cdc travel immunizations philippines

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• Section 2 - Interactions Between Travel Vaccines & Drugs
• Section 2 - Travelers’ Diarrhea

Yellow Fever Vaccine & Malaria Prevention Information, by Country

Cdc yellow book 2024.

Author(s): Mark Gershman, Rhett Stoney (Yellow Fever) Holly Biggs, Kathrine Tan (Malaria)

The following pages present country-specific information on yellow fever (YF) vaccine requirements and recommendations, and malaria transmission information and prevention recommendations. Country-specific maps are included to aid in interpreting the information. The information in this chapter was accurate at the time of publication; however, it is subject to change at any time due to changes in disease transmission or, in the case of YF, changing entry requirements for travelers. Updated information reflecting changes since publication can be found in the online version of this book and on the Centers for Disease Control and Prevention (CDC) Travelers’ Health website. Recommendations for prevention of other travel-associated illnesses can also be found on the CDC Travelers’ Health website .

Yellow Fever Vaccine

Entry requirements.

Entry requirements for proof of YF vaccination under the International Health Regulations (IHR) differ from CDC’s YF vaccination recommendations. Under the IHR, countries are permitted to establish YF vaccine entry requirements to prevent the importation and transmission of YF virus within their boundaries. Certain countries require proof of vaccination from travelers arriving from all countries ( Table 5-25 ); some countries require proof of vaccination only for travelers above a certain age coming from countries with risk for YF virus transmission. The World Health Organization (WHO) defines areas with risk for YF virus transmission as countries or areas where YF virus activity has been reported currently or in the past, and where vectors and animal reservoirs exist.

Unless issued a medical waiver by a yellow fever vaccine provider, travelers must comply with entry requirements for proof of vaccination against YF.

WHO publishes a list of YF vaccine country entry requirements and recommendations for international travelers approximately annually. But because entry requirements are subject to change at any time, health care professionals and travelers should refer to the online version of this book and the CDC Travelers’ Health website for any updates before departure.

CDC Recommendations

CDC’s YF vaccine recommendations are guidance intended to protect travelers from acquiring YF virus infections during international travel. These recommendations are based on a classification system for destination-specific risk for YF virus transmission: endemic, transitional, low potential for exposure, and no risk ( Table 2-08 ). CDC recommends YF vaccination for travel to areas classified as having endemic or transitional risk (Maps 5-10 and 5-11 ). Because of changes in YF virus circulation, however, recommendations can change; therefore, before departure, travelers and clinicians should check CDC’s destination pages for up-to-date YF vaccine information.

Duration of Protection

In 2015, the US Advisory Committee on Immunization Practices published a recommendation that 1 dose of YF vaccine provides long-lasting protection and is adequate for most travelers. The recommendation also identifies specific groups of travelers who should receive additional doses, and others for whom additional doses should be considered (see Sec. 5, Part 2, Ch. 26, Yellow Fever ). In July 2016, WHO officially amended the IHR to stipulate that a completed International Certificate of Vaccination or Prophylaxis is valid for the lifetime of the vaccinee, and YF vaccine booster doses are not necessary. Moreover, countries cannot require proof of revaccination (booster) against YF as a condition of entry, even if the traveler’s last vaccination was >10 years ago.

Ultimately, when deciding whether to vaccinate travelers, clinicians should take into account destination-specific risks for YF virus infection, and individual risk factors (e.g., age, immune status) for serious YF vaccine–associated adverse events, in the context of the entry requirements. See Sec. 5, Part 2, Ch. 26, Yellow Fever , for a full discussion of YF disease and vaccination guidance.

Table 2-08 Yellow fever (YF) vaccine recommendation categories 1

Malaria prevention.

The following recommendations to protect travelers from malaria were developed using the best available data from multiple sources. Countries are not required to submit malaria surveillance data to CDC. On an ongoing basis, CDC actively solicits data from multiple sources, including WHO (main and regional offices); national malaria control programs; international organizations; CDC overseas offices; US military; academic, research, and aid organizations; and the published scientific literature. The reliability and accuracy of those data are also assessed.

If the information is available, trends in malaria incidence and other data are considered in the context of malaria control activities within a given country or other mitigating factors (e.g., natural disasters, wars, the coronavirus disease 2019 pandemic) that can affect the ability to control malaria or accurately count and report it. Factors such as the volume of travel to that country and the number of acquired cases reported in the US surveillance system are also examined. In developing its recommendations, CDC considers areas within countries where malaria transmission occurs, substantial occurrences of antimalarial drug resistance, the proportions of species present, and the available malaria prophylaxis options.

Clinicians should use these recommendations in conjunction with an individual risk assessment and consider not only the destination but also the detailed itinerary, including specific cities, types of accommodations, season, and style of travel, as well as special health conditions (e.g., pregnancy). Several medications are available for malaria prophylaxis. When deciding which drug to use, consider the itinerary and length of trip, travelers’ previous adverse reactions to antimalarials, drug allergies, medical history, and drug costs. For a thorough discussion of malaria and guidance for prophylaxis, see Sec. 5, Part 3, Ch. 16, Malaria .

Philippines

Entry requirements : Required for travelers ≥9 months old arriving from countries with risk for YF virus transmission; this includes >12-hour airport transits or layovers in countries with risk for YF virus transmission. 1

CDC recommendations : Not recommended

• Palawan and Mindanao Islands
• No malaria transmission in metropolitan Manila (the capital) or other urban areas
• Chloroquine
• P. falciparum (85%)
• P. vivax (15%)
• P. knowlesi 6 , P. malariae , and P. ovale (rare)
• Atovaquone-proguanil, doxycycline, mefloquine, tafenoquine 3

Other Vaccines to Consider

See Health Information for Travelers to Philippines .

1 Current as of November 2022. This is an update of the 2010 map created by the Informal WHO Working Group on the Geographic Risk of Yellow Fever.

2 Refers to Plasmodium falciparum malaria, unless otherwise noted.

3 Tafenoquine can cause potentially life-threatening hemolysis in people with glucose-6-phosphate-dehydrogenase (G6PD) deficiency. Rule out G6PD deficiency with a quantitative laboratory test before prescribing tafenoquine to patients.

4 Mosquito avoidance includes applying topical mosquito repellant, sleeping under an insecticide-treated mosquito net, and wearing protective clothing (e.g., long pants and socks, long-sleeve shirt). For additional details on insect bite precautions, see Sec. 4, Ch. 6, Mosquitoes, Ticks & Other Arthropods.

5 Primaquine can cause potentially life-threatening hemolysis in people with G6PD deficiency. Rule out G6PD deficiency with a quantitative laboratory test before prescribing primaquine to patients.

6 P. knowlesi is a malaria species with a simian (macaque) host. Human cases have been reported from most countries in Southwest Asia and are associated with activities in forest or forest-fringe areas. P. knowlesi has no known resistance to antimalarials.

Yellow Fever Maps

2 In 2017, the Centers for Disease Control and Prevention (CDC) expanded its YF vaccination recommendations for travelers going to Brazil because of a large YF outbreak in multiple states in that country. Please refer to the CDC  Travelers’ Health website for more information and updated recommendations.

3 YF vaccination is generally not recommended for travel to areas where the potential for YF virus exposure is low. Vaccination might be considered, however, for a small subset of travelers going to these areas who are at increased risk for exposure to YF virus due to prolonged travel, heavy exposure to mosquitoes, or inability to avoid mosquito bites. Factors to consider when deciding whether to vaccinate a traveler include destination-specific and travel-associated risks for YF virus infection; individual, underlying risk factors for having a serious YF vaccine–associated adverse event; and destination entry requirements.

The following authors contributed to the previous version of this chapter: Mark D. Gershman, Emily S. Jentes, Rhett J. Stoney (Yellow Fever) Kathrine R. Tan, Paul M. Arguin (Malaria)

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Travel Vaccines and Advice for the Philippines

The Philippines is made up of over 7,000 islands, with views and activities to suit every traveler’s preferences. There are beaches perfect for sun tanning, diving, boating, kayaking, surfing or even kite-boarding.

More inland, there is rock climbing and tons of zip-lines to explore. In the cities, travelers will be able to appreciate the Spanish-Filipino architecture, historical buildings and welcoming people.

On This Page: Do I Need Vaccines for Philippines? Other Ways to Stay Healthy in Philippines Do I Need a Visa or Passport for Philippines? What Is the Climate Like in Philippines? Is It Safe to Travel to Philippines? Visiting Cebu Island What Should I Pack for Philippines? U.S. Embassy to Philippines

Do I Need Vaccines for Philippines?

Yes, some vaccines are recommended or required for Philippines. The CDC and WHO recommend the following vaccinations for Philippines: typhoid , hepatitis A , polio , yellow fever , Japanese encephalitis , chikungunya , rabies , hepatitis B , influenza , COVID-19 , pneumonia , meningitis , chickenpox , shingles , Tdap (tetanus, diphtheria and pertussis) and measles, mumps and rubella (MMR) .

See the bullets below to learn more about some of these key immunizations:

• Typhoid – Food & Water – Shot lasts 2 years. Oral vaccine lasts 5 years, must be able to swallow pills. Oral doses must be kept in refrigerator.
• Hepatitis A – Food & Water – Recommended for most travelers.
• Polio – Food & Water – Due to an increase in cases globally, an additional adult booster is recommended for most travelers to any destination.
• Yellow Fever – Mosquito – Required if traveling from a country with risk of yellow fever transmission.
• Japanese Encephalitis – Mosquito – Recommended depending on itinerary and activities. May be given to short- and extended-stay travelers, recurrent travelers and travel to rural areas. Present throughout country. Most cases from April to August.
• Chikungunya – Mosquito – Active transmission is reported in the region but is uncommon. Travelers to more rural regions should be vaccinated.
• Rabies – Saliva of Infected Animals – High risk country. Vaccine recommended for long-term travelers and those who may come in contact with animals.
• Hepatitis B – Blood & Body Fluids – Recommended for travelers to most regions.
• Influenza – Airborne – Vaccine components change annually.
• COVID-19 – Airborne – Recommended for travel to all regions, both foreign and domestic.
• Pneumonia – Airborne – Two vaccines given separately. All 65+ or immunocompromised should receive both.
• Meningitis – Direct Contact & Airborne – Given to anyone unvaccinated or at an increased risk, especially students.
• Chickenpox – Direct Contact & Airborne – Given to those unvaccinated that did not have chickenpox.
• Shingles – Direct Contact – Vaccine can still be given if you have had shingles.
• Polio – Food & Water – Considered a routine vaccination for most travel itineraries. Single adult booster recommended.
• TDAP (Tetanus, Diphtheria & Pertussis) – Wounds & Airborne – Only one adult booster of pertussis required.
• Measles Mumps Rubella (MMR) – Various Vectors – Given to anyone unvaccinated and/or born after 1957. One time adult booster recommended.

See the table below for more information:

Specific Vaccine Information

• Typhoid – Typhoid, caused by Salmonella Typhi, is primarily transmitted through tainted food and water. Protection against this disease involves vaccination combined with good hygiene and careful food consumption.
• Hepatitis A – Hepatitis A is a highly contagious liver infection caused by the hepatitis A virus, typically spreading through contaminated food or water, or close contact with an infected person. Symptoms can include fatigue, nausea, stomach pain, and jaundice. The hepatitis A vaccine is a safe and effective shot that provides immunity against the virus, usually given in two doses.
• Japanese Encephalitis – Japanese encephalitis is a mosquito-borne viral infection affecting the brain, prevalent in rural Asia. It can cause neurological symptoms and, in severe cases, death. The Japanese encephalitis vaccine, administered via injection, effectively prevents the virus, recommended for people living in or traveling to endemic areas.
• Chikungunya – Chikungunya, transmitted by Aedes mosquitoes, can be prevented through measures like mosquito repellent use. Vaccination provides the best form of protection.
• Rabies – Rabies is a lethal disease transmitted through the saliva of infected animals, and vaccination is the key to prevention. Pre-exposure vaccination is advised for individuals at risk, and immediate post-exposure vaccination is crucial if one encounters a potentially rabid animal.
• Hepatitis B – Hepatitis B, a liver infection spread through bodily fluids, poses a significant health risk. Safe practices help, but vaccination is the ultimate safeguard. It prompts the immune system to produce antibodies, ensuring strong and persistent protection.
• Measles, Mumps, Rubella (MMR) – Measles, mumps, and rubella are contagious diseases transmitted via respiratory droplets and touch. Preventing these illnesses is primarily achieved through vaccination, using the MMR vaccine. It’s administered in two doses and provides immunity against all three viruses.

Malaria in Philippines

Malaria is present on Palawan and Mindanao islands. No malaria transmission is reported in Manila or other urban areas at this time. Antimalarials is recommended for travel to rural areas. Atovaquone, doxycycline, mefloquine and tafenoquine are the most commonly recommended antimalarials for the region. Note, chloroquine resistant malaria is present in the Philippines.

Japanese encephalitis vaccines are mandatory for those living in rural areas, hiking or camping. Those that plan to stay longer than a month should consider getting vaccinated.

Tuberculosis is found in some parts of the Philippines. If you believe you have been exposed, contact a healthcare provider and schedule a TB test as soon as possible.

Visit our vaccinations page to learn more. Travel safely with Passport Health and schedule your appointment today by calling or book online now .

Other Ways to Stay Healthy in Philippines

Prevent bug bites in philippines.

Prevent bug bites by wearing long clothing and using EPA-registered insect repellents like DEET or picaridin. Be mindful of bug-prone hours and secure your sleeping space with nets and screens. If bitten, clean the affected area, avoid scratching, and consider over-the-counter treatments, while promptly seeking medical attention for severe symptoms.

Food and Water Safety in Philippines

Stay healthy overseas by favoring cooked and hot dishes, reputable eateries, and practicing good hand hygiene. Stick to bottled or sealed beverages and use caution with tap water. Enjoy hot drinks and alcohol responsibly. To steer clear of travelers’ diarrhea , follow these strategies: eat safe foods, drink treated water, maintain hand hygiene, consider probiotics, and be discerning about local cuisine.

Altitude Sickness in Philippines

Altitude sickness, or acute mountain sickness (AMS), results from oxygen deprivation at high altitudes, leading to symptoms like headaches and nausea. Prevent AMS by ascending slowly, staying hydrated, and considering medication. If symptoms worsen, descend immediately to lower altitudes and seek medical assistance.

Infections To Be Aware of in Philippines

• Dengue – Dengue fever, a viral infection spread by mosquitoes, is characterized by symptoms like high fever and rash. Prevention involves protective measures against mosquito bites and eliminating breeding sites. For those affected, seeking prompt medical care, staying hydrated, and using specific pain relievers under guidance is essential for recovery.
• Schistosomiasis – Schistosomiasis is a parasitic infection transmitted through contaminated water. Avoiding contact with infected water sources and using protective clothing can reduce the risk of infection. Seeking medical evaluation promptly if symptoms such as fever and fatigue manifest enables timely diagnosis and treatment, preventing complications and promoting recovery.
• Zika – Zika, a virus carried by Aedes mosquitoes, can pose risks, particularly for pregnant women. Preventing Zika requires using mosquito repellent, practicing safe sex, and getting rid of mosquito breeding sites.

Do I Need a Visa or Passport for Philippines?

A visa is required for entry to the Philippines. A valid passport and proof of return ticket are needed for entry.

Sources: Embassy of Philippines and U.S. State Department

What Is the Climate Like in Philippines?

The Philippines has a tropical climate, with hot and humid weather throughout the year. The temperature generally ranges from 75 to 90 degrees depending on the region. Some of the most popular tourist destinations in the Philippines include Boracay Island, Palawan, Cebu, Manila, and Siargao Island.

The best time to visit these destinations varies depending on the region. December to May is generally the best time to visit, as the weather is dry and sunny. The rainy season runs from June to November, and typhoons can occur during this period. March to October is the best time to visit Siargao Island, while November to April is the best time to visit Batanes.

Visitors should prepare for hot and humid weather, and pack appropriate clothing and sunscreen. It is also recommended to bring rain gear if visiting during the rainy season. Despite occasional weather challenges, the Philippines is a beautiful and diverse country with plenty to offer. From pristine beaches to cultural landmarks and delicious cuisine, there is something for everyone to enjoy.

Is It Safe to Travel to Philippines?

The U.S. Department of State warns against all non-essential travel to the Sulu Archipelago and through the southern Sulu Sea. Travelers should also be very cautious when traveling to Mindanao, as there have been terrorist threats, insurgent activities, and kidnappings.

pick-pocketing, ATM card fraud, and con games are common.

Travelers should avoid carrying unnecessary valuables with them. Be cautious while traveling and travel with a partner when possible. Do not accept a ride from a taxi that has already accepted another passenger or use ATMs with unusual coverings attached to the card receiver.

Visiting Cebu Island

Avoid mosquitoes and other bugs, insect-borne disease are a threat throughout the world., keep the bugs away with passport health’s repellent options .

Cebu Island is one of the most popular tourist destinations in the Philippines.

Cebu Island has a rich history and culture that is evident in its many historic sites and landmarks. Visitors can explore the iconic Magellan’s Cross, which marks the spot where Ferdinand Magellan first set foot in the Philippines in 1521.

The island is also known for its beautiful beaches and water activities. Visitors can enjoy swimming, snorkeling, and diving in the crystal-clear waters or take a boat tour to explore nearby islands and islets.

Cebu also has a vibrant nightlife and delicious local cuisine. Visitors can sample a variety of local dishes, including the famous Cebu lechon (roast pig). Many visitors choose to party the night away in the island’s many bars and nightclubs.

A trip to Cebu Island offers visitors the perfect combination of history, culture, natural beauty, and fun.

What Should I Pack for Philippines?

The Philippines is a beautiful and popular destination. It is key to make sure you bring everything with you to fully enjoy your trip.

• Money Belt – Due to the amount of pick-pocketing that occurs, a money belt will allow you to keep your money and passport safe.
• Bug Spray – The climate in the Philippines is hot and humid. This creates a breeding ground for bugs, especially mosquitoes.
• Cash – Because of frequent ATM frauds, it is best to stick to avoid withdrawing cash if possible.
• Umbrella – During the rainy season there will be frequent warm rains and an umbrella will serve to keep you dry during these showers.

U.S. Embassy to Philippines

When traveling it is very helpful to find out exactly where the U.S. embassy or consulates are located. Keep the address written down in case you have a legal problem, you lose your passport, or you want to report a crime. Be sure to keep a copy of your passport with you in case you lose the original.

U.S. Embassy Manila 1201 Roxas Boulevard Ibex Hill Manila, Philippines 1000 Telephone: (632) 301-2000 Fax: (632) 301-2017

Visit the Embassy to Philippines website before departure to confirm correct contact details for the office.

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Entry Guidelines

As per IATF Resolution No. 2 (s. 2022) on the ENTRY, QUARANTINE and TESTING Requirements of inbound travelers to the Philippines

A. FULLY VACCINATED (Filipino and Foreign Travelers)

- No pre-departure COVID-19 Test requirement - Must have received the 2nd dose in a 2-dose series or a single dose COVID-19 vaccine more than fourteen (14) days prior to the date and time of departure from the country of origin/port of embarkation.

B. UNVACCINATED or PARTIALLY VACCINATED (Filipino and Foreign Travelers)

1. Travelers 15 years and older shall present a remotely supervised/laboratory-based Rapid Antigen Test administered and certified by a healthcare professional in a healthcare facility, laboratory, clinic, or other similar establishment taken 24 hours prior to the date and time of departure from country of origin/first port of embarkation in a continuous travel to the Philippines, excluding lay-overs; provided that, he/she has not left the airport premises or has not been admitted into another country during such lay-over. 2. Travelers 15 years and older who fail to present a negative pre-departure testing shall be required to undergo a laboratory-based Antigen Test UPON ARRIVAL at the airport. 3. ACCOMPANIED minors below 15 years of age who are NOT VACCINATED for any reason whatsoever shall follow the quarantine protocols of their parent/s or an accompanying adult/guardian traveling with them. 4. UNACCOMPANIED minors below 15 years of age who are NOT VACCINATED for any reason whatsoever shall follow the protocols set forth in Section B (1) and (2) above. NOTE:- Any inbound traveler, whether Filipino or Foreign national, who shall test positive for COVID-19 through rapid antigen test shall be subjected to the latest prevailing quarantine and isolation protocols of the DOH.

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Philippines Travel Advisory

Travel advisory may 16, 2024, philippines - level 2: exercise increased caution.

Updated to reflect changes in the country summary and information on the Sulu Archipelago, Marawi City.

Exercise increased caution to the Philippines due to  crime, terrorism, civil unrest, and kidnapping.  Some areas have increased risk. Read the entire Travel Advisory.

Do Not Travel to:

• The Sulu Archipelago, including the southern Sulu Sea, due to  crime, terrorism, civil unrest,  and  kidnapping .
• Marawi City in Mindanao due to  terrorism  and  civil unrest .

Reconsider Travel to:

• Other areas of Mindanao due to  crime, terrorism, civil unrest,  and  kidnapping .

Country Summary:  Terrorists and armed groups have carried out kidnappings, bombings, and other attacks targeting public areas like tourist sites, markets, and local government facilities in the Philippines.  Violent crimes are also common in the Philippines such as robbery, kidnappings, and physical assaults. Protests happen in the Philippines and could turn violent and/or result in traffic jams and road closures with limited capacity of the local government to respond.

There are stringent travel protocols and restrictions for U.S. government employees under the U.S. Embassy’s (Chief of Mission) security responsibility when traveling to certain areas of the country as stated below.

Read the  country information page  for additional information on travel to the Philippines.

If you decide to travel to the Philippines:

• Monitor local media for breaking events and adjust your plans based on new information.
• Avoid demonstrations. 
• Enroll in the  Smart Traveler Enrollment Program (STEP)  to receive Alerts and make it easier to locate you in an emergency.   
• Follow the Department of State on  Facebook  and  Twitter/X .   
• Review the  Country Security Report  for the Philippines.
• Visit the CDC page for the latest  Travel Health Information  related to your travel.
• Prepare a contingency plan for emergency situations. Review the  Traveler’s Checklist .

The Sulu Archipelago and Sulu Sea – Level 4: Do Not Travel

Terrorist and armed groups in the Sulu Archipelago and the Sulu Sea have historically engaged in kidnappings for ransom on land and at sea, in addition to bombings and other attacks. These incidents often target foreign nationals, including U.S. citizens, local government entities, and security personnel.

The U.S. government’s ability to provide emergency services to U.S. citizens in this region is very limited. U.S. government employees under the U.S. Embassy’s (Chief of Mission) security responsibility are required to obtain special authorization to travel to these areas.

Visit our website for  Travel to High-Risk Areas .

Marawi City in Mindanao – Level 4: Do Not Travel

Civilians face risk of death or injury from ongoing clashes between terrorist group remnants and Philippine security forces in Marawi.

The U.S. government’s ability to provide emergency services to U.S. citizens in Marawi City is very limited. U.S. government employees under the U.S. Embassy’s (Chief of Mission) security responsibility are required to obtain special authorization to travel to Marawi City.

Mindanao (except Davao City, Davao del Norte Province, Siargao Island, and the Dinagat Islands) – Level 3: Reconsider Travel

Terrorist and armed groups in Mindanao have historically engaged in kidnappings for ransom, in addition to bombings and other attacks. These incidents often target foreign nationals, including U.S. citizens, as well as civilians, local government entities, and security forces.

The U.S. government has limited ability to provide emergency services to U.S. citizens in large parts of Mindanao. U.S. government employees under the U.S. Embassy’s (Chief of Mission) security responsibility are required to obtain special authorization to travel to areas outside of Davao City, Davao del Norte Province, Siargao Island, and the Dinagat Islands.

Travel Advisory Levels

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Vaccines for Travelers

Vaccines protect travelers from serious diseases. Depending on where you travel, you may come into contact with diseases that are rare in the United States, like yellow fever. Some vaccines may also be required for you to travel to certain places.

Getting vaccinated will help keep you safe and healthy while you’re traveling. It will also help make sure that you don’t bring any serious diseases home to your family, friends, and community.

On this page, you'll find answers to common questions about vaccines for travelers.

Which vaccines do I need before traveling?

The vaccines you need to get before traveling will depend on few things, including:

• Where you plan to travel . Some countries require proof of vaccination for certain diseases, like yellow fever or polio. And traveling in developing countries and rural areas may bring you into contact with more diseases, which means you might need more vaccines before you visit.
• Your health . If you’re pregnant or have an ongoing illness or weakened immune system, you may need additional vaccines.
• The vaccinations you’ve already had . It’s important to be up to date on your routine vaccinations. While diseases like measles are rare in the United States, they are more common in other countries. Learn more about routine vaccines for specific age groups .

How far in advance should I get vaccinated before traveling?

It’s important to get vaccinated at least 4 to 6 weeks before you travel. This will give the vaccines time to start working, so you’re protected while you’re traveling. It will also usually make sure there’s enough time for you to get vaccines that require more than 1 dose.

Where can I go to get travel vaccines?

Start by finding a:

• Travel clinic
• Health department
• Yellow fever vaccination clinic

Learn more about where you can get vaccines .

What resources can I use to prepare for my trip?

Here are some resources that may come in handy as you’re planning your trip:

• Visit CDC’s travel website to find out which vaccines you may need based on where you plan to travel, what you’ll be doing, and any health conditions you have.
• Download CDC's TravWell app to get recommended vaccines, a checklist to help prepare for travel, and a personalized packing list. You can also use it to store travel documents and keep a record of your medicines and vaccinations.
• Read the current travel notices to learn about any new disease outbreaks in or vaccine recommendations for the areas where you plan to travel.
• Visit the State Department’s website to learn about vaccinations, insurance, and medical emergencies while traveling.

Traveling with a child? Make sure they get the measles vaccine.

Measles is still common in some countries. Getting your child vaccinated will protect them from getting measles — and from bringing it back to the United States where it can spread to others. Learn more about the measles vaccine.

Find out which vaccines you need

CDC’s Adult Vaccine Quiz helps you create a list of vaccines you may need based on your age, health conditions, and more.

Take the quiz now !

Get Immunized

Getting immunized is easy. Vaccines and preventive antibodies are available at the doctor’s office or pharmacies — and are usually covered by insurance.

Find out how to get protected .

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Philippines set to ease restrictions on fully vaccinated international tourists

Jan 28, 2022 • 3 min read

The Philippines is reopening to vaccinated tourists without quarantine from February © Getty Images

The  Philippines has been largely cut off to foreign visitors since the start of the pandemic but that's set to change next month.

With powdery beaches, including  Boracay's  5km signature White Beach, world-class surf and dive spots, UNESCO World Heritage sites, and more than 7000 islands spread across the Pacific Ring of Fire, the Philippines has plenty to offer tourists. But since the pandemic began in March 2020, most have been cut off or subject to strict quarantine rules.

Starting February 10, that will change when border restrictions are eased for travelers from 157 countries, including the United States, the United Kingdom, Canada, Ireland, Australia, South Korea, Germany and more.

They'll be permitted to visit the Philippines without quarantine—if they are vaccinated against COVID-19 and test negative for the virus.

Tourism Secretary Berna Romulo-Puyat said [the reopening] "will contribute significantly to job restoration, primarily in tourism-dependent communities, and in the reopening of businesses that have earlier shut down."

Initially, the Philippines had planned to reopen in December but that was postponed when the Super-typhoon Rai struck; wiping out resorts, restaurants and cafes in tourist destinations, particularly the popular surfing and diving spot Siargao where, per NPR, the recovery is ongoing .

COVID-19 in the Philippines

The Philippines—a nation of 110 million people—has one of the lowest vaccination rates in Asia with just 50% of the population double jabbed and a slow booster campaign rollout. Since the end of December, the country has been experiencing a surge in new COVID-19 cases caused by the Omicron variant but, according to the New York Times, health officials are reporting milder cases  and domestic restrictions are easing.

What you need to know before visiting the Philippines

Fully vaccinated returning Filipinos can travel to the Philippines without quarantine from February 1; fully vaccinated foreign travelers can visit from February 10.

Travelers from the list of 157 approved countries are permitted to visit the Philippines without a visa if their stay is under 21 days, a border policy that has been in place since before the pandemic. They're required to have a return or outbound ticket and a passport that is valid for at least six months from the date of arrival.

To be considered fully vaccinated, arrivals must have had at least two doses of any COVID-19  vaccine approved by the World Health Organization , or one shot of a Johnson & Johnson vaccine. An official certificate of vaccination is accepted as proof.

Arrivals also have to test negative for COVID-19 within 48 hours prior to departing for the Philippines.

Unvaccinated foreign arrivals are banned from traveling to the Philippines starting February 16. Children under the age of 18 are exempt.

COVID-19 restrictions vary across destinations in the Philippines , though most resorts, restaurants, museums and tourist attractions are open with some capacity limits in place. Check the Philippines' official tourism website for the latest updates before you go

You might also like: The 12 best beaches in the Philippines The Philippines for beginners: 7 first-timer fails to avoid on your trip No more 7-day quarantine as Thailand encourages vaccinated tourists to return

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Philippines

Before you travel check that:

• your destination can provide the healthcare you may need
• you have appropriate travel insurance for local treatment or unexpected medical evacuation

This is particularly important if you have a health condition or are pregnant.

Emergency medical number

Call 911 and ask for an ambulance.

Contact your insurance company promptly if you’re referred to a medical facility for treatment.

Vaccinations and health risks

At least 8 weeks before your trip check the latest information on vaccinations and health risks in TravelHealthPro’s Philippines guide . Risks include:

• tick-borne encephalitis

Find out where to get vaccines and whether you have to pay on the NHS travel vaccinations page .

Mosquito-borne diseases are a risk all year round. However, there’s a heightened risk of dengue during the rainy season (June to October). You should take precautions to avoid being bitten by mosquitoes .

The legal status and regulation of some medicines prescribed or bought in the UK can be different in other countries.

Read best practice when travelling with medicines on TravelHealthPro .

The NHS has information on whether you can take your medicine abroad .

Healthcare facilities in the Philippines

The availability of medical care varies across the Philippines and may not meet the standards of care in the UK, particularly in rural and remote areas. Many places, including some tourist destinations, do not have easy access to emergency medical care.

Private hospital treatment and medical transport is expensive – the daily cost in intensive care units can be more than £1,000. Make sure you have adequate travel health insurance and accessible funds to cover the cost of any medical treatment, including repatriation.

Travel and mental health

Read FCDO guidance on travel and mental health . There is also mental health guidance on TravelHealthPro .

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COVID-19: travel health notice for all travellers

Philippines travel advice

Latest updates: Health – editorial update

Last updated: September 9, 2024 16:13 ET

On this page

Safety and security, entry and exit requirements, laws and culture, natural disasters and climate, philippines - exercise a high degree of caution.

Exercise a high degree of caution in the Philippines due to crime, terrorism and kidnapping.

Western Mindanao - Avoid all travel

• Lanao del Sur
• Lanao del Norte
• Maguindanao
• Misamis Occidental
• South Cotabato
• Sultan Kudarat
• Zamboanga del Norte
• Zamboanga del Sur
• Zamboanga Sibugay

Central and Eastern Mindanao - Avoid non-essential travel

• Agusan del Norte
• Agusan del Sur
• Davao de Oro
• Davao del Norte
• Davao del Sur, excluding Davao City
• Davao Occidental
• Davao Oriental
• Misamis Oriental
• Surigao del Norte, excluding Siargao Island
• Surigao del Sur

Back to top

Mindanao island

Extremists have been active in the southern Philippines for several years.

Although local authorities have demobilized some of violent extremist groups in the recent years, there's still a risk of terrorist attacks and kidnappings, especially in the following regions:

• Bangsamoro Autonomous Region in Muslim Mindanao
• Zamboanga Peninsula
• Sulu archipelago

Bombs causing deaths, injuries, and property destruction have exploded in public areas of major centres, including the cities of:

• General Santos

Clashes may occur between insurgent groups and security forces.

There's a risk of being in the wrong place at the wrong time. The Government of Canada's ability to provide consular assistance is limited if you get stranded in this area.

If you chose to travel in the southern Philippines despite this advisory:

• remain indoors as much as possible
• be aware of your surroundings at all times
• avoid crowded places
• always travel with identification
• expect an increased security presence in public areas, especially around malls and transportation hubs
• stop at security checkpoints
• monitor local media
• follow the advice and instructions of local authorities

There is a threat of terrorism in the southern Philippines.

In recent years, the Filippino government has intensified its fight against terrorists. Counterterrorism operations diminished the capacity of terrorist groups to operate in the Philippines. However, militants remain in the country even if attacks are less common.

Terrorist have carried out attacks, including in major cities and places visited by foreigners. Attacks are far more frequent in Western Mindanao, where government forces and rebel groups clash.

Further attacks may not be ruled out. Targets could include:

• government buildings, including military and police installations
• places of worship
• airports and other transportation hubs and networks
• public areas such as tourist destinations, restaurants, bars, coffee shops, shopping centres, markets, hotels and other sites frequented by foreigners

Always be aware of your surroundings when in public places.

Be particularly vigilant during the following:

• sporting events
• religious holidays
• public celebrations
• major political events, such as elections

Terrorists have used such occasions to mount attacks.

There is a threat of kidnapping across the country, including in Metro Manila. In coastal areas, criminals target individuals on private boats, in marinas and resorts. They have also kidnapped cargo vessel crews.

Kidnappings are usually for ransom, targeting both local and foreign nationals perceived to have money. Criminals have killed some victims.

While in the Philippines:

• maintain a high level of vigilance and personal security awareness at all times
• stay in reputable accommodation with adequate security measures
• report any suspicious behaviour to security forces
• if you are abducted, comply with the kidnappers' demands and do not resist

Crime remains a serious concern throughout the country.

Violent crime, such as armed robbery, sexual assault, and murder, occur regularly. Gangs are active, including in Metro Manila.

The possession of guns and other weapons is common and poorly regulated. Arms trafficking is a significant problem throughout the country and criminals have attacked foreigners, even in wealthy neighborhoods.

• Be aware of your surroundings at all times
• Avoid showing signs of affluence
• If threatened by robbers, don't resist

Petty crime

Petty crime, such as pickpocketing, swarming and bag snatching, occurs, especially in urban areas.

• Ensure that your belongings, including your passport and other travel documents, are secure at all times
• Be careful in crowded shopping malls and other public places
• Avoid carrying large sums of money
• Keep valuables in safe place
• Keep backpacks and bags away from traffic, as motorcyclists may grab them from pedestrians, sometimes causing injury
• Beware of friendly strangers offering to take you around town or on an excursion

Spiked food and drinks

Some criminals have drugged and robbed tourists travelling alone after an invitation to visit a tourist attraction.

Snacks, beverages, gum and cigarettes may contain drugs that could put you at risk of sexual assault and robbery.

• Be wary of accepting these items from new acquaintances
• Never leave food or drinks unattended or in the care of strangers

Credit card and ATM fraud occurs frequently. Illegal electronic devices are sometimes attached to ATM card readers, enabling them to record information such as the user's PIN.

Be cautious when using debit or credit cards:

• pay careful attention when your cards are being handled by others
• use ATMs located in well-lit public areas or inside a bank or business
• avoid using card readers with an irregular or unusual feature
• cover the keypad with one hand when entering your PIN
• check for any unauthorized transactions on your account statements

Overseas fraud

Online financial scams

Internet is frequently used to initiate financial scams. Scammers often use fake profiles to target Westerners and steal from them. Once they succeed in building a virtual relationship, they ask for money for various purposes. This could include business or financial opportunities such as:

• money transfers
• lucrative sales
• gold purchase
• inheritance notices
• bank overpayments

If you intend to do business in the Philippines:

• ensure that any business opportunity is legitimate before leaving
• don't travel to the Philippines with the intention to obtain restitution after losing money to a fraud

Internet romance

Internet romance is also common. Victims of this type of scams have lost thousands of dollars. Before travelling to the Philippines to visit someone you met online:

• keep in mind that you may be the victim of a scam
• inform yourself about the country's customs and laws on conjugal relations and marriage
• be sure to retain possession of your return plane ticket, money, and passport

Child abuse

Locals with children may befriend single male tourists and then accuse them of child abuse to extort money from them.

Report any incident of crime or scams to local police before you leave the country.

Women's safety

Women travelling alone may be subject to some forms of harassment and verbal abuse.

Advice for women travellers

Demonstrations

Demonstrations take place, including in Manila. Clashes may occur between security forces and demonstrators, especially in Mindanao and remote areas of northern Luzon.

Filipino law prohibits political activities by foreigners. Participating in demonstrations may result in being detained or deported.

Even peaceful demonstrations can turn violent at any time. They can also lead to disruptions to traffic and public transportation.

• Avoid areas where demonstrations and large gatherings are taking place
• Follow the instructions of local authorities
• Monitor local media for information on ongoing demonstrations

Mass gatherings (large-scale events)

Water activities

Coastal waters can be dangerous. Riptides are common. Several drownings occur each year.

Most of the time, lifeguards are not present to supervise swimmers. Many beaches don't offer warnings of dangerous conditions.

Water pollution is also a concern.

• Seek local advice before swimming
• Avoid swimming if red flags are flown

Scuba diving

Diving schools and rescue services may not adhere to Canadian standards.

• Use only reputable dive companies
• Make sure the company offers proper safety equipment

Water safety abroad

Road safety

Road conditions.

Road conditions vary throughout the country. Some roads, including major highways, are poorly maintained. Traffic is very heavy, especially in Metro Manila.

Driving conditions may quickly become hazardous. During the rainy season, metro centres often become impassable due to flash floods.

Driving habits

Many drivers don't respect traffic laws. They are reckless. They often drive at excessive speeds or way below the speed limit on highways. Accidents causing fatalities are common. Pedestrians don't have priority over cars.

Even minor road incidents can escalate quickly and lead to violent assaults.

If driving in the Philippines:

• avoid travel outside urban areas or tourist centres after dark
• stay on national highways and paved roads
• avoid any confrontation

Most people travel using mopeds. Fatal scooter accidents involving tourists are common.

If renting a scooter or moped:

• be vigilant while driving
• avoid renting from operators who don't provide a helmet with the rental
• avoid driving on roads in disrepair

Public transportation

The safety and reliability of public transportation are poor.

Minibuses, known as jeepneys, and large buses are often old, poorly maintained, and overcrowded. Pickpocketing and armed robberies are frequent, especially in large cities such as Manila and Cebu.

Some interurban buses have also been involved in fatal accidents.

Motorcycles

Motorcycle transportation is prevalent throughout the country, whether by habal-habal or tricycle.

Habal-habal are motorcycles with extensions, which can carry several passengers at a time. They are illegal and dangerous.

Tricycles are rather a safe option as they don't drive very fast. However, vehicles may be in poor condition. They aren't metered and can be hailed anywhere.

• Don't use habal-habal
• Avoid using tricycles at night on country roads
• Agree on a fare with the tricycle driver before departing to avoid scams

Although most taxi services are safe and reliable, there have been extortion incidents from taxi drivers.

To minimize your risks:

• avoid hailing a taxi on the street
• only enter metered taxis from a reliable company and insist the meter be turned on
• prefer hotel transportation, official airport taxis, or a ridesharing app
• never share taxis with strangers
• ask for the windows being rolled up and doors locked at all times
• never hand your phone to the driver to allow them to see the map
• record the taxi's licence plate and provide the information to a relative/friend

Ferry accidents occur. Some vessels are poorly maintained and overcrowded. Accidents are more prevalent during the rainy season as storms can develop quickly. As a result, local authorities may suspend ferry services on short notice when a storm signal is raised, even if the weather is clear. You could get stranded at ports for several days.

If travelling by sea:

• use only a reliable company
• don't board vessels that appear overloaded or unseaworthy
• make sure you have access to a life jacket
• plan for extra time, especially during the rainy season

Pirate attacks and armed robbery targeting ships occur in coastal waters. You may face an elevated threat of kidnapping in waters:

• around Mindanao
• in the Sulu Sea
• in the Celebes Sea
• south of Palawan Island
• south of Negros Island
• around Siquijor Island

Mariners should take appropriate precautions.

Live piracy report  - International Maritime Bureau

We do not make assessments on the compliance of foreign domestic airlines with international safety standards.

Information about foreign domestic airlines

Every country or territory decides who can enter or exit through its borders. The Government of Canada cannot intervene on your behalf if you do not meet your destination’s entry or exit requirements.

We have obtained the information on this page from the Philippine authorities. It can, however, change at any time.

Verify this information with the  Foreign Representatives in Canada .

Entry requirements vary depending on the type of passport you use for travel.

Before you travel, check with your transportation company about passport requirements. Its rules on passport validity may be more stringent than the country’s entry rules.

Regular Canadian passport

Your passport must be valid at least 6 months beyond the date you expect to leave the Philippines.

Passport for official travel

Different entry rules may apply.

Official travel

Passport with “X” gender identifier

While the Government of Canada issues passports with an “X” gender identifier, it cannot guarantee your entry or transit through other countries. You might face entry restrictions in countries that do not recognize the “X” gender identifier. Before you leave, check with the closest foreign representative for your destination.

Other travel documents

Different entry rules may apply when travelling with a temporary passport or an emergency travel document. Before you leave, check with the closest foreign representative for your destination.

Useful links

• Foreign Representatives in Canada
• Canadian passports

Tourist visa: not required for stays of up to 30 days Business visa: not required for stays of up to 30 days Student visa: required

If you need to extend your stay above the 30-day visa-free period, you must get the proper authorization from local authorities before this period ends.

The visa that immigration officials issue upon your arrival in the Philippines takes precedence over any visa you may have obtained from a Philippine embassy or consulate abroad.

If you're leaving the Philippines using a temporary passport issued inside the country, consult the Philippine Bureau of Immigration to obtain the required exit stamps.

Bureau of Immigration – Republic of the Philippines

Registration

All travelers must register their entry and exit from the country in the Philippine's eTravel System within 72 hours before travel.

Foreign nationals staying in the Philippines for longer than 59 days must register with the local authorities.

You must present yourself to a Bureau of Immigration office to register your biometrics, such as fingerprinting, and obtain a special security registration number.

• Philippine E-Travel System – Republic of the Philippines
• Bureau of Immigration offices – Republic of the Philippines

Other entry requirements

Customs officials may ask you to show them a return or onward ticket.

Boracay Island

Local authorities are restricting visitors to Boracay Island.

You may need proof of accommodation in an accredited hotel to be allowed entry.

Exit requirements

Travel pass.

Foreign nationals travelling on a visa issued by one of the following authorities must present a travel pass to leave the country:

• the Department of Justice
• the Board of Investments
• the Philippine Retirement Authority
• the Philippine Economic Zone Authority
• the economic zones

Travel pass – Bureau of Immigration, Republic of the Philippines

Emigration clearance certificate

If you've been in the country for 6 months or more, you must obtain an emigration clearance certificate (ECC), also known as an exit clearance, and pay applicable fees at least 72 hours before your expected departure.

This also applies to children born in the Philippines who are leaving the country for the first time on a foreign passport.

Emigration clearance certificate – Bureau of Immigration, Republic of the Philippines

• Children and travel

Children under 15 years travelling alone need a Waiver for Exclusion Ground to enter the Philippines.

• Waiver for Exclusion Ground – Bureau of Immigration, Republic of the Philippines
• Travelling with children

Yellow fever

Learn about potential entry requirements related to yellow fever (vaccines section).

Relevant Travel Health Notices

• Global Measles Notice - 13 March, 2024
• Zika virus: Advice for travellers - 31 August, 2023
• COVID-19 and International Travel - 13 March, 2024
• Dengue: Advice for travellers - 9 September, 2024

This section contains information on possible health risks and restrictions regularly found or ongoing in the destination. Follow this advice to lower your risk of becoming ill while travelling. Not all risks are listed below.

Consult a health care professional or visit a travel health clinic preferably 6 weeks before you travel to get personalized health advice and recommendations.

Routine vaccines

Be sure that your  routine vaccinations , as per your province or territory , are up-to-date before travelling, regardless of your destination.

Some of these vaccinations include measles-mumps-rubella (MMR), diphtheria, tetanus, pertussis, polio, varicella (chickenpox), influenza and others.

Pre-travel vaccines and medications

You may be at risk for preventable diseases while travelling in this destination. Talk to a travel health professional about which medications or vaccines may be right for you, based on your destination and itinerary. 

There is a risk of hepatitis A in this destination. It is a disease of the liver. People can get hepatitis A if they ingest contaminated food or water, eat foods prepared by an infectious person, or if they have close physical contact (such as oral-anal sex) with an infectious person, although casual contact among people does not spread the virus.

Practise  safe food and water precautions and wash your hands often. Vaccination is recommended for all travellers to areas where hepatitis A is present.

Measles is a highly contagious viral disease. It can spread quickly from person to person by direct contact and through droplets in the air.

Anyone who is not protected against measles is at risk of being infected with it when travelling internationally.

Regardless of where you are going, talk to a health care professional before travelling to make sure you are fully protected against measles.

Japanese encephalitis is a viral infection that can cause swelling of the brain.  It is spread to humans through the bite of an infected mosquito. Risk is very low for most travellers. Travellers at relatively higher risk may want to consider vaccination for JE prior to travelling.

Travellers are at higher risk if they will be:

• travelling long term (e.g. more than 30 days)
• making multiple trips to endemic areas
• staying for extended periods in rural areas
• visiting an area suffering a JE outbreak
• engaging in activities involving high contact with mosquitos (e.g., entomologists)

  Hepatitis B is a risk in every destination. It is a viral liver disease that is easily transmitted from one person to another through exposure to blood and body fluids containing the hepatitis B virus.  Travellers who may be exposed to blood or other bodily fluids (e.g., through sexual contact, medical treatment, sharing needles, tattooing, acupuncture or occupational exposure) are at higher risk of getting hepatitis B.

Hepatitis B vaccination is recommended for all travellers. Prevent hepatitis B infection by practicing safe sex, only using new and sterile drug equipment, and only getting tattoos and piercings in settings that follow public health regulations and standards.

Malaria  is a serious and sometimes fatal disease that is caused by parasites spread through the bites of mosquitoes.   There is a risk of malaria in certain areas and/or during a certain time of year in this destination. 

Antimalarial medication may be recommended depending on your itinerary and the time of year you are travelling. Consult a health care professional or visit a travel health clinic before travelling to discuss your options. It is recommended to do this 6 weeks before travel, however, it is still a good idea any time before leaving.    Protect yourself from mosquito bites at all times:  • Cover your skin and use an approved insect repellent on uncovered skin.  • Exclude mosquitoes from your living area with screening and/or closed, well-sealed doors and windows. • Use insecticide-treated bed nets if mosquitoes cannot be excluded from your living area.  • Wear permethrin-treated clothing.    If you develop symptoms similar to malaria when you are travelling or up to a year after you return home, see a health care professional immediately. Tell them where you have been travelling or living. 

 The best way to protect yourself from seasonal influenza (flu) is to get vaccinated every year. Get the flu shot at least 2 weeks before travelling.  

 The flu occurs worldwide. 

•  In the Northern Hemisphere, the flu season usually runs from November to   April.
•  In the Southern Hemisphere, the flu season usually runs between April and   October.
•  In the tropics, there is flu activity year round. 

The flu vaccine available in one hemisphere may only offer partial protection against the flu in the other hemisphere.

The flu virus spreads from person to person when they cough or sneeze or by touching objects and surfaces that have been contaminated with the virus. Clean your hands often and wear a mask if you have a fever or respiratory symptoms.

Yellow fever   is a disease caused by a flavivirus from the bite of an infected mosquito.

Travellers get vaccinated either because it is required to enter a country or because it is recommended for their protection.

• There is no risk of yellow fever in this country.

Country Entry Requirement*

• Proof of vaccination is required if you are coming from or have transited through an airport of a country   where yellow fever occurs.

Recommendation

• Vaccination is not recommended.
• Discuss travel plans, activities, and destinations with a health care professional.
• Contact a designated  Yellow Fever Vaccination Centre  well in advance of your trip to arrange for vaccination.

About Yellow Fever

Yellow Fever Vaccination Centres in Canada * It is important to note that  country entry requirements  may not reflect your risk of yellow fever at your destination. It is recommended that you contact the nearest  diplomatic or consular office  of the destination(s) you will be visiting to verify any additional entry requirements.

In this destination, rabies is carried by dogs and some wildlife, including bats. Rabies is a deadly disease that spreads to humans primarily through bites or scratches from an infected animal. While travelling, take precautions , including keeping your distance from animals (including free-roaming dogs), and closely supervising children.

If you are bitten or scratched by an animal while travelling, immediately wash the wound with soap and clean water and see a health care professional. Rabies treatment is often available in this destination. 

Before travel, discuss rabies vaccination with a health care professional. It may be recommended for travellers who are at high risk of exposure (e.g., occupational risk such as veterinarians and wildlife workers, children, adventure travellers and spelunkers, and others in close contact with animals). 

Coronavirus disease (COVID-19) is an infectious viral disease. It can spread from person to person by direct contact and through droplets in the air.

It is recommended that all eligible travellers complete a COVID-19 vaccine series along with any additional recommended doses in Canada before travelling. Evidence shows that vaccines are very effective at preventing severe illness, hospitalization and death from COVID-19. While vaccination provides better protection against serious illness, you may still be at risk of infection from the virus that causes COVID-19. Anyone who has not completed a vaccine series is at increased risk of being infected with the virus that causes COVID-19 and is at greater risk for severe disease when travelling internationally.

Before travelling, verify your destination’s COVID-19 vaccination entry/exit requirements. Regardless of where you are going, talk to a health care professional before travelling to make sure you are adequately protected against COVID-19.

Safe food and water precautions

Many illnesses can be caused by eating food or drinking beverages contaminated by bacteria, parasites, toxins, or viruses, or by swimming or bathing in contaminated water.

• Learn more about food and water precautions to take to avoid getting sick by visiting our eat and drink safely abroad page. Remember: Boil it, cook it, peel it, or leave it!
• Avoid getting water into your eyes, mouth or nose when swimming or participating in activities in freshwater (streams, canals, lakes), particularly after flooding or heavy rain. Water may look clean but could still be polluted or contaminated.
• Avoid inhaling or swallowing water while bathing, showering, or swimming in pools or hot tubs. 

Cholera is a risk in parts of this country. Most travellers are at very low risk.

To protect against cholera, all travellers should practise safe food and water precautions .

Travellers at higher risk of getting cholera include those:

• visiting, working or living in areas with limited access to safe food, water and proper sanitation
• visiting areas where outbreaks are occurring

Vaccination may be recommended for high-risk travellers, and should be discussed with a health care professional.

Travellers' diarrhea is the most common illness affecting travellers. It is spread from eating or drinking contaminated food or water.

Risk of developing travellers' diarrhea increases when travelling in regions with poor standards of hygiene and sanitation. Practise safe food and water precautions.

The most important treatment for travellers' diarrhea is rehydration (drinking lots of fluids). Carry oral rehydration salts when travelling.

Typhoid   is a bacterial infection spread by contaminated food or water. Risk is higher among children, travellers going to rural areas, travellers visiting friends and relatives or those travelling for a long period of time.

Travellers visiting regions with a risk of typhoid, especially those exposed to places with poor sanitation, should speak to a health care professional about vaccination.  

There is a risk of schistosomiasis in this destination. Schistosomiasis is a parasitic disease caused by tiny worms (blood flukes) which can be found in freshwater (lakes, rivers, ponds, and wetlands). The worms can break the skin, and their eggs can cause stomach pain, diarrhea, flu-like symptoms, or urinary problems. Schistosomiasis mostly affects underdeveloped and r ural communities, particularly agricultural and fishing communities.

Most travellers are at low risk. Travellers should avoid contact with untreated freshwater such as lakes, rivers, and ponds (e.g., swimming, bathing, wading, ingesting). There is no vaccine or medication available to prevent infection.

Insect bite prevention

Many diseases are spread by the bites of infected insects such as mosquitoes, ticks, fleas or flies. When travelling to areas where infected insects may be present:

• Use insect repellent (bug spray) on exposed skin
• Cover up with light-coloured, loose clothes made of tightly woven materials such as nylon or polyester
• Minimize exposure to insects
• Use mosquito netting when sleeping outdoors or in buildings that are not fully enclosed

To learn more about how you can reduce your risk of infection and disease caused by bites, both at home and abroad, visit our insect bite prevention page.

Find out what types of insects are present where you’re travelling, when they’re most active, and the symptoms of the diseases they spread.

• In this country,   dengue  is a risk to travellers. It is a viral disease spread to humans by mosquito bites.
• Dengue can cause flu-like symptoms. In some cases, it can lead to severe dengue, which can be fatal.
• The level of risk of dengue changes seasonally, and varies from year to year. The level of risk also varies between regions in a country and can depend on the elevation in the region.
• Mosquitoes carrying dengue typically bite during the daytime, particularly around sunrise and sunset.
• Protect yourself from mosquito bites . There is no vaccine or medication that protects against dengue.

Zika virus is a risk in this country. 

Zika virus is primarily spread through the bite of an infected mosquito. It can also be sexually transmitted. Zika virus can cause serious birth defects.

During your trip:

• Prevent mosquito bites at all times.
• Use condoms correctly or avoid sexual contact, particularly if you are pregnant.

If you are pregnant or planning a pregnancy, you should discuss the potential risks of travelling to this destination with your health care provider. You may choose to avoid or postpone travel. 

For more information, see Zika virus: Pregnant or planning a pregnancy.

There is a risk of chikungunya in this country. The level of risk may vary by:

The virus that causes chikungunya is spread through the bite of an infected mosquito. It can cause fever and pain in the joints. In some cases, the joint pain can be severe and last for months or years.

Protect yourself from mosquito bites at all times.

Learn more:

Insect bite and pest prevention Chikungunya

Animal precautions

Some infections, such as rabies and influenza, can be shared between humans and animals. Certain types of activities may increase your chance of contact with animals, such as travelling in rural or forested areas, camping, hiking, and visiting wet markets (places where live animals are slaughtered and sold) or caves.

Travellers are cautioned to avoid contact with animals, including dogs, livestock (pigs, cows), monkeys, snakes, rodents, birds, and bats, and to avoid eating undercooked wild game.

Closely supervise children, as they are more likely to come in contact with animals.

Person-to-person infections

Stay home if you’re sick and practise proper cough and sneeze etiquette , which includes coughing or sneezing into a tissue or the bend of your arm, not your hand. Reduce your risk of colds, the flu and other illnesses by:

•   washing your hands often
• avoiding or limiting the amount of time spent in closed spaces, crowded places, or at large-scale events (concerts, sporting events, rallies)
• avoiding close physical contact with people who may be showing symptoms of illness 

Sexually transmitted infections (STIs) , HIV , and mpox are spread through blood and bodily fluids; use condoms, practise safe sex, and limit your number of sexual partners. Check with your local public health authority pre-travel to determine your eligibility for mpox vaccine.  

Tuberculosis is an infection caused by bacteria and usually affects the lungs.

For most travellers the risk of tuberculosis is low.

Travellers who may be at high risk while travelling in regions with risk of tuberculosis should discuss pre- and post-travel options with a health care professional.

High-risk travellers include those visiting or working in prisons, refugee camps, homeless shelters, or hospitals, or travellers visiting friends and relatives.

Medical services and facilities

Good medical services and facilities are limited in availability, especially outside major urban areas. Public medical clinics often lack basic resources and equipment.

Quality of care varies greatly throughout the country.  Most hospitals will require a down payment of estimated fees at the time of admission. They may also require additional payments during hospitalization. 

Some hospitals require patients to have a full-time caregiver. You may have to hire one if you’re travelling alone.

Emergency services are not widely available. Time response can be slow.

Make sure you get travel insurance that includes coverage for medical evacuation and hospital stays.

Health and safety outside Canada

Some medication that can be purchased over-the-counter in Canada is illegal in the Philippines. If you bring some medicines with you, you’re responsible for determining their legality before departing. If you enter the country with drugs locally considered illegal, including prescription drugs, you may be fined or detained.

• Make sure your medicines are legal in the Philippines before departure
• Bring your own medicines, but only in quantities sufficient for the duration of your stay
• Seal and declare a separate quantity of prescription drugs before departing the Philippines if you’re travelling onward to another country
• Always keep your medication in the original container
• Carry a copy of your prescriptions as well as a letter from your physician stating the dosage and your relevant medical condition
• Pack your medicines in your carry-on luggage

Medical tourism

Canadian citizens have died or had serious health complications following cosmetic or other elective surgeries abroad.

Before leaving for medical travel:

• make sure you have done your research
• use reputable health-care providers only

Receiving medical care outside Canada

Air pollution

Air pollution can be severe in several major cities. It may affect people suffering from respiratory ailments.  

During periods of high pollution:

• limit your activities outdoors
• follow the instructions of local authorities

You must abide by local laws.

Learn about what you should do and how we can help if you are arrested or detained abroad .

Penalties for possession, use, trafficking or importation, including through e-commerce, of illegal drugs are severe. Convicted offenders can expect life imprisonment and heavy fines.

Many drugs considered as legal in Canada are illegal in the Philippines. This includes cannabis, regardless of quantity and purpose of use, as well as some over-the-counter medicine and prescription drugs.

• Pack your own luggage and monitor it closely at all times
• Never transport other people's packages, bags or suitcases

Drugs, alcohol and travel

Child sex tourism

Penalties for pedophilia are severe. Under Philippine law, a child is defined as a person under 18.

Police may investigate any adult who is with:

• an unrelated child 12 years of age or younger, or 10 years or more his/her junior
• an unrelated child under age 18 inside the room of a house, hotel, or other similar establishments, vehicle, or other secluded location, and is suspected of having the intention to exploit the child sexually

Child Sex Tourism: It’s a Crime

Photography

The government prohibits any photography of official buildings or military installations that is intended for publication.

If you wish to marry in the Philippines, ensure that you're well informed regarding legal requirements. Visit the Embassy of Canada to the Philippines website for information on documents and procedures.

• Embassy of Canada to the Philippines
• Marriage overseas factsheet

To protect the environment, local authorities restrict access to Boracay Island.

Some activities are also prohibited, including  the consumption of alcohol and tobacco in public places, including White Beach.

If you plan to visit Boracay, make sure you know about the rules and regulations before leaving.

Filipino law prohibits political activities by foreigners.

Attending any protest, demonstration, or political rally as a foreign national may lead to detention and deportation.

Identification

Authorities may request to see your ID at any time.

• Carry valid identification at all times
• Keep a photocopy of your passport in case it's lost or seized
• Keep a digital copy of your ID and travel documents

Dual citizenship

Dual citizenship is legally recognized in the Philippines.

If you are a Canadian citizen, but also a citizen of the Philippines, our ability to offer you consular services may be limited while you're there. You may also be subject to different entry/exit requirements .

Dual citizens

Dual citizens must obtain a certificate of recognition from Philippine authorities to ensure the legal recognition of both citizenships.

International Child Abduction

The Hague Convention on the Civil Aspects of International Child Abduction is an international treaty. It can help parents with the return of children who have been removed to or retained in certain countries in violation of custody rights. It does not apply between Canada and the Philippines.

If your child was wrongfully taken to, or is being held in the Philippines by an abducting parent:

• act as quickly as you can
• consult a lawyer in Canada and in the Philippines to explore all the legal options for the return of your child
• report the situation to the nearest Canadian government office abroad or to the Vulnerable Children's Consular Unit at Global Affairs Canada by calling the Emergency Watch and Response Centre

If your child was removed from a country other than Canada, consult a lawyer to determine if The Hague Convention applies.

Be aware that Canadian consular officials cannot interfere in private legal matters or in another country's judicial affairs.

• International Child Abductions: A guide for affected parents
• Canadian embassies and consulates by destination
• Request emergency assistance

You can drive in the Philippines with a valid Canadian driver's licence for up to 90 days. After that period, you must apply for a local driving permit.

You should carry an international driving permit.

International Driving Permit

The currency in the Philippines is the peso (PHP).

ATMs are available in larger cities but may be scarce in rural areas. Make sure to have access to cash in local currency if you're travelling outside larger urban areas.

You may enter the Philippines with:

• up to PHP 50,000
• up to US$10,000 or other currency equivalent

You need a written authorization from local authorities for greater amounts.

Climate change

Climate change is affecting the Philippines. Extreme and unusual weather events are becoming more frequent. Monitor local news to stay informed on the current situation.

Typhoons and monsoons

The rainy or monsoon season extends from May to November, but storms can occur throughout the year. The Philippines experiences around 20 typhoons per year, mostly between June and November.

Seasonal flooding can hamper overland travel and reduce the provision of essential services. Roads may become impassable and bridges damaged. Flooding and mudslides are frequent following heavy rains, even in Metro Manila.

If you decide to travel to the Philippines during the rainy season:

• know that you expose yourself to serious safety risks
• be prepared to change your travel plans on short notice, including cutting short or cancelling your trip
• stay informed of the latest regional weather forecasts
• carry emergency contact information for your airline or tour operator
• Tornadoes, cyclones, hurricanes, typhoons and monsoons
• Philippine Weather Services and Warnings – Philippine Atmospheric, Geophysical and Astronomical Services Administration
• Nationwide Operational Assessment of Hazards – University of the Philippines

Seismic activity

The Philippines is located on the Pacific Ring of Fire and experiences regular seismic activity.

There are several active and potentially active volcanoes in the Philippines, mainly on Luzon island.

Taal is one of the main active volcanoes in Batangas on Luzon Island. It continuously shows signs of a possible eruption. The Philippine Institute of Volcanology and Seismology is constantly monitoring the Taal Volcano. Local authorities may raise alert levels and issue evacuation orders on short notice.

Volcanic activity may escalate suddenly. Volcanic ash clouds may cause disruptions to domestic and international flights.

If you are near active volcanoes:

• monitor levels of volcanic activity through the local media
• pay careful attention to all warnings issued
• follow the advice of local authorities, including evacuation orders
• be prepared to modify your travel arrangements or even evacuate the area on short notice

Earthquakes

The Philippines is located in an active seismic zone. Earthquakes occur regularly and strong aftershocks may occur after the initial quake.

Familiarize yourself with earthquake security measures in public and private buildings, including airports.

The Philippines is prone to tsunamis.

A tsunami can occur within minutes of a nearby earthquake. However, the risk of a tsunami can remain for several hours following the first tremor.

If you're staying on the coast, familiarize yourself with the region's evacuation plans in the event of a tsunami warning.

• Hazard Hunter – Philippine Institute of Volcanology and Seismology
• Philippine Institute of Volcanology and Seismology – Department of Science and Technology
• Earthquakes – What to Do?
• Latest earthquakes   – U.S. Geological Survey
• Tsunami alerts – U.S. Tsunami Warning System

Local services

In case of emergency, dial 911.

Consular assistance

For emergency consular assistance, call the Embassy of Canada to the Philippines, in Manila, and follow the instructions. At any time, you may also contact the Emergency Watch and Response Centre in Ottawa.

The decision to travel is your choice and you are responsible for your personal safety abroad. We take the safety and security of Canadians abroad very seriously and provide credible and timely information in our Travel Advice to enable you to make well-informed decisions regarding your travel abroad.

The content on this page is provided for information only. While we make every effort to give you correct information, it is provided on an "as is" basis without warranty of any kind, expressed or implied. The Government of Canada does not assume responsibility and will not be liable for any damages in connection to the information provided.

If you need consular assistance while abroad, we will make every effort to help you. However, there may be constraints that will limit the ability of the Government of Canada to provide services.

Learn more about consular services .

Risk Levels

  take normal security precautions.

Take similar precautions to those you would take in Canada.

  Exercise a high degree of caution

There are certain safety and security concerns or the situation could change quickly. Be very cautious at all times, monitor local media and follow the instructions of local authorities.

IMPORTANT: The two levels below are official Government of Canada Travel Advisories and are issued when the safety and security of Canadians travelling or living in the country or region may be at risk.

  Avoid non-essential travel

Your safety and security could be at risk. You should think about your need to travel to this country, territory or region based on family or business requirements, knowledge of or familiarity with the region, and other factors. If you are already there, think about whether you really need to be there. If you do not need to be there, you should think about leaving.

  Avoid all travel

You should not travel to this country, territory or region. Your personal safety and security are at great risk. If you are already there, you should think about leaving if it is safe to do so.

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Tips for traveling in the Philippines right now, from people who just went

Flights to Manila may be more expensive than they were before the pandemic

Underwater photographer Erik Lucas has regularly traveled to the Philippines since 2014, using those trips to teach workshops on capturing the Pacific country’s vibrant marine life . Then the pandemic hit, and Lucas waited years to return. “The moment they announced that they were reopening without quarantine, I booked tickets,” Lucas says.

The Philippines began welcoming fully vaccinated international travelers from approved countries in February. On April 1, the archipelago will reopen to fully vaccinated travelers from all countries.

While there are covid-specific entry requirements to get to the Philippines, Lucas felt the end result was worth the additional effort, and he encourages other travelers to visit. “Absolutely go,” he says.

To prepare for your own trip, By The Way collected advice from recent visitors and travel experts on how to navigate a pandemic trip to the Philippines.

Should you travel to a Level 4 country?

Know the basic travel requirements

Fully vaccinated travelers must provide proof of immunization (your white CDC card will do) as well as A negative RT-PCR result from a test taken within 48 hours of departure to the Philippines. This timeline excludes layovers as long as travelers stay within airports.

Children under 12 are exempt from the vaccination requirement if they are traveling with a fully vaccinated parent.

Visitors who are unvaccinated, partially vaccinated or whose vaccination status can’t be confirmed also have to provide proof of a negative PCR test taken within 48 hours of their flight to the Philippines, in addition to other quarantine requirements .

All travelers must register with the One Health Pass (OHP), apply for an e-Health Declaration Card (e-HDC) and show that they have purchased travel insurance that includes covid-19 treatment with a minimum coverage of $35,000. Lucas used the Squaremouth platform to find the travel insurance he needed to meet the Philippines’ entry requirements.

Once you’ve arrived, there may also be specific domestic travel restrictions depending on the destination. Check to make sure if you need an additional coronavirus test before taking trips within the country .

Airports are slammed. Here are 6 ways to manage the chaos.

Keep track of travel restrictions online

As with all trips during the pandemic, it is critical to watch for updates to travel restrictions ahead of your trip.

“It changes all the time,” says Pow Belgado, who visited the Philippines in March to see her family in Manila and Batangas. She turned to the Facebook page of the Philippines’ Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF). “They’re very up to date,” she says, adding that the page made understanding travel restrictions more manageable with easy-to-read graphics.

Belgado also recommends checking for news through the Philippine embassy and contacting its staff if you have any confusion. “I had a question and they emailed me back on a Sunday,” she says. “I was quite surprised.”

Hans Van Der Sande, treasurer of the casino and resort complex Okada Manila, relied on updates from the Philippine Airlines website. Its Covid-19 Travel Guide offers information for passengers flying to, from and within the Philippines.

You can also visit the official tourism website or the Department of Health ’s website.

Anticipate fewer flight options

Daniel Robbins booked his flight to the Philippines as soon as he heard about the reopening plan. Because Robbins was so early, there weren’t great flight options to get from Los Angeles to Manila; airlines are still ramping up services to the country.

“[I got] like the only [flight] available before it started getting very expensive,” he says. “I had to fly from California to Hawaii, Hawaii to Guam, Guam to Manila. It took forever.”

While planning for his 2½-week trip to Manila and Cebu, Norman Villaroman — a native of the Philippines and founder of the family travel blog Go Places With Kids — also noticed tickets were more expensive than before the pandemic.

As demand rises for flights to the Philippines, the cost of tickets should go down, and options should increase. Villaroman says travelers should make sure the flight is flexible in case they need to cancel or reschedule based on the results of a coronavirus test.

How to use vaccine passports for international travel

How to prepare for your travel day

Travelers will have to present their essential documents — such as proof of vaccination and OHP QR code — at their departure airport when checking in for their flight, again before they board and upon landing in the Philippines. They will also be asked to show their travel insurance and test results before departing.

“They check every step of the way,” Lucas says, noting that he was surprised how thoroughly they reviewed his travel insurance policy.

Robbins arrived at the airport much earlier than usual, giving himself four hours in case something went awry. Before he left home, he made sure he had multiple copies of every required document for his trip. “I didn’t want to rely on them only being on my phone,” he says.

What happens when you land

Visitors will have to show their essential travel documents when they arrive in the Philippines. The process is smooth, Belgado says, but she recommends sitting as close as you can to the front of the plane so you can be one of the first to the counters for your document review.

Once you have gone through immigration and coronavirus procedures at the airport, you are free to leave and begin your adventure. Just make sure you keep track of your vaccination card throughout your trip — most hotels require guests to provide proof of vaccination to enter and check in.

“Having your vaccine card is almost as important as having your passport,” Van Der Sande says.

Aside from vaccine requirements, Van Der Sande says the only other major coronavirus precaution is that masks are required in public places .

Otherwise, there aren’t many restrictions limiting a traveler’s experience in the Philippines. Bars and restaurants are open, but they may have limited capacity. Belgado says she went to the beach, malls and casinos, and “it felt normal.”

Robbins enjoyed the reduced capacity on his snorkel excursion. Although that meant customers had to wait a little longer for their turn to board a boat, people weren’t packed in together like they would be before the pandemic.

13 places vaccinated travelers can go without taking a coronavirus test

Plan your coronavirus tests to get home

As a reminder, anyone coming to the United States must get an approved test within a day of their flight.

Belgado says people staying in Manila should have no problem finding and arranging a coronavirus test, but if you’re staying in a smaller or more remote destination, plan your test with more care. While staying in Batangas, she didn’t realize the testing lab needed to send out her sample to another facility, so getting results took much longer than she expected. She had to splurge on a second test to make sure she could get the results in time.

When planning your own tests, Belgado says, ask the lab how long they will need to process a test within your travel window.

To cut the stress of finding a test locally, Villaroman packed an at-home test that is approved for U.S. travel restrictions. Should you go this route, note that tests must be approved by the Centers for Disease Control and Prevention and be taken over a video call with real-time supervision from a telehealth service. Some options include Qured’s antigen self-tests and BinaxNOW’s kit (not the over-the-counter version found at drugstores; you have to order the COVID-19 Ag Card Home Test online and make sure it includes video-call support). Detect’s coronavirus test uses the same technology as a PCR lab test and delivers results in about an hour.

“I also brought some extra at-home tests for peace of mind just so I could test myself if I had symptoms,” Villaroman says, echoing advice from many coronavirus experts .

More travel tips

Vacation planning: Start with a strategy to maximize days off by taking PTO around holidays. Experts recommend taking multiple short trips for peak happiness . Want to take an ambitious trip? Here are 12 destinations to try this year — without crowds.

Cheap flights: Follow our best advice for scoring low airfare , including setting flight price alerts and subscribing to deal newsletters. If you’re set on an expensive getaway, here’s a plan to save up without straining your credit limit.

Airport chaos: We’ve got advice for every scenario , from canceled flights to lost luggage . Stuck at the rental car counter? These tips can speed up the process. And following these 52 rules of flying should make the experience better for everyone.

Expert advice: Our By The Way Concierge solves readers’ dilemmas , including whether it’s okay to ditch a partner at security, or what happens if you get caught flying with weed . Submit your question here . Or you could look to the gurus: Lonely Planet and Rick Steves .

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Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2024–25 Influenza Season

Recommendations and Reports / August 29, 2024 / 73(5);1–25

Lisa A. Grohskopf, MD 1 ; Jill M. Ferdinands, PhD 1 ; Lenee H. Blanton, MPH 1 ; Karen R. Broder, MD 2 ; Jamie Loehr, MD 3 ( View author affiliations )

Introduction

Primary changes and updates, recommendations for the use of influenza vaccines, 2024–25, influenza vaccine composition and available vaccines, storage and handling of influenza vaccines, additional sources of information regarding influenza and influenza vaccines, acknowledgments, acip influenza vaccine work group.

• Article PDF

This report updates the 2023–24 recommendations of the Advisory Committee on Immunization Practices (ACIP) concerning the use of seasonal influenza vaccines in the United States (MMWR Recomm Rep 2022;72[No. RR-2]:1–24). Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. Trivalent inactivated influenza vaccines (IIV3s), trivalent recombinant influenza vaccine (RIV3), and trivalent live attenuated influenza vaccine (LAIV3) are expected to be available. All persons should receive an age-appropriate influenza vaccine (i.e., one approved for their age), with the exception that solid organ transplant recipients aged 18 through 64 years who are receiving immunosuppressive medication regimens may receive either high-dose inactivated influenza vaccine (HD-IIV3) or adjuvanted inactivated influenza vaccine (aIIV3) as acceptable options (without a preference over other age-appropriate IIV3s or RIV3). Except for vaccination for adults aged ≥65 years, ACIP makes no preferential recommendation for a specific vaccine when more than one licensed and recommended vaccine is available. ACIP recommends that adults aged ≥65 years preferentially receive any one of the following higher dose or adjuvanted influenza vaccines: trivalent high-dose inactivated influenza vaccine (HD-IIV3), trivalent recombinant influenza vaccine (RIV3), or trivalent adjuvanted inactivated influenza vaccine (aIIV3). If none of these three vaccines is available at an opportunity for vaccine administration, then any other age-appropriate influenza vaccine should be used.

Primary updates to this report include the following two topics: the composition of 2024–25 U.S. seasonal influenza vaccines and updated recommendations for vaccination of adult solid organ transplant recipients. First, following a period of no confirmed detections of wild-type influenza B/Yamagata lineage viruses in global surveillance since March 2020, 2024–25 U.S. influenza vaccines will not include an influenza B/Yamagata component. All influenza vaccines available in the United States during the 2024–25 season will be trivalent vaccines containing hemagglutinin derived from 1) an influenza A/Victoria/4897/2022 (H1N1)pdm09-like virus (for egg-based vaccines) or an influenza A/Wisconsin/67/2022 (H1N1)pdm09-like virus (for cell culture-based and recombinant vaccines); 2) an influenza A/Thailand/8/2022 (H3N2)-like virus (for egg-based vaccines) or an influenza A/Massachusetts/18/2022 (H3N2)-like virus (for cell culture-based and recombinant vaccines); and 3) an influenza B/Austria/1359417/2021 (Victoria lineage)-like virus. Second, recommendations for vaccination of adult solid organ transplant recipients have been updated to include HD-IIV3 and aIIV3 as acceptable options for solid organ transplant recipients aged 18 through 64 years who are receiving immunosuppressive medication regimens (without a preference over other age-appropriate IIV3s or RIV3).

This report focuses on recommendations for the use of vaccines for the prevention and control of seasonal influenza during the 2024–25 influenza season in the United States. A brief summary of the recommendations and a link to the most recent Background Document containing additional information are available at https://www.cdc.gov/acip-recs/hcp/vaccine-specific/flu.html?CDC_AAref_Val=https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/flu.html . These recommendations apply to U.S.-licensed influenza vaccines. Updates and other information are available from CDC’s influenza website ( https://www.cdc.gov/flu ). Vaccination and health care providers should check this site periodically for additional information.

Influenza viruses typically circulate annually in the United States, most commonly from the late fall through the early spring. Most persons who become ill after influenza virus infection recover without serious complications or sequelae. However, influenza can be associated with serious illnesses, hospitalizations, and deaths, particularly among older adults, very young children, pregnant persons, and persons of all ages with certain chronic medical conditions ( 1 – 7 ). Influenza also is an important cause of missed work and school ( 8 – 10 ).

Routine annual influenza vaccination for all persons aged ≥6 months who do not have contraindications has been recommended by CDC and the Advisory Committee on Immunization Practices (ACIP) since 2010 ( 11 ). Vaccination provides important protection from influenza illness and its potential complications. The effectiveness of influenza vaccination varies depending on multiple factors such as the age and health of the recipient, the type of vaccine administered, the types and subtypes of influenza viruses circulating in the community, and the degree of similarity between circulating viruses and those included in the vaccine ( 12 ). During each of the six influenza seasons from 2010–11 through 2015–16, influenza vaccination prevented an estimated 1.6–6.7 million illnesses, 790,000–3.1 million outpatient medical visits, 39,000–87,000 hospitalizations, and 3,000–10,000 respiratory and circulatory deaths each season in the United States ( 13 ). During the severe 2017–18 season, notable for an unusually long duration of widespread high influenza activity throughout the United States and higher rates of outpatient visits and hospitalizations compared with recent seasons, vaccination prevented an estimated 7.1 million illnesses, 3.7 million medical visits, 109,000 hospitalizations, and 8,000 deaths ( 14 ), despite an overall estimated vaccine effectiveness of 38% (62% against influenza A[H1N1]pdm09 viruses, 22% against influenza A[H3N2] viruses, and 50% against influenza B viruses) ( 14 ).

This report updates the 2023–24 ACIP recommendations regarding the use of seasonal influenza vaccines ( 15 ) and provides recommendations and guidance for vaccination providers regarding the use of influenza vaccines in the United States for the 2024–25 season. Various formulations of influenza vaccines are available ( Table 1 ). Contraindications and precautions for the use of influenza vaccines are summarized ( Tables 2 and 3 ). Abbreviations are used in this report to denote the various types of vaccines ( Box ). A summary of these recommendations and a Background Document containing additional information on influenza, influenza-associated illness, and influenza vaccines are available at https://www.cdc.gov/acip-recs/hcp/vaccine-specific/flu.html?CDC_AAref_Val=https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/flu.html .

ACIP provides annual recommendations for the use of influenza vaccines for the prevention and control of seasonal influenza in the United States. The ACIP Influenza Work Group meets by teleconference once to twice per month throughout the year. Work Group membership includes multiple voting members of ACIP, representatives of ACIP liaison organizations, and consultants. Discussions include topics such as influenza surveillance, vaccine effectiveness and safety, vaccination coverage, program feasibility, cost effectiveness, and vaccine supply. Presentations are requested from invited experts and published and unpublished data are discussed.

The Background Document that supplements this report contains literature related to recommendations made in previous seasons. The information included in the Background Document for such topics is not a systematic review; it is intended to provide an overview of background literature and is periodically updated with literature being identified primarily through a broad search for English-language articles on influenza and influenza vaccines. In general, longstanding recommendations in this document that were made in previous seasons reflect expert opinion, and systematic review and assessment of evidence was not performed. Systematic review and evidence assessment are not performed for minor wording changes to existing recommendations, changes in the Food and Drug Administration (FDA)-recommended viral antigen composition of seasonal influenza vaccines, and minor changes in guidance for the use of influenza vaccines (e.g., guidance for timing of vaccination and other programmatic issues, guidance for dosage in specific populations, guidance for selection of vaccines for specific populations that are already recommended for vaccination, and changes that reflect use that is consistent with FDA-licensed indications and prescribing information).

Typically, systematic review and evaluation of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach ( 16 ) are performed for new recommendations or substantial changes in the current recommendations (e.g., expansion of the recommendation for influenza vaccination to new populations not previously recommended for vaccination or potential preferential recommendations for specific vaccines).

Evidence is reviewed by the ACIP influenza Work Group, and Work Group considerations are included within the ACIP Evidence to Recommendations framework (EtR) ( 17 ) to inform the development of recommendations that are proposed for vote by the ACIP. Systematic review, GRADE, and the ACIP EtR framework were used in the development of the updated recommendations for adult solid organ transplant recipients discussed in this report.

Primary changes and updates to the recommendations described in this report include 1) the composition of 2024–25 U.S. seasonal influenza vaccines and 2) updated recommendations for vaccination of adult solid organ transplant recipients. Information relevant to these changes includes the following:

• The composition of the 2024–25 U.S. seasonal influenza vaccines includes an update to the influenza A(H3N2) component. For the 2024–25 season, U.S.-licensed influenza vaccines will contain hemagglutinin (HA) derived from 1) an influenza A/Victoria/4897/2022 (H1N1)pdm09-like virus (for egg-based vaccines) or an influenza A/Wisconsin/67/2022 (H1N1)pdm09-like virus (for cell culture-based and recombinant vaccines, 2) an influenza A/Thailand/8/2022 (H3N2)-like virus (for egg-based vaccines) or an influenza A/Massachusetts/18/2022 (H3N2)-like virus (for cell culture-based and recombinant vaccines), and 3) an influenza B/Austria/1359417/2021 (Victoria lineage)-like virus (for egg-based, cell culture-based, and recombinant vaccines). Recommendations for the composition of Northern Hemisphere influenza vaccines are made by the World Health Organization (WHO), which organizes a consultation, usually in February of each year. Surveillance data are reviewed, and candidate vaccine viruses are discussed. Information about the WHO meeting of February 2024 for selection of the 2024–25 Northern Hemisphere influenza vaccine composition is available at https://www.who.int/publications/m/item/recommended-composition-of-influenza-virus-vaccines-for-use-in-the-2024-2025-northern-hemisphere-influenza-season . Subsequently, FDA, which has regulatory authority over vaccines in the United States, convenes a meeting of its Vaccines and Related Biological Products Advisory Committee (VRBPAC). This committee considers the recommendations of WHO, reviews and discusses similar data, and makes a final decision regarding the composition of influenza vaccines licensed and marketed in the United States. Materials from the VRBPAC discussion on March 5, 2024, during which the composition of the 2024–25 U.S. influenza vaccines was discussed, are available at https://www.fda.gov/advisory-committees/advisory-committee-calendar/vaccines-and-related-biological-products-advisory-committee-march-5-2024-meeting-announcement . For the 2024–25 influenza season, FDA has recommended that the U.S. seasonal influenza vaccine composition no longer include influenza B/Yamagata, as there have been no confirmed detections of influenza B/Yamagata viruses in global influenza surveillance since March 2020 ( 18 , 19 ).
• Recommendations for vaccination of adult solid organ transplant recipients have been updated to include HD-IIV3 and aIIV3 as acceptable options for solid organ transplant recipients aged 18 through 64 years who are receiving immunosuppressive medication regimens (without a preference over other age-appropriate IIVs or RIV3). To inform this recommendation, a systematic review and GRADE of evidence concerning effectiveness and safety of HD-IIV3 and aIIV3 compared with standard-dose unadjuvanted inactivated influenza vaccines was conducted. A summary of this review and the GRADE evidence tables is available at https://www.cdc.gov/vaccines/acip/recs/grade/influenza-solid-organ-transplant.html . A summary of the ACIP EtR framework is available at https://www.cdc.gov/vaccines/acip/recs/grade/influenza-solid-organ-transplant-etr.html .

Groups Recommended for Vaccination

Routine annual influenza vaccination of all persons aged ≥6 months who do not have contraindications continues to be recommended. All persons should receive an age-appropriate influenza vaccine (one that is approved for their age), with the exception that solid organ transplant recipients aged 18 through 64 years who are receiving immunosuppressive medication regimens may receive either HD-IIV3 or aIIV3 as acceptable options (without a preference over other age-appropriate IIV3s or RIV3) (see Immunocompromised Persons). Influenza vaccines expected to be available for the 2024–25 season, their age indications, and their presentations are described (Table 1). ACIP makes no preferential recommendation for the use of any one influenza vaccine over another when more than one licensed and recommended vaccine is available, except for selection of influenza vaccines for persons aged ≥65 years (see Older Adults). Recommendations regarding timing of vaccination, considerations for specific populations, the use of specific vaccines, and contraindications and precautions are summarized in the sections that follow.

Timing of Vaccination

Timing of the onset, peak, and decline of influenza activity varies from season to season ( 20 ). Decisions about timing need to consider the unpredictability of the influenza season, possible waning of vaccine-induced immunity over the course of a season, and practical considerations. For most persons who need only 1 dose of influenza vaccine for the season, vaccination should ideally be offered during September or October. However, vaccination should continue after October and throughout the influenza season as long as influenza viruses are circulating and unexpired vaccine is available. To avoid missed opportunities for vaccination, providers should offer vaccination during routine health care visits and hospitalizations. Revaccination (i.e., providing a booster dose) to persons who have been fully vaccinated for the season is not recommended, regardless of when the current season vaccine was received.

Influenza vaccines might be available as early as July or August; however, vaccination during July and August is not recommended for most groups because of potential waning of immunity over the course of the influenza season ( 21 – 40 ), particularly among older adults ( 21 , 22 , 24 , 31 , 34 , 40 ). However, vaccination during July or August can be considered for any recipient for whom there is concern that they will not be vaccinated at a later date. Considerations for timing of vaccination include the following:

• For most adults (particularly adults aged ≥65 years) and for pregnant persons in the first or second trimester: Vaccination during July and August should be avoided unless there is concern that vaccination later in the season might not be possible.
• Children who require 2 doses: Certain children aged 6 months through 8 years require 2 doses of influenza vaccine for the season (see Children Aged 6 Months Through 8 Years: Number of Influenza Vaccine Doses) ( Figure ). These children should receive their first dose as soon as possible (including during July and August, if vaccine is available) to allow the second dose (which must be administered ≥4 weeks later) to be received, ideally, by the end of October.
• Children who require only 1 dose: Vaccination during July and August can be considered for children of any age who need only 1 dose of influenza vaccine for the season. Although waning of immunity after vaccination over the course of the season has been observed among all age groups ( 21 – 40 ), there are fewer published studies reporting results specifically among children ( 21 , 30 , 32 , 33 , 37 , 39 , 40 ). Moreover, children in this group might visit health care providers during the late summer months for medical examinations before the start of school. Vaccination can be considered at this time because it represents a vaccination opportunity.
• Pregnant persons in the third trimester: Vaccination during July and August can be considered for pregnant persons who are in the third trimester during these months because vaccination has been associated in multiple studies with reduced risk for influenza illness in their infants during the first months after birth, when they are too young to receive influenza vaccine ( 41 – 44 ). For pregnant persons in the first or second trimester during July and August, waiting to vaccinate until September or October is preferable, unless there is concern that later vaccination might not be possible.

An increasing number of observational studies ( 21 – 40 ) have reported decreased vaccine effectiveness with increasing time after vaccination within an influenza season. The rate of waning effectiveness observed in these studies varied considerably and waning effects were inconsistent across age groups, seasons, and influenza virus types and subtypes; although several studies reported faster waning against influenza A(H3N2) viruses than against influenza A(H1N1) or influenza B viruses ( 25 , 31 , 35 , 40 ). A meta-analysis of 14 studies examining waning of influenza vaccine effectiveness using the test-negative design found a significant decline in effectiveness after vaccination against influenza A(H3N2) and influenza B but not against influenza A(H1N1) ( 45 ). In that study, VE against influenza A(H3N2) declined, on average, by 32 percentage points, from 45% during the first 3 months to 13% in the fourth to sixth months after vaccination. The rate of waning effectiveness also might vary with age; in several studies, waning was more pronounced among older adults ( 21 , 22 , 24 , 31 , 34 , 40 ). Several recent multiseason studies of waning protection found that the odds of influenza infection increased by 9% to 28% per month after vaccination among vaccinees of all ages and by 12% to 29% per month among vaccinees aged ≥65 years ( 33 , 39 , 40 ). There are fewer studies of waning specifically among children, with some reporting waning effectiveness ( 21 , 32 , 33 , 37 , 40 ) and others finding no evidence of waning effectiveness ( 30 , 39 ). Complicating the interpretation of studies of waning effectiveness is the fact that observed decreases in protection might be at least partially due to bias, unmeasured confounding, or emergence of antigenic drift variants of influenza viruses that are less well-matched to the vaccine viruses.

Community vaccination programs should balance persistence of vaccine-induced protection through the season with avoiding missed opportunities to vaccinate or vaccinating after onset of influenza circulation occurs. Although delaying vaccination might result in greater immunity later in the season, deferral might result in missed opportunities to vaccinate as well as difficulties in vaccinating a population within a more constrained period. Modeling studies examining the consequences of delaying vaccination (until September or October) among older adults in the United States found that delaying vaccination is beneficial if the delay does not cause a substantial reduction in overall vaccination coverage (because of failure of some persons who would prefer earlier vaccination to get vaccinated later in the fall) ( 46 – 48 ). Among older adults, delayed vaccination would be beneficial, on balance, if vaccine coverage declines by no more than 6% in a mild season ( 47 ) or by about 15% in a moderately severe season ( 46 , 48 ). However, these results are sensitive to many factors, especially the rate of waning of vaccine effectiveness, about which there remains considerable uncertainty.

Vaccination efforts should continue throughout the season because the duration of the influenza season varies, and influenza activity might not occur in certain communities until February, March, or later ( 20 ). Providers should offer influenza vaccine at health care visits to those not yet vaccinated, and organized vaccination campaigns should continue throughout the influenza season, including after influenza activity has begun in the community. Although vaccination by the end of October is recommended, vaccine administered in December or later, even if influenza activity has already begun, might be beneficial in most influenza seasons. Providers should offer influenza vaccination to unvaccinated persons who have already become ill with influenza during the season because the vaccine might protect them against other circulating influenza viruses.

Guidance for Influenza Vaccination in Specific Populations and Situations

Populations at higher risk for medical complications attributable to severe influenza.

All persons aged ≥6 months who do not have contraindications should be vaccinated annually. However, vaccination to prevent influenza is particularly important for persons who are at increased risk for severe illness and complications from influenza and for influenza-related outpatient, emergency department, or hospital visits. When vaccine supply is limited, vaccination efforts should focus on vaccination of persons at higher risk for medical complications attributable to severe influenza who do not have contraindications. These persons include the following (order of listing does not imply hierarchy or prioritization among these populations):

• All children aged 6 through 59 months.
• All persons aged ≥50 years.
• Adults and children who have chronic pulmonary (including asthma), cardiovascular (excluding isolated hypertension), renal, hepatic, neurologic, hematologic, or metabolic disorders (including diabetes mellitus).
• Persons who are immunocompromised due to any cause (including but not limited to immunosuppression caused by medications or HIV infection).
• Persons who are or will be pregnant during the influenza season.
• Children and adolescents (aged 6 months through 18 years) who are receiving aspirin- or salicylate-containing medications and who might be at risk for experiencing Reye syndrome after influenza virus infection.
• Residents of nursing homes and other long-term care facilities.
• American Indian or Alaska Native persons.
• Persons who are extremely obese (body mass index ≥40 for adults).

IIV3 or RIV3 are suitable for all persons recommended for vaccination, including those in the risk groups listed. LAIV3 is not recommended for certain populations, including certain of these listed groups. Contraindications and precautions for the use of LAIV3 are noted (Table 2).

Persons Who Live with or Care for Persons at Higher Risk for Influenza-Related Complications

All persons aged ≥6 months without contraindications should be vaccinated annually. However, emphasis also should be placed on vaccination of persons who live with or care for those who are at increased risk for medical complications attributable to severe influenza. When vaccine supply is limited, vaccination efforts should focus on administering vaccination to persons at higher risk for influenza-related complications as well as persons who live with or care for such persons, including the following:

• Health care personnel, including all paid and unpaid persons working in health care settings who have the potential for exposure to patients or to infectious materials. These personnel might include but are not limited to physicians, nurses, nursing assistants, nurse practitioners, physician assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, contractual staff members, and others not directly involved in patient care but who might be exposed to infectious agents (e.g., clerical, dietary, housekeeping, laundry, security, maintenance, administrative, billing staff, and volunteers). ACIP guidance for vaccination of health care personnel has been published previously ( 49 ).
• Household contacts (including children aged ≥6 months) and caregivers of children aged ≤59 months (<5 years) and adults aged ≥50 years, particularly contacts of children aged <6 months.
• Household contacts (including children aged ≥6 months) and caregivers of persons with medical conditions that put them at higher risk for severe complications from influenza.

Health care personnel and persons who are contacts of persons in these groups (except for of contacts of severely immunocompromised persons who require a protected environment) can receive any influenza vaccine that is otherwise indicated. Persons who care for severely immunocompromised persons requiring a protected environment should not receive LAIV3. ACIP and the Healthcare Infection Control Practices Advisory Committee (HICPAC) have previously recommended that health care personnel who receive LAIV should avoid providing care for severely immunocompromised persons requiring a protected environment for 7 days after vaccination and that hospital visitors who have received LAIV should avoid contact with such persons for 7 days after vaccination ( 50 ). However, such persons need not be restricted from caring for or visiting less severely immunocompromised persons.

Children Aged 6 Through 35 Months: Influenza Vaccine Dose Volumes

Five IIV3s are approved for children aged ≥6 months (Table 1). Four of these vaccines are egg based (Afluria, Fluarix, FluLaval, and Fluzone), and one is cell culture–based (Flucelvax). For these vaccines, the approved dose volumes for children aged 6 through 35 months are as follows ( Table 4 ):

• Afluria: 0.25 mL per dose. However, 0.25-mL prefilled syringes are no longer available. For children aged 6 through 35 months, a 0.25-mL dose must be obtained from a multidose vial ( 51 ).
• Fluarix: 0.5 mL per dose ( 52 ).
• Flucelvax: 0.5 mL per dose ( 53 ).
• FluLaval: 0.5 mL per dose ( 54 ).
• Fluzone: Either 0.25 mL or 0.5 mL per dose. Per the package insert, each dose can be given at either volume ( 55 ); however, 0.25-mL prefilled syringes are no longer available.

For all of these IIV3s, persons aged ≥36 months (≥3 years) should receive 0.5 mL per dose. Alternatively, healthy children aged ≥24 months (≥2 years) can receive LAIV3, 0.2 mL intranasally (0.1 mL in each nostril) ( 56 ). LAIV3 is not recommended for certain populations and is not approved for children aged <2 years or adults >49 years (see Contraindications and Precautions for the Use of LAIV3) (Table 2). RIV3 is not approved for children aged <18 years ( 57 ). High-dose inactivated influenza vaccine (HD-IIV3) ( 58 ) and adjuvanted inactivated influenza vaccine (aIIV3) ( 59 ) are not approved for persons aged <65 years.

Care should be taken to administer an age-appropriate vaccine at the appropriate volume for each dose. For IIV3s, the recommended volume can be administered from a prefilled syringe containing the appropriate volume (as supplied by the manufacturer) or a multidose vial. Multidose vials should be used only for the maximum number of doses specified in the package insert. Any vaccine remaining in a vial after the maximum number of doses has been removed should be discarded, regardless of the volume of the doses obtained or any remaining volume in the vial.

Children Aged 6 Months Through 8 Years: Number of Influenza Vaccine Doses

Children aged 6 months through 8 years require 2 doses of influenza vaccine administered a minimum of 4 weeks apart during their first season of vaccination for optimal protection ( 60 – 63 ). Determination of the number of doses needed is based on 1) the child’s age at the time of the first dose of 2024–25 influenza vaccine and 2) the number of doses of influenza vaccine received in previous influenza seasons.

• Those who have previously received ≥2 total doses of trivalent or quadrivalent influenza vaccine ≥4 weeks apart before July 1, 2024, require only 1 dose for the 2024–25 season. The previous 2 doses of influenza vaccine do not need to have been received in the same season or consecutive seasons.
• Those who have not previously received ≥2 doses of trivalent or quadrivalent influenza vaccine ≥4 weeks apart before July 1, 2024, or whose previous influenza vaccination history is unknown, require 2 doses for the 2024–25 season. The interval between the 2 doses should be ≥4 weeks. Children aged 6 months through 8 years who require 2 doses of influenza vaccine should receive their first dose as soon as possible (including during July and August, if vaccine is available) to allow the second dose (which must be administered ≥4 weeks later) to be received, ideally, by the end of October. For children aged 8 years who require 2 doses of vaccine, both doses should be administered even if the child turns age 9 years between receipt of dose 1 and dose 2.
• Adults and children aged ≥9 years need only 1 dose of influenza vaccine for the 2024–25 season.

Pregnant Persons

Pregnant and postpartum persons are at higher risk for severe illness and complications from influenza, particularly during the second and third trimesters. Influenza vaccination during pregnancy is associated with reduced risk for respiratory illness and influenza among pregnant and postpartum persons as well as infants during the first months of life ( 41 – 44 , 64 ). ACIP and the American College of Obstetricians and Gynecologists recommend that persons who are pregnant or who might be pregnant or postpartum during the influenza season receive influenza vaccine ( 65 ). IIV3 or RIV3 can be used. LAIV3 should not be used during pregnancy but can be used postpartum. Influenza vaccine can be administered at any time during pregnancy (i.e., during any trimester), before and during the influenza season. Early vaccination (i.e., during July and August) can be considered for persons who are in the third trimester during these months if vaccine is available because this can provide protection for the infant during the first months of life when they are too young to be vaccinated ( 41 – 44 , 64 ).

Although experience with the use of IIVs during pregnancy is substantial, data specifically reflecting administration of influenza vaccines during the first trimester are limited. Most studies have not noted an association between influenza vaccination and adverse pregnancy outcomes, including spontaneous abortion (miscarriage) ( 66 – 76 ). One observational Vaccine Safety Datalink (VSD) study conducted during the 2010–11 and 2011–12 seasons noted an association between receipt of IIV containing influenza A(H1N1)pdm09 and risk for miscarriage in the 28 days after receipt of IIV, when an H1N1pdm09-containing vaccine also had been received the previous season ( 77 ). However, in a larger VSD follow-up study, IIV was not associated with an increased risk for miscarriage during the 2012–13, 2013–14, and 2014–15 seasons, regardless of previous season vaccination ( 78 ).

There is less experience with the use of more recently licensed influenza vaccines (e.g., cell culture-based and recombinant vaccines) during pregnancy compared with previously available products. For ccIIV, a review of Vaccine Adverse Event Reporting System (VAERS) reports from 2013 through 2020 ( 79 ) and a prospective cohort study conducted from 2017 through 2020 ( 80 ) did not reveal unexpected safety events among pregnant persons. Data from a randomized controlled trial (RCT) conducted at Clinical Immunization Safety Assessment (CISA) Project sites comparing the safety of RIV4 versus IIV4 in 382 pregnant persons supported the safety of RIV4 in pregnancy ( https://stacks.cdc.gov/view/cdc/122379 ) ( 81 ). Pregnancy registries and surveillance studies exist for certain products, for which information can be found in package inserts.

Older Adults

ACIP recommends that adults aged ≥65 years preferentially receive any one of the following higher dose or adjuvanted influenza vaccines: high-dose inactivated influenza vaccine (HD-IIV3), recombinant influenza vaccine (RIV3), or adjuvanted inactivated influenza vaccine (aIIV3). If none of these three vaccines is available at an opportunity for vaccine administration, then any other age-appropriate influenza vaccine should be administered ( 82 , 83 ).

Older adults (aged ≥65 years) are at increased risk for severe influenza-associated illness, hospitalization, and death compared with younger persons ( 4 , 84 , 85 ). Influenza vaccines are often less effective in this population ( 12 ). HD-IIV, RIV, and aIIV have been evaluated in comparison with nonadjuvanted SD-IIVs in this age group. Two of these vaccines, HD-IIV and RIV, are higher dose vaccines, which contain an increased dose of HA antigen per vaccine virus compared with nonadjuvanted SD-IIVs (60 μ g for HD-IIV3 and 45 μ g for RIV3, compared with 15 μ g for standard-dose inactivated vaccines) ( 57 , 58 ). The adjuvanted vaccine contains 15 μ g of HA per virus, similarly to nonadjuvanted SD-IIVs, but contains the adjuvant MF59 ( 59 ).

HD-IIV, RIV, and aIIV have shown relative benefit compared with SD-IIVs in certain studies, with the most evidence available for HD-IIV3. Randomized efficacy studies comparing these vaccines with nonadjuvanted SD-IIVs against laboratory-confirmed influenza outcomes are few in number ( 86 – 88 ) and cover few influenza seasons. Observational studies, predominantly retrospective cohort studies using diagnostic code–defined (rather than laboratory-confirmed) influenza outcomes, are more numerous and include more influenza seasons ( 89 – 99 ). Certain observational studies have reported relative benefit for HD-IIV, RIV, and aIIV in comparison with nonadjuvanted SD-IIVs, particularly in prevention of influenza-associated hospitalizations. The size of this relative benefit has varied from season to season and is not observed in all studies in all seasons, making it difficult to generalize the findings to all or most seasons. Studies directly comparing HD-IIV, RIV, and aIIV with one another are few and do not support a conclusion that any one of these vaccines is consistently superior to the others across seasons ( 89 – 91 , 94 , 100 , 101 ).

Immunocompromised Persons

ACIP recommends that persons with compromised immunity (including but not limited to persons with congenital and acquired immunodeficiency states, persons who are immunocompromised due to medications, and persons with anatomic and functional asplenia) should receive IIV3 or RIV3. All persons should receive an age-appropriate influenza vaccine (i.e., one approved for their age), with the exception that solid organ transplant recipients aged 18 through 64 years who are receiving immunosuppressive medication regimens may receive either HD-IIV3 or aIIV3 as acceptable options (without a preference over other age-appropriate IIV3s or RIV3). ACIP recommends that LAIV3 not be used for immunocompromised persons because of the uncertain but biologically plausible risk for disease attributable to the live vaccine virus. Use of LAIV3 in persons with these and other conditions is discussed in more detail (see Dosage, Administration, Contraindications, and Precautions) (Table 2).

Regarding solid organ transplant recipients specifically, a systematic review and meta-analysis including seven studies pertaining to use of higher dose (HD-IIV, double-dose SD-IIV, and RIV) and MF59-adjuvanted influenza vaccines compared with SD-IIV in this population noted no difference in likelihood of influenza-associated hospitalization (GRADE certainty level Low). However, evidence suggested potentially improved immunogenicity, with greater likelihood of seroconversion for both HD-IIV3 and aIIV3 relative to SD-IIV (GRADE certainty level Moderate for HD-IIV3 vs SD-IIV and Low for aIIV3 vs SD-IIV) for the influenza A(H1N1), influenza A(H3N2), and influenza B vaccine components. There was no evidence of increased risk of graft rejection with either HD-IIV3 or aIIV3 relative to SD-IIV (GRADE certainty level Moderate). Only one study included children. No evidence was available for RIV vs SD-IIV ( https://www.cdc.gov/vaccines/acip/recs/grade/influenza-solid-organ-transplant.html ; https://www.cdc.gov/vaccines/acip/recs/grade/influenza-solid-organ-transplant-etr.html ).

Immunocompromised states comprise a heterogeneous range of conditions with varying risks for severe infections. In many instances, limited data are available regarding the effectiveness of influenza vaccines in the setting of specific immunocompromised states ( 102 ). Timing of vaccination might be a consideration (e.g., vaccinating during a period either before or after an immunocompromising intervention). The Infectious Diseases Society of America has published detailed guidance for the selection and timing of vaccines for persons with specific immunocompromising conditions ( 103 ). Immune response to influenza vaccines might be blunted in persons with certain conditions, such as congenital immune deficiencies, and in persons receiving cancer chemotherapy, posttransplant regimens, or immunosuppressive medications.

Persons with a History of Guillain-Barré Syndrome After Influenza Vaccination

A history of Guillain-Barré syndrome (GBS) within 6 weeks of a previous dose of any type of influenza vaccine is considered a precaution for influenza vaccination (Table 2). Persons who are not at higher risk for severe influenza complications (see Populations at Higher Risk for Medical Complications Attributable to Severe Influenza) and who are known to have experienced GBS within 6 weeks of a previous influenza vaccination typically should not be vaccinated. As an alternative to vaccination, providers might consider using influenza antiviral chemoprophylaxis for these persons ( 104 ). However, the benefits of influenza vaccination might outweigh the possible risks for certain persons who have a history of GBS within 6 weeks after receipt of influenza vaccine and who also are at higher risk for severe complications from influenza.

Persons with a History of Egg Allergy

ACIP recommends that all persons aged ≥6 months with egg allergy should receive influenza vaccine. Any influenza vaccine (egg based or nonegg based) that is otherwise appropriate for the recipient’s age and health status can be used ( https://www.cdc.gov/vaccines/acip/recs/grade/influenza-egg-allergy.html ; https://www.cdc.gov/vaccines/acip/recs/grade/influenza-egg-allergy-etr.html ). Egg allergy alone necessitates no additional safety measures for influenza vaccination beyond those recommended for any recipient of any vaccine, regardless of severity of previous reaction to egg. All vaccines should be administered in settings in which personnel and equipment needed for rapid recognition and treatment of acute hypersensitivity reactions are available.

Most available influenza vaccines, with the exceptions of RIV3 (Flublok, licensed for persons aged ≥18 years) and ccIIV3 (Flucelvax, licensed for persons aged ≥6 months), are prepared by propagation of virus in embryonated eggs and might contain trace amounts of egg proteins, such as ovalbumin. Among those U.S.-licensed influenza vaccines for which ovalbumin content is reported, quantities are generally small (≤1 μ g/0.5mL dose) ( 51 , 52 , 54 – 56 , 58 , 59 ). Reviews of studies of administration of egg-based influenza vaccines to persons with egg allergy have noted no cases of anaphylaxis or serious hypersensitivity reactions ( 105 , 106 ). Severe allergic reactions after administration of the egg-free vaccine RIV to egg-allergic persons have been noted in VAERS reports ( 107 – 109 ). These reports highlight both the possibility that observed reactions after egg-based influenza vaccines might be caused by substances other than egg proteins and the importance of being prepared to recognize and manage serious hypersensitivity reactions when administering any vaccine to any recipient (regardless of allergy history).

Severe and life-threatening reactions to vaccines can rarely occur with any vaccine and in any vaccine recipient, regardless of allergy history. Providers are reminded that all vaccines should be administered in settings in which personnel and equipment needed for rapid recognition and treatment of acute hypersensitivity reactions are available. All vaccination providers should be familiar with their office emergency plan and be certified in cardiopulmonary resuscitation ( 110 ). No postvaccination observation period is recommended specifically for egg-allergic persons. However, ACIP recommends that vaccination providers consider observing patients (seated or supine) for 15 minutes after administration of any vaccine to decrease the risk for injury should syncope occur ( 110 ).

Although egg allergy is neither a contraindication nor precaution to the use of any influenza vaccine, there are contraindications and precautions related to allergies to vaccine components other than egg and to previous allergic reactions to influenza vaccines (see Persons with Previous Allergic Reactions to Influenza Vaccines and Dosage, Administration, Contraindications, and Precautions) (Tables 2 and 3).

Persons with Previous Allergic Reactions to Influenza Vaccines

As is the case for all vaccines, influenza vaccines contain various components that might cause allergic and anaphylactic reactions. Most influenza vaccine package inserts list among contraindications to their use a history of previous severe allergic reaction (e.g., anaphylaxis) to any component of the vaccine or to a previous dose of any influenza vaccine ( 51 , 52 , 54 – 56 , 58 , 59 ). For ccIIV3 and RIV3, a history of a severe allergic reaction to any vaccine component is listed as a contraindication; no labeled contraindication is specified for a history of allergic reaction to any other influenza vaccine ( 53 , 57 ). However, severe allergic reactions, although rare, can occur after influenza vaccination, even among persons with no previous reactions or known allergies. Vaccine components and excipients can be found in package inserts. However, identifying the causative agent without further evaluation (i.e., through evaluation and testing for specific allergies) can be difficult. Severe allergic reactions after vaccination with RIV have been reported to VAERS, certain of which have occurred among persons reporting previous allergic reactions to egg or to influenza vaccines and that might represent a predisposition to allergic manifestations in affected persons ( 107 – 109 ). Because these rare but severe allergic reactions can occur, ACIP recommends the following for persons with a history of severe allergic reaction to a previous dose of an influenza vaccine (Table 3):

• A history of severe allergic reaction (e.g., anaphylaxis) to any influenza vaccine (i.e., any egg-based IIV, ccIIV, RIV, or LAIV of any valency) is a contraindication to future receipt of all egg-based IIV3s and LAIV3. Each individual egg-based IIV3 and LAIV3 is also contraindicated for persons who have had a severe allergic reaction (e.g., anaphylaxis) to any component of that vaccine (excluding egg; see Persons with a History of Egg Allergy).
• A history of a severe allergic reaction (e.g., anaphylaxis) to any egg-based IIV, RIV, or LAIV of any valency is a precaution for the use of ccIIV3. If ccIIV3 is administered in such instances, vaccination should occur in an inpatient or outpatient medical setting and should be supervised by a health care provider who is able to recognize and manage severe allergic reactions. Providers also can consider consultation with an allergist to help determine the vaccine component responsible for the allergic reaction.
• A history of a severe allergic reaction (e.g., anaphylaxis) to any ccIIV of any valency or to any component of ccIIV3 is a contraindication to future receipt of ccIIV3.
• A history of a severe allergic reaction (e.g., anaphylaxis) to any egg-based IIV, ccIIV, or LAIV of any valency is a precaution for the use of RIV3. If RIV3 is administered in such instances, vaccination should occur in an inpatient or outpatient medical setting and should be supervised by a health care provider who is able to recognize and manage severe allergic reactions. Providers can also consider consultation with an allergist to help determine the vaccine component responsible for the allergic reaction.
• A history of a severe allergic reaction (e.g., anaphylaxis) to any RIV of any valency or to any component of RIV3 is a contraindication to future receipt of RIV3.

Vaccination Issues for Travelers

In temperate climate regions of the Northern and Southern Hemispheres, influenza activity is seasonal, occurring during approximately October–May in the Northern Hemisphere and April–September in the Southern Hemisphere. In the tropics, influenza might occur throughout the year ( 111 ). The timing of influenza activity and predominant types and subtypes of influenza viruses in circulation vary by geographic region ( 112 ). Travelers can be exposed to influenza when traveling to an area where influenza is circulating or when traveling as part of large tourist groups (e.g., on cruise ships) that include persons from areas of the world where influenza viruses are circulating ( 113 – 116 ).

Travelers who want to reduce their risk for influenza should consider influenza vaccination, preferably at least 2 weeks before departure. In particular, persons who live in the United States and are at higher risk for influenza complications and who were not vaccinated with influenza vaccine during the previous Northern Hemisphere fall or winter should consider receiving influenza vaccination before departure if they plan to travel to the tropics, to the Southern Hemisphere during the Southern Hemisphere influenza season (April–September), or with organized tourist groups or on cruise ships to any location. Persons at higher risk who received the previous season’s influenza vaccine before travel should consult with their health care provider to discuss the risk for influenza and other travel-related diseases before embarking on travel during the summer. All persons (regardless of risk status) who are vaccinated in preparation for travel before the upcoming influenza season’s vaccine is available, or who received the immediately preceding Southern Hemisphere influenza vaccine, should receive the current U.S. seasonal influenza vaccine the following fall or winter.

Influenza vaccine formulated for the Southern Hemisphere might differ in viral composition from the Northern Hemisphere vaccine. For persons traveling to the Southern Hemisphere during the Southern Hemisphere influenza season, receipt of a current U.S.-licensed Southern Hemisphere influenza vaccine formulation before departure might be reasonable but might not be feasible because of limited access to or unavailability of Southern Hemisphere formulations in the United States. Most Southern Hemisphere influenza vaccine formulations are not licensed in the United States, and they are typically not commercially available. More information on influenza vaccines and travel is available at https://wwwnc.cdc.gov/travel/diseases/influenza-seasonal-zoonotic-and-pandemic . Additional information on global influenza surveillance by region is available at https://www.who.int/tools/flunet .

Use of Influenza Antiviral Medications

Administration of any IIV3 or RIV3 to persons receiving influenza antiviral medications for treatment or chemoprophylaxis of influenza is acceptable. Data concerning vaccination with LAIV3 in the setting of influenza antiviral use are not available. However, influenza antiviral medications might interfere with the action of LAIV3 because this vaccine contains live influenza viruses.

The package insert for LAIV3 notes that influenza antiviral agents might reduce the effectiveness of the vaccine if administered within the interval from 48 hours before to 14 days after vaccination ( 56 ). However, the newer influenza antivirals peramivir and baloxavir have longer half-lives than oseltamivir and zanamivir, approximately 20 hours for peramivir ( 117 ) and 79 hours for baloxavir ( 118 ), and could potentially interfere with the replication of LAIV3, if administered >48 hours before vaccination. Potential interactions between influenza antivirals and LAIV3 have not been studied, and the ideal intervals between administration of these medications and LAIV3 are not known. Assuming a period of at least 5 half-lives for substantial decrease in drug levels ( 119 ), a reasonable assumption is that peramivir might interfere with the mechanism of LAIV3 if administered from 5 days before through 2 weeks after vaccination and baloxavir might interfere if administered from 17 days before through 2 weeks after vaccination. The interval between influenza antiviral receipt and LAIV3 during which interference might occur could be further prolonged in the presence of medical conditions that delay medication clearance (e.g., renal insufficiency). Persons who receive these medications during these periods before or after receipt of LAIV3 should be revaccinated with another appropriate influenza vaccine (e.g., IIV3 or RIV3).

Administration of Influenza Vaccines with Other Vaccines

IIV3s and RIV3 can be administered simultaneously or sequentially with other inactivated vaccines or live vaccines. Injectable vaccines that are given concomitantly should be administered at separate anatomic sites. Vaccines that are administered at the same time as influenza vaccines that might be more likely to be associated with local injection site reactions (e.g., HD-IIV3 and aIIV3) should be given in different limbs, if possible. LAIV3 can be administered simultaneously with other live or inactivated vaccines. However, if two live vaccines are not given simultaneously, at least 4 weeks should pass after administration of one live vaccine (such as LAIV3) before another live vaccine is administered ( 110 ).

In recent years, multiple vaccines containing nonaluminum adjuvants have been licensed for use in the United States for the prevention of various infectious diseases. Examples include AS01 B (in Shingrix, recombinant zoster subunit vaccine [RZV]) ( 120 ), AS01 E (in Arexvy, respiratory syncytial virus vaccine) ( 121 ) MF59 (in Fluad [aIIV3]) ( 59 ), and cytosine phosphoguanine oligodeoxynucleotide (in Heplisav-B, recombinant hepatitis B surface antigen vaccine) ( 122 ). Data are limited regarding coadministration of these vaccines with other adjuvanted or nonadjuvanted vaccines, including COVID-19 vaccines. Coadministration of RZV with nonadjuvanted IIV4 has been studied, and no evidence of decreased immunogenicity or safety concerns was noted ( 123 ). A CISA RCT in persons aged ≥65 years found that the proportion of participants with at least one severe local or systemic reaction was not higher after simultaneous administration of RZV dose 1 and quadrivalent adjuvanted inactivated influenza vaccine compared with simultaneous administration of RZV dose 1 and quadrivalent high-dose inactivated influenza vaccine ( 124 ). Data on the immunogenicity and safety of simultaneous or sequential administration of two nonaluminum adjuvant–containing vaccines are limited, and the ideal interval between such vaccines when given sequentially is not known. In the study of Shingrix and nonadjuvanted IIV4 ( 123 ), most reactogenicity symptoms resolved within 4 days. Because of the limited data on the safety of simultaneous administration of two or more vaccines containing nonaluminum adjuvants and the availability of nonadjuvanted influenza vaccine options, selection of a nonadjuvanted influenza vaccine can be considered in situations in which influenza vaccine and another vaccine containing a nonaluminum adjuvant are to be administered concomitantly. However, influenza vaccination should not be delayed if a specific vaccine is not available. As recommended for all vaccines, vaccines with nonaluminum adjuvants should be administered at separate anatomic sites from other vaccines that are given concomitantly ( 110 ).

For more recently introduced and new vaccines, data informing simultaneous administration with influenza vaccines might be limited or evolving. Providers should consult current CDC/ACIP recommendations and guidance for up-to-date information.

Influenza Vaccine Composition for the 2024–25 Season

All influenza vaccines licensed in the United States will contain components derived from influenza viruses antigenically similar to those recommended by FDA ( https://www.fda.gov/advisory-committees/advisory-committee-calendar/vaccines-and-related-biological-products-advisory-committee-march-5-2024-meeting-announcement ) ( 125 ). All influenza vaccines expected to be available in the United States for the 2024–25 season will be trivalent vaccines. For the 2024–25 season, U.S. egg-based influenza vaccines (i.e., vaccines other than ccIIV3 and RIV3) will contain HA derived from

• an influenza A/Victoria/4897/2022 (H1N1)pdm09-like virus,
• an influenza A/Thailand/8/2022 (H3N2)-like virus, and
• an influenza B/Austria/1359417/2021 (Victoria lineage)-like virus.

For the 2024–25 season, U.S. cell culture–based inactivated (ccIIV3) and recombinant (RIV3) influenza vaccines will contain HA derived from

• an influenza A/Wisconsin/67/2022 (H1N1)pdm09-like virus,
• an influenza A/Massachusetts/18/2022 (H3N2)-like virus, and
• an influenza B/Austria/1359417/2021 (Victoria lineage)-like virus

Vaccines Available for the 2024–25 Season

Availability of specific types and brands of licensed seasonal influenza vaccines in the United States is determined by the manufacturers of the vaccines. Information presented concerning vaccines expected to be available and their approved indications and usage reflects current knowledge and is subject to change.

Various influenza vaccines will be available for the 2024–25 season (Table 1). For many vaccine recipients, more than one type or brand of vaccine might be appropriate within approved indications and ACIP recommendations. Current prescribing information and ACIP recommendations should be consulted for up-to-date information. Contraindications and precautions for the different types of influenza vaccines are summarized (Tables 2 and 3), as are dose volumes (Table 4).

Not all influenza vaccines are likely to be uniformly available in any specific practice setting or geographic locality. Vaccination should not be delayed to obtain a specific product when an appropriate one is available. Within these guidelines and approved indications, ACIP makes no preferential recommendation for the use of any one influenza vaccine over another when more than one licensed and recommended vaccine is available, except for selection of influenza vaccines for persons aged ≥65 years (see Older Adults).

Dosage, Administration, Contraindications, and Precautions

Trivalent inactivated influenza vaccines (iiv3s).

Available Vaccines. As in recent seasons, various inactivated influenza vaccines (IIVs) are expected to be available for 2024–25 (Table 1); all are expected to be trivalent (IIV3s). Standard-dose, nonadjuvanted IIV3s are licensed for persons aged as young as 6 months. However, for certain IIV3s, the approved dose volume for children aged 6 through 35 months differs from that for older children and adults (Table 4). Care should be taken to administer the appropriate dose volume. Two IIV3s, the MF59-adjuvanted IIV3 Fluad (aIIV3) and the high-dose IIV3 Fluzone High-Dose (HD-IIV3), are approved only for persons aged ≥65 years, but are acceptable options for solid organ transplant recipients aged 18 through 64 years who are receiving immunosuppressive medication regimens, without a preference over other age-appropriate IIV3s or RIV3.

Standard-dose, nonadjuvanted IIV3s contain 15 μ g of HA per vaccine virus in a 0.5-mL dose (7.5 μ g of HA per vaccine virus in a 0.25-mL dose). For 2024–25, this category is expected to include five different vaccines (Table 1). Four of these are egg-based vaccines (Afluria, Fluarix, FluLaval, and Fluzone), and one is a cell culture–based vaccine (Flucelvax [ccIIV3]). All are approved for persons aged ≥6 months. Egg-based and cell culture–based vaccines differ in the substrate in which reference vaccine viruses supplied to the manufacturer are propagated in quantities sufficient to produce the needed number of doses of vaccine. For the IIV3s Afluria ( 51 ), Fluarix ( 52 ), FluLaval ( 54 ), and Fluzone ( 55 ), reference vaccine viruses are propagated in eggs. For Flucelvax (ccIIV3), reference vaccine viruses are propagated in Madin-Darby canine kidney cells instead of eggs ( 53 ).

Two additional IIV3s that will be available for the 2024–25 season are approved only for persons aged ≥65 years. These vaccines are egg based. Trivalent high-dose inactivated influenza vaccine (Fluzone High-Dose; HD-IIV3) contains 60 μ g of HA per vaccine virus (180 μ g total) in a 0.5-mL dose ( 58 ). Trivalent adjuvanted inactivated influenza vaccine (Fluad; aIIV3) contains 15 μ g of HA per vaccine virus (45 μ g total) and MF59 adjuvant ( 59 ).

Dosage and Administration. Standard-dose nonadjuvanted IIV3s are approved for children aged as young as 6 months. Certain of these IIV3s are approved at different dose volumes for very young children than for older children and adults. Care should be taken to administer the correct dose volume for each needed dose (see Children Aged 6 Through 35 Months: Influenza Vaccine Dose Volumes) (Tables 1 and 4):

• Afluria: The approved dose volume for children aged 6 through 35 months is 0.25 mL per dose. Persons aged ≥36 months (≥3 years) should receive 0.5 mL per dose ( 51 ).
• Fluarix: The approved dose volume is 0.5 mL per dose for all persons aged ≥6 months ( 52 ).
• Flucelvax: The approved dose volume is 0.5 mL per dose for all persons aged ≥6 months ( 53 ).
• FluLaval: The approved dose volume is 0.5 mL per dose for all persons aged ≥6 months ( 54 ).
• Fluzone: The approved dose volume for children aged 6 through 35 months is either 0.25 mL or 0.5 mL per dose. Persons aged ≥36 months (≥3 years) should receive 0.5 mL per dose ( 55 ).

If prefilled syringes are not available, the appropriate volume can be administered from a multidose vial. Of note, dose volume is distinct from the number of doses. Children in this age group who require 2 doses for 2024–25 need 2 separate doses administered ≥4 weeks apart, regardless of the specific IIV3 used and volume given for each dose (see Children Aged 6 Months Through 8 Years: Number of Influenza Vaccine Doses) (Figure).

For children aged 36 months (3 years) through 17 years and adults aged ≥18 years, the dose volume for all IIV3s is 0.5 mL per dose. If a smaller vaccine dose (e.g., 0.25 mL) is inadvertently administered to a person aged ≥36 months, the remaining volume needed to make a full dose should be administered during the same vaccination visit or, if measuring the needed remaining volume is a challenge, administering a repeat dose at the full volume is acceptable. If the error is discovered later (after the recipient has left the vaccination setting), a full dose should be administered as soon as the recipient can return. Vaccination with a formulation approved for adult use should be counted as a single dose if inadvertently administered to a child.

IIV3s are administered intramuscularly (IM). For adults and older children, the deltoid muscle is the preferred site. Infants and younger children should be vaccinated in the anterolateral thigh. Additional specific guidance regarding site selection and needle length for IM injection is provided in the General Best Practice Guidelines for Immunization ( 110 ). One IIV3, Afluria, is licensed for IM injection via the PharmaJet Stratis jet injector for persons aged 18 through 64 years ( 51 ). Persons in this age group can receive Afluria via either needle and syringe or this specific jet injection device. Children aged 6 months through 17 years and adults aged ≥65 years should receive this vaccine by needle and syringe only. No other IIV3s are licensed for administration by jet injector.

Contraindications and Precautions for the Use of IIV3s. Manufacturer package inserts and updated CDC and ACIP guidance should be consulted for information on contraindications and precautions for individual influenza vaccines. Each IIV3, whether egg based or cell culture based, has a labeled contraindication for persons with a history of a severe allergic reaction to any component of that vaccine (Tables 2 and 3). However, although egg is a component of all IIV3s other than ccIIV3, ACIP makes specific recommendations for the use of influenza vaccine for persons with egg allergy (see Persons with a History of Egg Allergy). All egg-based IIV3s are contraindicated in persons who have had a severe allergic reaction (e.g., anaphylaxis) to a previous dose of any influenza vaccine (any egg-based IIV, ccIIV, RIV, or LAIV of any valency). Use of ccIIV3 is contraindicated in persons who have had a severe allergic reaction (e.g., anaphylaxis) to any ccIIV of any valency. A history of severe allergic reaction (e.g., anaphylaxis) to any other influenza vaccine (i.e., any egg-based IIV, RIV, or LAIV of any valency) is a precaution for the use of ccIIV3 (see Persons with Previous Allergic Reactions to Influenza Vaccines) (Tables 2 and 3). If ccIIV3 is administered in such an instance, vaccination should occur in an inpatient or outpatient medical setting and should be supervised by a health care provider who is able to recognize and manage severe allergic reactions. Providers can also consider consultation with an allergist to help identify the vaccine component responsible for the reaction. Information about vaccine components can be found in the package inserts for each vaccine. Prophylactic use of antiviral agents is an option that can be considered for preventing influenza among persons who cannot receive vaccine, particularly for those who are at higher risk for medical complications attributable to severe influenza ( 104 ).

Moderate or severe acute illness with or without fever is a general precaution for vaccination ( 110 ). A history of GBS within 6 weeks after receipt of a previous dose of influenza vaccine is considered a precaution for the use of all influenza vaccines (Table 2).

Trivalent Recombinant Influenza Vaccine (RIV3)

Available Vaccine. One recombinant influenza vaccine, Flublok (RIV3), is expected to be available during the 2024–25 influenza season. RIV3 is approved for persons aged ≥18 years. This vaccine contains recombinant HA produced in an insect cell line using genetic sequences from cell-derived influenza viruses and is manufactured without the use of influenza viruses or eggs ( 57 ).

Dosage and Administration . RIV3 is administered by IM injection via needle and syringe. A 0.5-mL dose contains 45 μ g of HA derived from each vaccine virus (135 μ g total).

Contraindications and Precautions for the Use of RIV3. Manufacturer package inserts and updated CDC and ACIP guidance should be consulted for information on contraindications and precautions for individual influenza vaccines. RIV3 is contraindicated in persons who have had a severe allergic reaction (e.g., anaphylaxis) to a previous dose of any RIV of any valency or to any component of RIV3. A history of a severe allergic reaction (e.g., anaphylaxis) to any other influenza vaccine (i.e., any egg-based IIV, ccIIV, or LAIV of any valency) is a precaution for the use of RIV3. If RIV3 is administered in such an instance, vaccination should occur in an inpatient or outpatient medical setting and should be supervised by a health care provider who is able to recognize and manage severe allergic reactions. Providers can also consider consulting with an allergist to help identify the vaccine component responsible for the reaction (Tables 2 and 3).

Moderate or severe acute illness with or without fever is a general precaution for vaccination ( 110 ). A history of GBS within 6 weeks after receipt of a previous dose of influenza vaccine is considered a precaution for the use of all influenza vaccines (Table 2). RIV3 is not approved for children aged <18 years.

Trivalent Live Attenuated Influenza Vaccine (LAIV3)

Available Vaccine. One live attenuated influenza vaccine, FluMist (LAIV3), is expected to be available during the 2024–25 influenza season. LAIV3 is approved for persons aged 2 through 49 years. LAIV3 contains live attenuated influenza viruses that are propagated in eggs. These viruses are cold adapted (so that they replicate efficiently at 25°C [77°F]) and temperature sensitive (so that their replication is restricted at higher temperatures, 39°C [102.2°F] for influenza A viruses and 37°C [98.6°] for influenza B viruses). The live attenuated vaccine viruses replicate in the nasopharynx, which is necessary to promote an immune response ( 56 ). No preference is expressed for LAIV3 versus other influenza vaccines used within specified indications.

Dosage and Administration. LAIV3 is administered intranasally using the supplied prefilled, single-use sprayer containing 0.2 mL of vaccine. Approximately 0.1 mL (i.e., one half of the total sprayer contents) is sprayed into the first nostril while the recipient is in the upright position. An attached dose-divider clip is removed from the sprayer to permit administration of the second half of the dose into the other nostril. Sniffing of the dose is not necessary. If the recipient sneezes immediately after administration, the dose should not be repeated. However, if nasal congestion is present that might impede delivery of the vaccine to the nasopharyngeal mucosa, deferral of administration should be considered until resolution of the illness, or another appropriate vaccine should be administered instead. Each total dose of 0.2 mL contains 10 6.5–7.5 fluorescent focus units of each vaccine virus ( 56 ).

Contraindications and Precautions for the Use of LAIV3. Manufacturer package inserts and updated CDC and ACIP guidance should be consulted for information on contraindications and precautions for individual influenza vaccines. Conditions considered by ACIP to be contraindications and precautions for the use of LAIV3 are summarized (Table 2). These include two labeled contraindications that appear in the package insert ( 56 ) and other conditions for which there is either uncertain but biologically plausible potential risk associated with live viruses or limited data for use of LAIV. Contraindications to use of LAIV3 include the following (Tables 2 and 3):

• Severe allergic reaction (e.g., anaphylaxis) to any component of the vaccine or to a previous dose of any influenza vaccine (i.e., any egg-based IIV, ccIIV, RIV, or LAIV of any valency; a labeled contraindication noted in the package insert). However, although egg is a component of LAIV3, ACIP makes specific recommendations for the use of influenza vaccine for persons with egg allergy (see Persons with a History of Egg Allergy).
• Children and adolescents receiving concomitant aspirin- or salicylate-containing medications, because of the potential risk for Reye syndrome (a labeled contraindication noted in the package insert).
• Children aged 2 through 4 years who have received a diagnosis of asthma or whose parents or caregivers report that a health care provider has told them during the preceding 12 months that their child had wheezing or asthma or whose medical record indicates a wheezing episode has occurred during the preceding 12 months.
• Children and adults who are immunocompromised due to any cause, including but not limited to immunosuppression caused by medications, congenital or acquired immunodeficiency states, HIV infection, anatomic asplenia, or functional asplenia (such as that due to sickle cell anemia).
• Close contacts and caregivers of severely immunosuppressed persons who require a protected environment.
• Persons with active communication between the cerebrospinal fluid (CSF) and the oropharynx, nasopharynx, nose, or ear or any other cranial CSF leak.
• Persons with cochlear implants, because of the potential for CSF leak that might exist for a period after implantation (providers might consider consultation with a specialist concerning the risk for persistent CSF leak if an inactivated or recombinant vaccine cannot be used).
• Receipt of influenza antiviral medication within the previous 48 hours for oseltamivir and zanamivir, previous 5 days for peramivir, and previous 17 days for baloxavir. The interval between influenza antiviral receipt and LAIV3 during which interference might potentially occur might be further prolonged in the presence of medical conditions that delay medication clearance (e.g., renal insufficiency).

Precautions to the use of LAIV3 include the following (Tables 2 and 3):

• Moderate or severe acute illness with or without fever.
• History of GBS within 6 weeks after receipt of any influenza vaccine.
• Asthma in persons aged ≥5 years.
• Other underlying medical condition (other than those listed under contraindications) that might predispose to complications after wild-type influenza virus infection (e.g., chronic pulmonary, cardiovascular [except isolated hypertension], renal, hepatic, neurologic, hematologic, or metabolic disorders [including diabetes mellitus]).

In all instances, approved manufacturer packaging information should be consulted for authoritative guidance concerning storage and handling of specific influenza vaccines. Typically, influenza vaccines should be protected from light and stored at temperatures that are recommended in the package insert. Recommended storage temperatures are typically 36°F–46°F (2°C–8°C) and should be maintained at all times with adequate refrigeration and temperature monitoring. Vaccine that has frozen should be discarded. Specific recommendations for appropriate refrigerators and temperature monitoring equipment can be found in the Vaccine Storage and Handling Toolkit, available at https://www.cdc.gov/vaccines/hcp/storage-handling/?CDC_AAref_Val=https://www.cdc.gov/vaccines/hcp/admin/storage/toolkit/index.html .

Vaccines should not be used beyond the expiration date on the label. In addition to the expiration date, multidose vials also might have a beyond-use date (BUD), which specifies the number of days the vaccine can be kept once first accessed. After being accessed for the first dose, multidose vials should not be used after the BUD. If no BUD is provided, then the listed expiration date is to be used. Multidose vials should be returned to recommended storage conditions between uses. Package information might also specify a maximum number of doses contained in multidose vials (regardless of remaining volume). No more than the specified number of doses should be removed, and any remainder should be discarded. Providers should contact the manufacturer for information on permissible temperature excursions and other departures from recommended storage and handling conditions that are not discussed in the package labeling.

Influenza Surveillance, Prevention, and Control

Updated information regarding influenza surveillance, detection, prevention, and control is available at https://www.cdc.gov/flu . U.S. surveillance data are updated weekly throughout the year on FluView ( https://www.cdc.gov/flu/weekly ) and can be viewed in FluView Interactive ( https://www.cdc.gov/flu/weekly/fluviewinteractive.htm ). In addition, periodic updates regarding influenza are published in MMWR ( https://www.cdc.gov/mmwr/index.html ). Additional information regarding influenza and influenza vaccines can be obtained from CDCINFO by calling 1–800–232–4636. State and local health departments should be consulted about availability of influenza vaccines, access to vaccination programs, information related to state or local influenza activity, reporting of influenza outbreaks and influenza-related pediatric deaths, and advice concerning outbreak control.

Vaccine Adverse Event Reporting System (VAERS)

The National Childhood Vaccine Injury Act of 1986 requires health care providers to report any adverse event listed by the vaccine manufacturer as a contraindication to future doses of the vaccine or any adverse event listed in the VAERS Table of Reportable Events Following Vaccination ( https://vaers.hhs.gov/docs/VAERS_Table_of_Reportable_Events_Following_Vaccination.pdf ) that occurs within the specified period after vaccination. In addition to mandated reporting, health care providers are encouraged to report any clinically significant adverse event after vaccination to VAERS. Information on how to report a vaccine adverse event is available at https://vaers.hhs.gov/index.html .

National Vaccine Injury Compensation Program (VICP)

The National Vaccine Injury Compensation Program (VICP), established by the National Childhood Vaccine Injury Act of 1986, as amended, is a no-fault alternative to the traditional tort system. It provides compensation to persons found to be injured by certain vaccines. VICP covers most vaccines routinely given in the United States. The Vaccine Injury Table ( https://www.hrsa.gov/sites/default/files/hrsa/vicp/vaccine-injury-table-01-03-2022.pdf ) lists the vaccines covered by VICP and the associated injuries and conditions that might receive a legal presumption of causation. If the injury or condition is not in the table or does not meet the requirements in the table, persons must prove that the vaccine caused the injury or condition. Claims must be filed within specified time frames. Persons of all ages who receive a VICP-covered vaccine might be eligible to file a claim. Additional information is available at https://www.hrsa.gov/vaccine-compensation or by calling 1–800–338–2382.

Additional Resources

Acip statements.

• Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States: https://www.cdc.gov/vaccines/hcp/imz-schedules/adult-age.html?CDC_AAref_Val=https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html
• Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, United States: https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html
• Immunization of Health Care Personnel: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2011. MMWR Recomm Rep 2011;60(No.RR-7):1–45: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6007a1.htm

General Best Practice Guidelines for Immunization:

• General Best Practice Guidelines for Immunization: https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html

COVID-19 Vaccine Recommendations and Guidance

• ACIP recommendations for the use of COVID-19 vaccines: https://www.cdc.gov/acip-recs/hcp/vaccine-specific/covid-19.html?CDC_AAref_Val=https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/covid-19.html
• Clinical Care Considerations for COVID-19 Vaccination: https://www.cdc.gov/vaccines/covid-19/clinical-considerations/index.html
• Use of COVID-19 Vaccines in the United States—Interim Clinical Considerations: https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html
• FDA COVID-19 Vaccines page: https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccines

Vaccine Information Sheets

• IIV3 and RIV3: https://www.cdc.gov/vaccines/hcp/vis/vis-statements/flu.pdf
• LAIV3: https://www.cdc.gov/vaccines/hcp/vis/vis-statements/flulive.pdf

Influenza Vaccine Package Inserts

• https://www.fda.gov/vaccines-blood-biologics/vaccines/vaccines-licensed-use-united-states

CDC Influenza Antiviral Guidance

• Influenza Antiviral Medications: Summary for Clinicians: https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm

Infectious Diseases Society of America Influenza Antiviral Guidance

• Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenza: https://academic.oup.com/cid/article/68/6/e1/5251935
• American Academy of Pediatrics Guidance
• American Academy of Pediatrics Recommendations for Prevention and Control of Influenza in Children (Red Book Online): https://publications.aap.org/redbook

Infectious Diseases Society of America Guidance for Vaccination of Immunocompromised Hosts

• 2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host: https://academic.oup.com/cid/article/58/3/e44/336537

American College of Obstetricians and Gynecologists

• Influenza in Pregnancy: Prevention and Treatment: https://www.acog.org/clinical/clinical-guidance/committee-statement/articles/2024/02/influenza-in-pregnancy-prevention-and-treatment

Voting members of the Advisory Committee on Immunization Practices: Helen Keipp Talbot, MD, Vanderbilt University, Nashville, Tennessee (Chair); Oliver Brooks, MD, Watts HealthCare Corporation, Los Angeles, California; Wilbur H. Chen, MD, University of Maryland School of Medicine, Baltimore, Maryland; Sybil Cineas, MD, Warren Alpert Medical School of Brown University, Providence, Rhode Island; Matthew F. Daley, MD, Kaiser Permanente Colorado, Aurora, Colorado; Denise J. Jamieson, MD, Carver College of Medicine, University of Iowa, Iowa City, Iowa; Camille Nelson Kotton, MD, Harvard Medical School, Boston, Massachusetts; Jamie Loehr, MD, Cayuga Family Medicine, Ithaca, New York; Sarah S. Long, MD, Drexel University College of Medicine, Philadelphia, Pennsylvania; Yvonne Maldonado, MD, Stanford University School of Medicine, Palo Alto, California; Robert Schechter, MD, California Department of Public Health, Richmond, California; Albert Shaw, MD, Yale School of Medicine, New Haven, Connecticut.

Alicia Budd, MPH; Jessie Chung, MPH; Sascha Ellington, PhD; Brendan Flannery, PhD; Andrew Kroger, MD; Samantha Olson, MPH; David Shay, MD; Tom Shimabukuro, MD; and Tim Uyeki, MD; CDC.

Jamie Loehr, MD, Ithaca, New York (Chair); Robert Atmar, MD, Houston, Texas; Kevin Ault, MD, Kalamazoo, Michigan; Edward Belongia, MD, Marshfield, Wisconsin; Henry Bernstein, DO, Hempstead, New York; Thomas Boyce, MD, Marshfield, Wisconsin; Timothy Brennan, MD, Silver Spring, Maryland; Kristina Angel Bryant, MD, Louisville, Kentucky; Doug Campos-Outcalt, MD, Phoenix, Arizona; Uzo Chukwuma, PhD, Rockville, Maryland; Sarah Coles, MD, Phoenix, Arizona; Frances Ferguson, MD, Newton, Georgia; Alicia Fry, MD, Atlanta, Georgia; Sandra Adamson Fryhofer, MD, Atlanta, Georgia; Krissy Moehling Geffel, PhD, Pittsburgh, Pennsylvania; Michael Ison, MD, Rockville, Maryland; Wendy Keitel, MD, Houston, Texas; Camille Kotton, MD, Boston, Massachusetts; Marie-Michèle Léger, MPH, Alexandria, Virginia; Susan Lett, MD, Boston, Massachusetts; Zackary Moore, MD, Raleigh, North Carolina; Rebecca L. Morgan, PhD, Cleveland, Ohio; Cynthia Nolletti, MD, Silver Spring, Maryland; Jesse Papenburg, MD, Montreal, Quebec, Canada; Jo Resnick, PhD, Silver Spring, Maryland; Chris Roberts, PhD; Rockville, Maryland; William Schaffner, MD, Nashville, Tennessee; Robert Schechter, MD, Richmond, California; Kenneth Schmader, MD, Durham, North Carolina; Tamara Sheffield, MD, Salt Lake City, Utah; Angela Sinilaite, MPH, Ottawa, Ontario, Canada; Peter Szilagyi, MD, Los Angeles, California; Helen Keipp Talbot, MD, Nashville, Tennessee Matthew Zahn, MD, Santa Ana, California.

Corresponding author : Lisa A. Grohskopf, Influenza Division, National Center for Immunization and Respiratory Diseases, CDC. Telephone: 404-639-2552; Email: [email protected] .

1 Influenza Division, National Center for Immunization and Respiratory Diseases, CDC; 2 Immunization Safety Office, National Center for Emerging and Zoonotic Infectious Diseases, CDC; 3 Jamie Loehr, MD, Cayuga Family Medicine, Ithaca, New York

Disclosure of Relationship and Unlabeled Use

All authors have completed and submitted the International Committee of Medical Journal Editors form for the disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

This report includes discussion of the unlabeled use of influenza vaccines in the recommendations for persons with a history of egg allergy and for solid organ transplant recipients aged 18 through 64 years. With regard to persons with a history of egg allergy, history of severe allergic reaction (e.g., anaphylaxis) to the vaccine or any of its components (which include egg for certain vaccines) is a labeled contraindication to receipt of most IIV3s and LAIV3. However, ACIP recommends that all persons aged ≥6 months with egg allergy should receive influenza vaccine. Any influenza vaccine (egg based or nonegg based) that is otherwise appropriate for the recipient’s age and health status can be used. With regard to solid organ transplant recipients aged 18 through 64 years, the high-dose inactivated influenza vaccine (HD-IIV3) and adjuvanted inactivated influenza vaccine (aIIV3) are approved for persons aged ≥65 years. However, ACIP recommends that solid organ transplant recipients aged 18 through 64 years who are receiving immunosuppressive medication regimens may receive either HD-IIV3 or aIIV3 as acceptable options, without a preference over other age-appropriate IIV3s or RIV3.

CDC Adoption of ACIP Recommendations for MMWR Recommendations and Reports, MMWR Policy Notes, and Immunization Schedules (Child/Adolescent, Adult)

Recommendations for routine use of vaccines in children, adolescents, and adults are developed by the Advisory Committee on Immunization Practices (ACIP). ACIP is chartered as a Federal Advisory Committee to provide expert external advice and guidance to the Director of CDC on use of vaccines and related agents for the control of vaccine preventable diseases in the civilian population of the United States. Recommendations for routine use of vaccines in children and adolescents are harmonized to the greatest extent possible with recommendations made by the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), the American College of Obstetricians and Gynecologists (ACOG), the American College of Nurse-Midwives (ACNM), the American Academy of Physician Associates (AAPA), and the National Association of Pediatric Nurse Practitioners (NAPNAP). Recommendations for routine use of vaccinations in adults are harmonized with recommendations of AAFP, ACOG, ACNM, AAPA, the American College of Physicians (ACP), the American Pharmacists Association (APhA), and the Society for Healthcare Epidemiology of America (SHEA). ACIP recommendations are forwarded to CDC’s Director and once adopted become official CDC policy. These recommendations are then published in CDC’s Morbidity and Mortality Weekly Report (MMWR). Additional information is available at https://www.cdc.gov/vaccines/acip .

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Abbreviations: ACIP = Advisory Committee on Immunization Practices; aIIV3 = adjuvanted inactivated influenza vaccine, trivalent; ccIIV3 = cell culture-based inactivated influenza vaccine, trivalent; HA = hemagglutinin; HD-IIV3 = high-dose inactivated influenza vaccine, trivalent; IIV3 = inactivated influenza vaccine, trivalent; IM = intramuscular; LAIV3 = live attenuated influenza vaccine, trivalent; MDV = multidose vial; NAS = intranasal; PFS = prefilled syringe; RIV3 = recombinant influenza vaccine, trivalent. * Manufacturer package inserts and updated CDC and ACIP guidance should be consulted for additional information concerning, but not limited to, indications, contraindications, warnings, and precautions. Package inserts for U.S.-licensed vaccines are available at https://www.fda.gov/vaccines-blood-biologics/vaccines/vaccines-licensed-use-united-states . Availability and characteristics of specific products and presentations might change or differ from what is described in this table and in the text of this report. † Although a history of severe allergic reaction (e.g., anaphylaxis) to egg is a labeled contraindication to the use of egg-based IIV3s and LAIV3, ACIP recommends that all persons aged ≥6 months with egg allergy should receive influenza vaccine and that any influenza vaccine (egg based or nonegg based) that is otherwise appropriate for the recipient’s age and health status can be used (see Persons with a History of Egg Allergy). § The approved dose volume for Afluria is 0.25 mL for children aged 6 through 35 months and 0.5 mL for persons aged ≥3 years. However, 0.25-mL prefilled syringes are no longer available. For children aged 6 through 35 months, a 0.25-mL dose must be obtained from a multidose vial. ¶ IM-administered influenza vaccines should be administered by needle and syringe only, except for the MDV presentation of Afluria, which can alternatively be given by the PharmaJet Stratis jet injector for persons aged 18 through 64 years only. For older children and adults, the recommended site for IM influenza vaccination is the deltoid muscle. The preferred site for infants and young children is the anterolateral aspect of the thigh. Additional specific guidance regarding site selection and needle length for IM administration is available in the General Best Practice Guidelines for Immunization available at https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html . ** Not applicable. †† Fluzone is approved for children aged 6 through 35 months at either 0.25 mL or 0.5 mL per dose; however, 0.25-mL prefilled syringes are no longer available. If a prefilled syringe of Fluzone is used for a child in this age group, the dose volume will be 0.5 mL per dose.

Abbreviations: ACIP = Advisory Committee on Immunization Practices; ccIIV = cell culture–based inactivated influenza vaccine (any valency); ccIIV3 = cell culture–based inactivated influenza vaccine, trivalent; CSF = cerebrospinal fluid; IIV = inactivated influenza vaccine (any valency); IIV3 = inactivated influenza vaccine, trivalent; LAIV = live attenuated influenza vaccine (any valency); LAIV3 = live attenuated influenza vaccine, trivalent; RIV = recombinant influenza vaccine (any valency); RIV3 = recombinant influenza vaccine, trivalent. * Manufacturer package inserts and updated CDC and ACIP guidance should be consulted for additional information concerning, but not limited to, indications, contraindications, warnings, and precautions. When a contraindication is present, a vaccine should not be administered. When a precaution is present, vaccination should generally be deferred but might be indicated if the benefit of protection from the vaccine outweighs the risk for an adverse reaction (see the General Best Practice Guidelines for Immunization, available at https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html ). Package inserts for U.S.-licensed vaccines are available at https://www.fda.gov/vaccines-blood-biologics/vaccines/vaccines-licensed-use-united-states . † Although a history of severe allergic reaction (e.g., anaphylaxis) to egg is a labeled contraindication to the use of egg-based IIV3s and LAIV3, ACIP recommends that all persons aged ≥6 months with egg allergy should receive influenza vaccine, and that any influenza vaccine (egg based or nonegg based) that is otherwise appropriate for the recipient’s age and health status can be used (see Persons with a History of Egg Allergy). § Labeled contraindication noted in package insert. ¶ If administered, vaccination should occur in a medical setting and should be supervised by a health care provider who can recognize and manage severe allergic reactions. Providers can consider consultation with an allergist in such cases to assist in identification of the component responsible for the allergic reaction. ** Injectable vaccines are recommended for persons with cochlear implant because of the potential for CSF leak, which might exist for a period after implantation. Providers might consider consultation with a specialist concerning risk for persistent CSF leak if an inactivated or recombinant vaccine cannot be used. †† Use of LAIV3 in context of influenza antivirals has not been studied; however, interference with activity of LAIV3 is biologically plausible, and this possibility is noted in the package insert for LAIV3. In the absence of data supporting an adequate minimum interval between influenza antiviral use and LAIV3 administration, the intervals provided are based on the half-life of each antiviral. The interval between influenza antiviral receipt and LAIV3 for which interference might potentially occur might be further prolonged in the presence of medical conditions that delay medication clearance (e.g., renal insufficiency). Influenza antivirals might also interfere with LAIV3 if initiated within 2 weeks after vaccination. Persons who receive antivirals during the period starting with the specified time before receipt of LAIV3 through 2 weeks after receipt of LAIV3 should be revaccinated with an age-appropriate IIV3 or RIV3.

Abbreviations: ACIP = Advisory Committee on Immunization Practices; ccIIV = cell culture–based inactivated influenza vaccine (any valency); ccIIV3 = cell culture–based inactivated influenza vaccine, trivalent; IIV = inactivated influenza vaccine (any valency); IIV3 = inactivated influenza vaccine, trivalent; LAIV = live attenuated influenza vaccine (any valency); LAIV3 = live attenuated influenza vaccine, trivalent; RIV = recombinant influenza vaccine (any valency); RIV3 = recombinant influenza vaccine, trivalent. * Manufacturer package inserts and updated CDC and ACIP guidance should be consulted for additional information, including, but not limited to indications, contraindications, warnings, and precautions. Package inserts for U.S.-licensed vaccines are available at https://www.fda.gov/vaccines-blood-biologics/vaccines/vaccines-licensed-use-united-states . † When a contraindication is present, a vaccine should not be administered, consistent with the General Best Practice Guidelines for Immunization (Source: Kroger A, Bahta L, Long S, Sanchez P. General best practice guidelines for immunization; https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html ). In addition to the contraindications based on history of severe allergic reaction to influenza vaccines that are noted in the table, each individual influenza vaccine is contraindicated for persons who have had a severe allergic reaction (e.g., anaphylaxis) to any component of that vaccine. Vaccine components can be found in package inserts. Although a history of severe allergic reaction (e.g., anaphylaxis) to egg is a labeled contraindication to the use of egg-based IIV3s and LAIV3, ACIP recommends that all persons aged ≥6 months with egg allergy should receive influenza vaccine, and that any influenza vaccine (egg based or nonegg based) that is otherwise appropriate for the recipient’s age and health status can be used (see Persons with a History of Egg Allergy). § When a precaution is present, vaccination should generally be deferred but might be indicated if the benefit of protection from the vaccine outweighs the risk for an adverse reaction, consistent with the General Best Practice Guidelines for Immunization (Source: Kroger A, Bahta L, Long S, Sanchez P. General best practice guidelines for immunization; https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html ). Providers can consider using the following vaccines in these instances; however, vaccination should occur in an inpatient or outpatient medical setting with supervision by a health care provider who is able to recognize and manage severe allergic reactions: 1) for persons with a history of severe allergic reaction (e.g., anaphylaxis) to any egg-based IIV or LAIV of any valency, the provider can consider administering ccIIV3 or RIV3; 2) for persons with a history of severe allergic reaction (e.g., anaphylaxis) to any ccIIV of any valency, the provider can consider administering RIV3; and 3) for persons with a history of severe allergic reaction (e.g., anaphylaxis) to any RIV of any valency, the provider can consider administering ccIIV3. Providers can also consider consulting with an allergist to help determine which vaccine component is responsible for the allergic reaction.

BOX. Abbreviation conventions for influenza vaccines discussed in this report.

• IIV = inactivated influenza vaccine
• RIV = recombinant influenza vaccine
• LAIV = live attenuated influenza vaccine
• 3 for trivalent vaccines: one A(H1N1), one A(H3N2), and one B virus (from one lineage)
• 4 for quadrivalent vaccines: one A(H1N1), one A(H3N2), and two B viruses (one from each lineage)
• All influenza vaccines expected to be available in the United States for the 2024–25 season are trivalent vaccines. However, abbreviations for quadrivalent vaccines (e.g., IIV4) might be used in this report when discussing information specific to quadrivalent vaccines
• Abbreviations for general vaccine categories (e.g., IIV) might be used when discussing information that is not specific to valency or to a specific vaccine in that category.
• a for MF59-adjuvanted inactivated influenza vaccine (e.g., aIIV3)
• cc for cell culture–based inactivated influenza vaccine (e.g., ccIIV3)
• HD for high-dose inactivated influenza vaccine (e.g., HD-IIV3)
• SD for standard-dose inactivated influenza vaccine (e.g., SD-IIV3)

FIGURE. Influenza vaccine dosing algorithm for children aged 6 months through 8 years* — Advisory Committee on Immunization Practices, United States, 2024–25 influenza season.

* Children aged 6 months through 8 years who require 2 doses of influenza vaccine should receive their first dose as soon as possible (including during July and August, if vaccine is available) to allow the second dose (which must be administered ≥4 weeks later) to be received, ideally, by the end of October. For children aged 8 years who require 2 doses of vaccine, both doses should be administered even if the child turns age 9 years between receipt of dose 1 and dose 2.

Abbreviation: HA = hemagglutinin. * For persons aged ≥36 months (≥3 years), the dose volume is 0.5 mL per dose for all inactivated influenza vaccines. † The approved dose volume for Afluria is 0.25 mL for children aged 6 through 35 months and 0.5 mL for persons aged ≥3 years. However, 0.25-mL prefilled syringes are no longer available. For children aged 6 through 35 months, a 0.25-mL dose must be obtained from a multidose vial. § Per the package insert, Fluzone is approved for children aged 6 through 35 months at either 0.25 mL or 0.5 mL per dose; however, 0.25-mL prefilled syringes are no longer available. If a prefilled syringe of Fluzone is used for a child in this age group, the dose volume will be 0.5 mL per dose. The 5.0 mL multidose vials should be accessed for only 10 doses, regardless of the volume of the doses obtained or any remaining volume in the vial. Any vaccine remaining in a vial after the maximum number of doses has been removed should be discarded.

Suggested citation for this article: Grohskopf LA, Ferdinands JM, Blanton LH, Broder KR, Loehr J. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2024–25 Influenza Season. MMWR Recomm Rep 2024;73(No. RR-5):1–25. DOI: http://dx.doi.org/10.15585/mmwr.rr7305a1 .

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