Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

New 2017-18 Influenza Vaccine Recommendations

MMWR; ePub 2017 Aug 25; Grohskopf, et al

The Centers for Disease Control and Prevention (CDC) has issued the recommendations of the Advisory Committee on Immunization Practices (ACIP) for the 2017-18 influenza season. The CDC continues to recommend routine annual influenza vaccination for all persons aged ≥6 months who do not have contraindications. Standard dose or high dose vaccine is acceptable for adults aged ≥65 years. Among the changes from last year:

  • Vaccine viruses included in the 2017–18 US trivalent influenza vaccines will be an A/Michigan/45/2015 (H1N1)pdm09–like virus, an A/Hong Kong/4801/2014 (H3N2)-like virus, and a B/Brisbane/60/2008–like virus (Victoria lineage). Quadrivalent influenza vaccines will contain these 3 viruses and an additional influenza B vaccine virus, a B/Phuket/3073/2013–like virus (Yamagata lineage).
  • Afluria Quadrivalent and Flublok Quadrivalent are now available for patients aged ≥18 years, and there is an expansion of the age indication for FluLaval Quadrivalent, previously licensed for ≥3 years, to ≥6 months.
  • Pregnant women may receive any licensed, recommended, age-appropriate influenza vaccine.
  • FluMist Quadrivalent should not be used during the 2017–18 season due to concerns about its effectiveness against influenza A(H1N1)pdm09 viruses in the US during the 2013–14 and 2015–16 influenza seasons.


Grohskopf LA, Sokolow LZ, Broder KR, et al. Prevention and control of seasonal influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2017–18 influenza season. MMWR Recomm Rep. 2017;66(No. RR-2):1–20. doi:10.15585/mmwr.rr6602a1.


Essentially, everyone over 6 months of age should receive flu vaccine. Vaccination should be offered by the end of October, with some questioning whether August and September are too early to give the flu vaccine. The ACIP notes that some data indicate that early vaccination (eg, in July and August) might be associated with suboptimal immunity before the end of the influenza season, stating, “although delaying vaccination might result in greater immunity later in the season, deferral also might result in missed opportunities to vaccinate.” Therefore, flu vaccine should be given when available. While any approved flu vaccine can be used for those over 65 years of age, it is worth noting that Fluzone High-Dose (HD-IIV3; Sanofi Pasteur, Swiftwater, PA) had superior efficacy compared to trivalent vaccine in a randomized trial conducted over 2 seasons among 31,989 persons aged ≥65 years1, and the ACIP concludes that the quadrivalent vaccine therefore might provide better protection than the trivalent vaccine studied for this age group. —Neil Skolnik, MD

  1. DiazGranados CA, Dunning AJ, Kimmel M, et al. Efficacy of high-dose versus standard-dose influenza vaccine in older adults. N Engl J Med. 2014;371:635–45. doi:10.1056/NEJMoa131572.