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Can You Give High Dose Flu To Under 65

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Why Are Adjuvanted Formulations Of Influenza Vaccine The Preferred Vaccine For Those 65 Years

High Dose Influenza Vaccine Under Age 65: Dr. David Liew

A gradual decline of the immune system occurs as people age , impacting how the immune system responds to immunisation. For adults aged 65 years the adjuvanted QIV, Fluad® Quad is preferentially recommended over standard QIVs as the antibody response is increased in comparison to non-adjuvanted QIV influenza vaccines.

Time For Your Flu Vaccine: Do You Need A Higher Dose

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To avoid a miserable case of the flu and the complications it can cause, get a flu shot before the start of the season, ideally in early fall.

The pros and cons of the high-dose vaccine, and tips to protect yourself from infection this season.

The flu is far more than a fever and sniffles that sideline you for a few days. In older adults, it can lead to serious complications like bronchitis and pneumonia, and it can worsen existing medical conditions such as heart disease, asthma, and diabetes. In fact, most flu-related hospitalizations and nearly all deaths from the disease occur in people 65 and older.

“The strength of the immune response tends to decrease with age. So as people get older, they are more likely to become significantly ill from diseases like the flu,” explains Dr. Elisa Choi, an internal medicine and infectious disease specialist at Harvard Vanguard Medical Center. The best way to protect yourself against the flu is by getting vaccinated, but because of the natural decline in your immune system, you may produce fewer flu-fighting antibodies in response to the vaccine than you once did, and be less protected as a result.

What Are Some Side Effects That I Need To Call My Doctor About Right Away

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

  • Signs of an allergic reaction, like rash hives itching red, swollen, blistered, or peeling skin with or without fever wheezing tightness in the chest or throat trouble breathing, swallowing, or talking unusual hoarseness or swelling of the mouth, face, lips, tongue, or throat.
  • A burning, numbness, or tingling feeling that is not normal.
  • Not able to move face muscles as much.
  • Trouble controlling body movements.
  • Feeling fussy.
  • Crying that is not normal.

These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects.

You may report side effects to the FDA at 1-800-332-1088. You may also report side effects at

Recommended Reading: Are There 2 Types Of Flu Shots

Whats New And Resources For The 2021

The CDC maintains a page dedicated to the current flu season. There is a section for the public and also a section for providers. This is a good place to get up-to-date information on influenza and influenza vaccination. You can find it here:

Note that the CDCs Flu FAQ page currently includes lots of information about influenza and COVID-19, such as how to tell them apart, why its safe to be vaccinated for both at the same time, and more.

The CDC also provides information specific to older adults here:

Side Effects And Risks

Older Adults and COVID

It is much safer to get the flu vaccine than to get the flu. Flu vaccines are safe and well-tolerated. Side effects are usually mild and last a few days. Common side effects include pain, redness and swelling at the injection site headache, fever, muscle aches, joint pain or feeling tired. Side effects in children include irritability, drowsiness or loss of appetite.

In rare cases, serious allergic reactions can occur. Seek medical attention if you have trouble breathing, rash or swelling of the face and throat. Allergic reactions can be treated and are usually temporary. The risk of Oculo-Respiratory Syndrome or Guillain-Barré Syndrome after flu vaccination is very low, about one case in a million flu shots.

Also Check: Type A Vs Type B Flu

What We Know About Covid

Q: How are COVID-19 and influenza similar and how are they different?

A: COVID-19 and influenza have many similarities, but also many differences.

The main similarities are:

  • Both viruses are mostly spread through an airborne route. This means that steps you take to protect yourself from COVID-19, such as social distancing measures and avoiding crowded indoor spaces, will likely reduce your risk of catching influenza as well.
  • The initial symptoms of infection have a lot in common. Namely, both often start with upper respiratory symptoms such as cough, runny nose, fatigue, fever, and body aches. This means it will be difficult to tell the two conditions apart, unless laboratory testing is used.
  • Both are more likely to cause severe illness in people who are older or frail.

Even though both viruses often cause viral pneumonia, there are significant differences between the two. They are actually quite different types of viruses. The differences include:

In short, influenza and COVID-19 are similar in terms of how they spread and common initial symptoms. But COVID-19 has so far caused more serious disease, and at this time, remains harder to treat, in part because it seems to affect the body in more significant ways than influenza usually does.

For more on the similarities and differences between influenza and COVID-19:

Q: Is it possible to get influenza and COVID-19 at the same time? How do they affect each other?

Live Attenuated Influenza Vaccine

Children 2-17 years of age who are eligible for an influenza vaccine can receive FluMist® Quadrivalent by nasal spray.

The nasal spray vaccine will be available at health units, some pharmacies and some doctors’ offices. Pharmacists will be able to give the nasal spray flu vaccine to children 2 years of age and older. The Influenza Clinic locator will list if a nasal spray vaccine is available at that clinic. Call ahead to confirm. The nasal spray vaccine is not approved for use in those younger than 2 years of age and they should receive their influenza vaccine by needle.

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Can You Get Two For Better Coverage

The currently available enhanced vaccines protect against three flu strains, whereas the standard vaccine protects against four.

But for most people, there is no evidence that receiving multiple doses of different vaccines in any one year is any better than getting a single dose of vaccine.

In theory, the four-strain vaccines protect against one more strain than the enhanced three-strain vaccines. But in most seasons, few infections are caused by the fourth strain.

There are some specific groups of people for whom two doses may be recommended, including young children receiving the vaccine for the first time, and some people with bone marrow or organ transplants. Seek advice from your doctor if this describes you or your childrens situation.

Its important to note that none of the standard or enhanced flu vaccines are completely protective they reduce, but dont completely eliminate, the risk of getting influenza.

A single dose of any influenza vaccine in each season is the most effective strategy to reduce your chance of getting influenza.

People At High Risk Of Influenza

Health Watch | High dose flu vaccine
  • All children 6 to 59 months of age
  • Adults and children with the following chronic health conditions:
  • cardiac or pulmonary disorders
  • diabetes mellitus and other metabolic diseases
  • cancer, immune compromising conditions due to underlying disease, therapy, or both, such as solid organ transplant or hematopoietic stem cell transplant recipients
  • renal disease
  • neurologic or neurodevelopment conditions, including:
  • neuromuscular
  • seizure disorders
  • obesity of 40 and over)
  • children 6 months to 18 years of age undergoing treatment for long periods with acetylsalicylic acid
  • this is because of the potential increase of Reye’s syndrome associated with influenza
  • People who are pregnant
  • People of any age who are residents of nursing homes and other chronic care facilities
  • Adults 65 years of age and older
  • Indigenous people
  • Also Check: Number Of Flu Cases 2021

    What Other Flu Vaccines Are Available For People 65 Years And Older

    In addition to Fluzone High-Dose Quadrivalent, one other influenza vaccine is licensed specifically for people 65 years and older. The adjuvanted flu vaccine,FLUAD Quadrivalent, external icon contains an adjuvant, an ingredient intended to help improve immune response.

    One recombinant influenza vaccine, Flublok Quadrivalent , is available during the 20202021 influenza season. Flublok Quadrivalent was first licensed by the FDA in the United States for use in adults 18 years and older in 2017. An earlier trivalent version was licensed in 2013 but was later replaced by the quadrivalent version. A new CDC study showed that flu shots made using recombinant technology produced a better antibody response among health care personnel compared with both cell-based and traditional flu shots.

    What About The Adjuvanted Vaccine

    Clinical trials have not been designed to show the different rates of flu infection after taking the adjuvanted vaccine compared with the standard vaccine. But studies have examined the effectiveness of this vaccine in preventing hospitalisations with influenza.

    One trial found a small decrease in influenza infection in people who had been given adjuvanted vaccine, compared with standard vaccine, but this difference was not statistically significant.

    Another recent trial has been performed in nursing home residents. Preliminary results suggest a very small reduction in hospitalisations compared with those who took the standard vaccine.

    Despite a lack of clinical trial data, several observational studies have found getting the adjuvanated vaccine means youre less likely to be hospitalised with influenza than if you receive the standard vaccine.

    As with the studies of the high-dose vaccine, the estimated degree of protection varies between studies, reflecting differences in circulating strains, study types, and populations.

    Don’t Miss: Which Flu Vaccine Should I Get

    Vaccine Wastage And Cold Chain Requirements

    • Vaccine wastage due to spoilage or expiry is a concern for all immunization programs in Ontario, including the Universal Influenza Immunization Program. The Vaccine Storage and Handling Guidelines have been developed to facilitate proper storage and handling of publicly funded vaccines and minimize vaccine wastage as well as promote vaccine safety and effectiveness.
    • When minimum cold chain requirements are not met by a health care provider or setting, the public health unit has the authority to withhold vaccines until compliance issues have been resolved or until completion of other follow-up deemed necessary to ensure appropriate vaccine storage and handling.

    Should Everyone 65 Years


    The immune system weakens as humans age. This places older individuals at greater risk of severe illness. Aging also affects the immune systems ability to respond to threats. A higher dose flu shot gives older people a better immune response and better protection.

    Check with a healthcare professional if this vaccine is right for your medical situation.

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    When To Get The Flu Shot

    Flu season typically runs from late fall to early spring.

    Flu shots are now available for all Ontarians. You should get a flu shot as soon as possible because it takes two weeks to take effect.

    The National Advisory Committee on Immunization now recommends that COVID-19 vaccines may be given at the same time as the flu vaccine.

    Talk to your doctor or pharmacy to learn more.

    How Do Flu Vaccines For Seniors Work

    As we age, our immune systems do not function as well as they once did. Flu immunizations for seniors are designed to help our bodies better fight infection with more antibodies. These antibodies will support the immune system in fighting off infection.

    The CDC reports that 80 to 90 percent of all flu-related deaths are among those over 65. Flu vaccinations for seniors are designed and recommended to help keep those 65+ safe all year long.

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    Uiip Vaccines For Specific Age Groups: Product Availability

    Age Group

    • The publicly funded QIV products will be distributed based on product availability at the Ontario Government Pharmaceutical and Medical Supply Services
      • Requests for specific QIV products are not permitted.
      • The four publicly funded QIV products are considered equivalent.
    • Note: Flucelvax® Quad is only authorized for use in Canada for individuals 2 years of age and older and Afluria® Tetra is only authorized for use in Canada for individuals 5 years of age and older.
    • QIV-HD will be available to order by primary care providers , long-term care homes, hospitals, participating pharmacies and retirement homes.

    Who Needs To Get A High

    Manufacturing delay causes shortage of high-dose flu shot for seniors

    Fluzone High-Dose Quadrivalent is only FDA-approved for people over 65, so if youre younger than that, you should stick to the regular dose vaccine. Speak with your healthcare provider to decide which available flu vaccine is the best option for you.

    If youre over 65 and questioning your flu vaccines options, contact your healthcare provider. Theyll let you know which of the three CDC-recommended flu vaccines for people over 65 is the best for you.

    If your pharmacy or healthcare providers office doesnt have high-dose flu vaccines in stock, its recommended to get vaccinated with a regular dose vaccine instead of waiting for Fluzone High-Dose Quadrivalent to be restocked. A regular dose vaccine will still offer you protection against the flu.

    Recommended Reading: When Should You Take A Flu Shot

    Which Influenza Vaccination Is Best For Older Adults

    Looking at the list of available flu shots can be overwhelming. In looking at this years CDC table of available influenza vaccines, I counted eight options that are available for people aged 65 or older:

    • 4 standard-dose quadrivalent inactivated vaccines
    • 1 standard-dose quadrivalent inactivated vaccine manufactured with a newer cell culture-based technology
    • 1 high-dose quadrivalent inactivated vaccine
    • 1 standard-dose quadrivalent adjuvanted inactivated vaccine
    • 1 quadrivalent recombinant vaccine

    Only Fluzone High-Dose Quadrivalent and Fluad Quadrivalent carry an age indication specific to 65 years or older.

    However, the CDC does not recommend any influenza vaccine over another, for adults aged 65 or older.

    So if you are an older adult, or if youre trying to arrange a flu shot for an aging relative, which flu vaccine should you try to get?

    My take is this: if you have a choice, go for one of the vaccines designed for older adults.

    Why? Because we know that as people get older, their immune systems tend to respond less vigorously to immunization. And because research suggests that the high-dose flu shot generates higher antibody titers and has been associated with better influenza outcomes.

    We do have more research and experience for Fluzone High-Dose than for Fluad, so unless you are enrolling in a clinical trial of Fluad, I would suggest going with the Fluzone High-Dose.

    Bottom line:

    Use The Following Questionsto Find Out More From Your Doctor Or Pharmacist:

    • What

    Indication and Safety Information:

    FLUZONE® High-Dose Quadrivalent

    FLUZONE® High-Dose Quadrivalent is a vaccine used to prevent influenza in adults 65 years of age and older. Influenza is an infection caused by the influenza virus. Annual vaccination using the current vaccine is recommended for prevention against influenza as immunity declines in the year following vaccination and because circulating strains of influenza virus change from year to year. Persons with a history of severe allergic reaction to eggs or egg products or any component of FLUZONE® High-Dose Quadrivalent should not receive the vaccine. FLUZONE® High-Dose Quadrivalent will only protect against the strains of influenza virus for those that are closely related. FLUZONE® High-Dose Quadrivalent will not protect against any other strains of influenza virus. FLUZONE® High-Dose Quadrivalent is not indicated for the prevention of hospitalization or death or to reduce the risk of complications after the onset of disease. As with all vaccines, FLUZONE® High-Dose Quadrivalent does not protect 100% of people immunized. The most common side effects are pain at the injection site, muscle ache. Allergic reactions can occur. Contact your healthcare provider to see if this vaccine is right for you. For more information, visit

    FLUZONE® Quadrivalent

    • This website is for Canadian residents only.

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    Recovering From The Flu

    Most people recover from the flu in 5 to 7 days.

    If you think you have the flu, you should stay home, get plenty of rest and drink lots of clear liquids. You can also call 811 to speak with a registered nurse who can help you manage your symptoms and give you advice about whether you need to seek additional care.

    For some people, the flu can be serious. If youre at high risk of complications, or if your symptoms get worse or last a long time, you should contact your health care provider. Possible complications of the flu include pneumonia, worsening of chronic conditions, and death.

    Increased Interest In Vaccinations

    We each need to do our part: modeling care and leadership ...

    Chager identified, through her own professional experience during the COVID-19 pandemic, there has been increased interest in vaccines more broadly.

    I’ve actually seen it with other vaccinations as well, not just influenza, she said. I’d say that maybe there is just a little bit more acceptance of the value of vaccinations.

    Pharmasave conducted a survey 7,000 consumers across Ontario and Atlantic Canada, which found that 86 per cent of respondents said they plan to get a flu shot this year, up from 78 per cent last year.

    I’m sure that the fall season and patients being really uneasy about getting sick during these months has a lot to do with the sentiment to get the influenza vaccination, Chager said.

    In Ontario, its recommended that anyone six months and older receive the influenza vaccination but pharmacies are only able to inject in people over the age of five.

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