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The New Flu Shot for Older Americans: Answers to Your Questions

What men and women want to know about the high-dose flu shot and this year's flu season

The approach of this year's flu season has not been the wild and woolly experience it was last year, when a new pandemic influenza virus had the country on high alert. But it's early yet — and last year's headlines seem to have left the public a little more determined to stay informed and prepared. One item of particular interest to older Americans now — and one that has generated a number of questions — is a new, high-dose flu vaccine designed specifically to give them extra protection.

What is Fluzone High-Dose and where can I find it?

Fluzone High-Dose is a new seasonal flu vaccine with four times the amount of active ingredient as the standard flu shot. It was approved in December 2009 by the U.S. Food and Drug Administration (FDA) specifically for people age 65 and older.

The high-dose shot has been shipped to doctors' offices, pharmacies and long-term care facilities around the country, says Donna Cary, spokesperson for Sanofi Pasteur, maker of Fluzone High-Dose. But because it's a new product, it's not as widely available as the standard flu shot.

If you're interested in getting the new shot, try calling your health care provider, or check the American Lung Association's online flu-shot locator for clinics and stores offering flu shots, then contact some in your area to see whether they have the high-dose vaccine. Safeway, Walgreens, Kmart and Kroger are among the chains advertising the high-dose shot.

Why should older people need a high-dose flu shot?

Flu vaccine works by stimulating the body's own immune system to fight off the virus. In older people, this response is significantly less robust than in young adults. So the regular flu shot is less effective at protecting the very people who need protection the most because they're at high risk for complications like pneumonia.

"There's definitely room for improvement in our current vaccines," says Janet McElhaney, M.D., who heads the geriatric medicine division at the University of British Columbia and has done research on influenza immunization. "With the current vaccines, you may still get the flu, although the risk of your going to the hospital with that illness is significantly reduced." The idea behind the high-dose shot (as well as a shot marketed in Europe that includes a potency booster known as an adjuvant) is to spur stronger immunity in the elderly, thus further reducing their chances of severe illness — or indeed of contracting the flu at all.

Is the Fluzone High-Dose shot definitely better than the standard flu vaccine?

The answer to that question is, we don't know yet. In order to receive the FDA's okay to market the vaccine, its maker conducted research looking at immune response in people given the shot; as expected, the high-dose shot stimulated significantly larger immune response than the regular vaccine. "The antibody boost that you see is one indicator of what the protection might be," says Carolyn Bridges, M.D., an epidemiologist at the National Center for Immunization and Respiratory Diseases, part of the Centers for Disease Control and Prevention (CDC). "But it's not the same as seeing, clinically, did it prevent people from getting sick or not?" A clinical trial following men and women who got the high-dose shot, which ends in 2012, should go a long way toward answering that question. At present, says Bridges, the CDC "has not expressed a preference" for the high-dose shot over regular flu vaccine.

How much does the high-dose shot cost?

Sanofi Pasteur's list price for the shot is about $25, roughly double the cost of standard Fluzone. Medicare will cover either shot.

Can I get the high-dose shot if I'm younger than 65?

Physicians — but not pharmacists — are legally entitled to prescribe medications "off-label," that is, for uses or in populations other than those specifically approved by the FDA. But this is more common when a product has been on the market for a while.

I'm over 65 and received a standard-dose flu shot already this season. Should I try to get the high-dose shot? Or try to get a second regular flu shot?

No, you should consider yourself immunized. Studies show that getting a delayed second dose doesn't necessarily hike antibody response, and there's some concern that it might actually have a negative effect on your immunity, according to McElhaney. "What I would advise my mother is, if you've already had the regular seasonal dose, wait until next year for another dose," she says.

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