What is the recommended flu vaccine for a 75-year-old?

Recommended Flu Vaccine for a 75-Year-Old

For adults aged 75 years, a high-dose influenza vaccine (HD-IIV3), recombinant influenza vaccine (RIV3), or adjuvanted influenza vaccine (aIIV3) is preferentially recommended over standard-dose influenza vaccines. 1

Preferred Vaccine Options for Adults ≥65 Years

The Advisory Committee on Immunization Practices (ACIP) specifically recommends that adults aged 65 years and older should preferentially receive one of the following influenza vaccines:

• High-dose inactivated influenza vaccine (HD-IIV3) - Contains 60 μg of hemagglutinin per virus strain (4 times the standard dose) 1
• Recombinant influenza vaccine (RIV3) - Contains 45 μg of hemagglutinin per virus strain 1
• Adjuvanted inactivated influenza vaccine (aIIV3) - Contains standard 15 μg of hemagglutinin plus MF59 adjuvant 1

Rationale for Enhanced Vaccines in Older Adults

Older adults (≥65 years) are at substantially increased risk for severe influenza-associated illness, hospitalization, and death compared with younger individuals 1. The immune response to standard influenza vaccines is often diminished in this age group, leading to reduced vaccine effectiveness.

Enhanced vaccines have demonstrated:

• Superior immunogenicity - Higher antibody titers compared to standard-dose vaccines 2
• Better clinical protection - Meta-analyses show HD-IIV3 provides:
  • 19.5% better protection against influenza-like illness 3
  • 17.8% better protection against influenza-related hospitalizations 3
  • 24.3% better protection against pneumonia 3

Effectiveness in Reducing Mortality

High-dose influenza vaccine has been associated with reduced mortality even among older adults who develop breakthrough influenza infections. A large retrospective study found significant mortality reductions of 17-29% with HD-IIV3 compared to unvaccinated individuals across three influenza seasons 4.

Administration Details

• Dose: 0.5 mL for all options 1
• Route: Intramuscular injection into the deltoid muscle 1
• Timing: Should be administered as soon as possible before or during the influenza season

Important Considerations

• If none of the preferred vaccines (HD-IIV3, RIV3, or aIIV3) is available at the time of vaccination, any age-appropriate standard influenza vaccine should be used rather than delaying vaccination 1
• The relative benefit of these enhanced vaccines compared to standard-dose vaccines varies by season 1
• Studies directly comparing HD-IIV3, RIV3, and aIIV3 with one another are limited and do not consistently show superiority of any one of these vaccines over the others 1

Common Pitfalls to Avoid

1. Delaying vaccination while waiting for a specific vaccine formulation - It's better to receive any available influenza vaccine than to remain unvaccinated
2. Assuming all enhanced vaccines are equivalent - While all three enhanced options are preferentially recommended, individual responses may vary
3. Overlooking contraindications - Always check for history of severe allergic reactions to previous influenza vaccines or vaccine components

In summary, for a 75-year-old individual, a high-dose influenza vaccine (HD-IIV3), recombinant influenza vaccine (RIV3), or adjuvanted influenza vaccine (aIIV3) should be administered preferentially, with the goal of providing optimal protection against influenza and its complications.