2022–2023 Season

What’s new for 2022–2023

A few things are different for the 2022–2023 influenza (flu) season, including:

• The composition of flu vaccines has been updated.
• For the 2022–2023 flu season, there are three flu vaccines that are preferentially recommended for people 65 years and older. These are Fluzone High-Dose Quadrivalent vaccine, Flublok Quadrivalent recombinant flu vaccine and Fluad Quadrivalent adjuvanted flu vaccine.
• The recommended timing of vaccination is similar to last season. For most people who need only one dose for the season, September and October are generally good times to get vaccinated. Vaccination in July and August is not recommended for most adults but can be considered for some groups. While ideally it's recommended to get vaccinated by the end of October, it's important to know that vaccination after October can still provide protection during the peak of flu season.
• The age indication for the cell culture-based inactivated flu vaccine, Flucelvax Quadrivalent (ccIIV4), changed from 2 years and older to 6 months and older.
• Pre-filled Afluria Quadrivalent flu shots for children are not expected to be available this season. However, children can receive this vaccine from a multidose vial at the recommended dose.

Flu vaccine

What is CDC’s recommendation for getting a flu vaccine for the 2022-2023 flu season?

Annual flu vaccination is recommended for everyone 6 months and older, with few exceptions as has been the case since 2010. New this season, however, is a preferential recommendation for the use of higher dose and adjuvanted flu vaccines in people 65 and older over standard dose, unadjuvanted flu vaccines.

What viruses will the 2022–2023 flu vaccines protect against?

There are many different flu viruses, and they are constantly changing. The composition of U.S. flu vaccines is reviewed annually and updated as needed. The recommendations for the 2022–2023 season include two updates compared with the recommended composition of last season's U.S. flu vaccines. Both the influenza A(H3N2) and the influenza B(Victoria lineage) vaccine virus components were updated.

The recommendations for egg-based and cell-based and recombinant flu vaccines are listed below:

Egg-based vaccine composition recommendations:

• An A/Victoria/2570/2019 (H1N1) pdm09-like virus
• An A/Darwin/9/2021 (H3N2)-like virus (updated)
• A B/Austria/1359417/2021-like virus (B/Victoria lineage) (updated)
• A B/Phuket/3073/2013-like virus (B/Yamagata lineage)

Cell- or recombinant-based vaccine composition recommendations:

• An A/Wisconsin/588/2019 (H1N1) pdm09-like virus
• An A/Darwin/6/2021 (H3N2)-like virus (updated)
• A B/Austria/1359417/2021-like virus (B/Victoria lineage) (updated)
• A B/Phuket/3073/2013-like virus (B/Yamagata lineage)

This recommendation is the same as the Southern Hemisphere flu vaccine recommendation.

How much flu vaccine is expected to be available during the 2022–2023 flu season?

Flu vaccine is produced by private manufacturers, so supply depends on manufacturers. Vaccine manufacturers have projected that they will supply the United States with as many as 156.2 million to 170 million doses of influenza vaccines for the 2023–2024 season. These projections may change as the season progresses. All flu vaccines for the 2024–2025 season will be trivalent (three component). Most will be thimerosal-free or thimerosal-reduced vaccine (91%), and about 21% of flu vaccines will be egg-free.

Are any of the available flu vaccines recommended over others?

Yes, for some people. For the 2022–2023 flu season, there are three flu vaccines that are preferentially recommended for people 65 years and older. These are Fluzone High-Dose Quadrivalent vaccine, Flublok Quadrivalent recombinant flu vaccine and Fluad Quadrivalent adjuvanted flu vaccine. There is not a preferential recommendation for one of these three higher dose or adjuvanted flu vaccines over the others.

On June 22, 2022, CDC's Advisory Committee on Immunization Practices (ACIP) voted unanimously to preferentially recommend these vaccines over standard-dose unadjuvanted flu vaccines. This recommendation was based on a review of available studies which suggests that, in this age group, these vaccines are potentially more effective than standard dose unadjuvanted flu vaccines. There is no preferential recommendation for people younger than 65 years.

What if a preferentially recommended flu vaccine is not available?

If one of the three preferentially recommended flu vaccines for people 65 and older is not available at the time of administration, people in this age group should get a standard-dose flu vaccine instead.

What is CDC doing to promote flu vaccination for the 2022–2023 flu season?

CDC has annual educational campaigns to increase awareness about the importance of seasonal flu vaccination. For the 2022–2023 season, CDC will continue to emphasize the importance of flu vaccination beginning in September and for the entire flu season. The agency will conduct targeted communication outreach to specific groups of people who are at higher risk for developing serious complications from flu. Communication strategies for providers and the public will include:

• Educational outreach activities by CDC, including social media, press conferences, web page spotlights, radio media tours, op-eds, and other publications.
• Special educational efforts and a digital campaign to inform the general population, people with underlying health conditions, children, pregnant people, and African American and Hispanic audiences about the importance of flu vaccination.

In addition, as part of its new Partnering for Vaccine Equity program, CDC has provided more than $150 million in funding to support national, state, local, and community-level partners working to increase confidence in COVID-19 and flu vaccines among adults in racial and ethnic minority groups.

I don’t have a primary care provider. Where can I get a flu vaccine?

If you don’t have a health care provider you regularly see, you can find flu vaccines at many places, including health departments and pharmacies.

When is the best time to get my influenza vaccine?

It's best to be vaccinated before flu begins spreading in your community. September and October are generally good times to be vaccinated against flu. Ideally, everyone should be vaccinated by the end of October. However, even if you are not able to get vaccinated until November or later, vaccination is still recommended because flu most commonly peaks in February and significant activity can continue into May.

Additional considerations concerning the timing of vaccination for certain groups include:

• Adults, especially those 65 years and older, should generally not get vaccinated early (in July or August) because protection may decrease over time, but early vaccination can be considered for any person who is unable to return at a later time to be vaccinated.
• Some children need two doses of flu vaccine. For those children it is recommended to get the first dose as soon as vaccine is available, because the second dose needs to be given at least four weeks after the first. Vaccination during July and August also can be considered for children who need only one dose. Early vaccination can also be considered for people who are in the third trimester of pregnancy, because this can help protect their infants during the first months of life (when they are too young to be vaccinated).

Flu vaccine and COVID-19 vaccine coadministration

Can I get a COVID-19 vaccine and a flu vaccine during the same visit?

Yes, you can get a COVID-19 vaccine and a flu vaccine at the same time if you are eligible and the timing coincides.

Even though both vaccines can be given at the same visit, people should follow the recommended schedule for either vaccine: If you haven't gotten your currently recommended doses of COVID-19 vaccine, get a COVID-19 vaccine as soon as you can, and ideally get a flu vaccine by the end of October.

Is it safe to get a COVID-19 vaccine and a flu vaccine at the same time?

Studies conducted throughout the COVID-19 pandemic indicate that it is safe to get both a COVID-19 vaccine and a flu vaccine at the same visit. A recent CDC study published in JAMA suggests people who received a flu vaccine and an mRNA COVID-19 booster vaccine at the same time were slightly more likely (8% to 11%) to report systemic reactions including fatigue, headache, and muscle ache than people who only received a COVID-19 mRNA booster vaccine, but these reactions were mostly mild and resolved quickly. The findings of this study are consistent with safety data from clinical trials that did not identify any serious safety concerns with coadministration.

If you have concerns about getting both vaccines at the same time, you should speak with a health care provider.

Can I get a flu vaccine at the same time I get my COVID-19 booster shot?

Yes, you can get a flu vaccine at the same time you get a COVID-19 vaccine, including a COVID-19 booster shot.

Can children get a COVID-19 vaccine and a flu vaccine during the same visit?

Yes, children who are eligible for COVID-19 vaccination can get a COVID-19 vaccine and a flu vaccine at the same visit.

If your child is eligible, get them up to date on their recommended COVID-19 vaccine and annual flu vaccine as soon as possible. You can get both vaccines at the same time, but don't delay either vaccination in order to get them both at the same visit. Both vaccines are recommended, and your child should get the recommended doses for each vaccine.

All children 6 months and older should get a flu vaccine. Most children will only need one dose of flu vaccine. Your child's healthcare provider can tell you if your child needs two doses of flu vaccine.

Flu activity

Will new flu viruses circulate this season?

Flu viruses are constantly changing so it's not unusual for new flu viruses to appear each year.

When will flu activity begin and when will it peak?

The timing of flu is difficult to predict and can vary in different parts of the country and from season to season.

Flu vaccine coverage

What vaccine uptake estimates will CDC provide this season?

CDC's Weekly Flu Vaccination Dashboard will again provide preliminary, within-season, weekly influenza vaccination data which will be updated during the season as more data become available. The first posting of vaccine coverage data for the season is expected in early October.

How is CDC tracking weekly flu vaccination coverage among children 6 months–17 years old?

Flu vaccination coverage among children is assessed through the National Immunization Survey-Flu (NIS-Flu), which provides weekly flu vaccination coverage estimates for children 6 months–17 years old. NIS-Flu is a national random-digit-dialed cellular telephone survey of households conducted during the flu season (October–June). Additional information about NIS-Flu methods and estimates from 2021–2022 season are available at FluVaxView.

How is CDC tracking monthly flu vaccination coverage among pregnant people?

Flu vaccination coverage estimates among pregnant people are available via CDC's Weekly Flu Vaccination Dashboard. These estimates are based on electronic health record (EHR) data from the Vaccine Safety Datalink (VSD), a collaboration between CDC's Immunization Safety Office and nine integrated health care organizations. Of note, because these estimates are based on data from nine integrated health care systems, they may not be representative of all pregnant people in the United States.

How is CDC tracking the number of flu vaccines administered at pharmacies and doctor’s offices?

CDC tracks the number of flu vaccines administered at pharmacies and doctor's offices by utilizing new sources of vaccination data, including IQVIA data for vaccinations administered in retail pharmacies (e.g., pharmacy chains, mass merchandise, food stores, and independent pharmacies) and doctors' offices.

When will the first flu vaccine uptake estimates be provided for this season?

CDC's Weekly Flu Vaccination Dashboard provides preliminary, within-season, weekly flu vaccination data which will be updated during the season as more data become available. The first posting of vaccine coverage data for the season is expected in early October.

Click here for vaccination coverage estimates from past flu seasons. CDC will continue to provide end-of-season estimates of flu vaccination coverage from these data sources.

Seasonal flu and COVID-19

What is the difference between flu and COVID-19?

Influenza (Flu) and COVID-19 are both contagious respiratory illnesses, but they are caused by different viruses. COVID-19 is caused by infection with a coronavirus named SARS-CoV-2, and flu is caused by infection with influenza viruses. You cannot tell the difference between flu and COVID-19 by symptoms alone because some of the symptoms are the same. Some PCR tests can differentiate between flu and COVID-19 at the same time. If one of these tests is not available, many testing locations provide flu and COVID-19 tests separately. Talk to a healthcare provider about getting tested for both flu and COVID-19 if you have symptoms.

Will there be flu along with COVID-19 in the fall and winter?

While difficult to predict what will happen in the fall and winter, CDC expects SARS-CoV-2 to continue to spread during the fall and winter along with flu viruses.

Because symptoms of flu and COVID-19 are similar, how will I know if I have flu or COVID-19?

Your health care professional may order a test to help confirm whether you have flu or COVID-19 or some other illness.

Is there a test that can detect both flu and COVID-19?

Yes. There are tests that will check for seasonal influenza A and B viruses and SARS-CoV-2, the virus that causes COVID-19. Testing for these viruses at the same time gives public health officials important information about how flu and COVID-19 are spreading and what prevention steps people should take. These tests also help public health laboratories save time and testing materials, and possibly return test results faster.

Is it possible to have flu and COVID-19 at the same time?

Yes. It is possible to have flu and other respiratory illnesses, including COVID-19, at the same time. This is called a coinfection.

If I get sick with flu, am I at higher risk of contracting COVID-19?

Because COVID-19 is still a relatively new illness, we have little information about how flu illness might affect a person’s risk of getting COVID-19.

Will a flu vaccine protect me against COVID-19?

No. Flu vaccines do not protect against COVID-19. Flu vaccination reduces the risk of flu illness, hospitalization, and death in addition to having been shown to have other important benefits.

Likewise, getting a COVID-19 vaccine is the best protection against COVID-19, but those vaccines do not protect against flu. Visit the CDC's FAQ page for information about COVID-19 vaccinations.

Does a flu vaccination increase your risk of getting COVID-19?

No. There is no evidence that getting a flu vaccination raises your risk of getting sick from COVID-19 or any other coronavirus. (Common human coronaviruses usually cause mild to moderate upper-respiratory tract illnesses, like the common cold.)

I think I may have flu. Is it safe for me to visit my health care professional when COVID-19 is spreading in my community?

Health care professionals may have different practices for diagnosing and treating flu during the COVID-19 pandemic, such as wearing masks in a health care setting or offering telemedicine. If you have flu symptoms and are at higher risk of serious flu complications, you should call your health care professional as soon as possible to tell them about your symptoms. They may decide to treat you with flu antiviral medications. Follow the recommendations of your health care provider and CDC for doctor visits.

Will flu and COVID-19 coinfections be more common this flu season?

The past two flu seasons have seen historically low levels of flu. We might expect to see more coinfections as flu activity increases and as COVID-19 continues to spread.

Is CDC tracking coinfections of flu and COVID-19?

Yes. CDC is tracking flu and COVID-19 coinfections through its surveillance systems:

• CDC uses FluSurv-NET and COVID-NET to see how many people who are hospitalized with a positive lab test for flu that also have a positive lab test COVID-19.
• CDC can look at data from public health labs to see how many specimens tested for both flu and COVID-19 were positive for both.

Can you get more than one respiratory virus at the same time?

Yes, it is possible to get sick with more than one respiratory virus at the same time. This includes being sick with flu and COVID-19 at the same time. It is also possible to be sick with multiple flu viruses, like influenza A and B, at the same time.

How often do flu and COVID-19 coinfections occur?

An MMWR from Dec. 2022 found that during the 2021–22 influenza season, COVID-19 coinfections occurred in about 6% of pediatric flu-associated hospitalizations and in 16% of pediatric flu-associated deaths.

This is in line with preliminary data from the 2021–2022 season which found that between October 1, 2021, through April 30, 2022, 5.4% of patients of all ages hospitalized with flu also had COVID-19. During the 2021–2022 season, of the flu positive tests reported by public health labs and also tested for COVID, a little more than 4% of tests were positive for both flu and COVID-19.

This season, according to data from FluSurv-NET, about 3.1% of people hospitalized with lab-confirmed influenza also tested positive for SARS-CoV-2, the virus that causes COVID-19.

What are the implications?

While influenza and SARS-CoV-2 coinfections in children were relatively rare during the 2021–2022 flu season, they did occur and indicated potentially more severe illness. Most of the children who had flu and COVID-19 coinfections and were hospitalized or died had not been vaccinated against flu.

Information on COVID-19 vaccination and COVID-19 antiviral treatment was not available. To decrease the burden of flu and COVID-19, keep children up to date with recommended flu and COVID-19 vaccinations, which should both begin at 6 months of age.

Does it increase severity?

While influenza (flu) and SARS-CoV-2 (COVID-19) coinfections in children were relatively rare during the 2021–2022 flu season, they did occur and indicated potentially more severe illness.

Are some people at higher risk of coinfection?

In terms of children most at risk, the recent MMWR on coinfection presents descriptive results from surveillance data and cannot determine risk factors associated with hospitalization or death. However, the study found that among children, most coinfection patients who were hospitalized or died had not been vaccinated.

What is the latest information on the current season?

For the current season, there have been no COVID-19 coinfections reported among the 14 influenza-associated pediatric deaths reported so far.

Getting a flu vaccine during the COVID-19 pandemic

If COVID-19 is spreading in my community, should I still go out to get a flu vaccine?

Yes. Getting a flu vaccine is an essential part of protecting your health and your family's health every year. Take recommended precautions to protect yourself from COVID-19 while getting your flu vaccine.

Do I need a flu vaccine if I wear a mask and avoid crowds and others who are sick?

Yes. Wearing a mask and avoiding crowds and others who are sick can help protect you and others from respiratory viruses, like flu and the virus that causes COVID-19. However, the best way to reduce your risk of flu illness and its potentially serious complications is for everyone 6 months and older to get a flu vaccine each year. By getting a flu vaccine, you may also be protecting people around you who are more vulnerable to serious flu complications.

Information for health care professionals for administering flu vaccine during the COVID-19 pandemic

What is CDC’s recommendation regarding drive-through influenza vaccination clinics?

CDC developed guidance on drive-through vaccination clinics during the COVID-19 pandemic. Curbside and drive-through vaccination clinics are an option for vaccination clinics.

Should a flu vaccine be given to someone with suspected or confirmed COVID-19?

No. Flu vaccination should be deferred for people with suspected or confirmed COVID-19, whether or not they have symptoms, until they have met the criteria to discontinue their isolation. While mild illness is not a contraindication to flu vaccination, vaccination visits for these people should be postponed to avoid exposing health care personnel and other patients to the virus that causes COVID-19. When scheduling or confirming appointments for flu vaccination, patients should be instructed to notify the health care professional's office or clinic in advance if they currently have or develop any symptoms of COVID-19.

When can someone who recovered from COVID-19 receive a flu vaccine?

Flu vaccination should be deferred until a patient is no longer acutely ill. This may be different for patients who are already being cared for in a medical setting than it is for patients who are isolating at home. In a medical setting, the timing for vaccination is a matter of clinical discretion. In general, patients who are isolating at home should wait until they meet criteria for leaving isolation (even if they have no symptoms) to come to a vaccination setting in order to avoid spreading COVID-19 to others. CDC has guidance for when people can be around others after having COVID-19.

Is there guidance for safely administering vaccines during the COVID-19 pandemic?

CDC released Interim Guidance for Immunization Services During the COVID-19 Pandemic. This guidance is intended to help vaccination providers in a variety of clinical and alternative settings with the safe administration of vaccines during the COVID-19 pandemic. Health care professionals who give vaccines should also consult guidance from state, local, tribal, and territorial health officials.

What are clinical best practices for administering COVID-19 vaccines and influenza vaccines at the same time?

Best practices for administering more than one vaccine, including COVID-19 vaccines and influenza vaccines, include:

• When preparing more than one vaccine, label each with the name and dosage (amount) of vaccine, lot number, the initials of the preparer, and the exact beyond-use time, if applicable.
• Always inject vaccines into different injection sites. Separate injection sites by 1 inch or more, if possible so that any local reactions can be differentiated. Each muscle (deltoid, vastus lateralis) has multiple injection sites.

• If administered at the same time, COVID-19 vaccines and vaccines that might be more likely to cause a local injection site reaction (for example, high-dose and adjuvanted inactivated influenza vaccines) should be administered in different limbs, if possible.
• Inject vaccines rapidly without aspiration since aspiration is not recommended before administering a vaccine.
• There are many existing resources on administration and co-administration of vaccines relevant for health care providers, including:
  • Pink Book: Vaccine Administration | CDC
  • You Call The Shots: Vaccinating Adolescents (cdc.gov)
  • Vaccine Administration Training Module (cdc.gov)
  • Vaccine Administration: Needle Gauge and Length (cdc.gov)
  • Vaccine Administration: Intramuscular (IM) Injection Children 7 through 18 years of age and Vaccine Administration: Intramuscular (IM) Injection Adults 19 years of age and older
  • Intramuscular (IM) Injection: Sites – YouTube
  • Live, Attenuated Influenza Vaccine (LAIV) – YouTube
  • https://www.medpagetoday.com/meetingcoverage/acip/93283
  • King G, Hadler S. Simultaneous administration of childhood vaccines: an important public health policy that is safe and efficacious. Pediatr Infect Dis J 1994;13(5):394–407
  • COCA Call: 2021–2022 Influenza Vaccination Recommendations and Guidance on Coadministration with COVID-19 Vaccines

Will there be changes in how and where flu vaccines are given this fall and winter?

You can get your flu vaccine as you normally do, whether that's through your health care provider or your local pharmacist. CDC has been working with health care providers and state and local health departments on how to vaccinate people against flu without increasing their risk of exposure to respiratory viruses, like the virus that causes COVID-19, and has released Interim Guidance for Immunization Services During the COVID-19 Pandemic. This guidance is current for this season.

What steps can health care personnel take to safely give flu vaccine during the COVID-19 pandemic?

Applying infection prevention practices to all patient encounters is very important, including physical distancing when possible, wearing masks, hand hygiene, surface decontamination, and source control while in a health care facility. The potential for asymptomatic spread of the virus that causes COVID-19 underscores the importance of these practices. Immunization providers should refer to the guidance developed to prevent the spread of COVID-19 in health care settings, including outpatient and ambulatory care settings.

Is there guidance for giving flu vaccine in settings other than a doctor’s office (e.g., pharmacies; temporary, off-site, or satellite clinics; and large-scale influenza clinics)?

Yes. Guidance has been developed for giving vaccines at pharmacies, temporary, off-site, or satellite clinics, and large-scale influenza clinics. Other approaches for vaccination during the COVID-19 pandemic may include drive-through immunization services at fixed sites, curbside clinics, mobile outreach units, and home visits.

• The general principles outlined for health care facilities should also be applied to alternative vaccination sites, with additional precautions for physical distancing that are particularly relevant for large-scale clinics in communities with high levels of COVID-19 transmission.

Testing and treatment of respiratory illness when SARS-CoV-2 and influenza viruses are co-circulating

What should we do while waiting for diagnostic test results if we have a patient who is sick with influenza/COVID-19-like symptoms?

While waiting on results of testing, non-hospitalized persons with acute respiratory symptoms should isolate at home. Even if people test negative for both SARS-CoV-2 and influenza viruses, they should isolate because of the potential for false negative testing results – depending upon what kind of test was done (e.g., antigen test, molecular test) and the level of SARS-CoV-2 and influenza virus transmission in the community. Persons not hospitalized with suspected or confirmed influenza who are at increased risk for complications from influenza should receive antiviral treatment for influenza as soon as possible, regardless of illness duration.

For hospitalized patients, empiric oseltamivir treatment should be started as soon as possible for patients with suspected influenza without waiting for influenza testing results.

I have a patient who has influenza/COVID-19-like symptoms, how should I proceed with testing and treatment?

CDC has developed clinical algorithms that can help guide decisions for influenza testing and treatment when SARS-CoV-2 and influenza viruses are co-circulating.

Do antiviral medications for treatment of influenza have any effect on COVID-19?

FDA-approved antiviral medications for treatment of influenza have no activity against SARS-CoV-2 viruses, nor do they interact with medications used for treatment of COVID-19 patients. If a patient who is at higher risk for influenza complications is diagnosed with SARS-CoV-2 and influenza virus co-infection, they should receive antiviral treatment for influenza.