Adults aged 65 years or older should receive high-dose or adjuvanted seasonal influenza vaccines, according to a new CDC recommendation. Seasonal influenza disproportionately affects individuals aged 65 years or older, accounting for 70% to 85% of deaths from the disease and 50% to 70% of hospitalizations. Vaccination can reduce poor outcomes, yet some older adults may not have a strong immune response. To help increase their protection, the CDC’s Advisory Committee on Immunization Practices (ACIP) recently recommended preferentially using Fluzone High-Dose Quadrivalent (inactivated influenza vaccine [IIV4-HD]), Flublok Quadrivalent (recombinant influenza vaccine [RIV4]), or Fluad Quadrivalent (adjuvanted inactivated influenza vaccine quadrivalent [aIIV4]) for this age group. If high-dose or adjuvanted vaccines aren’t available, a standard seasonal influenza vaccine is recommended for older adults, the ACIP statement noted.
Why older adults need stronger flu shots
Dr. Barbara Bawer, a family medicine physician at The Ohio State University Wexner Medical Center, tells adults ages 65 and older need a higher dose of the flu vaccine because with age the immune system often weakens and does not build up enough of a response to the regular vaccine dose.
Dr. Phillip Kadaj, a Michigan-based internal medicine physician and medical expert for JustAnswer, explains that antigens are the immune system activating substances in the flu vaccine.
Bawer adds that if you’re over 65, getting a stronger dose of the flu shot is now what’s required to protect against contracting the flu and reduce the likelihood of becoming severely ill from the flu and requiring hospitalization.
Experts suggest the stronger dose of vaccine is coming at a critical time.
However, according to a survey from the National Foundation for Infectious Diseases (NFID), more than half of U.S. adults may be considering skipping this year’s flu shot.
Experts say that’s a problem.
They note that the flu shot is still the most effective way to prevent illness and severe symptoms.
And while the past few years have seen lower-than-average recorded flu levels, change is coming quickly.
Bawer says if we want to know what to expect this flu season, we can look at Southern Hemisphere countries such as Australia.
Australia is a predictor of what could come in the United States, says Bawer, and that country had its worst flu season in five years.
Kadaj agrees with the prediction of a severe flu season, saying he expects flu cases will become more prevalent again as COVID-19 infections have become less serious and people venture out more.
“As COVID-19 infections have become milder and we have effective vaccines for COVID-19, we should start to see an uptick in flu cases,” he says. “I would expect the flu cases this year to reach or get close to pre-pandemic levels.”
Bawer recommends people over 65 get their flu vaccine no later than by the first week in November and ideally in the last two weeks of October. Getting the shot any earlier than this may mean decreased immunity by the season’s end.
“Getting your shot now will give you enough protection from the strains in the vaccine to cover you during the peak flu months and 1 to 2 months on either end as well,” explained Bawer.
Bawer explains the pandemic’s previous impact on flu rates.
She says mask mandates since 2020 have made people more vigilant in their use of hand sanitizer and washing hands more frequently and thoroughly, which has lowered influenza rates across the board.
Also, people have been more cautious about attending gatherings, including holidays, so we have not had as many cases of the flu in the past two years.
“This is both wonderful and problematic,” Bawer says. “Wonderful, of course, because this means a healthier population from a flu standpoint, but this also means that we have much less or little data on the types of flu strains that are out there.”
“But now we no longer have mask mandates (except primarily in health care settings), and people are tired of avoiding loved ones over the holidays and missing out on events in general,” she said. “The combination of the two will yield possibly severe results.”
Experts say you can get vaccinated against the flu and receive a COVID-19 vaccine booster at the same time.
“When the pandemic first started, and the COVID-19 vaccines were brand new, we did not have enough information to know what type of side effects to expect,” says Bawer. “Therefore, we recommended a window between the COVID-19 vaccine and others to give time for people to show any side effects and learn what to expect.”
“More than two years into the pandemic and we now have that information,” she noted. “In many ways, this makes it no different than getting multiple booster vaccines at once or when kids get multiple vaccines during their well-child checks.”
Kadaj agrees, saying the two shots are perfectly fine to do together, but he does caution his patients saying that they may have more side effects.
Common and temporary symptoms from vaccines, says Kadaj, include:
“The reason [for caution] is that these patients are simply getting more antigen/immune activating substances at one time,” he says.
So, for example, someone may have a reaction to flu or COVID-19 vaccines, but when they are combined, the reactions are stronger and more likely, he says.
Nonetheless, he says getting vaccinated against COVID-19 and the flu is the best method of protecting yourself and your community from experiencing severe illness.
The more powerful flu shots have been available for several years. However, previous recommendations did not explicitly favor them over the standard flu vaccines, which help keep an influenza infection from progressing to a serious illness. “It was more of a soft recommendation,” says William Schaffner, M.D., a professor in the Division of Infectious Diseases at the Vanderbilt University School of Medicine.
But data collected from studies over the years now shows that there’s “better protection for people ages 65 and older with one of these enhanced vaccines,” Schaffner says. “So basically, the signal has gone out to all the providers that [they need] to make an effort to stock these vaccines going forward for people aged 65 and older.”
The CDC’s recommendation didn’t come with a preference for any one of the three enhanced vaccines on the market. Schaffner’s advice is to get the one that’s available. “Don’t be too picky,” he says. “They’re all really enhanced vaccines.” Just make sure you’re asking for one of the versions that is specifically recommended for older adults.
The high-dose and adjuvanted flu vaccines may result in more of the temporary, mild side effects that can occur with standard-dose seasonal flu shots, the CDC says. Expected side effects can include pain, redness or swelling at the injection site, headache, muscle ache and fatigue. These symptoms typically resolve within one to three days.
About 80 percent of Medicare beneficiaries already receive a higher-dose or adjuvanted flu vaccine, federal data shows. However, the CDC notes that racial and ethnic disparities exist. One study published in The Lancet Healthy Longevity found that minority groups were 26 to 32 percent less likely than whites to receive a high-dose flu vaccine.
“This recommendation could help reduce health disparities by making these vaccines more available to racial and ethnic minority groups,” the CDC’s Romero says.
The CDC recommends that everyone 6 months and older be vaccinated each year against the flu. If you’re 65 and older and one of the enhanced vaccines is not available when you go to get your flu shot, get a standard-dose flu vaccine instead, the CDC says.
“When you’re 65 and older and you’re talking about influenza, you need all the help that you can get,” Schaffner says. “So I have a very strong message to absolutely everyone 65 and older: Better to be vaccinated than not.”
Just in time for flu season
What does COVID-19 have to do with the flu?
The three available vaccines
