If You're Over 65, You Might Want to Get a High-Dose Flu Vaccine

bandaid on arm

Getty Images

Key Takeaways

  • A new study suggests that high-dose influenza vaccines are better than standard-dose vaccines at preventing hospitalization and death in older adults who get the flu.
  • Currently, the CDC recommends three different vaccines for American adults aged 65 and older.
  • Experts recommend getting your annual flu vaccine before the end of October.

Older adults might be able to lower their risk of getting seriously sick, or even dying from, influenza by getting a high-dose influenza vaccine instead of a standard dose.

A new study presented at the European Society of Cardiology (ESC) Congress 2022 in August supported the current flu shot guidelines for older Americans set by the Centers for Disease Control and Prevention (CDC).

Previous studies have suggested that getting the flu may raise a person's risk for cardiovascular events like heart attacks. It seems like getting a flu shot could be a reasonable way to try to lower that risk.

For the new trial, the researchers wanted to find out if the flu vaccine dose would have an effect on the risks of flu-related hospitalizations and deaths in older adults, specifically.

It was important to focus on this age group, as older adults may already be at a higher risk for heart problems (for example, if they already have heart disease).

Flu Fight: High-Dose vs. Standard Dose

The researchers looked at data on 12,477 older patients (average age 72) who had been randomly assigned to get either a high-dose or standard-dose flu vaccine.

The group that got a high-dose flu vaccine had a 49% lower risk of death and a 64% lower risk of hospitalization for the flu or pneumonia than the group that got the standard dose.

In a statement, Tor Biering-Sørensen, MD, PhD, MPH, a study co-author and associate professor at the University of Copenhagen, said that the findings "were encouraging but require confirmation in a larger trial before potentially guiding clinical practice."

The study's findings are in line with the current flu shot vaccine guidance for older Americans from the CDC. However, not every flu shot that's offered to this age group is a high-dose one. Here's what you should know about flu vaccine options for people over age 65.

Flu Shot Recommendations If You're Over 65

Older adults are at a higher risk for flu-related complications. Between 70% and 85% of seasonal flu-related deaths occur in people 65 and older, and 50% to 70% of seasonal flu-related hospitalizations occur in this age group.

The CDC recommends that people 65 and older get either a higher-dose or adjuvanted flu vaccine. The two vaccine types offer similar benefits but are a little different:

  • An adjuvant vaccine has an ingredient in it that helps the vaccine create a stronger immune response in the body.
  • A high-dose flu vaccine just provides a bigger dose of the substance that causes an immune response in the body (antigen) than standard flu vaccines do.

Thomas Russo, MD, professor and chief of infectious disease at the University at Buffalo in New York, told Verywell that it's "encouraging that both of these formulations seem to be doing a good job of providing protection."

Overall, Russo said there's no preference for which vaccine seniors should get, and he "would recommend either the high-dose or adjuvanted."

Which Type of Flu Shot Should You Get?

Earlier this year, the CDC’s Advisory Committee on Immunization Practices (ACIP) was thinking about recommending certain flu shots, including one high-dose flu vaccine.

Currently, there are three flu shot options that are recommended for older Americans:

  • Fluzone High-Dose Quadrivalent: This vaccine contains four times as much antigen as the standard dose. Data has shown that Fluzone creates a more powerful immune response in people 65 and older compared to a standard-dose flu vaccine.
  • Flublok Quadrivalent: This vaccine is made synthetically and does not require an egg-grown vaccine virus. It also has an adjuvant. Data shows that it's likely more effective than standard dose unadjuvanted flu vaccines in people age 65 and older.
  • Fluad Quadrivalent: This vaccine is made using an egg-based process, like most flu vaccines. It contains an adjuvant called MF59 to help create a stronger immune response.

According to the CDC, these options are the preferred choice for people over 65 "because a review of available studies suggested that, in this age group, these vaccines are potentially more effective than standard dose unadjuvanted flu vaccines."

Infectious disease expert Amesh A. Adalja, MD, a senior scholar at the Johns Hopkins Center for Health Security, told Verywell that high-dose flu vaccines "provide more of a stimulus to the immune system and counteract the less robust immune responses often seen in the elderly, who are also one of the highest risk groups for fatal influenza."

When to Get a Flu Shot

The CDC recommends that people aged 6 months and up get a flu vaccine every year. To make sure that you're protected by the time peak flu season rolls around, try to get your shot in September or October.

While flu shots start showing up at pharmacies and provider's officers by late summer, getting a flu shot in July or August might be too early. The protection from the shot fades with time, so if you get your vaccine too soon, it might not last the whole flu season.

That said, if you don't have the option of waiting, it's better to get vaccinated early than skip it altogether.

"If you happen to have an appointment with your physician, it's better to get your shot than rather than miss an opportunity," Russo said.

The same goes if you don't have a chance until later in the fall. The CDC recommends that you get your flu shot by the end of October. That said, if you have to wait a few weeks longer it won't be too late to get a flu shot.

What This Means For You

The CDC recommends a yearly influenza vaccine for all Americans aged 6 months and up.

Older people are at a higher risk for serious complications from the flu. If you're 65 years old or older, experts recommend getting your annual flu shot before the end of October, and opting for either a high-dose or adjuvant version.

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Centers for Disease Control and Prevention. Flu and people 65 years and older.

  2. European Society of Cardiology. Innovative randomised trial hints at mortality benefits with high-dose influenza vaccines.

  3. Kwong JC, Schwartz KL, Campitelli MA, et al. Acute myocardial infarction after laboratory-confirmed influenza infectionN Engl J Med. 2018;378:345–353. doi:10.1056/NEJMoa1702090

  4. American Heart Association. Flu shot reduces risk of death for people with heart disease.

  5. Centers for Disease Control and Prevention. Adjuvants and vaccines.

  6. Centers for Disease Control and Prevention. Fluzone high-dose seasonal influenza vaccine.

  7. Centers for Disease Control and Prevention. CDC director adopts preference for specific flu vaccines for seniors.

  8. Centers for Disease Control and Prevention. Recombinant influenza (flu) vaccine.

  9. Centers for Disease Control and Prevention. Adjuvanted flu vaccine.

By Korin Miller
Korin Miller is a health and lifestyle journalist who has been published in The Washington Post, Prevention, SELF, Women's Health, The Bump, and Yahoo, among other outlets.