fluzone Quadrivalent. Based on discussions at three public meetings by the Advisory Committee on Immunization practices (ACIP), the age indication for Afluria Quadrivalent has been expanded from age 5 years or older to age 6 months or older. The dose volume for Afluria Quadrivalent is 0.25 mL for children aged 6 through 35 months and 0.5 mL for everyone aged 3 years or older.

In addition, the dose volume for Fluzone Quadrivalent for children aged 6 through 35 months, which was previously 0.25 mL, is now either 0.25 mL or 0.5 mL. The dose volume for Fluzone Quadrivalent is 0.5 mL for anyone aged 3 years or older, according to the article in the Morbidity & Mortality Weekly Report.

Those changes were discussed at ACIP meetings on October 25, 2018, February 27, 2019, and June 27, 2019. Public-health officials also determined that 2019–2020 U.S. trivalent influenza vaccines will contain hemagglutinin (HA) derived from an A/Brisbane/02/2018 (H1N1)pdm09–like virus, an A/Kansas/14/2017 (H3N2)–like virus, and a B/Colorado/06/2017–like virus (Victoria lineage). Quadrivalent influenza vaccines will contain HA derived from these three viruses and a B/Phuket/3073/2013–like virus (Yamagata lineage).

CDC recommends routine annual influenza vaccination for everyone aged 6 months or older who does not have contraindications; it further states that a “licensed, recommended, and age-appropriate vaccine should be used.”

Expected to be available for the 2019-2020 season are inactivated influenza vaccines (IIVs), recombinant influenza vaccine (RIV), and live attenuated influenza vaccine (LAIV).

The CDC advises that standard-dose, unadjuvanted, inactivated influenza vaccines will be available in quadrivalent formulations (IIV4s), while high-dose (HD-IIV3) and adjuvanted (aIIV3) inactivated influenza vaccines will be available in trivalent formulations. Recombinant (RIV4) and live attenuated influenza vaccine (LAIV4) will also be available in quadrivalent formulations.

“During the six influenza seasons from 2010–11 through 2015–16, influenza vaccination prevented an estimated 1.6–6.7 million illnesses, 790,000–3.1 million outpatient medical visits, 39,000–87,000 hospitalizations, and 3,000–10,000 respiratory and circulatory deaths each season in the United States,” according to the MMWR article. “During the recent severe 2017–18 influenza season, notable for an unusually long duration of widespread high influenza activity throughout the United States and higher rates of outpatient visits and hospitalizations compared with recent seasons, vaccination is estimated to have prevented 7.1 million illnesses, 3.7 million medical visits, 109,000 hospitalizations, and 8,000 deaths, despite an overall estimated vaccine effectiveness of 38% (62% against influenza A[H1N1]pdm09 viruses; 22% against influenza A[H3N2] viruses; and 50% against influenza B viruses).”

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