ACP issues practice points on flu vaccination
Everyone ages 18 to 64 years who is not pregnant or immunocompromised should receive a standard-dose trivalent or standard-dose quadrivalent flu vaccine for the 2025-2026 influenza season, and older patients should get a high-dose vaccine, the College says.
New practice points from ACP say that everyone ages 18 to 64 years who is not pregnant or immunocompromised should receive a standard-dose trivalent or standard-dose quadrivalent (cell-based, egg-based, MF59-adjuvanted, or recombinant) influenza vaccine for the 2025-2026 season.
The practice points were developed by ACP's Population Health and Medical Science Committee and based on a rapid review of the best available evidence of the benefits and harms of trivalent and quadrivalent influenza vaccines in nonpregnant and nonimmunocompromised adults ages 18 years and older. The review was completed by the ACP Center for Evidence Reviews at Cochrane Austria and was funded by ACP.
Overall, 40 studies using two comparators were included. The most common comparator was the standard-dose trivalent or quadrivalent egg-based vaccine, followed by the high-dose trivalent or quadrivalent egg-based influenza vaccine. ACP considered evidence on benefits (reduced rates of pneumonia/lower respiratory tract disease, death, and hospitalization related to the flu, as well as laboratory-confirmed influenza) and harms (fever, idiopathic thrombocytopenic purpura, and serious adverse events).
In addition to the recommendation for those ages 18 to 64 years, ACP stated that those ages 65 years or older who are not immunocompromised should receive a high-dose trivalent or quadrivalent egg-based influenza vaccine. ACP did not examine evidence or make recommendations for pregnant women or immunocompromised adults. The practice points were published Nov. 18 by Annals of Internal Medicine.
In related news, the Infectious Diseases Society of America (IDSA) released guidelines for flu, respiratory syncytial virus (RSV), and COVID-19 vaccination in immunocompromised patients on Nov. 4. The recommendations were based on a systematic literature review conducted by the Vaccine Integrity Project, as well as supplementary searches and evidence reviews conducted by a panel of experts in infectious diseases.
The IDSA panel recommended that all adults and children who are immunocompromised receive an age-appropriate flu vaccine and an age-appropriate COVID-19 vaccine for the 2025-2026 season and that all immunocompromised adults and adolescents receive the RSV vaccine. The IDSA panel noted that live-attenuated flu vaccines, such as FluMist, are not recommended for people who are immunocompromised or those living in their households and said that patients should discuss vaccination timing and other individual considerations with their clinicians.