ACIP: Updated Vaccine Guidance for the 2022-2023 Influenza Season

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices has issued new guidelines for the prevention and control of seasonal influenza with vaccines for the 2022-2023 season. In general, routine annual vaccination is recommended for all patients 6 months of age and older who have no contraindications and should be completed by the end of October.

As the influenza season will coincide with the ongoing COVID-19 pandemic, influenza vaccination will help reduce the prevalence of influenza illness and can reduce symptoms that might be confused with COVID-19. Vaccination may also help prevent outbreaks that may further strain the health care system.

For the 2022–2023 season, all influenza vaccines are expected to be quadrivalent, containing hemagglutinin derived from 1 influenza A(H1N1)pdm09 virus, 1 influenza A(H3N2) virus, 1 influenza B/Victoria lineage virus, and 1 influenza B/Yamagata lineage virus.

Egg-based influenza vaccines:

• Will contain hemagglutinin derived from an influenza A/Victoria/2570/2019 (H1N1)pdm09-like virus (for egg-based vaccines), an influenza A/Darwin/9/2021 (H3N2)-like virus, an influenza B/Austria/1359417/2021 (Victoria lineage)-like virus, and an influenza B/Phuket/3073/2013 (Yamagata lineage)-like virus. 
• These include Afluria Quadrivalent, Fluarix Quadrivalent, FluLaval Quadrivalent, Fluzone Quadrivalent (all standard dose), Fluzone High-Dose Quadrivalent (high-dose formulation), Fluad Quadrivalent (standard dose with MF59 adjuvant), and FluMist Quadrivalent intranasal spray.

Cell culture-based inactivated or recombinant influenza vaccines:

• Will contain hemagglutinin 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.
• These include Flucelvax Quadrivalent (standard dose cell culture-based) and Flublok Quadrivalent (recombinant).

Updates to the guidance for this upcoming influenza season include the following:

• The Food and Drug Administration expanded the approval of Flucelvax Quadrivalent (cell culture-based quadrivalent inactivated influenza vaccine) to include children 6 months through less than 2 years old.
• Afluria Quadrivalent is not expected to be available in a 0.25 mL prefilled syringe. For children 6 through 35 months of age who require a 0.25 mL dose, health care providers must obtain the dose from a multidose vial.
• For persons 65 years of age and older, any 1 of the following higher dose or adjuvanted influenza vaccines are recommended: quadrivalent high-dose inactivated influenza vaccine, quadrivalent recombinant influenza vaccine, or quadrivalent adjuvanted inactivated influenza vaccine. 
  • If these vaccines are not available, then any other age-appropriate higher dose influenza vaccine should be used.

Current guidance indicates that COVID-19 vaccines can be coadministered with other vaccines including influenza vaccines. Clinical considerations regarding COVID-19 vaccination should be periodically reviewed for updated information.

The full report, which includes guidance for influenza vaccination of specific populations (eg, children, pregnant people, older patients, immunocompromised individuals), and situations (eg, history of Guillain-Barré Syndrome, egg allergy) can be found here.

This article originally appeared on MPR