Seasonal Influenza (Flu)

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Recommendations for Using TIV and LAIV

Influenza Prevention and Control Recommendations

Published for the 2010-11 Influenza Season; Adapted for the 2012-13 Influenza Season

Routine vaccination of all persons aged 6 months and older

Starting with the 2010-11 season, routine vaccination of all persons aged 6 months and older has been recommended and continues to be recommended for the 2012-13 season. During the 2009--10 influenza season, an estimated 85% of the U.S. population already had an indication for vaccination. A universal vaccination recommendation for all persons aged 6 months and older eliminates the need to determine whether each person has an indication for vaccination and emphasizes the importance of preventing influenza among person of all ages. The expansion of the recommendations for annual vaccination to include all adults is supported by evidence that influenza vaccines are safe and it is the best available way to prevent influenza. In addition, morbidity and mortality among adults aged younger than 50 years, including adults who were previously healthy, occurs in every influenza season. Although most adults in this age group who develop influenza-related complications have medical risk factors, some have no previously identified risk factors for influenza complications, or have risk factors but are unaware that they should be vaccinated. Expansion of vaccination recommendations to all adults reflects the need to remove potential barriers to receipt of influenza vaccine, including lack of awareness about vaccine indications among persons at higher risk for influenza complications and their close contacts. Although the capacity now exists to produce sufficient influenza vaccines to meet the predicted increase in demand, the annual supply of influenza vaccine and timing of its distribution cannot be guaranteed in any year.

Recommendations to include all adults

Further support for expansion of recommendations to include all adults is based on data from the 2009 pandemic experience. Data from epidemiologic studies conducted during the 2009 influenza A (H1N1) pandemic indicates that the risk for influenza complications among adults aged younger than 50 years who had 2009 pandemic influenza A (H1N1) is greater than is typically seen for seasonal influenza. Explosive outbreaks of 2009 H1N1 influenza among young adults in settings such as college campuses were part of the basis for prioritizing vaccination of all persons aged 6 months--24 years during the 2009 pandemic influenza response. Pandemic 2009 influenza A (H1N1)-like viruses are expected to continue to circulate during the 2012--13 influenza season. In addition, severe infections were observed more frequently in some younger adults who did not have previously recognized risk factors for influenza-related complications, including obese persons, persons in certain racial and ethnic minority groups, and postpartum women.

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Strains included in the 2012-2013 influenza vaccine

Both trivalent inactivated influenza vaccine (TIV) and live-attenuated influenza vaccine (LAIV) prepared for the 2012--13 season will include A/California/7/2009 (H1N1)-like, A/Victoria/361/2011 (H3N2)-like, and B/Wisconsin/1/2010-like antigens. The influenza B virus component of the 2012--13 vaccine is from the Yamagata lineage. These viruses will be used because they are representative of influenza viruses that are predicted to be circulating in the United States during the 2012--13 influenza season and have favorable growth properties in eggs. The H1N1 strain recommended for the 2012--13 trivalent influenza vaccine is the same as the vaccine strain in the 2009 H1N1 monovalent vaccines given during the pandemic. The 2009 pandemic influenza virus-derived vaccine strain has replaced the seasonal influenza H1N1 vaccine strains that were present in the vaccine since 1977.

Healthy nonpregnant persons aged 2--49 years

Healthy nonpregnant persons aged 2--49 years can choose to receive either TIV or LAIV. Some TIV formulations are FDA-licensed for use in persons as young as age 6 months (see Recommended Vaccines for Different Age Groups). Persons aged 65 years and older can be administered either standard-dose TIV (15 mcg per vaccine strain) or the licensed TIV containing 60 mcg HA antigen per vaccine strain (Sanofi pasteur). TIV is licensed for use in persons with high-risk conditions. LAIV is FDA-licensed for use only for persons aged 2--49 years. In addition, FDA has indicated that the safety of LAIV has not been established in persons with underlying medical conditions that confer a higher risk for influenza complications.

All children aged 6 months--8 years

Information about the vaccination schedule for children aged 6 months through 8 years is available in the 2012-13 recommendation.

Providing routine vaccination annually

In addition, emphasis on providing routine vaccination annually to certain groups at higher risk for influenza infection or complications is advised, including all children aged 6 months--18 years, all persons aged 50 years and older and other persons at risk for medical complications from influenza. These persons, their household and close contacts, and all health care personnel should continue to be a focus of vaccination efforts as providers and programs transition to routinely vaccinating all persons aged 6 months and older (Box).