Video
Recommended Flu Vaccines for Older Adults
An expert panel examines the distinctions among the 3 primary recommended flu vaccines for individuals aged 65 and above, assessing their efficacy compared with standard-dose flu vaccines.
Rodney E. Rohde, PhD, MS, SM (ASCP) CM, SVCM, MBCM, FACSc: We’re going to discuss some of the impacts of the ACIP [Advisory Committee on Immunization Practices] recommendations. I’ll start with Mr Worz. In 2022, the CDC [Centers for Disease Control and Prevention] adopted the ACIP’s recommendation to preferentially recommend the use of specific flu vaccines for adults 65 years and older, including higher-dose and adjuvant-based flu vaccines. To get a little more into this, what are the differences with respect to the 3 available recommended flu vaccines for patients older than 65 years of age? There’s Fluzone High-Dose Quadrivalent; Flublok Quadrivalent, which is recombinant; and Fluad Quadrivalent, which is the adjuvant-based flu vaccine.
Chad Worz, PharmD, BCGP, FASCP: It’s an important topic because these data have been around a little longer than even these recommendations. But ultimately, with these different vaccines they were able to show a 24% improvement in preventing flu. I’ve emphasized the word preventing because we’ve had so much dialogue around COVID-19 of prevention vs prevention of serious disease. This was 24% better at preventing the flu in this older population. It’s important that we make good decisions. As pharmacists, we’re always trying to make the right decision about medications for the patient. What’s the right drug for you? In a sense, this is that same conversation, but it’s vaccines. What’s the right vaccine for you? You’re over age 65, and you have some comorbidities. We need these higher-dose vaccines.
In terms of the differences, it’s about the dose. We talk about the lack of immune response that we get as we age. The Fluzone is 4 times the antigen as a normal flu vaccine. We’re giving you more antigens—in the hope that we’re stimulating or eliciting a better immune response. The Flublok is 3 times the antigen. Then we have the adjuvant that Mr Welch described earlier with the oil, trying to elicit that higher immune response. There’s no comparison between the vaccines in terms of which one is better than the other, but the difference between them is how they elicit that higher immune response. Maybe the most notable feature is in Flublok. You don’t have any risk of the egg allergy issue.
Rodney E. Rohde, PhD, MS, SM (ASCP) CM, SVCM, MBCM, FACSc: It’s interesting to think about too. Perhaps you guys want to comment on this. I always think about it with respect to the actual antigen. When you think about antigens, you’re talking about something that the body—the immune system—is going to come into contact with. There’s a presence there, a presentation, and then the immune system reacts to that. In a sense, in these types of vaccines, aren’t they just enhancing that response?
Adam C. Welch, PharmD, MBA, FAPhA: They are, either by having a higher level of antigen in the high dose or the recombinant or by having some adjuvant that helps your immune system use that response. You can build more protection, more antibodies, and more protection against that antigen if there’s more of it for your body to react to.
Rodney E. Rohde, PhD, MS, SM (ASCP) CM, SVCM, MBCM, FACSc: Excellent. It’s interesting to talk about. Sometimes when I’m discussing this with the general population, it’s easy for us to start talking about some of these terms: antigens, antibodies, immune system. All these things are important. Don’t you think they’re important to the public?
Randy McDonough, PharmD, MS, BCGP, BCPS, FAPhA: They’re really important, but you have to put it into language they understand. I may not use all that terminology, but we’ll talk about getting an immune response. We’ll talk about feeling run down the next day, or if you do have a sore arm, that’s your immune system revving up. It may take a good 2 weeks for you to get the full immunogenicity of the flu shot itself to be fully protected. That’s why the timing becomes important. If you’re going to be traveling or seeing family over the holidays, make sure you’re fully protected before you go. Have that conversation with the patient in a language they understand because medical professionals can get a little technical sometimes and use the wrong terminology. When we sit down with our patients, I make sure I’m using words they understand and that they understand the value.
As we start talking about the different vaccines and the safety of vaccines, what’s the difference? When you hear recombinant, patients think genetic material—it’s getting in my genes, it’s getting in my DNA. We need to make it clear to them that there’s no genetic material at all that’s going to be getting into any of their system whatsoever. It’s just a way for us to make the vaccine quickly and make a large amount of it. But it will have the same effect that you would see with a standard vaccine. It’s going to build the immunogenicity of the body.
Rodney E. Rohde, PhD, MS, SM (ASCP) CM, SVCM, MBCM, FACSc:That’s an important point. There’s commentary around standard doses and quadrivalent doses. We can talk about that, but that’s not what our patients need to hear. I even use terminology like the quadrivalent [vaccine] is like a vaccine on steroids. It’s an opportunity to boost your immune system, especially if you’re older, whereas a standard dose is generally for more healthy individuals whose immune system is robust. They don’t need that steroid boost.
Randy McDonough, PharmD, MS, BCGP, BCPS, FAPhA: That was the question we had, especially when the Fluzone High-Dose [Quadrivalent] first came out: “I’ve always gotten the standard, so why do I need this?” That required conversation and education to help them understand. You talked about having a lack of a response or not as good of a response as you get older. Make sure they fully understood that. I was surprised, but we didn’t have much pushback. We got most of our patients ages 65 and older during that first season—probably 95% got the high dose, which made us happy about.
Rodney E. Rohde, PhD, MS, SM (ASCP) CM, SVCM, MBCM, FACSc: It shows the value of community pharmacies.
Randy McDonough, PharmD, MS, BCGP, BCPS, FAPhA: Absolutely.
Rodney E. Rohde, PhD, MS, SM (ASCP) CM, SVCM, MBCM, FACSc: Hospital pharmacists who take the time to have that session, individually or with a family, can help dispel some issues…around hesitancy.
Randy McDonough, PharmD, MS, BCGP, BCPS, FAPhA: It doesn’t matter what health setting you’re in. When you have that patient in front of you, and we’re heading into flu season, this is the time to do it.
Rodney E. Rohde, PhD, MS, SM (ASCP) CM, SVCM, MBCM, FACSc: Meet them where they’re at.
Randy McDonough, PharmD, MS, BCGP, BCPS, FAPhA: Exactly. Make sure they’re getting the flu shot.
Adam C. Welch, PharmD, MBA, FAPhA: In 2022, when the preferential recommendations came out for 1 of 3 vaccines in patients ages 65 and older, those data had been buried in the recommendations for several years. They were in the supplements. A lot of individuals overlooked it. But in 2022 ACIP finally said, “There’s enough compelling evidence to say that in ages 65 and older, we need to do 1 of 3 vaccines.”
Randy McDonough, PharmD, MS, BCGP, BCPS, FAPhA: That was big when that happened. When they came out with that statement, that was the first time I saw a statement come out saying, “We have a preference for that particular vaccine for patients who are older.” That’s the first time I saw that.
Transcript edited for clarity.
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