Atlanta—For this influenza season—unlike in the past—adults aged 65 years and older are specifically recommended to receive a higher dose or adjuvanted influenza vaccine.

That could be the quadrivalent high-dose inactivated influenza vaccine (HD-IIV4), quadrivalent recombinant influenza vaccine (RIV4), or quadrivalent adjuvanted inactivated influenza vaccine (aIIV4), according to recommendations from the Advisory Committee on Immunization Practices (ACIP) published in the Morbidity & Mortality Weekly Report.

Only if none of those three vaccines is available for vaccine administration should a regular vaccine (i.e., any other age-appropriate influenza vaccine) be used. The ACIP makes no preferential recommendation for a specific vaccine when more than one licensed, recommended, and age-appropriate vaccine is available, except for those aged 65 years and older.

The recommendation and others came after four public meetings of ACIP that were held on October 20, 2021; January 12, 2022; February 23, 2022; and June 22, 2022.

Another difference this year is the composition of 2022-2023 U.S. seasonal influenza vaccines, which include updates to the influenza A (H3N2) and influenza B/Victoria lineage components. The CDC, which is advised by the ACIP, says that U.S.-licensed influenza vaccines will contain hemagglutinin (HA) derived from an influenza A/Victoria/2570/2019 (H1N1) pdm09-like virus (for egg-based vaccines) or an influenza A/Wisconsin/588/2019 (H1N1) pdm09-like virus (for cell culture–based or recombinant vaccines); an influenza A/Darwin/9/2021 (H3N2)-like virus (for egg-based vaccines) or an influenza A/Darwin/6/2021 (H3N2)-like virus (for cell culture–based or recombinant vaccines); an influenza B/Austria/1359417/2021 (Victoria lineage)-like virus; and an influenza B/Phuket/3073/2013 (Yamagata lineage)-like virus.

Also changed was the approved age indication for the cell culture–based inactivated influenza vaccine, Flucelvax Quadrivalent (ccIIV4). As of October 2021, after recommendations were issued for the last flu season, the age indication went from age 2 years or older to age 6 months or older.

Public health officials advised that all seasonal influenza vaccines expected to be available in the United States for the 2022-23 season are quadrivalent, containing HA derived from one influenza A (H1N1) pdm09 virus, one influenza A (H3N2) virus, one influenza B/Victoria lineage virus, and one influenza B/Yamagata lineage virus. Also expected to be available are inactivated influenza vaccines (IIV4s), recombinant influenza vaccine (RIV4), and live attenuated influenza vaccine (LAIV4). Trivalent influenza vaccines are no longer available, they added.

Even though influenza vaccines already are widely available and have been for several weeks, the ACIP suggested that most people who need only one dose of flu vaccine for the season should receive it no earlier than September or October.

“However, vaccination should continue after October and throughout the season as long as influenza viruses are circulating and unexpired vaccine is available,” the article noted. “For most adults (particularly adults aged ≥65 years) and for pregnant persons in the first or second trimester, vaccination during July and August should be avoided unless there is concern that vaccination later in the season might not be possible. Certain children aged 6 months through 8 years need 2 doses; these children should receive the first dose as soon as possible after vaccine is available, including during July and August. Vaccination during July and August can be considered for children of any age who need only 1 dose for the season and for pregnant persons who are in the third trimester if vaccine is available during those months.”

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