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Patients with COVID-19 should delay getting their influenza vaccine, not because of any evidence about how the virus affects vaccination, but in order to ensure others in the healthcare setting are not exposed unnecessarily, CDC officials said on a call with clinicians on Thursday.

Routine vaccination should be deferred for patients with suspected or confirmed COVID-19, regardless of symptoms, and patients should be screened for COVID-19 symptoms before and during the visit. In addition, clinicians should don personal protective equipment (PPE) during vaccination, including masks, eye protection and gloves, when appropriate.

On a Clinician Outreach and Communication Activity (COCA) call entitled "2020-2021 Influenza Vaccination Recommendations and Clinical Guidance during the COVID-19 Pandemic," agency officials attempted to navigate through uncharted waters in infectious diseases, as COVID-19 is set to collide with influenza season.

Officials often look to the southern hemisphere as an indicator for the U.S. flu season, but they reported flu activity at "much lower rates than is typical," said Lisa Grohskopf, MD, of the CDC. She added that while fewer countries are reporting data and fewer viruses are being detected, social distancing and other preventive measures may have helped reduce the spread of influenza.

"The COVID-19 pandemic also has influenced health-seeking behaviors and testing priorities and capacities, making interpretation challenging," she added.

Nevertheless, with dueling outbreaks in the U.S., demand for flu shots is expected to be particularly high, with over 190 million doses available. This brings a new set of considerations, including potentially extending influenza vaccination season (September through December or later).

Providers should also work to ensure certain adults at higher risk from COVID-19 get their flu shot, including:

• Staff and residents of long-term care facilities
• Adults with underlying illnesses
• African Americans and Hispanics
• Adults who are part of "critical infrastructure"

When thinking about how to administer vaccines within the office, CDC officials recommended physical distancing of at least 6 feet apart, as well as limiting and monitoring points of entry, including installing "barriers" to limit physical contact with patients at triage. The agency also recommended "enhanced surface decontamination."

During vaccination visits, all providers should wear a face mask, though N95 masks are not recommended. In areas of moderate to substantial community transmission, CDC also recommends eye protection. For intransal or oral vaccines, providers should wear gloves, though they are optional for intramuscular or subcutaneous vaccines.

Patients older than 2 years should also wear face coverings, if tolerated, and practice "cough etiquette." The agency stressed the importance of hand hygiene, including at least 60% alcohol hand sanitizer for patients.

Clinicians were allowed to ask questions during the call. They asked about COVID-19 therapies, such as remdesivir and dexamethasone, and the flu shot. However, there is no official guidance on the use of COVID-19 therapeutics when a patient also has influenza, nor is there any evidence about the optimal interval between receiving remdesivir and a flu shot, Grohskopf said.

A negative COVID-19 test should not be required prior to being vaccinated, said Tara Jatlaoui, MD, of the CDC. A patient who has been exposed to COVID-19 should stay home and self-monitor their symptoms, and get their flu shot once they are out of isolation.

"It's not really a safety issue if the patient is asymptomatic. The concern is for exposure of others in the healthcare setting," she said.

This was true even in the case of symptomatic or asymptomatic adults over age 65, who are considered to be at higher risk of influenza hospitalization and death. Jatlaoui still recommended these patients wait to receive their flu shot until "they meet criteria for discontinuing [COVID-19] isolation."

CDC's Advisory Committee for Immunization Practices (ACIP) recommendations were published on Thursday in the Morbidity and Mortality Weekly Report. The agency also on its website.

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