Share the Latest Advice About 2019-2020 Influenza Immunizations

What's new with flu vaccines for 2019-2020?

This year's vaccines contain different A strains (H1N1 and H3N2) than last year...but the same B strains.

WHEN to give. Recommend getting a flu vaccine by the end of October...but continue to vaccinate as long as flu is circulating.

CDC is now saying that vaccinating in July or August is likely linked to waning immunity before flu season ends...especially in seniors.

Keep in mind, flu activity usually peaks in January or later. Explain that CDC is aiming to balance missed opportunities to vaccinate against not knowing when flu outbreaks will start.

But evidence about waning immunity is still inconsistent. Don't give a "booster" dose...even if patients got a flu vaccine in the summer.

WHAT to give. Continue to emphasize getting vaccinated...rather than worrying about which flu vaccine to use. There will only be quadrivalent options for patients under 65 this year.

For adults over 50, you'll hear Flublok Quadrivalent might be more effective than other quad has 3 times more antigen.

For adults over 65, discuss trivalent options intended to boost immunity...Fluzone High-Dose or adjuvanted Fluad.

Explain Fluzone High-Dose seems to prevent slightly more flu in seniors than standard-dose trivalent. Both Fluzone High-Dose and Fluad may cause more injection site reactions than standard trivalents.

But it's too soon to say how Fluad or Fluzone High-Dose stack up to each other...or to Flublok or standard quadrivalents.

If you stock FluMist Quadrivalent intranasal vaccine, consider it on equal footing with other options this year for healthy, NONpregnant patients 2 through 49. But expect manufacturing issues to limit supply.

HOW to give. Ask about other needed vaccines (pneumococcal, Tdap, etc)...and feel comfortable giving at the same visit as any flu vaccine.

There are theoretical concerns about more side effects when giving two vaccines with adjuvants...such as Fluad with Shingrix. Don't delay vaccination...but consider a flu vaccine other than Fluad if available.

Use our chart, Flu Vaccines for 2019-20, to compare options and get answers about vaccinating in pregnancy, egg allergy, illness, etc.

Key References

  • MMWR Recomm Rep 2019;68(3):1-21
  • Clin Infect Dis 2019;68(10):1623-30
  • Clin Infect Dis Published online Jun 29, 2019; doi:10.1093/cid/ciz452
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