ACIP Updates Flu Vaccine Recommendations for 2020-2021 Season


Primary updates to the guidance includes the composition of the 2020-2021 flu vaccines and the recent licensures of 2 new influenza vaccines.

Flu Shot

The Advisory Committee on Immunization Practices (ACIP) updated its seasonal flu vaccine guidance for the 2020-2021 influenza season.

With flu season approaching, pharmacies are gearing up for a busy season as the coronavirus disease 2019 (COVID-19) continues to circulate. Prevention of and reduction in the severity of influenza illnesses and reduction of outpatient illnesses, hospitalizations, and intensive care unit admission is especially important to alleviate stress on the US health care system during the pandemic.

According to ACIP, primary updates and changes to the recommendations include the vaccine virus composition for 2020-2021 US seasonal influenza vaccines and recent regulatory actions, including 2 new influenza vaccine licensures.

In general, routine annual influenza vaccination of all individuals aged 6 months and older who do not have contraindications continues to be recommended. No preferential recommendations is made for 1 influenza vaccine product over another for individuals for whom more than 1 licensed, recommended, and appropriate product is available.

The composition of the 2020-2021 US influenza vaccine includes updates to the influenza A(H1N1)pdm09, influenza A(H3N2), and influenza B/Victoria lineage components. The following influenza vaccines will be available for this season:

  • Egg-based influenza vaccines that will contain hemagglutinin (HA) derived from an influenza A/Guangdong-Maonan/SWL1536/2019 (H1N1)pdm09-like virus, an influenza A/Hong Kong/2671/2019 (H3N2)-like virus, an influenza B/Washington/02/2019 (Victoria lineage)-like virus, and (for quadrivalent egg-based vaccines) an influenza B/Phuket/3073/2013 (Yamagata lineage)-like virus.
  • Cell culture-based inactivated (ccIIV4) and recombinant (RIV4) influenza vaccines that will contain HA derived from an influenza A/Hawaii/70/2019 (H1N1)pdm09-like virus, an influenza A/Hong Kong/45/2019 (H3N2)-like virus, an influenza B/Washington/02/2019 (Victoria lineage)-like virus, and an influenza B/Phuket/3073/2013 (Yamagata lineage)-like virus.

Two new influenza vaccine licensures are described in the updated guidance:

  1. Fluzone High-Dose Quadrivalent (HD-IIV4) is approved for use in individuals aged ≥65 years. For the 2020-2021 season, Fluzone High-dose Quadrivalent is expected to replace the previously available trivalent formulation of Fluzone High-Dose (HD-IIV3).
  2. Fluad Quadrivalent (aIIV4) is approved for use in individuals aged ≥65 years. Both Fluad Quadrivalent and the previously licensed trivalent formulation of Fluad (aIIV3) are expected to be available for the 2020-2021 season.

Additional changes include:

  1. Anatomic and functional asplenia; active communication between cerebrospinal fluid (CSF) and oropharynx, nasopharynx, nose, or ear or any other cranial CSV leak; and cochlear implant have been added to the Contraindications and Precautions section related to live attenuated influenza vaccine use.
  2. Information has been added concerning the use of live attenuated influenza vaccine in the setting of influenza antiviral medication use.
  3. Recommendations concerning vaccination of individuals with egg allergy who receive either cell culture-based inactivated or recombinant influenza quadrivalent vaccine now state additional measures are needed only if a vaccine other than ccIIV4 or RIV4 is used.

Read the full report for more information.


Grohskopf LA, Alyanak E, Broder KR, et al. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices–United States, 2020-21 influenza season. Morbidity and Mortality Weekly Report. 2020. Doi: icon

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