Influenza Vaccine Considerations in the 65+ Population

SupplementsImmunization Guide for Pharmacists
Volume 1
Issue 3

Influenza vaccination decreases mortality and intensive care unit admissions and length of stay among patients who are 65 years and older.

Because between 70% and 85% of seasonal influenza (flu)-related deaths occur in people 65 years and older and between 54% and 70% of seasonal flu-related hospitalizations occur in this age group, the CDC recommends that adults 65 years and older receive a flu vaccination each year (see table).1 Influenza vaccination in these patients also has shown to decrease mortality and intensive care unit admissions, as well as hospital length of stay.2 Many patients in this population do not realize that more than 1 vaccine formulation is available or that they may benefit from a higher-dose vaccine, so pharmacists have a crucial role in educating these patients about the importance of receiving the most appropriate flu vaccine.

The 2 flu vaccine options to consider for people 65 years and older are Fluad and Fluzone High-Dose (HD). Fluad is a standard adjuvanted trivalent vaccine made with the MF59 additive, which creates a stronger immune response to vaccination than the standard trivalent vaccine alone. Fluzone HD contains 4 times the amount of antigen as the standard trivalent dose. Both Fluad and Fluzone HD are administered intramuscularly as a single dose of 0.5 mL. Adverse effects seen for both vaccines are mild and may include pain, redness, or swelling at the injection site; headache; muscle ache; and malaise.3,4

Patients should be advised that immunity will start to develop about 2 weeks after receiving the vaccination. For patients with an egg allergy that results in symptoms more severe than hives (ie, angioedema or respiratory distress), the vaccine should be administered in a medical setting under supervision of a health care provider who is able to recognize and manage a severe allergic reaction. Patients with a history of Guillain-Barré syndrome within 6 weeks of a previous dose of flu vaccine are not advised to be vaccinated unless their health care provider has advised that the benefit of receiving the vaccine outweighs the risk. The intranasal flu vaccine, FluMist, is not recommended for this age group because of its potentially poor efficacy.1,3,4

The results of a clinical trial indicated that adults 65 years and older who received Fluzone HD had 24% fewer influenza infections compared with those who received the standard trivalent-dose vaccine.1 Randomized clinical trials are underway comparing Fluad and Fluzone HD to determine more definitively if one vaccine is inferior to the other; however, the CDC and its advisory committee have not indicated a preference between Fluzone HD and Fluad for prevention of flu in people 65 years and older.1,5,6 Vaccination choice should therefore be based on insurance coverage and cost for patients.

Nadia Archambault, PharmD, a graduate of the University of Rhode Island, is a performance specialist for Pharmacy Development Services.


  • Influenza Vaccine Considerations in the 65+ Population
  • Uncertainty Remains in the Match or Mismatch for the 2019-2020 Flu Vaccine
  • Early Interventions Are Vital for Treating Influenza, Especially in Patients With Chronic Conditions


  • People 65 years and older & influenza. CDC website. Accessed May 13, 2019.
  • Arriola C, Garg S, Anderson EJ, et al. Influenza vaccination modifies disease severity among community-dwelling adults hospitalized with influenza. Clin Infect Dis. 2017;65(8):1289-1297. doi: 10.1093/cid/cix468.
  • FLUAD [prescribing information]. Summit, NJ: Sequris USA Inc; 2018. Accessed May 13, 2019.
  • Fluzone High-Dose [prescribing information]. Swiftwater, PA: Sanofi Pasteur Inc; 2019. pdf. Accessed May 13, 2019.
  • FLUAD vs FLUZONE HD Influenza Vaccine in Residents of Long Term Care. Updated April 9, 2019. Accessed May 13, 2019.
  • FLUAD vs Fluzone High-Dose Study. NCT03183908. Updated September 27, 2018. Accessed May 13, 2019.

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