What dose of influenza vaccine is recommended for a 74-year-old?

Influenza Vaccine Dosing for a 74-Year-Old

For a 74-year-old individual, a high-dose quadrivalent influenza vaccine (HD-IIV4) is preferentially recommended, administered as a single 0.7 mL dose. 1, 2

Vaccine Options for Adults ≥65 Years

The Advisory Committee on Immunization Practices (ACIP) recommends preferential use of enhanced influenza vaccines for adults 65 years and older. These enhanced options include:

1. High-dose quadrivalent influenza vaccine (HD-IIV4) - contains 60 μg of hemagglutinin per vaccine virus (240 μg total) in a 0.7 mL dose 1
2. Adjuvanted quadrivalent influenza vaccine (aIIV4) - contains 15 μg of hemagglutinin per vaccine virus with MF59 adjuvant 1
3. Recombinant quadrivalent influenza vaccine (RIV4) 2

Clinical Rationale for Enhanced Vaccines in Older Adults

Enhanced vaccines are preferred for older adults due to:

• Superior immunogenicity: High-dose vaccines elicit higher hemagglutination inhibition (HAI) titers compared to standard-dose vaccines 2
• Greater clinical efficacy: HD-IIV4 has demonstrated 24.2% higher relative efficacy against laboratory-confirmed influenza compared to standard-dose vaccines in large randomized trials 3
• Reduced mortality: High-dose vaccination is associated with lower post-influenza mortality among older adults with breakthrough influenza, even during seasons with poor vaccine-strain match 4
• Decreased hospitalizations: Enhanced vaccines have shown reduced risk of influenza-related hospitalizations and complications 5

Administration Details

• Dose volume: 0.7 mL for HD-IIV4 1
• Route: Intramuscular injection into the deltoid muscle 1
• Timing: Ideally administered by the end of October, before the onset of influenza activity 2

Important Considerations

• If a high-dose vaccine is unavailable, the other enhanced vaccine options (aIIV4 or RIV4) should be used instead 2
• If no enhanced vaccine options are available, standard-dose influenza vaccine (0.5 mL) should be administered rather than delaying vaccination 2
• Standard-dose vaccines are not preferred for this age group but would still provide some protection if enhanced vaccines are unavailable 1, 2

Safety Profile

• Enhanced vaccines have similar safety profiles to standard-dose vaccines
• High-dose vaccines may cause slightly more frequent injection site reactions and mild systemic effects, but serious adverse events are rare and comparable to standard-dose vaccines 2, 3
• The benefits of enhanced protection significantly outweigh the minimal increase in mild side effects 3

The evidence clearly supports using enhanced influenza vaccines for adults ≥65 years, with high-dose quadrivalent influenza vaccine being a preferred option for a 74-year-old to maximize protection against influenza and its complications.