What's new with flu vaccines for 2019-2020?
This year's vaccines contain different A strains (H1N1 and H3N2) than last year...but the same B strains.
WHEN to give. Recommend getting a flu vaccine by the end of October...but continue to vaccinate as long as flu is circulating.
You'll hear experts now say vaccinating in July or August is likely linked to waning immunity before flu season ends...especially in seniors.
Keep in mind, flu activity usually peaks in January or later. Explain that the aim is to balance missed opportunities to vaccinate against not knowing precisely when flu outbreaks will start.
But evidence about waning immunity is still inconsistent. Don't give a "booster" dose...even if patients got a flu vaccine in early fall.
WHAT to give. Continue to emphasize getting vaccinated...rather than worrying about which flu vaccine to use.
You'll see a new injectable quadrivalent in this year's lineup...Afluria (af-LER-ee-ah) for patients 5 years and up.
But don't expect FluMist Quadrivalent intranasal vaccine to be available this year...due to manufacturing issues.
For kids and adolescents, recommend an injectable QUADrivalent (Fluzone, etc)...since it has additional influenza B coverage. But feel comfortable recommending a TRIvalent (Agriflu, etc) as an alternative.
For adults over 65, discuss trivalent options intended to boost immunity...Fluzone High-Dose or adjuvanted Fluad.
Explain Fluzone High-Dose seems to prevent slightly more flu in seniors than standard-dose trivalent. Both Fluzone High-Dose and Fluad may cause more injection site reactions than standard trivalents.
But it's too soon to say how Fluzone High-Dose or Fluad stack up to each other...or to quadrivalent vaccines for this age group.
HOW to give. Ask about other needed vaccines (pneumococcal, Tdap, etc)...and feel comfortable giving at the same visit as any flu vaccine.
There are theoretical concerns about more side effects when giving two vaccines with adjuvants...such as Fluad with Shingrix. Don't delay vaccination...but consider a flu vaccine other than Fluad if available.
- Clin Infect Dis 2019;68(10):1623-30
- Clin Infect Dis Published online Jun 29, 2019; doi:10.1093/cid/ciz452
- Chart: Flu Vaccines for 2019-2020