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High-Dose Flu Vaccine For Older Adults

Dr. Novella  has recently written about this year’s seasonal flu vaccine and Dr. Crislip has reviewed the evidence for flu vaccine efficacy. There’s one little wrinkle that they didn’t address — one that I’m more attuned to because I’m older than they are.

I got my Medicare card last summer, so I am now officially one of the “elderly.” A recent review by Goodwin et al. showed that the antibody response to flu vaccines is significantly lower in the elderly. They called for a more immunogenic vaccine formulation for that age group. My age group. One manufacturer has responded.

Fluzone High-Dose vaccine contains 60 mcg of hemagglutinin antigen from each strain, compared to 15 mcg in the standard dose vaccine. This high-dose preparation has been tested in three clinical studies (here, here, and here) of 4453 healthy people aged 65 years and older. In each of these studies the high-dose vaccine produced significantly higher antibody levels than the standard dose vaccine. There was a dose-related increase in minor local side effects (arm pain, redness and swelling at the injection site), but no increase in serious adverse effects. Most recipients had minimal or no adverse effects.

We don’t yet have data to prove that the increase in antibody titers will result in fewer clinical influenza illnesses and complications, but it seems logical that it would. A study comparing the effectiveness of Fluzone High-Dose to Fluzone is expected to be completed in 2012. The high-dose vaccine is more expensive, but Medicare pays for it.

The Medical Letter recently covered the 2010-2011 flu vaccines and did not recommend (or advise against) the high-dose formulation for older patients, because the clinical efficacy data are not yet available. Neither the CDC nor the ACIP has been willing to express a preference for one vaccine over another at this time. I asked our own infectious disease expert, Dr. Crislip, and he recommends the high-dose in view of its improved immunogenicity and biological plausibility. 

I’m 65 and my husband is older: We opted for the high-dose vaccine. Not everyone will agree, but shouldn’t older patients be given the facts and the option?

*This blog post was originally published at Science-Based Medicine*

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