Why Adults 65+ Need a Special Flu Shot
As we age, our immune systems undergo a process called immunosenescence, which weakens our body's ability to fight off infections. This puts older adults at a significantly higher risk for serious complications from the flu, such as pneumonia, bronchitis, and the worsening of chronic health conditions like heart disease. In fact, the Centers for Disease Control and Prevention (CDC) estimates that people 65 years and older bear the greatest burden of severe flu disease during most seasons.
To combat this weakened immune response, standard-dose flu vaccines may not be as effective in this age group. In response, several specialized flu vaccines have been developed to provide a stronger protective immune response for older adults.
The Three Preferentially Recommended Vaccines for Seniors
For the 2024-2025 flu season, the CDC and the Advisory Committee on Immunization Practices (ACIP) preferentially recommend three types of flu vaccines for people aged 65 and older. These are considered potentially more effective than standard-dose vaccines and should be requested specifically. The three options are:
- High-Dose Quadrivalent Flu Shot: Contains four times the amount of antigen as a standard-dose vaccine. This higher dose is intended to create a more robust immune response in older adults. It is marketed as Fluzone High-Dose Quadrivalent.
- Adjuvanted Quadrivalent Flu Shot: Includes an adjuvant, which is an ingredient that helps create a stronger immune response. The adjuvant boosts the body's response to the vaccine antigen. This vaccine is marketed as Fluad Quadrivalent.
- Recombinant Quadrivalent Flu Shot: This vaccine is produced using a different method that doesn't use egg-grown viruses. It is also designed to provide a stronger immune response and is marketed as Flublok Quadrivalent.
Comparing High-Dose vs. Standard-Dose Flu Shots
| Feature | High-Dose/Adjuvanted/Recombinant | Standard-Dose |
|---|---|---|
| Targeted Age Group | Preferentially recommended for adults 65+ | Approved for most people 6 months+ |
| Antigen Strength | Higher antigen dose (4x) or enhanced immune response via adjuvant or recombinant tech | Standard antigen dose |
| Immune Response | Designed to induce a stronger immune response | Adequate response for younger, healthier individuals |
| Effectiveness in Seniors | Studies show potential for better protection against severe outcomes like hospitalization in older adults | Less effective in seniors due to immunosenescence |
| Side Effects | Mild, temporary side effects (sore arm, headache) might be slightly more common but serious events are rare | Mild, temporary side effects (sore arm, headache, muscle aches) |
Important Timing and Availability
While flu vaccines are typically available as early as July or August, adults 65 and older should consider waiting until September or October. The reason is that immunity from the vaccine can wane over several months, and waiting ensures maximum protection during the peak of flu season (December to February). If you are unable to get vaccinated during this optimal window, however, getting a flu shot later is always better than not getting one at all.
It is also important to note that if a high-dose, adjuvanted, or recombinant vaccine is not immediately available when you go for your shot, you should still proceed with getting a standard-dose, age-appropriate vaccine. Protection from a standard dose is still valuable, and waiting risks missing out on any protection entirely if flu activity increases. The CDC provides resources to help locate vaccine providers, including pharmacies and doctors' offices.
Medicare Coverage and Other Vaccinations
For those on Medicare, the flu vaccine is covered under Medicare Part B with no out-of-pocket costs. This makes it accessible for most seniors. When getting your flu shot, it's also an excellent time to talk with your healthcare provider about other important vaccinations for older adults, such as the pneumococcal vaccine, which protects against a serious flu-related complication, pneumonia. You can often get both vaccines during the same visit. For further reading on CDC recommendations, visit the CDC website for people 65 years and older.
Conclusion
Who should get the over 65 flu shot? The answer is all adults aged 65 and older. While an annual flu shot is recommended for nearly everyone, the type of vaccine is especially important for seniors. The higher dose, adjuvanted, or recombinant flu vaccines provide enhanced protection against serious illness and hospitalization, which are more common and dangerous in this age group due to a weaker immune system. Prioritizing this annual immunization is a simple yet powerful step in maintaining health and wellness during flu season and beyond.
