Fluzone High-Dose Seasonal Influenza Vaccine

Arnold Solof, MD

Fluzone High-Dose Seasonal Influenza Vaccine

This year there is a new influenza vaccine formulation with 4 times the amount of antigen.  It is targeted to individuals 65 years or older.  People in that age group are more susceptible to complications of influenza, yet their aging immune systems don’t respond as well to the vaccine as do younger people.  Studies so far show it is 24 percent more effective in preventing influenza in that age group compared with the standard vaccine formulation without increased side effects.

Both my wife and I are over 65 years of age.  A couple of weeks ago I got my flu vaccine at the hospital (they give it to their medical staff).  I got the standard (regular dose) vaccine.  They didn’t have the high dose one.  My wife got her flu vaccine at Rite-Aid pharmacy.  She got FLUAD™ Flu Vaccine With Adjuvant. That vaccine, manufactured by Seqirus Vaccines Limited, uses an adjuvant to improve the immune response in people 65 or older.  Studies in that age group have found it more effective than the standard formulation in that age group, but I couldn’t find exact statistics.  No studies have been done comparing Fluzone High-Dose to Fluad.   

  I asked my primary care doctor what he is doing as far as Flu vaccine choice in older adults.  He said he is giving the Fluzone High-Dose to 65+ year-olds only if they have additional risk factors besides their age.   This didn’t make sense to me since that age by itself was a significant risk factor.

I checked the CDC website to see what their current guidelines were and they say:

“Does CDC recommend one vaccine above another for people 65 and older?

The CDC and its Advisory Committee on Immunization Practices have not expressed a preference for any flu vaccine indicated for people 65 and older. CDC recommends flu vaccination as the first and most important step in protecting against the flu.”

At first, I thought “that’s insane”.  They don’t prefer the more effective vaccines.  Then I tried to think of a plausible explanation for the recommendation and this is what I came up with.  Flu vaccine manufacturers have to plan and commit to the manufacture of the vaccine a year before it will be used.  The strains included in the vaccine are those they predict will most likely be circulating in the next flu season.  It takes a very long time for this to occur.  You can’t change things even months before the flu season hits because you won’t have enough time to redo the process.  Physicians, Pharmacies, and Health Clinics also have to commit most of their ordering of vaccines months before they will be receiving and administering them.  If CDC & ACIP said at the last minute that Fluzone High-Dose or Fluad should be used instead of regular flu vaccine in those 65+, there wouldn’t be enough of vaccines targeted for the older population to go around, and much of the already manufactured and purchased regular vaccine would go to waste, unused.

However, from the individual person’s point of view, the choice is clear to me.  If you are 65 or older you should preferentially receive either Fluzone High-Dose or Fluad.  If you haven’t already received your flu vaccine this year you can request one of those vaccines.

I predict next year the CDC & ACIP will change their recommendations to those above.  They will time it so vaccine manufacturers and clinicians have time to adjust the manufacturing and purchasing patterns for the following Flu season.  Then the guidelines will make sense.