Influenza Vaccine Recommendation for Elderly Males
For an elderly male aged 65 years or older, high-dose influenza vaccine (Fluzone High-Dose) is the preferred choice over standard adult trivalent vaccine, based on the Advisory Committee on Immunization Practices' (ACIP) current preferential recommendation for higher-dose or adjuvanted formulations in this age group. 1, 2
Primary Recommendation
ACIP now expresses a preferential recommendation for higher-dose or adjuvanted influenza vaccines specifically for adults aged ≥65 years, marking a shift from previous guidance that made no preference between standard and high-dose formulations. 1, 2
Fluzone High-Dose (HD-IIV3 or HD-IIV4) contains 60 μg of hemagglutinin per vaccine strain—four times the amount in standard-dose vaccines—and is licensed exclusively for persons aged ≥65 years. 2, 3
The high-dose vaccine should be administered as a single 0.5 mL intramuscular injection in the deltoid muscle. 2, 4
Evidence Supporting High-Dose Vaccine
The preferential recommendation is based on robust clinical evidence:
In a randomized trial of 31,989 persons aged ≥65 years, Fluzone High-Dose demonstrated superior efficacy with a relative efficacy of 24.2% (95% CI: 9.7–36.5%) compared to standard-dose vaccine for preventing laboratory-confirmed influenza. 1, 2
Multiple retrospective studies using Centers for Medicare and Medicaid Services data, Veterans Administration data, and nursing home trials have consistently confirmed these benefits. 1
High-dose vaccine reduces hospitalizations for pneumonia (relative VE = 17.8%; 95% CI: 8.1–26.5%), all-cause hospitalizations (relative VE = 9.1%; 95% CI: 2.4–15.3%), and influenza-like illness (relative VE = 19.5%; 95% CI: 8.6–29.0%). 1
Among nursing home residents aged >65 years, high-dose vaccine reduced respiratory-related hospital admissions (3.4% vs. 3.9%) and mortality (17.1% vs. 18.3%) compared to standard-dose vaccine. 2
Important Clinical Considerations
If high-dose vaccine is not available at the time of the visit, administer standard-dose influenza vaccine rather than delaying vaccination, as any influenza vaccine is better than no vaccine. 2, 4
The benefit of high-dose vaccine is most pronounced in adults aged ≥75 years, though benefits extend to all individuals ≥65 years regardless of comorbidities, frailty, or prior vaccination history. 2
High-dose vaccine recipients may experience more frequent injection site reactions and systemic adverse events compared to standard-dose recipients, but these are typically mild and transient. 1, 2
Common Pitfalls to Avoid
Do not administer high-dose vaccine to patients under 65 years of age (except for specific immunocompromised populations such as solid organ transplant recipients aged 18-64 years on immunosuppressive medications, where it is an acceptable option). 1, 2
Avoid vaccinating in July and August, as most adults should not be immunized during these months due to concerns about waning immunity before the peak of influenza season. 2, 4
Do not confuse high-dose formulations with standard-dose vaccines—high-dose vaccine is available as a prefilled syringe and should be clearly identified. 2