What is the recommended age for the high dose (influenza) flu vaccine?

High-Dose Influenza Vaccine Age Recommendations

The high-dose influenza vaccine (Fluzone High-Dose Quadrivalent) is licensed only for people 65 years and older. 1, 2

Age-Specific Recommendations

• High-dose influenza vaccine (Fluzone High-Dose) contains 4 times the amount of antigen for each virus strain compared to standard-dose vaccines and is specifically licensed for adults aged ≥65 years 1
• The Advisory Committee on Immunization Practices (ACIP) recommends that adults aged ≥65 years preferentially receive any one of the following higher-dose or adjuvanted influenza vaccines:
  • Trivalent high-dose inactivated influenza vaccine (HD-IIV3)
  • Trivalent recombinant influenza vaccine (RIV3)
  • Trivalent adjuvanted inactivated influenza vaccine (aIIV3) 1
• If none of these three preferred vaccines is available, then any other age-appropriate influenza vaccine should be used for adults ≥65 years 1

Evidence Supporting High-Dose Vaccine in Older Adults

• Multiple studies have shown that high-dose influenza vaccine elicits higher antibody responses and provides better protection against influenza and influenza-associated hospitalizations in adults ≥65 years 2, 3
• Patients receiving high-dose vaccine had significantly less risk of developing laboratory-confirmed influenza infections (Relative Risk 0.76,95% CI 0.65 to 0.90) compared to standard-dose vaccine recipients 3
• The high-dose vaccine has consistently demonstrated better protection against influenza outcomes across all older adult age groups (65+, 75+, 85+ years), regardless of the predominant circulating influenza strain 4

Special Populations

• Solid organ transplant recipients aged 18-64 years who are receiving immunosuppressive medication regimens may receive either high-dose inactivated influenza vaccine (HD-IIV3) or adjuvanted inactivated influenza vaccine (aIIV3) as acceptable options 1
• For all other individuals under 65 years without specific risk factors, high-dose formulations are not FDA-approved and should not be administered 2

Important Considerations

• The high-dose influenza vaccine is available as a 0.5 mL prefilled syringe with no mercury content and is administered as a single dose via the intramuscular route 2
• If high-dose vaccine is not available for adults ≥65 years, standard-dose influenza vaccine should be administered rather than delaying vaccination 2, 5
• Delays in vaccination or reductions in coverage due to waiting for high-dose vaccine could potentially increase influenza-related hospitalizations and deaths 5

Common Pitfalls

• Administering high-dose influenza vaccine to patients under 65 years without specific indications (such as solid organ transplantation with immunosuppression) is not FDA-approved 1, 2
• Delaying vaccination to wait for high-dose vaccine availability could leave patients unprotected during influenza season 2, 5
• Most adults, particularly those ≥65 years, should not be immunized too early (July and August) due to concerns about waning immunity before the peak of influenza season 2