This supplement was written by William T. Elliott, MD, FACP, Chair, Formulary Committee, Kaiser Permanente, California Division; Assistant Clinical Professor of Medicine, University of California-San Francisco. In order to reveal any potential bias in this publication, we disclose that Dr. Elliott reports no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study. For questions and comments, please e-mail:

The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) has published its recommendations for the coming 2014-2015 influenza season. This year’s vaccine will be identical to the 2013-2014 vaccine. The trivalent vaccine will again contain the H1N1 strain, as well as one additional influenza A antigen and one influenza B antigen. The quadrivalent vaccine adds an additional B antigen. The ACIP is recommending that children aged 6 months through 8 years receive two vaccinations administered ≥ 4 weeks apart if they did not receive last year’s vaccine. Since the vaccine is identical this flu season, a second vaccination is not needed if they were vaccinated last year. Children should preferentially receive the live attenuated influenza vaccine (Flumist) since it has been shown to be more effective in children. If Flumist is unavailable, children should receive the inactivated influenza injection. Flumist has been shown to be of similar efficacy to the standard vaccine in adults, so either vaccine is acceptable in anyone over the age of 8. The ACIP recommends that health care providers get the vaccine early — preferably in October. The vaccine should be available to patients as long as flu is circulating in the community. There is some evidence that antibody levels drop in the elderly 6 months after vaccination, but the ACIP does not recommend delaying vaccination in this group because of the risk of missed opportunities to vaccinate (MMWR Morb Mortal Wkly Rep 2014;63:691-697).