U.S. health experts anticipate a challenging flu season ahead now that mask mandates and other COVID-19 protections — measures that had the added benefit of driving down flu rates to historic lows — have largely disappeared. The right flu vaccine can help keep you from getting infected or experiencing potentially serious complications. If you’re an older adult, this annual flu shot is especially important. In past flu seasons, 70 to 85 percent of flu-related deaths and 50 to 70 percent of flu-related hospitalizations occurred in people age 65 years and older. The U.S. Food and Drug Administration (FDA) has approved two flu-vaccine types specifically for people 65 and up: higher-dose vaccines and adjuvanted (amped-up) standard-dose vaccines. But in years past the CDC did not suggest that seniors opt for one of those vaccines; instead, the agency recommended any licensed, age-appropriate flu vaccine, with no preference for one kind over any other. The CDC changed its position earlier this year. It now recommends that, when possible, seniors choose a higher-dose flu vaccine (Fluzone High-Dose or the egg-free Flublok recombinant) or an adjuvanted standard-dose flu vaccine (Fluad) over other types. If these vaccines aren’t available, the CDC recommends getting a regular standard-dose vaccine. “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,” said José R. Romero, MD, the director of the CDC’s National Center for Immunization and Respiratory Diseases, in a statement. He added that the new CDC recommendations are especially noteworthy for Black, Latino, and Asian seniors, who researchers have found are less likely than white seniors to get these extra-protective vaccines. Read on to learn more about the ideal flu vaccines for people 65 and older, including when to get the shot and what side effects to expect. Higher-dose or adjuvanted standard-dose vaccines are designed to stimulate the flagging immune systems of older adults. Compared with standard-dose (inactivated) flu vaccines, higher-dose flu shots contain four times the amount of antigen — the part of the vaccine that stimulates the immune system to produce protective antibodies.
2. The 65-and-Up Flu Shots Can Stave Off Infection, Serious Illness, and Death
Every flu season is different, so predicting the efficacy of any flu shot in a given year is difficult. Still, studies have shown that in seniors, the higher-dose and adjuvanted standard-dose flu vaccines can prevent more infections and save lives compared with standard-dose flu shots, says Paul Auwaerter, MD, the clinical director of the division of infectious diseases at Johns Hopkins Medicine in Baltimore. The data is best for the higher-dose vaccine, which in one study showed itself to be 24 percent better at preventing the flu in people 65 and older than the standard-dose vaccine, says Poland. The higher-dose vaccine also appears to be more effective than the standard-dose vaccine at keeping people who do get the flu out of the hospital. In a study conducted during the 2013–14 flu season of more than 38,000 residents in 823 nursing homes in 38 states, people 65 and older who got the Fluzone High-Dose vaccine had a lower risk of hospital admission than people in that age group who got the Fluzone standard dose; this was especially true for residents of long-term care facilities. “Both those studies were done with what’s called a trivalent vaccine — it covered two A strains and one B strain [of the influenza virus],” says Dr. Auwaerter. The higher-dose vaccine for the 2022–23 flu season will be quadrivalent, covering four flu strains, 2A and 2B, he explains. There will be no trivalent vaccine available for the upcoming flu season, per the CDC. A study published in July 2020 in the Journal of Infectious Diseases found that both the Fluzone High-Dose and Fluad (adjuvanted standard-dose) vaccines performed about the same in preventing the flu and flu-related hospitalizations among older adults. Poland reports that he has received both the standard-dose flu shot and the higher-dose shot. Based on his experience, he doesn’t think that most people will register much of a difference when it comes to side effects. He notes that it’s safe to get the COVID-19 vaccine or booster at the same time as any type of flu shot, including the higher-dose flu shot. Some research published in JAMA Network Open in July of this year suggests you’re more likely to have (generally mild) side effects if you get a COVID-19 booster and a flu shot simultaneously, so if that’s a concern, you may opt to space them out a bit.
4. The 65-and-Up Flu Shots Have a Track Record — and Are Covered by Medicare
Even though the CDC is just now recommending the 65-and-up flu shots over the standard-dose flu shots, these vaccines aren’t a new thing: They’ve been around for years, says Poland. If you are hearing about the higher-dose shot for the first time from your pharmacist or healthcare provider, it may be simply because this is the first year that the CDC is preferentially recommending it, along with the other vaccines designed for people 65 and older. “That’s because they have determined that the efficacy is superior, and there’s a good enough supply to recommend it,” says Poland. These types of vaccines are a little pricier than standard-dose vaccines, although Medicare will cover the cost for enrollees, he says. That’s also what the CDC advises: If you’re 65 or older and can’t find a place that administers higher-dose flu shots or adjuvanted standard-dose shots, go ahead and get the regular standard-dose vaccine. A flu shot has benefits even beyond lowering your risk of hospitalization or death as a result of the flu. For instance, “In people 65 or older, the benefit of getting the flu vaccine in preventing a heart attack is equal to taking a daily aspirin, taking a beta-blocker, or stopping smoking,” says Poland.
Get the High-Dose Flu Shot in September or October
You can get the flu shot anytime flu viruses are circulating, but timing your shot well will give you the maximum level of protection at the peak of flu season, which is typically between December and February. Keep in mind it takes about two weeks after vaccination for antibodies to develop and provide protection. Because immunity may decrease more quickly in older people, it is especially important that people 65 and older not get vaccinated too early. September and October are generally good times, per the CDC. If you miss that window, it still makes sense to get vaccinated. If you want to increase your chance of getting a flu shot designed for people 65 and up, call your primary care provider, local health department, or pharmacy before scheduling your appointment.
