ACIP: Updated Vaccine Guidance for the 2023-2024 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 2023-2024 season. Routine annual influenza vaccination is recommended for all patients 6 months of age and older who have no contraindications. Vaccination should ideally be completed by October though it should be offered throughout the season if influenza viruses continue to circulate.

For the 2023–2024 season, all influenza vaccines are expected to be quadrivalent, containing hemagglutinin (HA) derived from one influenza A(H1N1)pdm09 virus, one influenza A(H3N2) virus, one influenza B/Victoria lineage virus, and one influenza B/Yamagata lineage virus.

Egg-based influenza vaccines:

• Will contain HA derived from an influenza A/Victoria/4897/2022 (H1N1)pdm09-like virus, 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 HA derived from an influenza A/Wisconsin/67/2022 (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:

• ACIP recommends all persons 6 months of age and older with egg allergy receive influenza vaccine (egg-based or nonegg-based) that is otherwise appropriate for the recipient’s age and health status.
  • It is no longer recommended that individuals who have had an allergic reaction to egg with symptoms other than urticaria should be vaccinated in a medical setting supervised by a health care provider who is able to recognize and manage severe allergic reactions if an egg-based vaccine is used.
  • Egg allergy alone does not require additional safety measures for influenza vaccination beyond those recommended for any recipient of any vaccine, regardless of severity of previous reaction to egg.
  • All vaccines should be administered in settings in which personnel and equipment needed for rapid recognition and treatment of acute hypersensitivity reactions are available.
  • Additional information about this recommendation can be found here.

Regarding simultaneous administration of influenza vaccine with the new respiratory syncytial virus (RSV]) vaccine, data included in the prescribing information for GSK’s Arexvy show no evidence for interference in the immune response to any of the antigens contained in both concomitantly administered vaccines. In this study (ClinicalTrials.gov Identifier: NCT04841577), participants 60 year of age and older received 1 dose of Arexvy and Fluarix Quadrivalent. The criteria for noninferiority of the immune responses in the control vs coadministration group were met, though RSV and influenza antibody titers were somewhat lower with coadministration; the clinical significance of this is unknown.

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) can be found here.

This article originally appeared on MPR