Older Adults Should Opt for High-Dose Flu Shots

A reminder for people 65-plus just ahead of flu season: When you roll up your sleeve for the vaccine this year, skip the standard version and opt for one with more oomph.

Since the summer of 2022, the Centers for Disease Control and Prevention (CDC) has recommended that adults 65 years and older get immunized with what’s known as a high-dose or adjuvanted flu vaccine.

These shots can offer greater protection to older people, who, due to immune system changes that happen with age, do not have as strong a response to vaccination as younger, healthier people.

Data shows that older adults bear the greatest burden of flu complications. It’s estimated that between 70 and 85 percent of seasonal flu-related deaths and 50 to 70 percent of flu-related hospitalizations occur in people 65 and older.

The three available vaccines

Stronger flu shots have been around for years, but until 2022, guidelines didn’t explicitly recommend them over the standard vaccines, which still protect against severe illness from an influenza infection.

“It was more of a soft recommendation,” says Dr. William Schaffner, an infectious disease expert and professor of preventive medicine at the Vanderbilt University School of Medicine in Nashville. 

But data collected from studies over the years shows that there’s “better protection for people age 65 and older with one of these enhanced vaccines,” Schaffner says. “So basically, the signal has gone out to all the providers that [they need] to make an effort to stock these vaccines going forward for people age 65 and older.”

The CDC’s recommendation doesn’t come with a preference for any one of the three enhanced vaccines on the market. Schaffner’s advice is to get the one that’s available.

“Don’t be too picky,” he says. “They’re all really enhanced vaccines.” Just make sure you’re asking for one of the versions that is specifically recommended for older adults.

• Fluzone High-Dose vaccine, an inactivated vaccine (meaning it uses the killed version of the germ that causes a disease) approved for people 65-plus, contains four times the antigen of standard-dose inactivated flu vaccines. Antigen is the part of the vaccine that helps your body build up protection against flu viruses, the CDC explains.
• Adjuvanted flu vaccine (Fluad), also an inactivated vaccine approved for people 65 and older, has the same amount of antigen as the standard shots but contains an adjuvant, or an ingredient added to a vaccine that helps create a stronger immune response to vaccination.
• Recombinant flu vaccine (Flubock), approved for people 18 and older, is made using a different vaccine technology. Recombinant flu vaccines do not use the flu virus or chicken eggs in the manufacturing process.