High-Dose Influenza Vaccination in Immunocompromised Individuals
While high-dose influenza vaccine can be considered for immunocompromised individuals, there is currently insufficient evidence to recommend it over standard-dose influenza vaccine for this population. 1
Current Recommendations for Immunocompromised Individuals
The National Comprehensive Cancer Network (NCCN) guidelines state that preliminary data have shown high-dose influenza vaccine to be safe for patients with cancer and may show more immunogenicity compared with standard-dose influenza vaccine. However, they note that further data are needed to assess whether high-dose influenza vaccine confers a clinical benefit compared with standard-dose vaccine for patients with cancer. 1
For immunocompromised individuals in general:
- Annual inactivated influenza vaccination is strongly recommended for all immunocompromised individuals 1
- LAIV (live attenuated influenza vaccine) should NOT be used in immunocompromised persons due to the theoretical risk of disease from the vaccine virus 1
- For most immunocompromised individuals, any age-appropriate inactivated influenza vaccine is acceptable 1
Special Considerations for Specific Immunocompromised Groups
Solid Organ Transplant Recipients
- Solid organ transplant recipients aged 18-64 years who are receiving immunosuppressive medications may receive either high-dose influenza vaccine (HD-IIV3) or adjuvanted influenza vaccine (aIIV3) as acceptable options 1
- These are considered acceptable alternatives without a preference over other age-appropriate IIV3s or RIV3 1
Older Adults with Immunocompromising Conditions
- For immunocompromised adults aged ≥65 years, any age-appropriate influenza vaccine formulation (standard-dose or high-dose, trivalent or quadrivalent, unadjuvanted or adjuvanted) or recombinant influenza vaccine (RIV4) are acceptable options 1
- No specific preference is expressed for any one vaccine type in this population 1
Evidence for High-Dose Vaccine in Immunocompromised Populations
Research suggests potential benefits of high-dose influenza vaccine in immunocompromised individuals:
- High-dose trivalent inactivated influenza vaccine (IIV3-HD) has shown stronger humoral responses compared to standard-dose vaccine in HIV patients, transplant recipients, and persons receiving immunosuppressant therapies 2
- Meta-analysis data indicates that high-dose influenza vaccine is consistently more immunogenic than standard-dose in adults aged ≥65 years and appears more immunogenic in immunocompromised individuals 3
- A systematic review found that high-dose TIV lowers rates of laboratory-confirmed influenza, mainly A(H3N2), in older adults compared to standard-dose, though specific data for immunocompromised patients is more limited 4
Important Clinical Considerations
When considering influenza vaccination for immunocompromised individuals:
- Timing of vaccination might be important (e.g., vaccinating during a period either before or after an immunocompromising intervention) 1
- The heterogeneous nature of immunocompromised states means that vaccine response may vary significantly between different conditions 1
- Vaccination should not be delayed if a specific product is not readily available 1
- Creating a "circle of protection" by vaccinating household members and healthcare contacts of immunocompromised individuals is an important complementary strategy 1
Conclusion
While high-dose influenza vaccine shows promise for immunocompromised individuals based on immunogenicity data, current guidelines do not definitively recommend it over standard-dose vaccines for most immunocompromised populations, with the exception of solid organ transplant recipients on immunosuppressive medications. Annual influenza vaccination with any age-appropriate inactivated vaccine remains the priority for immunocompromised individuals.