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.
Who Should Have The Vaccine
In 2021/22 flu season, the following people are eligible to receive the flu vaccine for free:
- All children aged 2 to 15 on 31st Aug 2021
- Those aged 50 years or over
- Those in long-term residential care homes
- Carers
- Frontline health and social care workers
- Close contacts of immunocompromised individuals
- Those aged 6 months to 65 years in at-risk groups including people with the following health conditions:
- Respiratory diseases, including asthma
- Heart disease, kidney disease or liver disease
- Neurological conditions including learning disability
- Diabetes
- A severely weakened immune system , a missing spleen, sickle cell anaemia or coeliac disease
- Being seriously overweight
Babies under 6 months old are too young to receive a flu vaccine. This is because they have maternal antibodies passed on from their mother which prevent the vaccine from working so well. Flu vaccination is offered to all pregnant women in the UK . As well as protecting pregnant women themselves, this also helps to protect their newborn babies from flu.
Your doctor may recommend the flu vaccine in other circumstances as well.
Who Qualifies For The Senior Flu Shot Is There A Cost Difference
The CDC recommends the senior flu shot for everyone age 65 or older who does not have a medical reason to skip the flu shot. The CDC does not recommend one flu vaccine over the other for older adults. You can choose any flu vaccine available for your age group.
Medicare covers the full cost of any flu shot in adults who participate in the program. If you have different health insurance, the Affordable Care Act requires all flu shots including senior flu shots to be covered. If you do not have insurance, costs range from $0 to $40 at most pharmacies.
Adjuvanted Flu Vaccine. National Center for Immunization and Respiratory Diseases. Centers for Disease Control and Prevention. Link
Carlos A. DiazGranados, Andrew J. Dunning, Murray Kimmel, Daniel Kirby, et al. Efficacy of High-Dose versus Standard-Dose Influenza Vaccine in Older Adults. New England Journal of Medicine. August 14, 2014. Link
Flu & People 65 Years and Older. National Center for Immunization and Respiratory Diseases. Centers for Disease Control and Prevention. Link
Fluzone High-Dose Seasonal Influenza Vaccine. National Center for Immunization and Respiratory Diseases. Centers for Disease Control and Prevention. Link
Past Seasons Estimated Influenza Disease Burden. National Center for Immunization and Respiratory Diseases. Centers for Disease Control and Prevention. Link
Saundra Latham. Where to Get Cheap Flu Shots: Walmart vs. CVS vs. Costco and More. Cheapism. September 14, 2020. Link
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Which Option Is Best For You
If youre getting the flu vaccine, you may wonder whether one option is better than others. Your doctor can point you to the one that should work best for you.
In certain years, the nasal spray hasnt been recommended due to effectiveness concerns. But both the shot and the nasal spray are recommended for the 2020 to 2021 flu season.
For the most part, the flu vaccine is safe. But you should check with your doctor before getting it if you have one the following:
- a previous bad reaction to the vaccine or its ingredients
- a fever
Its not unusual to experience mild flu-like symptoms after a vaccination. These symptoms tend to disappear after one to two days. Other common side effects of the vaccine include soreness and redness at the injection site.
Are The New Vaccines Safe
Both vaccines are safe, but commonly cause mild side-effects, and very rarely can cause serious side-effects. However, these risks from the vaccine are less than from getting influenza infection.
The main side-effect of vaccines relates to their effect in stimulating the immune system.
In many people they cause a sore arm and, less commonly, a fever. The side-effects of these new flu vaccines are slightly more common than with standard vaccines.
Generally, these side-effects are mild and don’t last long.
None of the flu vaccines used in Australia contains live virus and therefore can’t cause flu infection. However, the vaccination season usually occurs around the same time as when another respiratory virus circulates, so this respiratory infection is commonly misattributed to vaccination.
Rare but serious side-effects, such as Guillain Barre Syndrome , have been described after flu vaccination.
Studies suggest the risk of these side-effects are less common after the flu vaccine than after flu infection.
People with allergies should discuss flu vaccines with their doctor. In the past, there has been concern the flu vaccines, which are manufactured in eggs, may elicit allergic reactions in people with egg allergy.
However, it is now thought people with egg allergies can receive flu vaccines safely under appropriate supervision.
In 2009, an adjuvanted vaccine was thought to be implicated in cases of narcolepsy in Europe.
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What Are Flu Vaccines For Seniors
Often referred to as High-Dose , based on the brand name of one popular flu vaccine, flu vaccines for seniors are super-charged to help keep people 65+ healthy throughout the flu season. The two approved vaccines for people 65+ either contain four times the antigens of a regular flu shot or an additive known as an adjuvant.
Both offer greater, but about the same as one another, protection from illness than standard egg-based quadrivalent vaccines, studies have shown.
What Is Different About The Senior Flu Shot
Most seasonal flu shots recommended by the CDC are still available for older adults. People over age 65 now have two additional options for flu vaccines that are specifically designed for their age group a high-dose flu vaccine and an adjuvanted flu vaccine.
Everyones immune system becomes weaker with age, no matter how healthy you are or how well you eat and exercise. A less effective immune system does not respond as strongly to vaccines as does a younger immune system. The two senior flu shots are specially designed to ensure that an older immune system responds well to the vaccine.
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If You’re Age 65 And Older
The choices include the regular flu shot , the high-dose flu shot , the quadrivalent flu shot and the egg-free shot called Flucelvax.
Should you get the high-dose vaccine or standard one?
Talk to your doctor about whether you need a high-dose vaccine, but studies do show that people who receive the high-dose vaccine produce more antibodies infection-fighting proteins in the blood than those who get the regular dose. That’s important because vaccines work by provoking the immune system’s defenses against the target disease, and older people tend to mount a weaker response.
In fact, the high-dose vaccine was developed to address concerns that the standard-dose shot doesn’t work very well in people 65 and older, the very group most likely to be hospitalized or die from flu complications. Last year, for example, the CDC reported that season’s regular vaccine lowered an older person’s risk of flu by only 27 percent, an unexpectedly low level of effectiveness compared with a 63 percent reduction for people ages 50 to 64.
Whether the high-dose shot’s effect on blood antibodies will translate into substantially fewer people getting sick is not yet clear. But signs are good that it offers at least some advantage. In August the vaccine’s maker, Sanofi Pasteur, issued preliminary findings from an ongoing clinical trial showing the higher dose increased flu prevention by 24 percent over the standard dose.
What about the new quadrivalent vaccine?
Better Protection Against The Flu
As noted earlier, better HI antibody responses are known to correlate with protection against influenza infection and reduced clinical disease risk. Yet while it is very encouraging that Fluzone HD induces higher serum antibody titers without significant safety concerns, the jury is still out on whether this actually translates into fewer confirmed cases and serious complications from the flu.
As a condition of licensure under FDAs accelerated approval process, the agency instructed Sanofi Pasteur to conduct a head-to-head study to compare Fluzone HD and Fluzone in 27,000 to 30,000 adult subjects 65 years of age and older. That study will be conducted over three flu seasons to try to account for typical fluctuation in vaccine efficacy, which is related to differences between the flu virus that arrives and the strains picked in advance to make the vaccine. The first season is already enrolled, with the 2010-2011 and 2011-2012 seasons to follow. Until that study is finished and the results are known, Fluzone HDs labeling informs providers and recipients that there have been no controlled studies demonstrating a decrease in influenza disease after vaccination with Fluzone High-Dose.
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Who Should Not Get The Influenza Vaccine
Speak with a health care provider if you:
- Have had a life-threatening reaction to a previous dose of influenza vaccine, or any part of the vaccine. People with egg allergies can be safely immunized with the influenza vaccine
- Have had severe oculo-respiratory syndrome after getting an influenza vaccine
- Are receiving a checkpoint inhibitor to treat cancer. This may affect when you should get the vaccine
- Developed Guillain-Barré Syndrome within 8 weeks of getting an influenza vaccine without another cause being identified
GBS is a rare condition that can result in weakness and paralysis of the body’s muscles. It most commonly occurs after infections. In rare cases GBS can also occur after some vaccines. GBS may be associated with influenza vaccine in about 1 per million recipients.
How Can Influenza Be Prevented
You can reduce the risk of getting influenza or spreading it to others by:
- Washing your hands regularly
- Cleaning and disinfecting objects and surfaces that people touch
- Promptly disposing of used tissues in the waste basket or garbage
- Coughing and sneezing into your shirt sleeve rather than your hands
- Staying home when you are ill
- Getting an influenza vaccine
Getting an influenza vaccine can help prevent you from getting sick with influenza and from spreading it to others.
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What Flu Shot To Take
The Advisory Committee on Immunization Practices at the CDC does not recommend one vaccine over the other.
Englund said the high-dose vaccines are preferable for patients 65 and older, but they should get the regular dose if a high-dose is unavailable.
“If the option is to get the standard dose or nothing,” Englund said. “We absolutely prefer the standard dose vaccine.”
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Fluzone High-Dose and FLUAD, like many other vaccines, are egg-based. Patients with severe egg allergies shouldn’t get the shot.
It’s not recommended for people who have a rare disorder called Guillain-Barré syndrome, in which the body’s immune system attacks the nerves.
Side effects for the high-dose vaccines mirror the standard dose: soreness around the injection site and a low, 24-hour fever.
Schaffner said this shouldnt deter patients as the alternative can be fatal.
A sore arm and one day of fever is a small price to pay to get prevention against influenza, which can be a very deadly infection, he said.
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The Jet Injector Method
Some sites that offer flu vaccination will offer a jet injection option sold under the brand name AFLURIA Quadrivalent. A jet injector uses a high-pressure, narrow stream of fluid to penetrate the skin instead of a hypodermic needle.
The injector method has typically been used to administer vaccines quickly to a large number of people, such as military recruits.
I havent seen it in use recently, says Conley, but apparently its coming back and its available in some places.
Philbrick stresses that the standard flu shot is going to be the easiest one to find and the availability of the other types may vary from location to location.
I think the important thing to note is that, currently, the CDC does not give preference to any one vaccine over the other, she says. If you look for an option, you should be able to find it eventually, but the most important thing is to settle on an option and get the vaccine.
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The Differences Between The Regular And Senior Flu Shots
Two other vaccines are indicated for people 65 and older, but no complete data exists on their effectiveness compared to the regular flu vaccine. However, several studies suggest the senior flu shot is more effective in people 65 and older.
- The high-dose flu vaccine, called Fluzone® High-Dose, contains four times as many antigens as a regular flu shot. It causes the body to produce many more antibodies than the regular seasonal flu shot. One study showed older adults who got the high-dose shot caught the flu 24% less often than adults who got the regular shot.
- The adjuvanted flu vaccine, called Fluad®, does not contain extra antigens. Instead, it contains an additional ingredient called an adjuvant that boosts the immune systems response to the vaccine. Its like giving the immune system an extra shot of caffeine to kick it into action. There are two different Fluad vaccines: trivalent, produced from three different strains of the flu virus, and quadrivalent, produced from four different flu strains.
The side effects from each senior flu shot are similar to side effects from the regular flu shot. You might experience redness, pain, or swelling where you received the shot. Some people also may have a headache, nausea, muscle ache, or a general feeling of discomfort for a day or two.
Safety And Side Effects
The inactivated flu vaccine does not contain the live virus and cannot cause flu. Flu vaccines have a very good safety record. The most commonly reported side effects of flu vaccines are:
- pain, swelling, bruising, hardness or redness at the injection site
- slightly raised temperature
- tiredness
- feeling generally unwell
A higher rate of these common side effects has been reported with Fluad, an adjuvanted trivalent vaccine which was recommended for people aged 65 and over in previous years. This year, Fluad Tetra is being offered to people aged over 65, which also uses an adjuvant. Side effects usually last 1-2 days.
There are several different makes of flu vaccine available each year. For more information on side effects, ask for the Patient Information Leaflet for the vaccine you are offered. Additional information about vaccine side effects, anaphylaxis and adverse reactions can be found here.
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What Are Fluzone High
Dr. William Schaffner, an infectious diseases specialist at Vanderbilt University Medical Center, said that although the two vaccines have the same outcome, they work a little differently.
Fluzone High-Dose contains four times the antigen that’s in a standard dose, effectively making it a stronger version of the regular flu shot. FLUAD pairs the regular vaccine with an adjuvant, an immune stimulant, to cause the immune system to have a higher response to the vaccine.
The data indicates that no matter what flu strain is out there, it provides more protection for older people, Schaffner said.
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?
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Concerns Over Egg Allergies
For this current 202021 flu season, about 81 percent of the vaccine supply uses egg-based manufacturing technology. Because most flu vaccinations are made using chicken eggs, people who administer the inoculation ask individuals if they have egg allergies. But this may be a measure of excessive caution.
I think that there has been a lot of concern that people who had egg allergies shouldnt get flu vaccines, says Conway. But I think the egg allergy concern now has largely been dismissed.
He emphasizes that egg allergies are extraordinarily uncommon, and the amount of egg protein thats in a flu vaccine is miniscule. Conway says that some doctors rely on the muffin test to determine if a patient has an egg allergy that is so extreme that the vaccine will trigger a severe reaction.
If you can eat a muffin that has eggs as one of its ingredients without having a reaction, youre good to go, he says.
The CDC warns that those who have a history of severe allergic reaction to egg should get the immunization but do so in an inpatient or outpatient medical setting, just in case they have a life-threatening reaction.