Seasonal Influenza and COVID-19 Vaccination Guidelines

Influenza Vaccination Recommendations

• The American Academy of Pediatrics recommends that all children aged ≥6 months should receive annual influenza vaccination, ideally by the end of October 2, 3
• The Centers for Disease Control and Prevention (CDC) recommends that children aged 6 months through 8 years receiving influenza vaccine for the first time or who have received only 1 dose before July 1, 2021, or whose vaccination status is unknown, should receive 2 doses of influenza vaccine administered 4 weeks apart 2, 3
• The CDC recommends that children who have previously received ≥2 doses of trivalent or quadrivalent influenza vaccine before July 1, 2022 (doses need not have been received during the same or consecutive seasons) require only 1 dose of the 2022-23 influenza vaccine 3
• For children aged 6 through 35 months, the CDC recommends the following dose volumes:
• The American Academy of Pediatrics recommends that children aged ≥36 months (≥3 years) should receive a 0.5 mL dose of any available, licensed, age-appropriate vaccine 2, 5
• Healthy children aged ≥24 months (≥2 years) may receive either inactivated influenza vaccine (IIV) or live attenuated influenza vaccine (LAIV), with no preference for one formulation over another 2
• The CDC recommends that all adults should receive annual influenza vaccination, with particular focus on those at higher risk for complications 1
• Adults aged ≥65 years may receive any age-appropriate IIV or the recombinant influenza vaccine (RIV4) 5
• High-dose inactivated influenza vaccine (HD-IIV4) and adjuvanted inactivated influenza vaccine (aIIV4) are approved only for adults aged ≥65 years 5

Special Considerations

• The CDC recommends that vaccination should continue to be offered as long as influenza viruses are circulating and unexpired vaccine is available 3
• Persons who have had laboratory-confirmed influenza should still receive annual influenza vaccination according to recommendations, as infection with one virus type or subtype does not confer immunity to other types or subtypes 6
• Individuals with moderate to severe acute illness should defer vaccination until their symptoms have improved 7

COVID-19 Vaccination Recommendations

• COVID-19 vaccines can be administered concurrently with influenza vaccines at different anatomical sites 8
• When administering vaccines with increased reactogenicity (e.g., adjuvanted or high-dose influenza vaccines) along with COVID-19 vaccines, they should be injected into different limbs 8

Contraindications and Precautions

• IIV should not be administered to infants younger than 6 months or individuals with severe allergic reactions to previous influenza vaccines or vaccine components 7
• LAIV should not be administered to children younger than 2 years, children with asthma or history of wheezing, children with chronic underlying medical conditions, or pregnant women 7
• Persons who care for severely immunocompromised individuals requiring a protected environment (should avoid contact for 7 days after receiving LAIV) 1
• Persons who have tested positive for COVID-19 or who are in quarantine should defer vaccination until they have recovered to avoid exposing others 1

Timing Considerations

• Vaccination should ideally occur before the onset of influenza activity in the community, preferably by the end of October 3
• Studies have shown decreasing vaccine effectiveness with increasing time post-vaccination within a single influenza season, with waning effects varying by age group, influenza virus type, and season 3
• Influenza and COVID-19 vaccines can be administered simultaneously at different anatomic sites, which can improve vaccination coverage and efficiency 8

Common Pitfalls to Avoid

• Delaying vaccination to administer vaccines separately when they can be given simultaneously may lead to missed opportunities for vaccination 8
• Failing to recognize that children aged 6 months through 8 years may need two doses of influenza vaccine depending on their vaccination history 3
• Unnecessarily delaying vaccination after recovery from influenza or COVID-19 infection may leave individuals vulnerable during peak respiratory virus season 6