Should a newly turned 65-year-old patient be involved in shared decision-making to choose between Fluzone HD (influenza vaccine) and other influenza vaccines?

Fluzone High-Dose Should Only Be Administered to Patients Aged 65 Years and Older

For a patient who has just turned 65, Fluzone High-Dose influenza vaccine is appropriate and recommended, but for patients under 65 years of age, standard-dose influenza vaccines should be used unless specific medical conditions warrant otherwise. 1, 2

Age-Based Recommendations for Influenza Vaccines

• The Advisory Committee on Immunization Practices (ACIP) recommends preferential use of higher-dose or adjuvanted influenza vaccines for adults 65 years and older 2
• Fluzone High-Dose (HD-IIV4) is specifically licensed only for adults aged 65 years and older 1, 2
• For adults under 65 years of age, standard-dose influenza vaccines are recommended 1
• The high-dose influenza vaccine contains 60 μg of hemagglutinin per vaccine virus (240 μg total), which is four times the amount in standard-dose vaccines 3, 2

Evidence Supporting Age-Based Recommendations

• Fluzone High-Dose met prespecified criteria for superior efficacy compared to standard-dose influenza vaccine in a randomized trial conducted among 31,989 persons aged ≥65 years 3
• While high-dose vaccine generally improves estimated vaccine efficacy in older adults, the benefit appears most consistent in individuals aged 75 and older 4
• Evidence supporting the superiority of high-dose vaccine over standard-dose vaccines in the 65-74 age group is more limited and often not statistically significant 4
• The Centers for Disease Control and Prevention (CDC) does not recommend high-dose influenza vaccine for adults under 65 years 1

Special Circumstances for High-Dose Vaccine in Younger Adults

• Patients with rheumatic and musculoskeletal diseases aged >18 and <65 years who are taking immunosuppressive medication may benefit from high-dose influenza vaccines 1, 2
• Solid organ transplant recipients aged 18-64 years who are receiving immunosuppressive medications may also benefit from high-dose vaccines 1, 2
• These special circumstances represent off-label use and may require prior authorization from insurance 1

Practical Approach to Vaccine Selection

• For a patient who has just turned 65, Fluzone High-Dose is appropriate and recommended 3, 2
• For patients under 65 without specific risk factors, standard-dose influenza vaccine should be used 1
• If the patient has specific immunocompromising conditions, consultation with a healthcare provider may be warranted to determine if early high-dose vaccination would be beneficial 1
• Vaccination should not be delayed if only standard-dose vaccine is available, as any influenza vaccine is preferred over no vaccination 2

Common Pitfalls and Caveats

• Administering high-dose vaccine to patients under 65 without specific medical indications is not FDA-approved and may not be covered by insurance 1, 2
• High-dose vaccine is associated with higher rates of mild side effects compared to standard-dose vaccines 4
• The cost-effectiveness of high-dose vaccines may be limited in younger elderly populations (65-74 years) 4
• Shared decision-making about vaccine choice should only occur within the context of FDA-approved indications and ACIP recommendations 3, 1