The Advisory Committee on Immunization Practices (ACIP) has updated its 2014 recommendations regarding the use of seasonal influenza vaccines for the 2015-16 season, including: antigenic composition of US seasonal influenza vaccines; information on influenza vaccine products expected to be available for the 2015-16 season; an updated algorithm for determining the appropriate number of doses for children aged 6 months through 8 years; and recommendations for the use of live attenuated influenza vaccine (LAIV) and inactivated influenza vaccine (IIV) when either is available. Among ACIP’s recommendations for 2015-16 are:

• All persons aged ≥6 months should receive influenza vaccine annually.

• For healthy children aged 2 through 8 years who have no contraindications or precautions, either LAIC or IIV is an appropriate option.

• LAIV should not be used in persons <2 year or >49 years; pregnant women; immunocompromised persons; or persons with a history of egg allergy.

• Since most influenza vaccine is grown in egg culture and contains trace amount of egg protein, individuals with severe allergic and anaphylactic reactions, not just hives, should receive recombinant influenza vaccine (RIV3, Flublok). Patients who have hives alone to eggs may receive IIV or RIV3.

For more recommendations and to view new and updated influenza product approvals for the 2015-16 season, click this table.

Citation: Grohskopf LA, Sokolow LZ, Olsen SJ, Bresee JS, Broder KR, Karron RA. Prevention and control of influenza with vaccines: Recommendations of the advisory committee on immunization practices, United States, 2015-16 influenza season. MMWR. 2015; 64(30)818-825.

Commentary: The main difference from last year’s recommendations is the removal of the preferential recommendation for LAIV for individuals aged 2-8 years. Otherwise, the general recommendation to vaccinate all individuals >6 months of age remains the same. Vaccination programs should begin by October. The recommendations note that a statistically significant decrease in antibody titers occurs by 6 months after vaccination for people ≥65 years of age¹. This makes the ideal timing of giving influenza vaccine tricky, and the CDC states, “Vaccination programs should balance maximizing the likelihood of persistence of vaccine-induced protection through the season with avoiding missed opportunities to vaccinate or vaccinating after influenza virus circulation begins.” In my read, this may mean that August is a bit early for influenza vaccine as 6 months takes one until February, when influenza can be near its peak, and vaccination sometime in October may be ideal. —Neil Skolnik, MD

1. Song JY. Long-term immunogenicity of influenza vaccine among the elderly. Vaccine. 2010;28:3929-35.