A: Yearly influenza vaccination continues to be recommended for everyone age 6 months and older. All available influenza vaccines in the United States continue to be quadrivalent (containing two influenza A and two influenza B strains). The changes in the CDC’s published Advisory Committee on Immunization Practices (ACIP) recommendations for influenza vaccination in 2022–2023 are summarized below:

• The 2022–23 vaccines include new influenza A (H3N2) and influenza B/Victoria lineage virus vaccine antigens.
• Flucelvax Quadrivalent (ccIIV4, Seqirus) is now FDA-approved for children age 6 months and older.
• Adults age 65 years and older should preferentially receive one of three higher dose or adjuvanted influenza vaccines: Fluzone High-Dose Quadrivalent (HD-IIV4, Sanofi), Flublok Quadrivalent recombinant (RIV4, Sanofi), and Fluad Quadrivalent adjuvanted (aIIV4, Seqirus) influenza vaccines. If none of these three preferred vaccines are available, any age-appropriate flu vaccine may be used.
• Updates were made to the recommended timing of vaccination. Influenza vaccination of most adults in July and August should be avoided unless there is a concern that later vaccination may not be possible. Vaccination in July and August may be considered for people in their third trimester of pregnancy.  Children who need one or two doses can get vaccinated in July and August. Vaccination of everyone age 6 months and older should continue as long as influenza viruses are circulating, and unexpired vaccine is available. 

The current ACIP recommendations for influenza vaccination are available here: www.cdc.gov/mmwr/volumes/71/rr/pdfs/rr7101a1-H.pdf. 

A: Influenza is the second most frequent cause of death from a vaccine-preventable disease in the United States after COVID-19. Rates of infection from seasonal influenza are highest among children, but the risks for complications, hospitalizations, and deaths are higher among adults age 65 years and older, children younger than 5 years, pregnant individuals, and people of any age who have medical conditions that place them at increased risk for complications from influenza.
 
From the 2010–11 through the 2019–20 seasons, the annual influenza-related disease burden has varied from approximately 9 to 45 million illnesses, 4 to 21 million medical visits, 140,000 to 810,000 hospitalizations and 12,000 to 61,000 deaths per year, including an average of 133 pediatric deaths reported to CDC (range 37–199) each year. For the 2020–21 and 2021–22 seasons, influenza disease burden was likely substantially reduced as a result of measures taken by many people to reduce the transmission of COVID-19, such as wearing face masks in public and reducing social interactions. Preliminary CDC estimates of the influenza burden during the 2021–22 season are: 8–11 million illnesses, 3.7–6.1 million medical visits, 82,000–170,000 hospitalizations, and 5,000–14,000 deaths. For more information on the health burden of influenza, see www.cdc.gov/flu/about/burden/index.html.

A: The timing and severity of influenza seasons are always unpredictable. Influenza viruses circulated at very low levels while measures to prevent the spread of COVID-19 were widely adopted, including social distancing, mask wearing, and reduction in travel. As the use of these COVID-19 mitigation measures has decreased, there has been an increase in the circulation of influenza and other respiratory viruses. Current information on influenza virus circulation can be found at www.cdc.gov/flu/weekly/index.htm.

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A: Multiple manufacturers are producing quadrivalent influenza vaccine for the U.S. market for the 2022–23 season. Inactivated influenza vaccines (IIV4) will be produced using egg-based, cell culture-based, and recombinant technologies. Live attenuated nasal spray vaccine will also be available.

Influenza vaccines are not all licensed for the same age groups.
 
Immunize.org has a 1-page printable document that summarizes each of the products available for the current influenza vaccination season at www.immunize.org/catg.d/p4072.pdf.

A: For most people, vaccination should begin in September and, ideally, be done by the end of October. For people not vaccinated by the end of October, vaccination efforts should continue as long as influenza viruses are circulating and unexpired vaccine is available.
 
For most adults, vaccination in July and August should be avoided unless there is concern that vaccination later in the season might not be possible. Early vaccination has been associated with decreased vaccine effectiveness before the end of the influenza season, particularly among older adults.
 
Vaccination in July and August may be considered for people in their third trimester of pregnancy, to allow time for protective maternal antibodies to transfer to the fetus, providing protection during early infancy. Children younger than 9 years old who need two doses of vaccine this season should receive their first dose as soon as possible so that they can get their second dose before the end of October. Children who need only one dose also can be vaccinated in July or August.

A: Yes. CDC’s clinical guidance for the use of COVID-19 vaccines states that any vaccine may be given on the same day or any day before or after COVID-19 vaccination, at a different anatomic site. According to the CDC’s “General Best Practice Guidelines for Immunization,” simultaneously administering all vaccines for which a person is eligible at the time of a visit increases the probability that a person will be fully vaccinated by the appropriate time.
 
IIV4 and RIV4 can be administered without regard to the timing of other live or inactivated vaccines. Injectable vaccines should be administered in separate anatomic sites when given on the same day.
 
LAIV4 may be given on the same day as any other live or inactivated vaccines. However, if two live vaccines are not given on the same day, they should be separated by at least 4 weeks.

A: Vaccinating people against influenza who have recently tested positive for COVID-19 involves multiple considerations, such as whether vaccinating them could expose others to COVID-19, how sick they are, their risk for severe influenza illness, the ability to vaccinate at a later date, and the desire to avoid confusing postvaccination symptoms with those of COVID-19. Usually, people who are in isolation should not be brought to a vaccination setting if doing so could expose others to COVID-19. Any moderate or severe acute illness is a precaution to influenza vaccination: vaccination should generally be deferred until recovery. For people with mild or asymptomatic COVID-19, delaying vaccination might be considered to avoid confusing COVID-19 symptoms with postvaccination reactions.
 
CDC may continue to modify recommendations for vaccination of this population.