Yes. It is especially important to vaccinate during pregnancy because of the increased risk for influenza-related complications during pregnancy and the baby’s increased risk of influenza-related illness and hospitalizations during the first 6 months of life.
Influenza vaccination during pregnancy reduces mothers’ risk of influenza illness, preterm labor, and their infants’ risk of influenza and influenza-related hospitalization in the first 6 months of life.
Vaccination can occur in any trimester, including the first. Only inactivated or recombinant influenza vaccines may be given during pregnancy. FluMist, a live vaccine, should not be given during pregnancy.
Last reviewed:
September 10, 2023
ACIP has recommended vaccinating during pregnancy with inactivated influenza vaccine since 1997. Studies have shown that pregnant people are at increased risk for complications, hospitalization, and even death from influenza because of the increased physiologic strain of pregnancy on their heart, lungs, and immune system. Vaccination can occur in any trimester, including the first.
Infants younger than 6 months old are at high risk of influenza-related complications, but influenza vaccine is not recommended for them because the immune response to influenza vaccination is limited before 6 months of age. Vaccinating during pregnancy provides maternal antibodies to the fetus which helps protect infants against influenza during the first 6 months of life until they can get vaccinated at age 6 months. Vaccinating pregnant people protects them, their unborn babies, and their babies after birth.
Last reviewed:
September 10, 2023
Pregnant people may receive any inactivated or recombinant influenza vaccine. They should not be given FluMist Quadrivalent because it is a live-virus vaccine.
Last reviewed:
September 10, 2023
Yes, unless you live in a state that has enacted legislation restricting use in pregnancy. There is no scientific evidence that thimerosal in vaccines is a cause of adverse events unless the patient has a systemic allergy to thimerosal.
Last reviewed:
September 10, 2023
No. The Advisory Committee on Immunization Practices (ACIP) does not recommend more than one dose of influenza vaccine per season, except for certain children being vaccinated for the first time.
Last reviewed:
September 10, 2023
A CDC-funded study found that people who had been vaccinated early in pregnancy with an influenza vaccine containing the pandemic H1N1 (H1N1pdm09) component and who also had been vaccinated the prior season with an H1N1pdm09-containing influenza vaccine had an increased risk of spontaneous abortion (miscarriage) in the 28 days after vaccination. This study did not quantify the risk of miscarriage and did not prove that influenza vaccine was the cause of the miscarriage. Earlier studies have not found a link between influenza vaccination and miscarriage. A larger follow-up study also funded by CDC which included 3 more years of data found no association between early miscarriage and influenza vaccination regardless of previous influenza season vaccination. These results are reassuring regarding the safety of influenza vaccination during pregnancy.
CDC, ACIP, and the American College of Obstetricians and Gynecologists (ACOG) all recommend influenza vaccination during any trimester of pregnancy. Influenza poses a danger to pregnant people and the vaccine can prevent influenza in pregnant people and their infants.
Last reviewed:
September 10, 2023
No. CDC and ACIP express no preference for preservative-free vaccine for infants or any other group of vaccine recipients.
No scientific evidence exists that thimerosal in vaccines is a cause of adverse events unless the patient has a systemic allergy to thimerosal. However, some states have enacted legislation that restricts the use of thimerosal-containing vaccines. Check with your state immunization manager to see if your state is one of them (www.immunize.org/coordinators).
Last reviewed:
September 10, 2023
People with a metabolic disease, including diabetes, should receive annual influenza vaccination with an inactivated or recombinant influenza vaccine.
Last reviewed:
September 10, 2023
Yes. Multiple sclerosis is not a contraindication to any vaccine, including influenza and pneumococcal vaccines.
Last reviewed:
September 10, 2023
Although some studies have demonstrated a transient increase in replication of HIV following inactivated influenza vaccine, other studies have not found this. This temporary increase in HIV titer has not been associated with deterioration in either T-lymphocyte counts or clinical condition. ACIP believes that annual influenza vaccination with inactivated vaccine will benefit many HIV-infected people.
Last reviewed:
September 10, 2023
In November 2015, FDA licensed Fluad (aIIV3, CSL Seqirus), a trivalent, MF59-adjuvanted inactivated influenza vaccine, for people age 65 years and older. Fluad is now quadrivalent (aIIV4). Fluad is the first adjuvanted influenza vaccine marketed in the U.S. An adjuvant is a substance added to a vaccine to increase the immune response to vaccination. The MF59 adjuvant is based on squalene, an oil that occurs naturally in many plants and animals. Fluad has been used in Europe since 1997 and is approved in many other countries. In contrast to Fluzone High-Dose Quadrivalent (Sanofi), Fluad is a standard-dose vaccine, containing 15 mcg of hemagglutinin per virus per dose.
Last reviewed:
September 10, 2023
Aging decreases the body’s ability to develop a good immune response after getting influenza vaccine, which places older people at greater risk of severe illness from influenza.
After years of review and deliberation, ACIP voted in June 2022 to recommend that all adults age 65 and older should preferentially receive one of the three different vaccine products that evidence suggests are likely to perform better than standard dose, unadjuvanted vaccines: Flublok recombinant quadrivalent influenza vaccine (RIV4, Sanofi), Fluad quadrivalent adjuvanted vaccine (aIIV4, CSL Seqirus), and Fluzone High-Dose quadrivalent vaccine (HD-IIV, Sanofi). However, if none of these three vaccines is available at the time of vaccination, any age-appropriate influenza vaccine may be administered.
For a thorough review of the evidence for this recommendation, see the 2022 published ACIP recommendations for influenza vaccination: www.cdc.gov/mmwr/volumes/71/rr/pdfs/rr7101a1-H.pdf.
Last reviewed:
September 10, 2023
No. These vaccines are licensed only for people age 65 years and older and are not recommended for younger people.
Last reviewed:
September 10, 2023
Yes, Flublok is licensed and recommended for adults age 18 years and older.
Last reviewed:
September 10, 2023
No, and this is not recommended.
Last reviewed:
September 10, 2023
People with cancer need to be protected from influenza, and they can and should receive inactivated or recombinant influenza vaccine (but not live nasal spray vaccine [FluMist]) even if they are immunosuppressed. Cancer patients and survivors are at higher risk for complications from influenza, including hospitalization and death. Here is a helpful CDC web page on cancer and influenza for patients: www.cdc.gov/cancer/flu.
Last reviewed:
September 10, 2023
Inactivated influenza vaccine or recombinant influenza vaccine should be administered beginning at least 6 months after bone marrow transplant and annually thereafter for the life of the patient. A dose of vaccine can be given as early as 4 months after transplant, but a second dose should be considered in this situation. A second dose is recommended routinely for all children younger than 9 years receiving influenza vaccine for the first time.
Last reviewed:
September 10, 2023
