High-Dose Influenza Vaccine Recommendations
The high-dose influenza vaccine is specifically recommended for adults aged 65 years and older, with the Advisory Committee on Immunization Practices (ACIP) recommending preferential use of higher-dose or adjuvanted influenza vaccines in this age group. 1, 2
Primary Recommendations
- High-dose influenza vaccine (Fluzone High-Dose) is licensed only for people 65 years and older 1
- As of June 2022, ACIP recommends preferential use of higher-dose or adjuvanted influenza vaccines for adults 65 years and older 1, 2
- The high-dose trivalent inactivated influenza vaccine (IIV3) contains 60 μg of hemagglutinin per strain, which is four times the amount in standard-dose vaccines 1, 3
Evidence Supporting High-Dose Vaccination in Older Adults
- High-dose influenza vaccine provides significantly better protection than standard-dose vaccines against laboratory-confirmed influenza illness in adults ≥65 years (relative efficacy 24.2%) 4
- Recent meta-analysis showed HD-IIV provides significantly better protection against influenza-like illness, influenza-related hospitalizations, and cardiovascular, cardiorespiratory, and all-cause hospitalizations in adults ≥65 years 5
- The relative vaccine effectiveness (RVE) of high-dose versus standard-dose influenza vaccines increases with age, with consistent benefits observed across all seasons for people aged ≥85 years 6
- In the 2022-2023 influenza season, high-dose vaccine showed 25.1% higher effectiveness against PCR-confirmed influenza hospitalization compared to standard-dose egg-based vaccine in adults ≥65 years 7
Special Populations Who May Benefit from High-Dose Vaccine Before Age 65
- Patients with rheumatic and musculoskeletal diseases aged >18 and <65 years who are taking immunosuppressive medication may benefit from high-dose influenza vaccine 1, 2
- Solid organ transplant recipients aged 18-64 years who are receiving immunosuppressive medications may also benefit from high-dose or adjuvanted vaccines 2
- For immunocompromised children who have received hematopoietic cell transplantation or solid organ transplantation, clinicians could consider administering 2 doses of high-dose trivalent inactivated vaccine, although this is off-label use 1
Important Considerations
- The high-dose vaccine has been shown to induce significantly higher antibody responses compared to standard-dose vaccines 4, 3
- Health economic analyses suggest that high-dose influenza vaccine can be a cost-effective alternative to standard-dose vaccines and may even be cost-saving in older adults 3
- If high-dose vaccine is not available, standard-dose influenza vaccine should be administered rather than delaying vaccination 2
Common Pitfalls and Caveats
- Patients under 65 years without specific risk factors should receive standard-dose influenza vaccine, as high-dose formulations are not FDA-approved for this age group 1
- Most adults, particularly those ≥65 years, should not be immunized in July and August due to concerns about waning immunity before the peak of influenza season 1
- For patients with malignant neoplasms receiving chemotherapy, influenza vaccination should generally be administered 2 weeks before cytotoxic chemotherapy when clinically possible 1
- For patients who have received anti-B cell therapies (e.g., rituximab), influenza vaccination should be deferred for 6 months after the last dose, ideally once there is evidence of B cell recovery 1