High Dose Flu Vaccine for the Elderly

Dr. Novella  has recently written about this year’s seasonal flu vaccine and Dr. Crislip has reviewed the evidence for flu vaccine efficacy.

There’s one little wrinkle that they didn’t address — one that I’m more attuned to because I’m older than they are.  I got my Medicare card last summer, so I am now officially one of the elderly. A recent review by Goodwin et al. showed that the antibody response to flu vaccines is significantly lower in the elderly.  They called for a more immunogenic vaccine formulation for that age group. My age group.

One manufacturer has responded. Fluzone High-Dose vaccine contains 60 mcg of hemagglutinin antigen from each strain, compared to 15 mcg in the standard dose vaccine. This high-dose preparation has been tested in three clinical studies (here, here, and here) of 4453 healthy people aged 65 years and older.   In each of these studies the high-dose vaccine produced significantly higher antibody levels than the standard dose vaccine. There was a dose-related increase in minor local side effects (arm pain, redness and swelling at the injection site) but no increase in serious adverse effects. Most recipients had minimal or no adverse effects. We don’t yet have data to prove that the increase in antibody titers will result in fewer clinical influenza illnesses and complications, but it seems logical that it would. A study comparing the effectiveness of Fluzone High-Dose to Fluzone is expected to be completed in 2012. The high-dose vaccine is more expensive, but Medicare pays for it.

 The Medical Letter recently covered the 2010-2011 flu vaccines and did not recommend (or advise against) the high-dose formulation for older patients, because the clinical efficacy data are not yet available. Neither the CDC nor the ACIP has been willing to express a preference for one vaccine over another at this time. I asked our own infectious disease expert, Dr. Crislip, and he recommends the high-dose in view of its improved immunogenicity and biological plausibility. 

I’m 65 and my husband is older: we opted for the high-dose vaccine. Not everyone will agree, but shouldn’t older patients be given the facts and the option?

Posted in: Vaccines

Leave a Comment (11) ↓

11 thoughts on “High Dose Flu Vaccine for the Elderly

  1. Ian says:

    What about adjuvants?

  2. Harriet Hall says:

    What about adjuvants?

    As far as I have been able to find out, it doesn’t contain any. The information I found said it contained four times the antigen dose and said nothing about adjuvants. It’s my understanding that no US flu vaccine has ever contained adjuvants, despite the fearmongering accusations of some anti-vaccine activists. But anyway, the presence of an adjuvant would not make me less likely to accept a vaccine. Adjuvants have been used in European vaccines for a long time with a solid record of safety. And there is at least one study showing that adding an adjuvant to FluZone increased its immunogenicity. Some have argued that we should have used adjuvants in last year’s H1N1 vaccine because it would have increased the number of doses available and would have helped avoid vaccine shortages.

  3. Fredeliot2 says:

    Every place I asked including my own doctor had not even heard of the high dose flue shot for seniors. My wife and I had to settle for the standard dose.

  4. Todd W. says:


    According to the insert, neither FluZone nor FluZone High Dose contain adjuvants.

  5. khan says:

    I got a flu shot today at the grocery pharmacy.

    The info sheet mentioned a “high-dose” for 65 and older.

    I’m 60.

  6. sheldon101 says:

    The Europeans approved the use of a new type of Flu vaccine, also available in a high dose formula. Canada approved the use of the new type, but only in the regular dose vaccine.

    The new vaccine contains inactivated flu vaccine. The difference is that the vaccine only goes into the skin — not the muscle. It only comes in a single dose with a special, teeny, tiny needle. Apparently, an injection into the skin provides a stronger response than when into the muscle. The usual dose for inactivated flu vaccine is 15mcg per strain. FluID/Intanza uses 9mcg. The version for the elderly has 15mcg.

    FluID/Intanza was approved by the EU on the same basis as Fluzone HD, namely that it results in a stronger immune response. Trials proving that it prevents flu more often in the elderly haven’t been done.

  7. Harriet Hall says:

    “Every place I asked including my own doctor had not even heard of the high dose flue shot for seniors.”

    I only heard about it on the car radio in a commercial for a drug store chain that was selling flu vaccinations. We had to call around to several local stores before we found one that knew what it was and had it in stock.

    It’s curious. Since they can charge twice as much as for the standard dose and get paid by Medicare and it costs the patient nothing, it would be in the pharmaceutical company’s interest and the pharmacy’s interest to advertise it like crazy. Seems inconsistent with the stereotypes about Big Pharma and drug detail salesmen educating doctors and the fixation on the profit motive.

  8. Epinephrine says:

    What’s the profit margin on it? Is it possible that with four times the antigen that charging double the price puts them at about the same amount of profit? After all, they could formulate 4 syringes of drug product with the drug substance used for a single syringe of the high dose.

    Perhaps the lack of a marketing push is precisely what one would expect.

  9. Ian says:

    I guess what I meant was, why increase dosage (which even when they don’t screw up the prediction or have problems with the production, I doubt they have huge surplusses) when adjuvants would maybe do the job.

    But I guess it’s a matter of what research has been done.

  10. Jeff S says:

    Whether you get the flu HD or seasonal dose it is important to get vaccine every year. Here is a good website to find flu vaccine clinics close and convenient to you to get a flu shot.

  11. kansas88 says:

    My grandmother received this shot today from a Walgreens take care clinic and is having severe reactions that include nausea, vomiting, chills, cold sweats, heavy and difficult breathing, dizziness and some behavioral changes. Be advised with this higher dose shot!!!

Comments are closed.