CDC Updates ACIP Guidance, Recommending Specific Flu Vaccines for Patients 65 and Older


Flublok Quadrivalent and Fluzone High-Dose Quadrivalent are both proven to prevent more cases in older adults compared with a standard-dose vaccine in randomized controlled trials.

The CDC published updated Advisory Committee on Immunization Practices (ACIP) guidance, granting preferential recommendation for specific flu vaccines in individuals aged 65 years and older, in its Morbidity and Mortality Weekly Report.

The recommendations include the use of specific flu vaccines for this age group, including higher-dose vaccines.

If none of the vaccines are available at the time of administration, the individuals should get other age-appropriate influenza vaccine instead, according to the recommendations.

Flublok Quadrivalent (Sanofi) and Fluzone High-Dose Quadrivalent (Sanofi), both influenza vaccines, were among those recommended for adults aged 65 years and older.

Both vaccines are indicated for immunization against disease caused by influenza A and B strains. Flublok Quadrivalent is given to those aged 18 years and older, while Fluzone High-Dose Quadrivalent is given to those aged 65 years and older.

Fluzone High-Dose protects against 4 strains of the flu and is the only influenza vaccine licensed for use in adults aged 65 years and older that demonstrated superior efficacy in a randomized controlled trial compared with a standard dose influenza vaccine.

Additionally, Fluzone High-Dose is the only influenza vaccine with 10 years of data demonstrating protection from the flu and related complications. In a meta-analysis of 15 published reports, including approximately 34 million individuals, patients who received Fluzone High-Dose experienced an 18% reduction in cardiorespiratory hospitalization and a 28% decrease in pneumonia hospitalization. Both reductions are above the standard dose vaccines’ reductions.

Fluzone High-Dose Quadrivalent builds upon the trivalent formula, which was clinically proven to be 24.4% more effective at preventing flu than the standard-dose Fluzone in adults aged 65 years and older.

According to data from Fluzone High-Dose, the adverse events (AEs) were slightly more frequent after vaccination than with a standard-dose vaccine.

Further, Flublok is the first and only recombinant influenza vaccine for adults aged 18 years and older in a clinical study shown to be 30% more effective than a standard dose of Fluarix Quadrivalent at preventing flu infection in more than 9000 individuals aged 50 years and older.

In this age group, the most common AEs were headache, pain at the injection site, tenderness and tiredness.

The effectiveness was judged by data from general day-to-day medical practice among more than 12 million adults aged 65 years and older and measured against standard-dose vaccines.

In the analysis, investigators included day-to-day medical practice of Medicare fee-for-service claims collected during the 2019 to 2020 influenza season.

The 5-vaccine relative effectiveness analysis showed that Flublok Quadrivalent had 13.3% fewer flu-related emergency department visits and hospitalizations compared with an egg-based standard dose quadrivalent vaccine.

The most common AEs were general discomfort, headaches, pain, and redness and/or swelling of the injection site.

Both vaccines should not be given to individuals with severe allergic reactions to any component of the vaccines, including eggs or egg products for the Fluzone High-Dose Quadrivalent. Additionally, the Fluzone High-Dose Quadrivalent should not be given to individuals who has had a severe allergic reaction after a previous dose of any influenza vaccine.


Sanofi higher dose flu vaccines preferentially recommended for adults 65+ in CDC Morbidity and Mortality Weekly Report. News release. Sanofi. August 26, 2022. Accessed August 29, 2022.

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