Influenza Vaccine Recommendation for a 55-Year-Old Patient
A 55-year-old patient should receive a standard-dose quadrivalent inactivated influenza vaccine (IIV4) containing 15 μg of hemagglutinin per strain in a 0.5 mL dose, administered intramuscularly in the deltoid muscle. 1
Standard-Dose Vaccine Options
For this age group, several appropriate standard-dose IIV4 options are available 1:
- Egg-based vaccines: Afluria Quadrivalent, Fluarix Quadrivalent, FluLaval Quadrivalent, or Fluzone Quadrivalent 1
- Cell culture-based vaccine: Flucelvax Quadrivalent 1
- Recombinant vaccine: Flublok Quadrivalent (RIV4) 1
All of these vaccines are FDA-approved for adults and contain 15 μg of hemagglutinin per strain in a 0.5 mL dose administered intramuscularly. 1
Why Not High-Dose or Adjuvanted Vaccines?
High-dose influenza vaccine (HD-IIV4) and adjuvanted influenza vaccine (aIIV4) are specifically licensed only for adults aged 65 years and older. 2, 3, 4 At age 55, this patient does not yet qualify for these enhanced formulations based on age alone. 3
The Advisory Committee on Immunization Practices (ACIP) expresses a preferential recommendation for higher-dose or adjuvanted formulations only in adults aged ≥65 years. 2, 5
Important Exceptions for Immunocompromised Patients
If this 55-year-old patient has specific immunocompromising conditions, enhanced vaccines may be considered 2, 3:
- Solid organ transplant recipients aged 18-64 years receiving immunosuppressive medications may receive high-dose or adjuvanted vaccines 2, 3
- Patients with rheumatic and musculoskeletal diseases aged >18 and <65 years taking immunosuppressive medication may benefit from high-dose or adjuvanted influenza vaccines 2, 3
However, such use would be off-label and may require prior authorization from insurance. 3
Practical Administration Details
- Route: Intramuscular injection 1
- Site: Deltoid muscle (preferred site for adults) 1, 3
- Dose volume: 0.5 mL 1
- Number of doses: One dose per influenza season 1
Timing Considerations
Most adults should not be immunized in July and August due to concerns about waning immunity before the peak of influenza season. 2 Vaccination should ideally occur in early fall when vaccine becomes available.
Key Clinical Pitfall
Do not delay vaccination to obtain a specific product. 1 If only one type of standard-dose vaccine is available (egg-based, cell culture-based, or recombinant), it should be administered rather than waiting for a different formulation. ACIP makes no preferential recommendation among standard-dose vaccines for this age group when more than one licensed, age-appropriate vaccine is available. 1