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2018-2019 Influenza Vaccines and Recommendations

Sept. 13, 2018 

The 2018-2019 influenza season begins Sept. 30, 2018. Influenza activity in Washington typically peaks mid-winter; however, influenza-associated hospitalizations have occurred as early as the first week of the season. Last season, the first influenza-associated death in Washington occurred in Pierce County in October. This August, we began receiving sporadic reports of positive influenza rapid tests.

Immunization remains the most effective way to prevent influenza. Since 2010, the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) has recommended annual influenza immunization for all people age 6 months and older with no contraindication to the vaccine. Immunization is especially important for people at greater risk of complication and death, and those who live with or care for them, including:

  • Children age 6 to 59 months.
  • Adults age 50 years and older.
  • People with chronic diseases.
  • Immunocompromised people.
  • Pregnant women.
  • Children age 6 months to 18 years who take aspirin or salicylate-containing drugs.
  • Long-term care facility residents.
  • American Indian and Alaska Natives.
  • People with body mass index (BMI) greater than 40 kg/m2.

2018-2019 trivalent vaccines include:

  • A/Michigan/45/2015 (H1N1) pdm09-like virus.
  • A/Singapore/INFIMH-16-0019/2016 (H3N2)-like.
  • B/Colorado/06/2017-like (Victoria lineage).

In addition to the above, 2018-2019 quadrivalent vaccines include:

  • B/Phuket/3073/2013-like (Yamagata lineage).

This season’s vaccines’ H3N2 and Victoria lineage viruses are different from last season’s northern hemisphere vaccines.

New this season:

  • Afluria Quadrivalent is now licensed for people age 5 years and older (was people age 18 years and older).
  • Fluarix Quadrivalent is now licensed for people age 6 months and older (was people age 3 years and older).
    • The dose for children age 6 to 35 months is 0.25 ml.
    • The dose for people age 3 years and older is 0.5 ml.

Because of its limited effectiveness against influenza A(H1N1) in previous seasons, ACIP did not recommend FluMist live attenuated influenza vaccine (LAIV) for the 2016-2017 and 2017-2018 seasons. FluMist’s H1N1 component was updated this season, so ACIP recommendations include LAIV for people age 2 to 49 years. ACIP has no preference for any age-appropriate influenza vaccine over another; however, the American Academy of Pediatrics (AAP) recommends inactivated influenza vaccines for all children. AAP states LAIV may be used for children who would not otherwise be vaccinated (e.g., for a child who refuses to receive an injection).

People allergic to eggs may receive any licensed age-appropriate influenza vaccine. People with a severe egg allergy should receive influenza vaccines in a clinical setting where healthcare personnel can recognize and treat allergic reactions. A history of severe allergic reaction to an influenza vaccine is a contraindication to influenza vaccine. All influenza vaccines licensed in the United States—other than Flucelvax and Flublok—are produced using chicken eggs. ACIP and AAP have no preference for recombinant or cell-culture vaccines for people who are allergic to eggs.

Because we cannot predict the onset and peak of influenza activity, ACIP and AAP recommend administering influenza vaccines as soon as they are available. Providers should not delay immunization because of concerns of waning immunity and decreasing effectiveness over time or preference for one vaccine over another.

2018-2019 Influenza Vaccines

Age  Vaccine  Type  Comment
 6 months or older  Fluarix Quadrivalent  IIV4  0.5 ml dose
 6 months or older  Flulaval Quadrivalent  IIV4  0.5 ml dose
 6 to 35 months  Fluzone Quadrivalent  IIV4  0.25 ml dose
 2 to 49 years  FluMist Quadrivalent  LAIV4  Intranasal route
 3 years or older  Fluzone Quadrivalent  IIV4  0.5 ml dose
 4 years or older  Flucelvax Quadrivalent  ccIIV4  Cell culture
 5 years or older  Afluria Trivalent  IIV3  May be administered by jet injector to people age 18 to 64 years
 5 years or older  Afluria Quadrivalent  IIV4  May be administered by jet injector to people age 18 to 64 years
 18 years or older  Flublok Quadrivalent  RIV4  Recombinant
 65 years or older  Fluad  aIIV3  MF59 adjuvanted
 65 years or older  Fluzone  HD-IIV3  High-dose



AAP Committee on Infectious Diseases. (2018). Recommendations for prevention and control of influenza in children, 2018-2019. Pediatrics, 142(4). doi:10.1542/peds.2018-2367.

Grohskopf, L. A., Sokolow, L. Z., Broder, K. R., Walter, E. B., Fry, A. M., & Jernigan, D. B. (2018). Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices—United States, 2018-19 influenza season. Morbidity and Mortality Weekly Report, 67(3). doi:10.15585/mmwr.rr6703a1.

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