High-Dose Influenza Vaccine: Name and Administration Protocol
The high-dose influenza vaccine is called Fluzone High-Dose, manufactured by Sanofi Pasteur, and is specifically licensed for adults aged 65 years and older. 1, 2
Key Information About Fluzone High-Dose
- Fluzone High-Dose is a trivalent inactivated influenza vaccine (TIV High-Dose) containing 60 μg of hemagglutinin per vaccine strain, which is four times the amount in standard-dose influenza vaccines (15 μg per strain) 1
- It is available as a 0.5 mL prefilled syringe with 0.0 μg mercury content 1
- The Advisory Committee on Immunization Practices (ACIP) now recommends preferential use of higher-dose or adjuvanted influenza vaccines for adults 65 years and older 2
- Fluzone High-Dose is administered as a single dose via the intramuscular (IM) route 1
Prescribing and Administration Protocol
- Prescribe as "Fluzone High-Dose" for patients aged 65 years and older 1
- Administration is via intramuscular injection in the deltoid muscle 1
- Only one dose (0.5 mL) is required per influenza season 1
- The vaccine should be stored according to manufacturer specifications and administered at room temperature 3
- Document administration in the patient's immunization record and report to appropriate immunization information systems 2
Important Considerations and Precautions
- Fluzone High-Dose should not be administered to persons under 65 years of age unless they have specific indications (such as immunocompromised status) 2
- If Fluzone High-Dose is not available, standard-dose influenza vaccine should be administered rather than delaying vaccination 2
- 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 2
- Common side effects may include injection site reactions (pain, redness, swelling) and systemic reactions (myalgia, malaise, headache) that are typically mild and transient 3
Special Populations
- For immunocompromised individuals who have received hematopoietic cell transplantation or solid organ transplantation, clinicians could consider administering 2 doses of high-dose trivalent inactivated vaccine 2
- Patients with rheumatic and musculoskeletal diseases aged >18 and <65 years who are taking immunosuppressive medication may benefit from high-dose influenza vaccine, though this would be off-label use 2
- For patients with malignant neoplasms receiving chemotherapy, influenza vaccination should generally be administered 2 weeks before cytotoxic chemotherapy when clinically possible 2
Clinical Evidence
- Immunogenicity data from multiple studies have shown that Fluzone High-Dose elicits higher hemagglutination inhibition (HAI) titers against influenza virus strains compared to standard-dose vaccines in older adults 1, 4
- While Fluzone High-Dose produces enhanced immunologic responses in adults ≥65 years, the ACIP initially did not express preference for high-dose over standard-dose vaccines 1
- Recent evidence has led to updated recommendations favoring high-dose or adjuvanted vaccines for older adults 2
- Despite improved immunogenicity, high-dose vaccine recipients may still have lower vaccine efficacy than younger adults receiving standard-dose vaccines 5