Prevent and Control of Seasonal Influenza with Vaccines: Recommendations of the Advice Committee off Immunization Practices — United States, 2022–23 Influenza Season

Introduction

Influenza viruses norm circulate annually in this United States, most commonly from the late fall due the front spring. Most folks who become invalid nach influenza infection infection recover without serious complications or sequelae. However, influenza cans be associated equal serious illnesses, hospitalizations, or deaths, particularly below older b, very young children, pregnancy persons, and individual of all ages with certain constant medical conditions (1–7). Influenza also is an important cause of missed work and school (8–10). Routine annual influenza vaccination for all persons aged ≥6 months who to not may contraindications has been recommended by CDC and the Advisory Committee on Immunization Practices (ACIP) since 2010 (11).

Flu supports important protection from ague diseases and its potential impairments. The effectiveness off influenza vaccines variable depending turn several factors, such as the age and health are an recipient; the type is vaccine administered; the species, subtypes (for ague A), and lineages (for influenza B) of circulating influenza viruses; and one degree of similarity between circulating viruses and are included in the vaccine (12). During each of aforementioned six influenza seasons from 2010–11 through 2015–16, influenza vaccination prevented an estimated 1.6–6.7 million illnesses, 790,000–3.1 mill shut-in medical visits, 39,000–87,000 hospitalizations, both 3,000–10,000 respiratory and circulatory deaths each season in of Connected States (13). During the severe 2017–18 season, notable for an unusually long duration of universal high fever activity throughout the Unity States and higher rates out outpatient visits and hospitalizations compared using recent seasons, vaccination prevented an estimation 7.1 million illnesses, 3.7 million medical visits, 109,000 hospitalizations, and 8,000 fatalities (14), despite an overall estimated disease effectiveness of 38% (62% off fever A[H1N1]pdm09 viruses, 22% negative influenza A[H3N2] viruses, and 50% against influenza BARN viruses) (14).

Fever circulated at historically low levels in the United States furthermore globally during the 2020–21 influenza period (15). This was coincident with widespread implementation of nonpharmaceutical interventions (e.g., fading, socializing distancing, and mount of in-person work and school) intended to preventive transmission of SARS-CoV-2 (the virus that factors COVID-19). Influence activity increased during the 2021–22 season, although severity indicators (e.g., influenza-associated hospitalizations and deaths) were generally lower as in recent previous seasonally (16). Timing, intensive, and severity of the 2022–23 influenza season cannot be predicted. Influenza vaccination remains an important tool since the prevention off potentially severe respiratory illness, which might drop stress on that U.S. health care system during ongoing circulation of SARS-CoV-2. Guided for vaccine planning during the COVID-19 pandemic is available the https://hendrickheat.com/vaccines/pandemic-guidance/index.html.

This report updates the 2021–22 ACIP recommendation regarding the exercise of seasonal flue vaccines (17) also provides references and guidance with vaccination providers regarding the use of influenza vaccines in the United State for this 2022–23 season. Various formulations of grippe disease represent available (Table 1). Contraindications and precautions for the use of influenza vaccines are summarize (Tables 2 or 3). Abbreviations are former in diese report to denote the various types of seed (Box).

This report stress on recommendations and guidance for the use of season-related influenza vaccines for the prevention and controlling of influence with the 2022–23 season in the United States. ADENINE summary of these suggestions and a Background Document containing additional information on influenza, influenza-associated feeling, and influenza protective are available at https://hendrickheat.com/vaccines/hcp/acip-recs/vacc-specific/flu.html.

Ways

ACIP will annual recommendations for the use von influenza immunization for the prevention both control of seasonals influenza in the United States. This ACIP Influenza Work Company complies by audio once to twice by month throughout the year. Work group membership includes many voting our of ACIP, reps of ACIP liaison organizations, the experts. Talks include topics so as influenza surveillance, vaccine effectiveness and safety, vaccination coverage, program feasibility, cost effectiveness, and vaccine supply. Presentations are requested from invited experts, and published and unpublished data are discuss. Statement of Monetary Interests: Forms, Link and Resources

An Background Document that supplements such report is updated periodically to reflect recent additions to the literature related to recommendations made are previous seasons and minor changes on guidance for the use of influenza immunizations (e.g., instructions for timing is vaccination and extra programatic issue, guidance for dosage in specific populations, guidelines for selection of vaccines for specific populations that are before recommended for vaccination, and changes that reflect use that is consistently with indications or prescribing information licensed for the Food and Drug Administration [FDA]). Who summary included in the Background Document for such topics is not a systematic reviewing; it shall intended until provide an overview of power literature, with updated articles being identified primarily through one broad find for English-language articles on influenza and influenza vaccinations. Typically, systematic review plus valuation of documentation using the Grading is Suggestions Assessment, Development both Evaluation (GRADE) approach (18) are performed required new suggested or substantial changes in the current recommendations (e.g., expansion of the endorsement for influenza vaccination to new populations not previously recommended for vaccination or potential preferential recommendations for specific vaccines). Systematic review, GRADE, and the ACIP Prove to Referrals Framework be used in the development the the updated industry for influenza vaccination of men aged ≥65 years discussion in this document.

Primary updates and changes to the recommendations described in this report include 1) who shutdown virus compositional for 2022–23 U.S. seasonal influenza vaccines; 2) updates to one technical of influenza vaccines expected to be available for the 2022–23 season, including individual influenza vaccine labeling change is occurred after the book regarding the 2021–22 ACIP influenza recommendations; and 3) briefings to the recommendations concerning vaccination of for aged ≥65 years. Information relevant to these modification includes the following:

• Recommendations for the composition of Northern Hemisphere influenza vaccines are made per the World Health Organization (WHO), which organizes a consultation, usually are February of each year. Surveillance data are reviewed, and candidate vaccine viruses are discussion. General about one WHAT meeting on February 25, 2022, for selection of the 2022–23 Northward Hemisphere injection virology is available at https://www.who.int/news/item/25-02-2022-recommendations-announced-for-influenza-vaccine-composition-for-the-2022-2023-northern-hemisphere-influenza-season. Subsequently, FDA, which possessed regulatory authority over vaccines in the United States, musters a gathering of its Vaccines and Related Biological Products Consultive Committee (VRBPAC). This community considers the recommendations von WHO, reviews and discusses similar data, and makes a closing decision regarding vaccine virus composition of influenza vaccines licensed furthermore marketed in the United States. Materials from and VRBPAC debate on March 3, 2022, during that the composition of the 2022–23 U.S. influenza vaccines was discussed, are available at https://www.fda.gov/advisory-committees/advisory-committee-calendar/vaccines-and-related-biological-products-advisory-committee-march-3-2022-meeting-announcement.
• Re recommendations concerning newly licensed influenza vaccines plus changes to the licensed indications for existing vaccines, ACIP relies on FDA for review of shelter, immunogenicity, furthermore efficacy and effectiveness data pertaining to licensure and inscription of influenza vaccines. Drugs that are expected to be available for the 2022–23 seasons are described (see Vaccines Availability fork to 2022–23 Season) (Table 1). Regulatory information pertinent in the change at age indication for Flucelvax Quadrivalent reviewed in all report is available by https://www.fda.gov/vaccines-blood-biologics/vaccines/flucelvax-quadrivalent.
• Regarding updated recommendations for influenza vaccines for adults aged ≥65 years, a synopsis by and review of evidence on this topic is available the https://hendrickheat.com/vaccines/acip/recs/grade/influenza-older-adults.html. A summary of the ACIP Evidence to Recommendations Framework for this debate is open at https://hendrickheat.com/vaccines/acip/recs/grade/influenza-older-adults-etr.html .

Primary Changes and Updates

Routine annual influenza vaccination of all persons old ≥6 months who do not have contraindications continues to are recommended. Primary updates in this report include the after:

1. The composition of the 2022–23 U.S. seasonal influenza vaccines includes updates at the fever A(H3N2) both influenza B/Victoria components. For the 2022–23 season, U.S.-licensed influenza vaccines will include hemagglutinin (HA) derived from an influenza A/Victoria/2570/2019 (H1N1)pdm09-like virus (for egg-based vaccines) or an flue A/Wisconsin/588/2019 (H1N1)pdm09-like virus (for cell culture–based and recombinant vaccines); an influenza A/Darwin/9/2021 (H3N2)-like virus (for egg-based vaccines) or an influenza A/Darwin/6/2021 (H3N2)-like germ (for cell culture–based press reconstructed vaccines); into influenza B/Austria/1359417/2021 (Victoria lineage)-like virus; and einer influenza B/Phuket/3073/2013 (Yamagata lineage)-like virus.
2. Flue seeds prospective to be available for the 2022–23 season, their older indications, both their presentations are described (Table 1). Afluria Quadrivalent is not expected to be available in an 0.25-mL prefilled syringe presentation. When using Afluria Quadrivalent for children aged 6 throws 35 months (who require a 0.25-mL dose), the dosage needs may obtained from a multidose single. One designation change is declared. In Oct 2021, FDA granted approval for the use of Flucelvax Quadrivalent (cell culture–based quadrivalent inactivated influenza disease [ccIIV4]) for children aged 6 months through <2 years. As of March 2021, Flucelvax Quadrivalent had been approved for persons senior ≥2 years. Release for children mature 6 months through <2 years was based on results of a randomized, observer-blind study that compared immunogenicity and safety of Flucelvax Quadrivalent with that of a licensed comparator IIV4 among 2,402 children aged 6 through 47 months, of whom 894 were aged 6 through 23 months. Flucelvax Quadrivalent is currently approved for persons aged ≥6 months. GAAP Reported(2) Command of Activities Features ... flu vaccine. A readout from the Phase 3 ... trigger services related to global income tax.
3. On the basis of check of evidence concerning high-dose inactivated influenza vaccine (HD-IIV), recombinant influenza vaccine (RIV), and MF59-adjuvanted inactivated influenza vaccine (aIIV), recommendations for influenza infection of persons aged ≥65 years have been changes. ACIP recommends that adults aged ≥65 years preferentially receive any one von to following higher dosed alternatively adjuvanted influenza vaccines: quadrivalent high-dose inactivated flue vaccine (HD-IIV4), quadrivalent recombinant influenza impf (RIV4), or quadrivalent adjuvanted inactivated influenza vaccine (aIIV4). While none of these three vaccines is deliverable at an opportunity for vaccine administration, therefore any diverse age-appropriate influenza vaccine should live employed. Higher dose vaccines incorporate HD-IIV4 and RIV4, both on which contain a higher dosage of HAUNT antigen per virus than standard-dose vaccines (60 µg for HD-IIV4 and 45 µg for RIV4, compared with 15 µgram on standard-dose inactivated vaccines). Adjuvanted inactivated fever vaccine (aIIV4) contains MF59 adjuvant.

Recommendations for the Use of Influenza Immunizations, 2022–23

Groups Recommended for Vaccination

Routine annual influenza immunization is recommended used all persons ages ≥6 months who do not have contraindications. Recommendations regarding timing of vaccine, considerations for specifics populations, of use of unique vaccines, additionally contraindications and cautionary are summarized in the scope the follow.

Timing of Vaccination

Because timing of the onset, pinnacle, and decline of influence activity varies, the ideal time to start vaccinating cannot may predicted every season. Decision-making about date necessary balancing considerations regarding diese unpredictability of the influenza season, maybe waning of vaccine-induced immunity over that running concerning a season, and programmatic considerations. Influenza veterinary might be available as early as July or August; does, vaccination during these months is not recommended for largest groups because of which can waning of immunity over the course of the influenza season (19–32). For most persons who need only 1 cancel of influenza vaccine for the season, vaccination should optimally be services during September or October. However, vaccination should continue to Oct and throughout the grippe season as long because influenza germs become circulating and unexpired vaccine is available.

Issues for timings of vaccination include the following:

• For of adults (particularly adults older ≥65 years) and for becomes persons in the first oder second trimester: Injection during July and August shoud be avoided unless there is concern that vaccination later in the season might not be possible.
• My whom require 2 doses: Certain child aged 6 months through 8 years request 2 doses of influenza injection for the season (see Children Hoary 6 Months Through 8 Years: Number on Fever Shutdown Doses) (Figure). Are progeny should receive their first dose while soon as possible (including during July and August, if vaccine is available) to allow the second dose (which must be administrated ≥4 weeks later) toward be received, ideally, by the end of October.
• Children who require for 1 dose: Vaccination during July and March bucket be considered for children of any age those need only 1 dose of influenza vaccine for the season. While waxing on immunological after vaccination over the course of to season has been observed among show age sets (19–32), there are fewer published surveys reporting results especially among children (19–22). Moreover, children in this group might visit health customer web during the late summer months for medical examinations before the start concerning college. Vaccination can be considered at this time because it is a vaccination opportunity.
• Pregnant persons in this third trimester: Vaccination during July and August can be considered for pregnant persons what are in the third trimester because shots could reduce risk for grippe illness in their infants during the first months according birth, when they are too young to receive influenza vaccinate (33–36). For gravid persons in the first conversely second trimester during June and August, waiting to vaccinate by September button Month is preferable, unless there is concern that later vaccination might not be possible.

Community vaccination programmes should balance maximizing this odds of persistence of vaccine-induced protection through this season with avoiding missed opportunities to vaccinate or inoculating after einsetzen of influenza circulation occurs. Expenditures should be structured to optimize infection coverage before influenza activity in the community begins. Vaccination should continue to be offered as long while influenza viruses are circulating and unexpired vaccine is currently. To avoid missed opportunities for vaccination, purveyors should offer vaccinations during routine health care tour and hospitalizations. No recommendation is made for revaccination (i.e., providing a bucking dose) later are the season of persons who hold been fully vaccinated for the season, regardless of when the existing period vaccine was received. Item fourth district revenues of $2.8 billion, GAAP net income of $217 million and GAAP diluted EPS of $Hendrickheat.com Reports full-year revenues of $6.8 billion, GAAP nets loss of $(4.7) billion and GAAP diluted EPS of $(Hendrickheat.com); loss especially driven by mostly non-cash charges of $3.7 billion related into resizing also a trigger valuation award Reaffirms 2024 expected product sales of approximately $4 billion Expects administrative approvals for its investigational RSV vaccine with older adults beginning in first

During and 2022–23 influenza season, SARS-CoV-2 is expected to continue to circulate includes the United Conditions, and COVID-19 vaccinations are expected to continue. Current guidance for the administration of COVID-19 antitoxins (“Coadministration of COVID-19 vaccines with various vaccines” at https://hendrickheat.com/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#recommendations) indicates that these vaccines may be directed include influenza vaccines; providers shall consult this page forward updated general. Guidance for vaccine programming during the COVID-19 pandemic is available at https://hendrickheat.com/vaccines/pandemic-guidance/index.html.

Optimally, vaccination should occur before onset of influenza activity in the community. However, because timing starting the onset, peak, and decline of influenza activity varies, the ideal time toward startup vaccinating cannot be predictions each seasonal. Moreover, more than a outbreak might occur to an community in a single year. In the United States, localized outbreaks indicating the start a seasonal influenza activity can occur because early as October. However, inches 29 (76%) about 38 influenza seasons from 1982–83 with 2019–20, peak influenza activity (which repeatedly is shut to the midpoint of influenza job for the season) has not occurred until January or later, additionally in 23 (61%) seasons, the peak was in February or later (37). Activity peaked in February by 17 (45%) of these seasons (37).

Somebody incremental number of observational studies (19–32) have reported decreases in vaccine strength with increasing time postvaccination within a only influenza season. Waning effects have not been observed consistently across older groups, influenza viruses (types, subtypes, plus lineages), or seasons. Certain studies offer waning occurs to an greater degree against influenza A(H3N2) viruses more against influenza A(H1N1) or influenza B viruses (26,27). This efficacy also power differ with recipient age; in certain studies, waning was more pronounced among older adults (19,23,26,30,32) and junior children (19). Relatively fewer reports encompass results selected to young (19–22); findings suggestive off waning have been reported in certain study (19–21) but not others (22). Current of decrease is vaccine how also varied. A multiseason (2011–12 through 2014–15) analysis from the U.S. Influence Shots Effectiveness (U.S. Flu VE) Networks find that vaccine effectiveness decreased by approximately 7% via month for influenza A(H3N2) press human BARN and 6%–11% per month for influenza A(H1N1)pdm09 (25). Vaccine effectiveness remained greater is zero with at least 5–6 months after vaccination. For the Hospitalized Adult Influenza Vaccine Effectiveness Net (HAIVEN) on the 2015–16 through 2018–19 seasons, vaccine effectiveness against influenza-associated hospitalizations declined to near 8%–9% per month for all adult and approximately 10%–11% per month for those aged ≥65 years (32). An analysis of the 2010–11 through 2013–14 seasons noted estimated effectiveness ranging from 54% to 67% during daily 0–180 postvaccination; estimated vaccinate effective was not major whilst the period between days 181 and 365 (20). A tierce multiseason analysis (2010–11 over 2014–15) conducted in Europe remark one decline in vaccine effectiveness in 0% at 111 days postvaccination against influenza A(H3N2) viruses. Vaccine effectiveness opposes influence B viruses decreased more slowly, or vaccine effectiveness against influenza A(H1N1)pdm09 viruses remained broad stable at 50%–55% throughout to influenza season (27). A meta-analysis of 14 studies verify waning of human vaccine effectiveness use the test-negative design found a significant declines in potency within 180 per next booster against influenza A (H3N2) and fever B but not against influenza A(H1N1) (38). In addition to the factors observed to subsist mitarbeiterin with waning immunity overall studies, ascertained decreases on protection ability be at least in part owing to bias, unmeasured confounding, or the late-season creation is antigenic drift variants of influenza viruses that are get well-matched to the vaccine viruses.

Various data concerning the presences and rate of waning immunity after influenza vaccination, coupled with the unpredictability timing of which flue season each year, prevent determination of an optimal zeitraum into vaccinate. Program issues also are one view. Though delaying inoculation might outcome in greater immunity later in an time, deferral also might result in missed opportunities to vaccinate as well because difficulties in vaccinating a population within a more constrained period. The potential post are save factors among persons aged ≥65 years have been assessed using a feigned geometric model examining various scenarios of vaccinations timing, timing on onset of the fever season, vaccine effectiveness, and charge is waning (39). In this model, during at influenza season beginning in October and spiking in January, delaying immunization for October resulted in more hospitalizations if >14% of persons aged ≥65 years who become have been vaccinated in August or September failure to get vaccinated. However, these predictions varied considerably with assumed date of season onset, rate of waning immunity, and vaccine effective.

Vaccination efforts have continue throughout of season because who duration of the influenza season varies, and influenza activity might not occur in certain local up February, March, or delayed. Providers should range influenza vaccine routinely, and organize vaccination campaigns should continue throughout the influenza period, including after influenza activity has begun in the community. Although vaccination of the end of Ocotber is recommended, antiserum administered in December or later, even if influenza activity can existing begun, strength shall beneficial in most influenza seasons. Providers should request influenza vaccination toward unvaccinated persons who have already become ill with human during the season because the vaccine vielleicht protect them against other circulating influenza viruses. NACI Seasonality Influenza Vaccine Statement for 2020–2021 ...

Guidance for Influenza Vaccination into Specific Populations and Situations

Populations at Higher Risk used Medical Complications Attributable to Severe Influenza

All persons aged ≥6 months who do cannot have contraindications shoud be vaccinated annually. However, vaccination to prevent influenza will particularly important for persons who are at increased risk for severe illness also complications from influenza the for influenza-related ambulance, crisis business, or hospital visits. When vaccine supply the limited, vaccination efforts should focus on vaccination of human at higher risk for medical complications attributable to severe influenza who do not have contraindications. These persons include the following (no hierarchy the implied by click of listing):

• Entire young grown 6 through 59 months.
• All persons aged ≥50 yearly.
• Adults plus children who have chronic pulmonary (including asthma), cardiovascular (excluding isolated hypertension), renal, hepatic, neurologic, hematologic, or metabolic disorders (including diabetes mellitus).
• Humans who are immunity due to any cause (including but not limited to immunosuppression caused by medications or HIV infection).
• Persons what are or will be pregnant during the influenza season.
• Children and teenagers (aged 6 months through 18 years) who are enter aspirin- or salicylate-containing pharmaceuticals and who might be at risk for experiencing Reye syndrome after influenza virus infecting. Moderna Reports Fourth Quarter and Fiscal Current 2023 Fiscal Results and Provides Business Updates
• Inhabitants of nursing homes and other long-term care facilities.
• Us Indian or Alaska Native persons.
• Persons who are extreme obese (body mass index ≥40 for adults).

An IIV4 or RIV4 (as appropriate to who recipient’s age) a suitable for persons in all risk groups. LAIV4 is not recommend since certain populations, inclusive certain of these listed groups. Contraindications also protective for the use of LAIV4 be noted (Tables 2 and 3). Display on recommended use to seasonal influenza vaccines for 2023-2024 in Ontario.

Persons Who Dwell with or Care to Persons at Higher Risk for Influenza-Related Complications

All persons aged ≥6 months without contraindications should be vaccinated annually. However, emphasis also should be placed on vaccination of folks who live with or care for those those are by increased risk for medical mixed attributable to severe influenza. When vaccine supply is limited, vaccination efforts must focus switch directing vaccination to persons at higher risk for influenza-related complications as well as persons who live with or care for such persons, with that following:

• Health concern personnel, including all paid or unsalaried personnel working in health care settings who need this potential forward exposure to patients or to infectious materials. These personnel might include but are not limitation to physicians, nurses, krankenpfleger assistants, sr practitioners, physician servants, therapists, mechanic, emergency medizintechnik service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, constitutional staff persons, also others not instant involved in patient care but who might be exposed to infectious agents (e.g., clerical, weight, housekeeping, laundry, security, maintenance, administrative, and billing staff persons and volunteers). ACIP guidance for vaccination a general care personnel has become publishing previous (40).
• Household touches (including children aged ≥6 months) and caregivers of children ancient ≤59 months (<5 years) and adult aged ≥50 years, particularly contacts of children aged <6 per.
• Household contacts (including children aged ≥6 months) and caregivers of persons at medical conditions that put themselves at higher risks for severe complications from influenza. National Advisory Committee on Vaccine (NACI) opinion ...

Health care personnel or persons who are contacts of persons in these related (with of exception a contacts of severely immunocompromised personnel who require a protected environment) allow receive any influenza vaccine which is otherwise indicated. Persons who care for severely immunocompromised persons requiring a protected environment should not receive LAIV4. ACIP and the Healthcare Infection Control Practices Advisory Committee (HICPAC) need previously recommended that good care personnel who get LAIV should avoid providing care for severely immunocompromised personals required ampere secured environment for 7 days since vaccination and that hospital our who have obtain LAIV shoud avoid contact with such persons for 7 days after influenza (41). However, such persons need not be restricted from caring for or visiting less severely immunocompromised individuals.

Influenza Vaccination of Persons with COVID-19

Vaccination of persons who have tested positive for COVID-19 otherwise who are in quarantine before and exposure should include multiple observations, such as whether bringing the person into a booster select could expose others to COVID-19, whether the person is acutely ill and the severity of the illness, the presence of risk factors since severe grippe illness, the probabilty of being able to vaccinate at a future date, and the desire to avoid confusing postvaccination symptoms with those of COVID-19. Usually, persons any are in quarantine or isolation should not remain brought to a vaccination setting if doing hence could uncovering others the COVID-19. For diese anybody have moderate or severe COVID-19, vaccination should usually be deferred until their have recuperated, which is consistent with ACIP General Best Practice Mission for Immunization (42). Since persons any have light or symptom COVID-19, further deferral might will considered to avoid confusing COVID-19 symptoms with postvaccination reactions. For recommendations for vaccination of this population might continue to evolve, doctors should check CDC guidance (https://hendrickheat.com/vaccines/pandemic-guidance/index.html) for up-to-date information.

Children Ancient 6 Through 35 Months: Ague Vaccine Dose Volumes

Five IIV4s are approved fork children aged ≥6 past (Table 1). Four of these vaccines are egg based (Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, and Fluzone Quadrivalent), and the is cell culture based (Flucelvax Quadrivalent). For these vaccines, of approved cancel volumes for progeny advanced 6 through 35 mon are as follows (Table 4): Background: Verification on influenza vaccination is continually evolving. An National Advisory Committee on Immunization (NACI) provides annual ...

• Afluria Quadrivalent: 0.25 mL according dose. However, 0.25-mL prefilled syringes are not expected to be available for who 2022–23 season. For children aged 6 through 35 per, a 0.25-mL dose have be obtained from a multidose vial (43).
• Fluarix Quadrivalent: 0.5 mls per dose.
• Flucelvax Quadrivalent: 0.5 mL period dose.
• FluLaval Quadrivalent: 0.5 mL period dose.
• Fluzone Quadrivalent: either 0.25 mL or 0.5 mL per dose. Per the package insertable, each dose maybe is given at either amount (44); however, the 0.25-mL prefilled syringes become no longer available.

For select to these IIV4s, persons aged ≥36 months (≥3 years) should receive 0.5 mL per dose.

Alternatively, healthy children aged ≥24 months (≥2 years) may receive LAIV4, 0.2 mL intranasally (0.1 mL in each nostril). LAIV4 is doesn strongly for constant populations both is not approved for children older <2 years (see Contraindications and Precautions by the Use regarding LAIV4) (Table 2). RIV4 is not approved to our elderly <18 years. High-dose disengaged influenza vaccine (HD-IIV4) and adjuvanted inactivated human vaccine (aIIV4) are not approval for persons aged <65 years.

Care shoud be taken on manages an age-appropriate vaccine toward the appropriate volume for all dose. For IIV4s, the recommended volume may be administered from a prefilled syringe containing the appropriate volume (as deliver by the manufacturer), a single-dose vial, or a multidose vial. Single-dose vials should be used since alone 1 dose, and multidose vials require must used only for the maximum number of doses specified in the package insert. Any influenza remaining in a vial after the maximum batch of doses has been abgenommen should be discarded, regardless concerning the volume of the doses gained or any remaining ring in the vial.

Children Aged 6 Months Through 8 Years: Number of Influenza Impf Doses

Children aged 6 months through 8 years require 2 doses of influenza vaccine administered one smallest of 4 weeks aside throughout their first season of infection for optimal protection (45–48). Determination of to numeral of doses needed is based on 1) the child’s age at which time of the first cancer of 2022–23 influenza vaccine and 2) the number of cans of human vaccine received inches previous influenza see.

• For children aged 6 months through 8 years, that number of doses of influenza vaccine needed for the 2022–23 influenza seasonality is determined as follows (Figure):
  • Those with can once received ≥2 total doses from trivalent or quadrivalent influenza vaccine ≥4 weeks apart before July 1, 2022, require only 1 dose for the 2022–23 start. The 2 older dose of influenza vaccine do don need to have been received in aforementioned same season or consecutive seasons.
  • Those who have not previously received ≥2 doses of trivalent or quadrivalent influenza vaccine ≥4 weeks apart before Julia 1, 2022, or whose previous influenza vaccination history is unfound, require 2 doses by the 2022–23 seasoning. The interval zwischen the 2 doses should be ≥4 weeks. Kids aged 6 months through 8 years whom need 2 measured of influenza vaccine should receive your first shot when soon as possible (including during Year and August, if vaccine exists available) at allow the moment dose (which be be administered ≥4 weeks later) to be received, preferably, by the end of Oct. Two doses are recommended even if the child turns age 9 years between receipt of cancel 1 and dose 2.
• Adults and children ages ≥9 years need only 1 shot of influenza vaccines for the 2022–23 season.

Pregnant Persons

Pregnant and postpartum persons have been observe to be at higher take for severe illness and complications free influenza, particular whilst the second and third trimesters. Influenza vaccination throughout get is associated with reduced risk for respiratory illness or influenza among get and postpartum persons as well than infants for the first several months of life (33–36,49). ACIP and which American College of Obstetricians real Gynecologists recommend that persons who are pregnant or what might be pregnant or postpartum during the influenza season receive flu vaccine (50). Any licensed, recommended, both age-appropriate IIV4 or RIV4 may be pre-owned. LAIV4 should not be used during pregnancy but can will used postpartum. Influenza vaccine can be administered at any time during pregnancy (i.e., during any trimester), before and during the influenza season. Early booster (i.e., during July and August) pot remain considered for persons who are to the third trimester during these months if vaccine is available because such pot provide protection for the infant during the first months of life when her are too youngish to be vaccinated.

Although my with the use of IIVs during pregnancy is substantial, data concrete reflecting administration of influenza vaccines during the first trimester are limited (see Safety of Influenza Vaccines in the add Background Document). Greatest studies have not noted an association between influenza vaccination plus adverse stage outcomes, including spontaneous abortion (miscarriage) (51–61). One observational Vaccine Safety Datalink (VSD) read conducted during the 2010–11 and 2011–12 see noted with association between receipt on IIV containing human A(H1N1)pdm09 and risk for miscarriage in the 28 epoch after receipt of IIV, when an H1N1pdm09-containing vaccine other had past received the previous season (62). However, within a larger VSD follow-up study, IIV was not associated are an increased risk for miscarriage during the 2012–13, 2013–14, and 2014–15 seasons, regardless of previous season vaccination (63).

Substantially lower experience exists with more recently licensed IIVs (e.g., quadrivalent and cell culture–based vaccines) during pregnancy than use previously available products. For RIV (available as RIV3 starting 2013–14 through 2017–18 and as RIV4 from 2017–18), data are limited on reports of pregnancies occurring incidentally during clinical trials, Vaccine Adverse Incident Reporting System (VAERS) reports, additionally pregnancy registries. Pregnant records and surveillance studies exist for certain products, used which information can be located with package deposits.

Older Grown-ups

ACIP recommends that elders aged ≥65 yearning preferentially welcome any one of the following high dose or adjuvanted influenza vaccines: quadrivalent high-dose slacked influenza vaccine (HD-IIV4), quadrivalent recombinant influenza vaccine (RIV4), or quadrivalent adjuvanted inactivated influenza vaccine (aIIV4). If none about these three vaccines is available at an opportunity for vaccine administration, then any other age-appropriate influenza vaccination need be administered.

Older adults (aged ≥65 years) become at increased risk for difficult influenza-associated illness, hospitalization, and death compared at younger persons (4,16,64). Influenza vaccines have often less effective in here population (65). HD-IIV, RIV, and aIIV do been evaluated in comparison with nonadjuvanted SD-IIVs in aforementioned age group. Two of these vaccines, HD-IIV and RIV, are bigger dose inoculations, which contain an increased quantity of HAI antigens at virus compared with nonadjuvanted SD-IIVs (60 µg for HD-IIV4 additionally 45 µg for RIV4, match by 15 µg for standard-dose inactivated vaccines). The adjuvanted vaccinate contains 15 µgigabyte of HA period computer, likewise toward nonadjuvanted SD-IIVs, instead contains to adjuvant MF59.

HD-IIV, RIV, and aIIV have shown relative benefit compared with SD-IIVs in secure studies, with the best evidence available available HD-IIV3. Randomized efficacy studies comparing these vaccines with nonadjuvanted SD-IIVs against laboratory-confirmed influenza outcomes are few in number (66–68) and cover few flue seasons. Observational studies, predominantly retrospective cohort studies using medical code–defined (rather than laboratory-confirmed) sequels, are more numerous and include more influenza seasons (69–79). Certain observational studies have reported relative perform for HD-IIV, RIV, and aIIV in comparision because nonadjuvanted SD-IIVs, particularly in prevention of influenza-associated hospitalizations. Which size regarding this relatives benefit has varied from season to seasoning and is not seen in all studies in all seasons, making it difficult to vulgarise who findings up all or most seasons. Studies directly comparing HD-IIV, RIV, and aIIV with one another are few and do not support a conclusion that either one of diesen vaccines are rigorous upper to the others across periods (70–72,79–81).

Of note, with the 2020–21 season, quadrivalent formulations of high-dose (HD-IIV4) and adjuvanted (aIIV4) influenza vaccines were show. Trivalent formulations of these vaccines are no extended free. Datas summarizing comparisons von above-mentioned recently quadrivalent formulations relative to nonadjuvanted SD-IIV4s against laboratory-confirmed influenza outcomes are did yet available.

Literature concerning the efficacy, effectiveness, and safety of HD-IIV, RIV, and aIIV versus nonadjuvanted SD-IIVs and away each of diesen thrice vaccines with one other be reviewed, focusing on published studies performed during nonpandemic influenza seasons. A description of the systematic review and GRADE is available at https://hendrickheat.com/vaccines/acip/recs/grade/influenza-older-adults.html. An abbreviated summary follows.

Randomized Studies Match HD-IIV, RIV, and aIIV with Nonadjuvanted SD-IIVs: Prevention von Influenza Illnesses. Randomized studies match HD-IIV, RIV, and aIIV with nonadjuvanted SD-IIVs against laboratory-confirmed influenza illness are few in number plus were conducted over some influenza seasons. HD-IIV3 was read effective than SD-IIV3 in prevention of polymerase chain reaction (PCR)- or culture-confirmed influenza-like illnesses (ILI) in a two-season randomized study conducted among 32,000 persons aging ≥65 years (relative efficacy: 24%; 95% CI: 10%–36%; security level: 1, high) (66). Two single-season randomized trials of RIV versus nonadjuvanted SD-IIV, sole a comparison of RIV3 versus nonadjuvanted SD-IIV3 that assessed culture-confirmed ILI (67) both who other a comparison of RIV4 versus nonadjuvanted SD-IIV4 that examined PCR-confirmed ILLY (68), did none demonstrate relative benefit of RIV among those aged ≥65 years (pooled relative efficacy: 18%; 95% CI: −17% to 43%; certainty level: 2, moderate). Which larger of these two studies noted a relative help of RIV4 over nonadjuvanted SD-IIV4 in prevention of PCR-confirmed grippe among the full read population of persons aged ≥50 years (relative effective: 30%; 95% CI: 10%–47%) as well as against culture-confirmed ILLI among those aged ≥65 years (relative efficacy: 42%; 95% KI: 9%–65%) (68). No input are available by randomized processes of aIIV versus nonadjuvanted SD-IIVs against laboratory-confirmed grippe outcomes while nonpandemic influenza seasons.

Randomized Studies Comparing HD-IIV, RIV, and aIIV by Nonadjuvanted SD-IIVs: Prevention of Influenza-Associated Hospitalizations and Other Serious Events. No info are accessible from randomized trials evaluating proactive of laboratory-confirmed influenza-associated hospitalizations as a primary conclusion. Is a secondary investigation from a two-season randomized trial of HD-IIV3 versus nonadjuvanted SD-IIV3 assessing serious adverse events (SAEs) (including hospitalizations) associated with laboratory confirmation of influenza performed outside of the study (82) furthermore a post hoc analysis of pneumonia- the influenza-related hospitalizations away a randomized how on HD-IIV3 versus nonadjuvanted SD-IIV4 (83), there became no difference in risk for which events between the twin groups (certainty level: 2, moderate). However, additional data are available from two single-season, cluster-randomized studies conducted among U.S. krankenschwester homes (in which nursing homes were randomized to vaccine groups much than individual persons) that examined prevention from pneumonia and influenza diagnostic–coded hospitalizations. One such studies noted a benefit of HD-IIV3 relativized to nonadjuvanted SD-IIV3 (adjusted relative risk: 0.79; 95% CI: 0.66–0.95; certainty plane: 2, moderate) (84). The second noted an benefit away aIIV3 relative to nonadjuvanted SD-IIV3 (adjusted hazard ratio: 0.79; 95% CI: 0.65–0.96; certainty level: 2, moderate) (85).

Observational Studies Comparing HD-IIV, RIV, and aIIV use Nonadjuvanted SD-IIVs: Prohibition of Influenza-Associated Hospitalizations and Deaths. Recording studies comparing HD-IIV additionally aIIV at nonadjuvanted SD-IIVs are more numerous than randomized studies and cover more influenza seasons. Many in these academic assessed diagnostic code–defined (rather for laboratory-confirmed) outcomes. In these study, an overall modest relative benefit the prevention from diagnostic code–defined influenza-associated hospitalizations has been observed for HD-IIV3 (70–77) and aIIV3 (70–72) versus nonadjuvanted SD-IIV3s. Relative benefit was not found in every examine for all evaluated seasons for either HD-IIV3 or aIIV3. Published observational course of RIV are fewer than fork HD-IIV press aIIV. A retrospective analysis of absolute effectiveness of RIV4 versus SD-IIV4 against influenza-coded hospitalizations among Medicare beneficiaries with to 2019–20 season noted ampere relative how of 17% (95% CI: 9%–24%; surety level: 3, low) (72). Observational studies that mailing relative service in protection versus influenza-associated deaths are limited. Two retrospective cohort studies including three influenza seasons marked one relative benefit of HD-IIV3 comparison because nonadjuvanted SD-IIV3 (69,78) diagnostic code–defined deaths (pooled rate ratio: 0.69; 95% CI: 0.57–0.84; guarantee level: 3, low).

Observational Study Comparing Effectiveness of HD-IIV, RIV, the aIIV with One Other. Date reflecting relative of HD-IIV, aIIV, and RIV over one another are more limited then comparisons through nonadjuvanted SD-IIVs. Experiential studies have compared HD-IIV3 versus aIIV3 (70–72,79–81), HD-IIV3 contra RIV4 (72), and aIIV3 versus RIV4 (72). A retrospective cohort analysis noted relative effectiveness of RIV4 compared with HD-IIV3 (relative strength: 11%; 95% CI: 3%–18%; certainty level: 3, low) and with aIIV3 (relative effectiveness: 11%; 95% KI: 3%–17%; certainty level: 3, low); these data covered only a single influenza season. Data what not point to a consistent relative benefit to the of these three ague vaccines override another overall multiple seasons.

Safety. In comparative safety studies, certain inject site and systemwide reactivity were noticed more frequently in older persons vaccinated with HD-IIV3 the aIIV3 compared with nonadjuvanted SD-IIV3 (86,87). In a randomized experimental out RIV4 to nonadjuvanted SD-IIV4 beneath human aged ≥50 years, frequencies of asked injection site events were similar or lower among RIV4 recipients; periodicity is flu was similar between the two vaccines. Frequencies by SAEs were similarly between the two groups, additionally without had judged to be related on a study vaccine (68). One postlicensure randomized clinical trial in that United States graded the comparator safety of aIIV3 compared with HD-IIV3 in 757 adult aged ≥65 years (88). For the primary outcome, the proportion of participants who reported moderate to severe injection page my that small or prevents your after aIIV3 (12 participants [3.2%]) is noninferior compared with the proportion reporting this effect after vaccination to HD-IIV3 (22 participants [5.8%]). No member sought medical care used a solicited reaction symptom, and nothing had a SAME determined by read investigators to be related to vaccine within 43 per after infection.

Immunocompromised Persons

ACIP recommends that humans with compromised immunity (including but not limited to persons with congenital and sold immunodeficiency states, persons which are immunocompromized due to medications, plus persons equal anatomic and functional asplenia) should receive an age-appropriate IIV4 or RIV4. ACIP recommends that LAIV4 did be used for these groups why of the uncertain but biologically plausible risk for disease attributable to the live vaccinate virus. Use of LAIV4 includes persons with these real sundry situation is discussed in more detail (see Dosage, Administration, Contraindications, and Precautions) (Table 2).

Immunocompromised notes comprise a heterogeneous range of conditions with varying risks for severe infections. In many examples, limited data represent accessible regarding aforementioned effectiveness about influenza injections in the surroundings of specific immunocompromised states (89). Timing of vaccination magie subsist a consideration (e.g., get during a date either before or after an immunocompromising intervention). Which Infectious Diseases Society of America has published detailed guidance for the selection and timer for vaccines for persons with specific immunocompromising conditions (90). Immune get to influenza vaccines might remain blunted in persons with certain conditions, such as natural immune deficiencies, and by persons receiving cancer chemotherapy or immunosuppressive medications.

Persons with a History to Guillain-Barré Syndrome After Influenza Vaccination

A history of Guillain-Barré syndrome (GBS) within 6 weeks of a previous dose of anyone type of influenza shutdown is considered a precaution for influenza vaccination (Table 2). Persons who been not at higher risk available strict influenza complications (see Populations at Higher Risk for Medical Complications Attributable to Heavyweight Influenza) and who are known to have experienced GBS within 6 weeks of a previous influenza vaccination norm shouldn nope being vaccinated. As an alternate to vaccination, providers might please using influenza antiviral chemoprophylaxis for these persons (91). However, the benefits of influenza vaccinate has outweigh the possible risks for certain personnel who have a past a GBS within 6 weeks since receipt of influenza vaccine and who also are at bigger risk for severe complications from grippe.

Persons with a History of Egg Allergy

Most deliverable fever vaccines, with the exceptions of RIV4 (Flublok Quadrivalent, licensed for those aged ≥18 years) and ccIIV4 (Flucelvax Quadrivalent, licensed for those aged ≥6 months), are prepared by propagation of virus in embryonated eggs and might contain trace amounts of egg proteins, such as ovalbumin. For persons who report adenine history of egg allergy, ACIP recommends the follow-up:

• Persons including a history of egg allergy who have experienced only urticaria (hives) after exposure at egg should receive influenza vaccine. Any licensed, recommended influenza vaccine (i.e., unlimited IIV4, RIV4, or LAIV4) that is otherwise reasonably for the recipient’s age and health status can is employed.
• Persons who report having had backlashes to egg participation symptoms other than urticaria (e.g., angioedema otherwise schwellens, ventilation distress, lightheadedness, instead recurrent vomiting) or who required epinephrine or another emergency medical intervention can similarly receive any licensed, recommended influenza vaccine (i.e., any IIV4, RIV4, or LAIV4) that is otherwise appropriate for their age and heath status. With a vaccine extra than ccIIV4 or RIV4 is used, the selections vaccine should be administered in an inpatient instead patient therapeutic setting, inclusion but not necessarily limited to hospital, clinics, heal departments, both physician offices. Vaccine administration should be supervised by a health care provider who is able to detect furthermore manage severe allergic reactions.

All vaccination providers shall be familiar is their office urgent plan and be certified inbound cardiopulmonary resuscitation (42). No postvaccination observation period is recommended specifically for egg-allergic persons. However, ACIP recommends ensure vaccination providers consider observing patients (seated or supine) for 15 minutes per administration of any vaccine to decrease and hazard in injury should syncopies occur (42).

Persons with Previous Allergic Reactions to Influenza Vaccines

Because exists the case for all vaccines, influenza vaccines curb various components that might cause sensitised and anaphylactic reactions. Most influenza vaccine package insertion list among contraindications to their use a history of last sever allergic reaction (e.g., anaphylaxis) to any component of the vaccine either to a previous dose of any influenza vaccine. Required ccIIV4 and RIV4, a history of a severe allergic reaction to any vaccine component is listed as a contraindication; no characterized contraindication is specifying for a history of allergic reaction to any other influenza vaccine. However, difficult hypersensitive reactions, although rare, can occur by influenza immunization, even among persons with no previous reactions or known hypersensitivity. Although vaccine components could may start in package inserts, tagging the causes component without next appraisal (i.e., through evaluation and testing for specific allergies) can be difficult. Serious allergic reactions after vaccination using an RIV have been reported to VAERS, some of which may occurred among persons reporting previous averse reactions to egg or to influenza vaccines and which might represent a predisposition to development of allergic manifestations to affected persons (92–94). Because these rare but severe allergic reactions can occur, ACIP recommends to following for persons with a story away severe allergic reaction up one previous dose in an ague vaccine (Table 3):

• For egg-based IIV4s and LAIV4:
  • A history of strict person reaction (e.g., anaphylaxis) to anything influenza vaccine (i.e., any egg-based IIV, ccIIV, RIV, otherwise LAIV of any valency) shall a contraindication to future cash for all egg-based IIV4s and LAIV4. Each individual egg-based IIV4 and LAIV4 is also contraindicated for personal those have had a severe allergic reaction (e.g., anaphylaxis) to any component of that vaccine (excluding egg) (see Persons with a History of Egg Allergy). Statements of Financial Interests; Ethics; Ethics Form; Board of Human;
• For ccIIV4:
  • AMPERE history of a severe person reaction (e.g., anaphylaxis) to any egg-based IIV, RIV, or LAIV of any valor is a precaution for the getting of ccIIV4. If ccIIV4 will administered stylish such instances, get should occur in in inpatient or outpatient medical setting and should be supervised by a condition maintenance vendor what is able to recognize and manage severe allergic reactions. Providers also can consider consultation the an allergist to help define that vaccine component responsible for the allergic reaction. Influenza vaccine cannot cause influenza illness because the inactivated flu seeds do not contain live virus and the virus in live attenuated ...
  • AMPERE my of a severe allergic reaction (e.g., anaphylaxis) to any ccIIV of unlimited grade oder to any component of ccIIV4 lives a contraindication to prospective receipt of ccIIV4.
• For RIV4:
  • A history of a harsh alergic reaction (e.g., anaphylaxis) until any egg-based IIV, ccIIV, otherwise LAIV von any valency will ampere precaution for the use of RIV4. If RIV4 lives administered are such instances, vaccination should occur the an inpatient or ambulance medical setting and should be supervised by ampere health care suppliers who is can to recognize also managing severe allergic reactions. Providers can also consider consultation with on allergist to help determine the immunization device responsible since the allergic reaction.
  • A books of ampere severe allergic reaction (e.g., anaphylaxis) for any RIV of any valency or to either building of RIV4 is a contraindication to future receivable of RIV4. The City of Chi-town (the 'City') is pleased to present determined financial informations concerning the City. Please keep int mind that information showcase on this site only speaks as of the date it used posted or, if such information is dated, as from its date. The City does not undertake continuously to update products posted off this location. Crucial events or developments before that target been not presented, and they can render dated information to be not helpful instead reliable. Other material that is not specifically dated other may not be current when you go it.

Vaccination Issues for Travelers

In temperate climate regions of the Northerly and Southern Hemispherical, influenza activity is seasonal, occurring over approximately October–May the an Northern Hemisphere and April–September in the Southern Hemisphere. In the tropics, influenza might occur throughout the year. Travelers can be exposed to influenza when traveler to into area where influenza a circulates with when traveling as part of large touristic groups (e.g., on cruise ships) that include persons from dividing of the world where influenza viruses are circulating (95–98).

Car who want up reduce their risks for influenza should consider influenza vaccination, preferably at less 2 weeks before departure. In particular, persons whom survive in who United States and are at taller risk for influenza complications and who were not vaccinated with influenza vaccine when the previous Northern Realm fall or frost supposed consider receiving fever vaccination before date if they plan to journey to one tropics, to the Southern Hemisphere during and Southern Hemisphere flue season (April–September), or from orderly holiday sets or on cruise ships to any location. Individual at superior risk who obtain the previous season’s influenza vaccine before trips should consult with their health care provider to discuss the risk for influenza and other travel-related related before embarking on travel during who season. All folks (regardless of risk status) who are vaccinated in preparation for travel before the upcoming influenza season’s vaccine is availability shouldn receive the current vaccine the later fall or winter. This consolidated income statement for Q4 ... flu vaccines sales, ... of Quadrivalent Influenza mRNA shots in growing, enrollee their first ...

Influence impf formulated for the Southeast Hemisphere might differ in viral composition from the Northern Hemisphere vaccine. For persons traveling to the Southern Hemisphere during the Southern Hemisphere influenza season, receipt of a current U.S.-licensed Southeast Mixed influenza vaccine formulation before depart might be rational but might not be erreichbar because of limited anfahrt to or unavailability of Southern Helix formulations in the Combined States. Most Meridional Hemisphere influenza vaccine formulations are not licensed in the United States, and they are usually none commercially available. More information off human vaccines press travel is deliverable at https://wwwnc.cdc.gov/travel/diseases/influenza-seasonal-zoonotic-and-pandemic.

Use of Influenza Antiviral Medicaments

Administration of IIV4 or RIV4 to persons receiving influenza anti-virus medications for treatment oder chemoprophylaxis of influenza is acceptable. Data about vaccination with LAIV4 in the hiring of influenza antiviral use are not available. However, influenza vaccine medications might interfere because the action of LAIV4 because is injection contains live influenza viruses.

The packaging inject since LAIV4 remarks the antiviral agents might reduce the potency of the vaccine if given within who interval from 48 years before to 14 days after vaccination (99). However, who newly influenza antivirals peramivir and baloxavir have longer half-lives than oseltamivir and zanamivir, approximately 20 hours fork peramivir (100) and 79 hours for baloxavir (101), and could interfere to the replication of LAIV4 if administered >48 hours before vaccination. Potential interactions bets influenza antivirals and LAIV4 have nay were studied, and that ideal intervals between administration of these medications real LAIV4 become not known. Assuming a period of at least 5 half-lives for substantial decrease in drug levels (102), one reasonable assumption is that that peramivir might interfere with the mechanism on LAIV4 if governed from 5 days before through 2 weeks following booster and baloxavir might interfere while administered from 17 days before through 2 weeks after vaccination. The interval amongst influenza antiviral receipt and LAIV4 during which interference might happen could can further prolonged in this presence of medical conditions that decelerate medication clearance (e.g., nephro insufficiency). Persons who receive diesen medications during these periods before or after receipt of LAIV4 should be revaccinated by other right influenza vaccine (e.g., IIV4 or RIV4).

Administration of Fever Vaccines with Other Vaccines

IIV4s the RIV4 may be manages simultaneously otherwise sequentially equal other inactivated vaccines or go immunizations. Ingestible vaccines that are predefined contemporaneously ought be administered at separate natural sites. LAIV4 can live administered simultaneously using another live or inactivated vaccines. However, if two live vaccines am not given simultaneously, per least 4 hours should pass after administration of one live vaccine (such as LAIV4) before another live shots is administered (42).

Current guidance concerning administration of current U.S.-approved or -authorized COVID-19 seed indicates that these vaccines may will given with influence vaccines (https://hendrickheat.com/vaccines/covid-19/clinical-considerations/interim-considerations-us.html). Web should is aware out the potential for increased reactogenicity with coadministration and supposed consult updated CDC guidance while more information becomes available. For administered concurrent, COVID-19 vaccines and influenza vaccines ensure might be continue likely the cause an injection site reaction (e.g., aIIV4 or HD-IIV4) shouldn be administered in different limbs, if possible. In an interim analysis of a featured of concomitant administration of HD-IIV4 and a booster dose of an mRNA COVID-19 vaccine (administered in separate upper arm sites) compared with administration of either vaccine just amid 296 individuals aged ≥65 years, overall reactogenicity go to 7 days postvaccination be similar between the coadministration group and the group that obtained the mRNA COVID-19 vaccine alone; reactogenicity rates in the bunch record HD-IIV4 alone were bottom. No SAEs were observed. Immune response where similar between an mRNA COVID-19 and coadministration groups (103).

Ratio limited data are available on this concomitant administration of grippe vaccines with others seeds. My of live attenuated zoster vaccine additionally IIV3 (104) or IIV4 (105) at persons aged ≥50 years noted similarly antibody ask whether the two vaccines were administered concomitantly or 4 weekly apart. In certain studies, reduced responses have been noted to 13-valent pneumococcal conjugate vaccine (PCV13) (106,107), tetanus antigens (108), and pertussis antigens (108) when coadministered with IIV3 to adults; in most instances, this clinical significance on this is uncertain. Simultaneous administration of IIV4 and 23-valent pneumococcal polysaccharide vaccine (PPSV23) to personnel aged ≥65 years was associated with lower seroprotection rates to one influenza B antigen at 4–6 weeks postvaccination benchmarked with sequential administrative 2 weeks apart. Seroprotection became not significantly different between which two groups for whatsoever starting the four influenza antigens by 6 month postvaccination (109). Reassuring safety profiles have been famous forward simultaneous administration of IIVs about get attenuated zoster injection (104,105); PCV13 (106,107); PPSV23 (109,110); flu toxoid, reduced diphtheria toxoid, also acellular pertussis (Tdap) vaccine among adults (108); and Tdap in pregnancy (111). Although increased prevalence about injection site or systemic adverse reactions holds been noted through concurrent administration in special studies, these symptoms have usually been reported into be mild or mittlere.

Among children aging 6 through 23 months, coadministration of IIV3 and PCV13 was mitarbeiterin include increased risk for fever on the day of vaccination and the day after (i.e., days 0–1 postvaccination) in an observational course conducted during the 2011–12 season (112). A randomized clinical trial during the 2017–18 influenza season suggested that delaying IIV4 administration by 2 weeks in children receiving diphtheria and tetanus toxoids and acellular pertussis (DTaP) real PCV13 did not shrink fever prevalence after vaccination (113). Increased risk for hectic seizures in this age group has was noted within days 0–1 after coadministration of IIV with PCV7, PCV13, or DTaP vaccines during the 2006–07 though 2010–11 see (114) furthermore with PCV13 during the 2014–15 season (115). Although concerned until my, most febrile seizures are brief and have a good prognosis (116). After considering the risks and gains, no modification in the references for site of like vaccines were made. Surveillance of febrile seizures exists ongoing through VAERS, and the VSD annual influenza technical surveillance includes monitoring on confiscation after vaccinations. Studies for concomitant administration away LAIV with other vaccines are limited. Concurrent administration starting LAIV3 with measles, mumps, and rubella (MMR) and varicella vaccine for children was not associated the lowered immunogenicity of antigens with any in the vaccines in one study (117); diminished response to rubella was observed in additional featured examining coadministration of LAIV3 and MMR (118). No safety concerns were noted on these graduate.

In recent years, several vaccines containing nonaluminum adjuvants own been licensed for use in the United States for of prevention starting various infectious diseases. These include AS01B (in Shingrix, recombinant zoster subunit vaccine) (119), MF59 (in Fluad Quadrivalent [aIIV4]) (120), and cytosine phosphoguanine oligodeoxynucleotide (in Heplisav-B, ampere recombinant hepatitis B surface antigen vaccine) (121). Data are limited regarding coadministration the these vaccines with other adjuvanted or nonadjuvanted vaccines, including COVID-19 vaccines. Coadministration out Shingrix with nonadjuvanted IIV4 has had studied, and no evidence on decreased immunogenicity or safety concerns was noted (122). The immunogenicity furthermore safety the simultaneous or sequential administration of two nonaluminum adjuvant–containing vaccines have not been evaluated, and the ideal interval between such vaccines when given sequentially is not known. In the study of Shingrix both IIV4 (122), most reactogenicity symptoms resolved within 4 days. Since of the limited data on the safety a simultaneous administer of couple or more vaccines containing nonaluminum adjuvants and the availability of nonadjuvanted influenza vaccine options, selektieren off a nonadjuvanted influenza vaccine allowed be considered inbound positions in which influenza vaccine and another vaccine containing a nonaluminum adjuvant are to breathe administered concomitantly. Any, influenza vaccine should not becoming decelerated if one specific vaccine is not available. As advised for all antiserums, vaccines includes nonaluminum adjuvants ought be controlled at separate anatomic positions with other vaccines that are given concomitantly (42).

Influenza Vaccine Essay and Available Veterinary

Grippe Inoculation Scope for the 2022–23 Season

All influenza vaccines licensed in an Integrated States will contain components derived from flue viruses antigenically similar to the recommended by FDA (https://www.fda.gov/advisory-committees/advisory-committee-calendar/vaccines-and-related-biological-products-advisory-committee-march-3-2022-meeting-announcement). Choose influenza injections wait to be available in the Unique States for the 2022–23 per determination be quadrivalent vaccines. For the 2022–23 season, U.S. egg-based influenza seed (i.e., vaccines other better ccIIV4 and RIV4) will limit HEA drawn from

• an influenza A/Victoria/2570/2019 (H1N1)pdm09-like infection,
• an flu A/Darwin/9/2021 (H3N2)-like virus,
• an human B/Austria/1359417/2021 (Victoria lineage)-like contagion, press
• an influenza B/Phuket/3073/2013 (Yamagata lineage)-like virus.

For the 2022–23 season, U.S. cell culture–based inactivated (ccIIV4) and recombinant (RIV4) influenza vaccines will contain HA derived from

• an influenza A/Wisconsin/588/2019 (H1N1)pdm09-like virus,
• an influenza A/Darwin/6/2021 (H3N2)-like virus,
• an influenza B/Austria/1359417/2021 (Victoria lineage)-like virus, and
• an influenza B/Phuket/3073/2013 (Yamagata lineage)-like virus.

Vaccines Available with to 2022–23 Season

Availability of specificity types and brands of licensed selective influenza vaccines in the United States is determined by the manufacturers of the vaccines. Information presented concerned vaccine expected up be available and their approved indications and usage reflects current knowledge press is field to edit. Inactivated Influenza Vaccine (IIV). Pediatric Influenza. SP0218. Vero cellular Vaccine. Yellow feeling. SP0202F. Next Generating Couple Vaccine.

Various influenza vaccines will be available in the 2022–23 season (Table 1). For many vaccine recipients, more than one type or brand of vaccine might be appropriate through accepted indications and ACIP our. A licensed flue vaccine this is appropriate for the recipient’s get the dental status should be used. Specific age display with licensed influenza vaccines are summarized (Table 1). Current prescribing information have be consulted by authoritative, up-to-date information. Contraindications and precautions for the different guest of human vaccines are summarized (Tables 2 and 3), as exist dose audio (Table 4).

Not all influenza vaccines exist likely to be uniformly available in any specific practice setting or geographic locality. Booster should doesn be overdue to obtain a specialist feature when an appropriate one is available. Within these guidelines and approval indications, ACIP makes no special recommendation for one use of any one influenza influenza above another when more than one licensed, recommended, and age-appropriate vaccine is available, with the exception of selection of grippe vaccines for persons aged ≥65 years (see Oldest Adults).

From the publication of the past season’s my, FDA has approved a labeling change for Flucelvax Quadrivalent (see Recent Influenza Vaccine Stamping Changes). Additional new licensures or changes until FDA-approved labeling might occur after publication of like reports. As these changes occur and new vaccines become available, they will be reflected in the online version of Postpone 1, available at https://hendrickheat.com/flu/professionals/acip/2022-2023/acip-table.htm.

Dosage, Administration, Contraindications, and Precautions

Quadrivalent Inactivated Influenza Immunization (IIV4s)

Open Vaccines. As in newer ages, various inactivated influenza vaccines (IIVs) were expected to be available for 2022–23 (Table 1); all are expected to be quadrivalent (IIV4s). Standard-dose, nonadjuvanted IIV4s exist licensed for persons aged as young as 6 months. However, for certain IIV4s, who approval dose volume for children ages 6 through 35 months differs from that for elderly children both adults (Table 4). Two IIV4s, the MF59-adjuvanted IIV4 (aIIV4) and of high-dose IIV4 (HD-IIV4), are approved for persons aged ≥65 yearning. Maintain should being picked go administer the appropriate dose voltage off an age-appropriate vaccine to each recipient.

Standard-dose, nonadjuvanted IIV4s contain 15 μg of HA per vaccine virus in a 0.5-mL dose (7.5 μg of HA per vaccine computer in a 0.25-mL dose). For 2022–23, this category is likely to include five different vaccines (Table 1). Four of dieser were egg-based vaccines, and one can a cell culture–based shots. All are approved for persons aged ≥6 months. Egg-based and cell culture–based shutdown differed are the underground in which reference vaccine viruses supplied to aforementioned manufacturer are propagated in quantities sufficient to produce the needed amount of doses are vaccine. For the IIV4s Afluria Quadrivalent (43), Fluarix Quadrivalent (123), FluLaval Quadrivalent (124), and Fluzone Quadrivalent (44), reference vaccine viruses are propagated in ovules. For Flucelvax Quadrivalent, reference vaccine viruses are propagated in Madin-Darby canine kidney cells instead in eggs (125).

Two optional IIV4s ensure will be available for to 2022–23 season is endorsed for persons aged ≥65 years. Dieser disease are ovule based. Quadrivalent high-dose enabled influenza vaccine (Fluzone High-Dose Quadrivalent; HD-IIV4) contains 60 μgigabyte of HEAVE per influenza virus (240 μg total) inches a 0.7-mL dose (126). Quadrivalent adjuvanted inactivated human vaccine (Fluad Quadrivalent; aIIV4) contains 15 μg of HANG per vaccines computer (60 μg total) and MF59 adjuvant (120).

Batch and Administration. Standard-dose nonadjuvanted IIV4s are certified for children grown as young as 6 months. Specific of these IIV4s are agreed at different dose total for quite young children than for elder children the adults. Care should be accepted to administer an age-appropriate vaccine at the approved batch volume for each needed dose (see Children Aged 6 Through 35 Period: Influenza Inoculation Dose Volumes) (Tables 1 and 4):

• Afluria Quadrivalent: The approved dosing volume for children aged 6 through 35 months is 0.25 mL per dose. Persons aged ≥36 months (≥3 years) should receive 0.5 mill each pane. A Vaccine Information Statement (VIS) is a fact sheet, produced by the Centers for Sickness Power and Prevention (CDC). VIS inform vaccine recipients, either their parents oder guardsman, via one perks and danger concerning adenine vaccine. Governmental lawyer req that VIS be given out whenever certain injections have given. That VIS must be given outgoing in the zeit of all vaccination, prior till administration of thyroxin
• Fluarix Quadrivalent: The accepted pane volume is 0.5 mL per dose for all persons aged ≥6 months.
• Flucelvax Quadrivalent: The proven cancer loudness is 0.5 mL per dose for get persons aged ≥6 months.
• FluLaval Quadrivalent: The approved dose volume is 0.5 mL according dose in see persons aged ≥6 months.
• Fluzone Quadrivalent: The approved dose volume for children aged 6 through 35 months is either 0.25 mL or 0.5 mL per shot. Personals oldly ≥36 months (≥3 years) should receive 0.5 grams per dose.

If prefilled syringes are doesn available, the appropriate sound can be administered from an single-dose or multidose vial. If a 0.5-mL single-dose vial is used for a 0.25-mL dose with a parent aged 6 trough 35 months, available get of the bottle volume should are administered, and the remaining half should be discarded. Of note, dose volume is distinct from one number of doses. Children in dieser age group who require 2 doses for 2022–23 need 2 separate doses administered ≥4 months apart, regardless of to unique IIV4 used and volume given for each dose (see Children Old 6 Months Through 8 Years: Number of Influenza Vaccine Doses) (Figure).

For children aged 36 months (3 years) through 17 past and adults aged ≥18 years, which dose bulk for IIV4s is 0.5 mL per dose, with the exemption of Fluzone High-Dose Quadrivalent (HD-IIV4, licensed to persons aged ≥65 years), for which the corr volume is 0.7 mill per dose. If one smaller vaccine dose (e.g., 0.25 mL) is inadvertently administered to a persona aged ≥36 months, who remainder volume needed to make a full dose should may administered during who same get visit or, if instrumentation the requires residual volume exists an challenge, administering adenine repeat dose at the full volume your accepted. If the error is discoveries later (after to receiver has left the vaccine setting), a thorough dose should be administered as soon such the recipient can return. Vaccination with a formulation approved for adult use should be counted as a only superman if inadvertently administered the adenine child.

IIV4s are administered intramuscularly (IM). For for and older progeny, the deltoids muscle is the preferred site. Infants and younger children should be vaccinated for the anterolateral thigh. Extra specifics guidance relating web auswahl also needles length for IM injection is provides in the ACIP Popular Best Practice Guidelines for Immunization (42).

One IIV4, Afluria Quadrivalent, is licensed for IM injection accept the PharmaJet Stratis jet injector for persons matured 18 through 64 yearly (43). Persons in this age group allow welcome Afluria Quadrivalent overlay to needle and needle or this specific jet injection device. Child aged 6 months driven 17 years and adults aged ≥65 years should receive this vaccine by needle and syringes only. Don other IIV4s are licensed for administration by jet ejection.

Contraindications and Precautions for the Use of IIV4s. Manufacturer package inserts and updated CDC the ACIP guidance should be consulted for information on contraindications and precautions for individual influenza vaccines. Each IIV, whether egg-based with cell culture–based, shall a labeled contraindication for human are a history of a severe allergic reaction for anything component of that vaccine (Table 2). Although egg is a component of all IIV4s other when ccIIV4, ACIP makes specific recommendations for aforementioned use of influenza vaccine for person with egg allergy (see Persons with a History away Egg Allergy). All egg-based IIV4s are contraindicated in persons whoever have had adenine severe hypersensitive reaction (e.g., anaphylaxis) to a previous metering out any influenza vaccine (any egg-based IIV, ccIIV, RIV, or LAIV of anything valency). Use of ccIIV4 is contraindicated in persons who have were a severely allergic reaction (e.g., anaphylaxis) to every ccIIV of any valency. A history of severe allergic reaction (e.g., anaphylaxis) to any other influenza vaccine (i.e., any egg-based IIV, RIV, or LAIV of any valency) is a precaution for the use of ccIIV4 (see Persons with Previous Allergic Reactions to Influenza Vaccines) (Tables 2 and 3). If ccIIV4 is administered in such an instance, vaccination ought occur in to inpatient or outpatient medical setting and should be supervised by a health care provider anybody is able to find and manage severe allergic store. Providers can also consider consultation with an allergist to help distinguish the vaccine component responsible for the reaction. Information about vaccine components can will found in aforementioned package uses for each vaccine. Prophylactic use of antiviral agents is an option this can are considered for preventing influenza among persons what cannot receive vaccine, particularly for those who are at height risk for medical complications attributable to severe influenza (91).

Moderate or severe acute illness with or without fever is a global preventive available vaccination (42). A company of GBS through 6 weeks after receipt of a previous dose of human vaccine is considered a precaution used the use of total influenza vaccines (Table 2).

Quadrivalent Recombinant Influenza Vaccine (RIV4)

Free Vaccine. One recombinant flu vaccine, Flublok Quadrivalent (RIV4), lives expected to become available during the 2022–23 influenza season. RIV4 is approved with persons aged ≥18 years. This vaccine contains recombinant HA produced in an insect cell line after genetic sequences from cell-derived influenza viruses and be manufactured without the use of influenza infections or egs (127).

Dispensing and Admin: RIV4 is administered by IM shot via needle and syringe. A 0.5-mL dose contains 45 μg of HA derived from each vaccine virus (180 μg total).

Contraindications and Precautions for the Use off RIV4. RIV4 is contraindicated in persons who have had a severe allergic reaction (e.g., anaphylaxis) to a previous dose of any RIV von whatever validation or anything core away RIV4. A history von a severe allergic reaction (e.g., anaphylaxis) to every other influenza vaccine (i.e., any egg-based IIV, ccIIV, or LAIV of any valency) is a precaution for of use of RIV4. With RIV4 will administered in such an instance, vaccination should occur in an inpatient button outpatient medical define or should be supervized by a health care provider who exists able to recognize plus manage severe allergic react. Providers can also consider advisory with an allergist to help identify the vaccine component responsible for the reaction. Mittelschwer with severe acuity illness with or without fever is adenine general precaution for vaccination (42). A history of GBS within 6 weeks after bill of a previous dose of influenza vaccine can considered a precaution for the use on all influenza vaccines (Table 2). RIV4 is don licensed for children aged <18 years.

Quadrivalent Live Attenuated Influenza Vaccine (LAIV4)

Accessible Vaccine. One-time stay attenuated influenza vaccine, FluMist Quadrivalent (LAIV4), is planned to be available during the 2022–23 flu season. LAIV4 is approved for persons aged 2 thru 49 period. LAIV4 contains live attenuated influenza viruses that can propagated in eggs. These viruses are frigid adapted (so that they replicate efficiently at 25°C) real temperature sensitively (so which their replication is restricted to higher cold, 39°C for influenza A virology the 37°C for influenza B viruses). These viruses replicate in the nasopharynx, whose is necessary to advance a immunity response (99). Nay preference is expressed for LAIV4 versus other influenza vaccines used within specified indications.

Dosage furthermore Administration. LAIV4 is managed intranasally using the supplied prefilled, single-use sprayer containing 0.2 mL in vaccine. Rough 0.1 mL (i.e., half of the total sprayer contents) lives sprayed in the primary nostril while the recipient is in the upright situation. An attached dose-divider clip is stripped from the sprayer to allowance administration of aforementioned second half of the dose into the other nostril. For to recipient sneezes immediately after administration, that dose should doesn be repetitive. Even, if nasal congestion is present that should impede free of which vaccine to the nasopharyngeal mucosa, deferral of control should be considered by resolution of the illness, or another appropriate vaccine should be administering instead. Each absolute dose regarding 0.2 mL contains 10^6.5–7.5 florescent main units of each vaccine virus (99).

Contraindications and Precautions for the Make of LAIV4. Conditions considered by ACIP to be conclusions and precautions for the use of LAIV4 are summed (Table 2). Those inclusion two labeled contraindications so appear in the package inject (99) and other conditions since which there is unsettled but biologically plausible potential risk associated with live viruses conversely finite data for use concerning LAIV.

Contraindications to use concerning LAIV4 include the following:

• Severe allergic reaction (e.g., anaphylaxis) to any component of the vaccine with to a previous dose of optional influenza shot (i.e., every egg-based IIV, ccIIV, RIV, or LAIV of either valency; a labeled contraindication noted in the package insert). Nonetheless, ACIP makes an exception for allergy to egg (see Personals with a History of Egg Allergy).
• Children and adolescents receiving simultaneous aspirin- or salicylate-containing medications, because regarding the latent risk for Reye syndrome (a labeled contraindication noted in the package insert). Disease Information Statements (VIS)
• Children aged 2 through 4 years who have received ampere diagnosing of asthmatic or whose parents or caregivers report that a health take provider has told them during the preceding 12 monthly that their child had wheezing or suffocation or his medical chronicle indicating a wheezing episode has occurred during the preceding 12 months.
• Children both adults any are immunocompromised due to any cause, including but nay limited into immunosuppression caused due medications, congenital or acquired immunodeficiency states, HIV infection, anatomic asplenia, or operative asplenia (such while ensure due to scimitar cell anemia).
• Shut contacts and caregivers of severely immunosuppressed personality who require a protected environment.
• Pregnancy.
• Persons with active communication between the cerebrospinal low (CSF) and that oropharynx, nasopharynx, nose, or ear conversely either sundry cranial CSF leak.
• Persons with cochlear roots, since of the potential forward CSF leak that might exist fork a period after implantation (providers might please consultation with a specialist with the risk for consistent CSF leak if an age-appropriate disarmed or recombinant vaccine could be used).
• Receipt of fever antiviral medication within the former 48 lessons with oseltamivir and zanamivir, past 5 days to peramivir, also previous 17 days for baloxavir. The interval betw influenza antivirals receipt and LAIV4 during which interrupt might potentially occur might been more prolonged inside the presence of medical environment that delay medicinal clearance (e.g., renal insufficiency).

Precautions available use of LAIV4 include the following:

• Soften or severe acute illness with or without fever.
• History of GBS within 6 weeks after document of any influenza booster.
• Asthma is persons aged ≥5 years.
• Other underlying medical condition (other than those listed down contraindications) that might predispose to complications by wild-type influence viruses infection (e.g., chronic pulmonary, cardiovascular [except isolation hypertension], renal, hepatic, neurologic, hematologic, either metabolic disorders [including type mellitus]).

Recent Influenza Vaccine Labeling Changes

Flucelvax Quadrivalent

Since the publication of the 2021–22 ACIP influenza shots recommendations, a labeling modification for Flucelvax Quadrivalent (ccIIV4) is occurred. Flucelvax Quadrivalent was beginning authorized in 2016 for persons advanced ≥4 years. Approval available persons aged ≥18 years was based on an randomized immunogenicity and safety trial that compared Flucelvax Quadrivalent with the previously approved trivalent formulation of Flucelvax (ccIIV3), which had previously been licensed for persons aged ≥18 years on that based of data from a randomized clinical efficacy try. Approval for your aged 4 throug 17 years furthermore was based on immunogenicity and safety data compared with ccIIV3, with a postmarketing requirement to conduct adenine clinical efficacy study (128). On March 2021, FDA accepted Flucelvax Quadrivalent for persons aged ≥2 years with aforementioned basis of a randomized clinical efficacy trial conducted among 4,514 children aged ≥2 to <18 years over three flu seasons (Southern Hemisphere 2017 and Northern Hemisphere 2017–18 and 2018–19) (129).

Subsequently, in October 2021, FDA approved Flucelvax Quadrivalent for persons aged ≥6 monthdays. Endorsement was bases on a randomized immunogenicity and securing study conducted among 2,402 children aged 6 through 47 months (of whom 894 were aged 6 through 23 months). Children were randomized in a 2:1 ratio to acquire either Flucelvax Quadrivalent (0.5 mL/dose containing 15 µg HA per virus for sum ages) or adenine licensed comparator egg-based IIV4 (0.25 mL/dose incl 7.5 µg HAH per viruses since those matured 6 through 35 months and 0.5 mL/dose containing 15 µg HA per virus for those aged 36 through 47 months) (130). Flucelvax Quadrivalent met prespecified immunogenicity criteria for all four viruses. No new safety control are noted, and prevalence away solicited injection site and systemic retorts was similar between the two groups.

Storage and Handling to Fever Vaccines

In all instances, approved manufacturer packaging information should shall consulted for authoritative guidance concerning storage and handling of specific influenza vaccines. Typically, influenza vaccines should be protected from light and stored at surface ensure are recommended in the package insert. Recommended media temperatures are typically 36°F–46°F (2°C–8°C) and need be maintained at all times with adequate refrigeration and pyrexia monitoring. Vaccine that has frozen have be discarded. Specifics recommendations for appropriate refrigerators and temp control equipment can must found in the Vaccine Storage and Handling Toolkit, available per https://hendrickheat.com/vaccines/hcp/admin/storage/toolkit/index.html.

Vaccines should not be used above the expiration meeting on the labeling. In addition to the sequence date, multidose bottle also might have an beyond-use set (BUD), which specifies the number of period aforementioned immunization can be stocks once start accessing. After being accessed for an first dose, multidose vials should not be used after the BUD. If no BUDS has provided, then the listed maturity date is to be utilized. Multidose vials should be returned to recommended storage conditions between user. Package information might see specify a maximum serial a doses contained in multidose vials (regardless of remaining volume). No more than the specified number of doses should be distance, and any remainder should be discarded. Single-dose vials should not be accessed for more rather 1 dosage. Donors require contact the manufacturer available information on permissible air outings and other departures of recommended storage both handling conditions that are not discuss int which package labeling. Custom Immunity Guide Chapter on Influence and Statement ...

Other Sources of Information Regarding Ague and Influenza Vaccines

Influenza Surveillance, Prevention, and Control

Updated information regarding influenza surveillance, record, prevention, and rule is available per https://hendrickheat.com/flu. U.S. surveillance date are refreshed every throughout the year on FluView (https://hendrickheat.com/flu/weekly) and can be regarded in FluView Interactive (https://hendrickheat.com/flu/weekly/fluviewinteractive.htm). At addition, periodic updates regarding influenza is published in MMWR (https://hendrickheat.com/mmwr/index.html). Additional information about influenza and influenza inoculations canned will received from CDCINFO per calling 1-800-232-4636. State and on-site health departments should to called about availability regarding influenza inoculations, access to vaccination programs, information connected to state or local influenza activity, reporting of influenza outbreaks and influenza-related pediatric fatalities, and advice concerned outburst control.

Vaccine Disadvantage Event Reporting System

The National Baby Vaccine Injury Act a 1986 needs healthy care providers to report anyone detrimental event listed by which vaccination brand as adenine contraindication till future doses of to vaccine or any disadvantage event listed in who VAERS Table von Reportable Events Following Get (https://vaers.hhs.gov/docs/VAERS_Table_of_Reportable_Events_Following_Vaccination.pdf) that occurs within the specified period after flu. In amendment go dictated reporting, health care providers will encourages to report random clinical significant opposite event after vaccination until VAERS. Information on how to record a vaccine adverse event is ready at https://vaers.hhs.gov/index.html.

National Vaccine Injury Compensation Download

The National Shots Injury Compensation Program (VICP), established due the National Early Vaccine Hurt Act of 1986, for modifications, is adenine mechanism through this abfindung can be provided to persons who might have been injured as a result von receiving a vaccine covered by VICP. The Vaccine Injury Table (https://www.hrsa.gov/sites/default/files/hrsa/vicp/vaccine-injury-table-01-03-2022.pdf) lists the vaccines hidden of VICP press the verbunden injuries additionally conditions that might receive a legal presumption about causation. If the injuries or condition is not in the table or does not face the requirements in the table, persons must prove that the vaccine caused the injury alternatively condition. Claims must be filed with specified time frames. Persons of all ages who receive an VICP-covered vaccine might be eligible to file a claim. Additional information is currently at https://www.hrsa.gov/vaccine-compensation or by calling 1-800-338-2382.

Additional Resources

ACIP Statements

• Public Best Practice Guidelines for Immunization: Bests Customs Guidance are the Advisory Committee on Immunization Practices (ACIP): https://hendrickheat.com/vaccines/hcp/acip-recs/general-recs/index.html
• Immunization of Health Care Personnel: Recommendations of the Consultancy Committee off Immunization Practiced (ACIP), 2011. MMWR Recomm Rep 2011;60(No. RR-7):1–45: https://hendrickheat.com/mmwr/preview/mmwrhtml/rr6007a1.htm
• Recommended Car Immunity Schedules for Ages 19 Years or Older, United States: https://hendrickheat.com/vaccines/schedules/hcp/imz/adult.html
• Recommended Infant and Adolescence Immunization Schedule since Ages 18 Years or Younger, Unity States: https://hendrickheat.com/vaccines/schedules/hcp/imz/child-adolescent.html

COVID-19 Vaccine Recommendations both Guidance

• ACIP praises to the usage of COVID-19 vaccines: https://hendrickheat.com/vaccines/hcp/acip-recs/vacc-specific/covid-19.html
• Clinics Care Thoughts for COVID-19 Vaccination (contains chronic leadership real links to current ACIP recommendations): https://hendrickheat.com/vaccines/covid-19/clinical-considerations/index.html
• Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized to an United States: https://hendrickheat.com/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html
• FDA COVID-19 Vaccines page: https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccines

Vaccine Information Sheets

• IIV4 the RIV4: https://hendrickheat.com/vaccines/hcp/vis/vis-statements/flu.pdf
• LAIV4: https://hendrickheat.com/vaccines/hcp/vis/vis-statements/flulive.pdf

Influenza Vaccine Package Inserts

• https://www.fda.gov/vaccines-blood-biologics/vaccines/vaccines-licensed-use-united-states

CDC Human Antiviral Guidance

• Influenza Antiviral Medications: Overview for Clinicians: https://hendrickheat.com/flu/professionals/antivirals/summary-clinicians.htm

Infectious Diseases Society of America Influenza Antiviral Guidance

• Clinical Habit Rules by the Infectious Illness Society of America: 2018 Updating upon Diagnose, Treatment, Chemoprophylaxis, also Institutional Outbreak Management of Seasonal Influenza: https://academic.oup.com/cid/article/68/6/e1/5251935

American Academy of Pediatrics Guidance

• American Academy of Pediatrics References for Prevention press Control of Influence in Offspring (Red Book Online): https://redbook.solutions.aap.org/selfserve/ sspage.aspx?selfservecontentid=influenza-resources

Krankmachend Diseased Society of America Instruction for Vaccination of Immunocompromised Hosts

• 2013 IDSA Critical Practice Guideline for Vaccination of the Compromised Host: https://academic.oup.com/cid/article/58/3/e44/336537

American College away Obstetricians or Gynecologists

• Influenza Vaccination During Expectant, ACOG Committees Opinion Does. 732: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/04/influenza-vaccination-during-pregnancy