Influenza Vaccination and Treatment Recommendations for 2022-2023

Influenza Immunization:

A routine annual influenza (i.e., flu) vaccination is recommended for all individuals equal to and greater than months of age. The recommendations below should always be discussed and approved by an individual’s primary care provider before vaccination occurs.

Children:

  • Children from 6 months through 8 years of age who have previously received 2 or more total doses of trivalent or quadrivalent influenza vaccine 4 or more weeks apart before July 1, 2022 will need 1 dose of the 2022-2023 influenza vaccine.
  • Children from 6 months through 8 years of age who have not previously received 2 or more total doses of trivalent or quadrivalent influenza vaccine 4 or more weeks apart before July 1, 2022 will need 2 doses of the 2022-23 influenza vaccine. These 2 doses should be given at least 4 weeks apart.
  • Children who are 9 years old or older only need 1 dose.

Adults 65 Years of Age or Older:

  • Adults 65 years or older should receive any one of the following higher dose or adjuvanted influenza vaccines: quadrivalent high-dose inactivated influenza vaccine (HD-IIV4), quadrivalent recombinant influenza vaccine (RIV4), or quadrivalent adjuvanted inactivated influenza vaccine (aIIV4).

Pregnancy:

  • Influenza vaccines, except the quadrivalent live attenuated (LAIV4), can be received in any trimester of pregnancy, if approved by one’s Ob/Gyn doctor.
  • The quadrivalent live attenuated vaccine (LAIV4) should not be used during pregnancy since it contains a live virus, but it can be used postpartum, if approved by one’s Ob/Gyn doctor.

Chronic Medical Conditions:

The quadrivalent live attenuated vaccine (LAIV4) should not be received in individuals with the following:

  • History of severe allergic reaction (i.e., anaphylaxis) to any component of the vaccine
  • Concomitant aspirin or salicylate-containing therapy in children and adolescents
  • Children between the ages of 2 – 4 years of age who have received a diagnosis of asthma or if a wheezing episode has occurred during the preceding 12 months
  • Children and adults who are immunocompromised due to any cause
  • Close contacts and caregivers of severely immunosuppressed individuals who require a protected environment

Egg Allergy:

  • Individuals who have experienced only hives after exposure to egg may receive any licensed recommended influenza vaccine appropriate for their age.
  • Individuals reporting symptoms other than hives after exposure to egg [i.e., angioedema (i.e., swelling), respiratory distress, lightheadedness, recurrent vomiting], or who required epinephrine or another emergency medical intervention, may also receive any influenza vaccine that is otherwise appropriate. If a vaccine other than a quadrivalent cell-based influenza vaccine (ccIIV4) such as Flucelvax® or a quadrivalent recombinant influenza vaccine (RIV4) such as Flublok® is selected, it should be administered in an inpatient or outpatient medical setting, supervised by a health care provider who can recognize and manage severe allergic reactions.

Previous Serious Allergic Reaction:

Influenza vaccines are contraindicated for those with a history of a severe allergic reaction to any component of that vaccine.

Travelers:

Travelers who wish to reduce the risk for influenza should consider vaccination, preferably at least 2 weeks before departure.

Vaccination and Influenza Antiviral Medications:

Individuals receiving influenza antiviral medications can take influenza vaccines other than a quadrivalent live attenuated influenza vaccine (LAIV4).

With Other Vaccines:

  • The quadrivalent inactivated influenza vaccine (IIV4) and the quadrivalent recombinant influenza vaccines (RIV4) may be administered concurrently or sequentially with other live or inactivated vaccines.
  • Injectable vaccines given simultaneously should be administered at separate anatomic sites.
  • The quadrivalent live attenuated vaccine (LAIV4) may be administered simultaneously with other inactivated or live vaccines. If not given simultaneously, then at least 4 weeks should pass between the administration of the quadrivalent live attenuated vaccine (LAIV4) and another live vaccine.

Administration of IIV4 and RIV4:

  • The quadrivalent inactivated influenza vaccines (IIV4) and quadrivalent recombinant influenza vaccines (RIV4) are administered intramuscularly (IM). For adults and older children, the deltoid muscle in the arm is the preferred site. For infants and younger children, the anterolateral thigh is the preferred site.
  • The quadrivalent recombinant influenza vaccine (RIV4) is licensed for individuals 18 years of age and older and should not be used for children and/or adolescents less than 18 years of age.

Administration of LAIV4:

  • The quadrivalent live attenuated influenza vaccine (LAIV4) is administered intranasally using the supplied prefilled, single-use sprayer containing 0.2 ml. of vaccine.
  • If the vaccine recipient sneezes immediately after administration, the dose should not be repeated.
  • If nasal congestion is present which may interfere with the delivery of the vaccine to the nasopharyngeal mucosa, a deferral should be considered, or another age-appropriate vaccine should be administered.

Treatment of Influenza:

The antiviral medications that are used to treat the flu (i.e., influenza) are more efficacious when they are begun within 2 days of the beginning of symptoms.
There are 4 FDA-approved antiviral drugs used in the treatment of influenza:

  • oseltamivir phosphate (Trade name: Tamiflu®)
  • zanamivir (Trade name: Relenza®)
  • peramivir (Trade name: Rapivab®)
  • baloxavir marboxil (Trade name: Xofluza®)

Oseltamivir (Tamiflu®) is available as a pill or liquid suspension and is FDA-approved for the early treatment of influenza in individuals 14 days of age and older. Zanamivir (Relenza®) is a powder that is inhaled and approved for the early treatment of influenza in individuals 7 years of age and older. Note that zanamivir is administered using an inhaler device and is not recommended for individuals with respiratory problems such as asthma or chronic obstructive pulmonary disease (COPD). Oseltamivir and zanamivir are given twice a day for 5 days. Peramivir (Rapivab®) is given once intravenously by a health care provider and is approved for the early treatment of influenza in individuals 6 months of age and older. Baloxavir (Xofluza®) is a pill given as a single dose by mouth and is approved for the early treatment of influenza in children 5 – 12 years of age who do not have any chronic medical conditions, and for all individuals 12 years of age and older.

The board certified allergists at Black & Kletz Allergy have been advising patients on the treatment and prevention of the flu (i.e., influenza) for many years in both children and adults. Black &Kletz Allergy has 3 convenient locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA which all offer on-site parking. The Washington, DC and McLean, VA locations are Metro accessible and there is a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line. Please call us to make an appointment or you can click Request an Appointment and we will reply within 24 hours by the next business day. The allergy specialists of Black & Kletz Allergy are eager to help you with your allergy, asthma, immunological, and vaccination needs. We are dedicated to providing first-rate care to you as we have been doing in the Washington, DC metropolitan area for more than 50 years.

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