Which flu vaccine is given to over 65?

With more than half of flu-related hospitalizations occurring in adults 65 and older, it's clear that older adults face a higher risk of severe illness from influenza. Knowing which flu vaccine is given to over 65 is crucial, as specific enhanced vaccines are recommended to provide a stronger immune response for this age group.

Quick Summary

Several enhanced flu vaccines are specifically recommended for people over 65, including high-dose (Fluzone High-Dose), adjuvanted (Fluad), and recombinant (Flublok) versions, which provide a stronger immune response than standard-dose vaccines. While standard-dose shots are still beneficial if enhanced versions are unavailable, the CDC preferentially recommends these boosted options to better protect older adults from serious flu complications.

Key Points

• Enhanced Vaccines: For adults 65 and older, the CDC preferentially recommends high-dose, adjuvanted, or recombinant flu vaccines over standard versions for better protection.

• Immune System Boost: These special vaccines are formulated to stimulate a stronger immune response in older adults, whose immunity naturally declines with age.

• High-Dose Option: Fluzone High-Dose Quadrivalent contains four times the antigen of a regular flu shot to boost effectiveness.

• Adjuvanted Option: Fluad Quadrivalent uses an adjuvant to amplify the immune system's response.

• Recombinant Option: Flublok Quadrivalent is an egg-free option that also produces a strong immune reaction.

• Standard Shot is a Last Resort: If enhanced vaccines are not available, a standard-dose shot is still recommended over no vaccination at all.

• Annual Timing: It's best for seniors to get their flu shot in the fall, ideally by the end of October, to be protected before the flu season peaks.

Why Older Adults Need Enhanced Flu Vaccines

As we age, our immune systems naturally become weaker and less responsive, a process known as immunosenescence. This makes it more difficult for older adults to fight off infections like influenza and mount a strong response to standard-dose flu vaccines. For this reason, the Centers for Disease Control and Prevention (CDC) and its Advisory Committee on Immunization Practices (ACIP) preferentially recommend enhanced flu vaccines for adults 65 years and older. These vaccines are specifically designed to provoke a more robust protective immune response in older adults, offering better protection against the flu and its complications, such as pneumonia and hospitalization.

The Three Types of Flu Vaccines Recommended for Seniors

For adults over 65, the CDC recommends three types of flu vaccines that are considered more effective than standard-dose options.

• High-Dose Flu Vaccine (e.g., Fluzone High-Dose Quadrivalent): This vaccine contains four times the amount of antigen as a standard-dose flu shot. The higher dose of antigen is intended to stimulate a stronger immune response, leading to better protection against the flu. Numerous studies have shown it is more effective at preventing flu in this age group than standard vaccines.
• Adjuvanted Flu Vaccine (e.g., Fluad Quadrivalent): This vaccine includes a special ingredient called an adjuvant (MF59®). The adjuvant helps create a stronger immune response by enhancing the body’s reaction to the vaccine. Studies suggest this may also help lower the risk of flu-related hospitalizations.
• Recombinant Flu Vaccine (e.g., Flublok Quadrivalent): Made without using the traditional egg-based manufacturing process, this vaccine uses recombinant DNA technology to produce the antigen. It has also been shown to provide a stronger immune response in older adults compared to standard vaccines.

What if an Enhanced Vaccine Isn't Available?

While the high-dose, adjuvanted, and recombinant vaccines are preferentially recommended, sometimes one or more of these options may not be readily available at a vaccination site. In this scenario, it is far better to receive a standard-dose flu shot than to skip vaccination entirely. Any age-appropriate flu vaccine is beneficial and will offer some level of protection against influenza. The important takeaway is to get vaccinated annually, ideally by the end of October, to ensure the best possible protection before flu season peaks.

Comparing the Enhanced Flu Vaccines for Seniors

To help you and your healthcare provider make an informed decision, here is a comparison of the three enhanced flu vaccine types recommended for adults 65 and older.

Feature	Fluzone High-Dose Quadrivalent	Fluad Quadrivalent (Adjuvanted)	Flublok Quadrivalent (Recombinant)
Mechanism	Contains four times the antigen of a standard vaccine to produce a stronger immune response.	Contains an adjuvant (MF59®) to boost the immune response to the antigen.	Produced using cell culture and recombinant DNA technology; does not contain actual virus.
Availability	Widely available at pharmacies and doctor's offices.	Available at many vaccination sites.	Widely available as an egg-free option.
Key Benefit	Significantly more antigen to strengthen the immune response.	Adjuvant enhances immune response for better protection.	Egg-free option with strong immune response, ideal for severe egg allergies.
FDA Approval	Approved specifically for adults 65+.	Approved for adults 65+.	Approved for adults 18+.

Other Important Vaccinations for Seniors

In addition to the annual flu shot, older adults are also advised to stay up-to-date with other important immunizations. Pneumococcal disease, which can lead to serious conditions like pneumonia, meningitis, and bloodstream infections, is a common complication of the flu. The CDC recommends specific pneumococcal vaccines (PCV15, PCV20, and PPSV23) for this age group to protect against these risks. Talking to your doctor about your full vaccination history and current recommendations is the best way to ensure comprehensive protection.

Conclusion

For adults over 65, securing a robust defense against the flu is paramount. The CDC's preferential recommendation of high-dose, adjuvanted, and recombinant vaccines reflects their proven ability to elicit a stronger immune response in this vulnerable population. While getting any flu vaccine is better than none, seeking out one of these enhanced options can provide peace of mind knowing you have maximized your protection against severe illness. A discussion with your healthcare provider can help determine the best vaccine choice for your individual health profile and availability.

Talk to your healthcare provider or visit the CDC's website for the most current vaccine guidance and availability.

Frequently Asked Questions

Why can't adults over 65 just get a standard flu shot?

While a standard flu shot offers some protection, older adults have a weaker immune response to vaccines due to natural aging. The preferentially recommended high-dose, adjuvanted, or recombinant vaccines are specifically designed to create a stronger, more protective immune response in this age group.

Is the high-dose flu shot painful for seniors?

The high-dose flu shot may cause slightly more frequent side effects, such as pain or soreness at the injection site, compared to a standard shot. However, these are generally mild and temporary, and the enhanced protection is considered to outweigh these minor side effects.

What is the difference between an adjuvanted and high-dose vaccine for over 65?

A high-dose vaccine (like Fluzone High-Dose) uses a greater quantity of antigen, while an adjuvanted vaccine (like Fluad) uses a special ingredient to boost the immune system's reaction. Both are designed to provide a stronger immune response in seniors than standard shots.

When should older adults get their flu vaccine?

The ideal time for older adults to receive their flu vaccine is in the early fall, by the end of October. This timing ensures maximum protection throughout the peak of flu season. However, vaccination should continue as long as flu viruses are circulating.

Can I get the high-dose flu vaccine if I am under 65?

High-dose vaccines are typically only approved by the FDA for people aged 65 and older. There are rare exceptions, such as for organ transplant recipients, but it's important to consult with a healthcare provider before pursuing this option if you are under 65.

Which flu vaccine is best for a senior with a severe egg allergy?

For seniors with severe egg allergies, the recombinant flu vaccine (Flublok Quadrivalent) is an excellent option as it is egg-free. This provides strong protection without the risk of an allergic reaction associated with egg-based vaccines.

Are enhanced flu shots available at most pharmacies and clinics?

Enhanced flu shots are widely available at many pharmacies and healthcare clinics, though their availability can vary. It is a good idea to call ahead to your local provider or use an online vaccine finder to check stock.