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Older Adults Should Opt for High-Dose Flu Shots

65 or over? The CDC has influenza vaccine recommendations just for you

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A reminder just ahead of flu season: When you roll up your sleeve for the shot 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 influenza 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.

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Older adults are more susceptible to complications from the flu. In fact, 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.

“Given their increased risk of flu-associated severe illness, hospitalization and death, it’s important to use these potentially more effective vaccines in people 65 years and older,” José R. Romero, M.D., director of the CDC’s National Center for Immunization and Respiratory Diseases, said in a July 2022 statement when the recommendation was first made.

The three available vaccines

The more powerful flu shots have been available for several years. However, previous recommendations did not explicitly favor them over the standard flu vaccines, which help keep an influenza infection from progressing to a serious illness. “It was more of a soft recommendation,” says William Schaffner, M.D., a professor in the Division of Infectious Diseases at the Vanderbilt University School of Medicine. But data collected from studies over the years now shows that there’s “better protection for people ages 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 aged 65 and older.”

The CDC’s recommendation didn’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 Quadrivalent, 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.
  • Fluad Quadrivalent, 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.
  • Flublok Quadrivalent, approved for people 18 and older, is made using a different vaccine technology (it’s a recombinant protein vaccine).

The high-dose and adjuvanted flu vaccines may result in more of the mild, temporary side effects that can occur with standard-dose seasonal flu shots, the CDC says. Expected side effects can include pain, redness or swelling at the injection site, headache, muscle ache and fatigue. These symptoms typically resolve within one to three days.

Before the CDC’s recommendation, about 80 percent of Medicare beneficiaries were already receiving a higher-dose or adjuvanted flu vaccine, federal data shows. However, the CDC notes that racial and ethnic disparities existed. One study published in The Lancet Healthy Longevity found that minority groups were 26 to 32 percent less likely than whites to receive a high-dose flu vaccine.


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The CDC’s 2022 recommendation “could help reduce health disparities by making these vaccines more available to racial and ethnic minority groups,” Romero says.

The CDC recommends that everyone 6 months and older be vaccinated each year against the flu. If you’re 65 or older and one of the enhanced vaccines is not available when you go to get your flu shot, get a standard-dose flu vaccine instead, the agency says.

“When you’re 65 and older and you’re talking about influenza, you need all the help that you can get,” Schaffner says. “So I have a very strong message to absolutely everyone 65 and older: Better to be vaccinated than not.” 

Editor’s note: This article, originally published July 1, 2022, has been updated to reflect new information.

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