At what age should a patient receive the high-dose flu vaccine?

High-Dose Flu Vaccine Recommendations by Age

Patients aged 65 years and older should receive one of the enhanced influenza vaccines, with the high-dose influenza vaccine being one of the preferred options for this age group. 1

Age-Based Recommendations

Adults 65 Years and Older

• The Advisory Committee on Immunization Practices (ACIP) recommends preferential use of enhanced influenza vaccines for adults ≥65 years, including:

  • High-dose quadrivalent influenza vaccine (HD-IIV4)
  • Adjuvanted quadrivalent influenza vaccine (aIIV4)
  • Recombinant quadrivalent influenza vaccine (RIV4) 1

• The high-dose trivalent inactivated influenza vaccine (Fluzone High-Dose) was first licensed in 2009 specifically for persons aged ≥65 years 2

• This recommendation is based on evidence showing:

  • 24.2% higher relative efficacy against laboratory-confirmed influenza compared to standard-dose vaccines 1
  • Reduced risk of influenza-related hospitalizations 1
  • Improved immune response in older adults who typically have diminished immune responses to standard-dose vaccines 3

Adults Under 65 Years

• Standard-dose influenza vaccines are recommended for adults under 65 years of age 4
• High-dose influenza vaccines are not FDA-approved for persons under 65 years 4

Scientific Rationale

The recommendation for high-dose vaccines in older adults is based on:

1. Immunogenicity data: High-dose vaccines elicit higher hemagglutination inhibition (HAI) titers against influenza virus strains compared to standard-dose vaccines 4

2. Efficacy evidence: Systematic reviews and meta-analyses show that high-dose influenza vaccines reduce the risk of laboratory-confirmed influenza by approximately 24% compared to standard-dose vaccines in adults ≥65 years 3

3. Safety profile: High-dose vaccines have a similar safety profile to standard-dose vaccines, though they may cause slightly more injection site reactions 1

Special Considerations

Immunocompromised Patients

• While not officially approved for this indication, some evidence suggests that immunocompromised adults aged 18-64 years may benefit from high-dose vaccines 1
• This includes solid organ transplant recipients and patients with rheumatic diseases on immunosuppressive medications 1

Nursing Home Residents

• Residents of long-term care facilities aged ≥65 years should receive high-dose or other enhanced influenza vaccines due to their particularly high risk status 1

Common Pitfalls to Avoid

1. Delaying vaccination: If a high-dose vaccine is not available, standard-dose influenza vaccine should be administered rather than delaying vaccination 1

2. Incorrect dosing: The high-dose influenza vaccine contains 60 μg of hemagglutinin per strain (four times the amount in standard-dose vaccines) 5

3. Using in unauthorized populations: High-dose vaccines are not approved for children or adults under 65 years outside specific circumstances 4

4. Confusing different enhanced vaccine types: Be aware of the differences between high-dose (HD-IIV4), adjuvanted (aIIV4), and recombinant (RIV4) enhanced vaccines 1

In summary, high-dose influenza vaccines should be administered to adults aged 65 years and older, while standard-dose vaccines remain appropriate for younger adults. This age-based recommendation aligns with the goal of maximizing protection against influenza-related morbidity and mortality in vulnerable populations.