Friday, September 29, 2023

What Is High Dose Flu Vaccine

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Individuals With Symptoms Of Covid

High dose flu vaccine for elderly

During the COVID-19 pandemic, individuals should postpone influenza vaccination until they have recovered if they have:

  • acute symptoms of COVID-19
  • any symptoms of acute respiratory infection, including minor symptoms such as sore throat or runny nose

This is because they can pose an unnecessary risk to others and healthcare providers if they have COVID-19. Individuals with COVID-19 symptoms should visit a healthcare professional or contact their local public health authority for information on getting tested.

What If The High

Manufacturers have increased flu shot production to meet the high demand for the 2020-2021 season. According to the CDC, between 188 million and 200 million doses will be distributed. All vaccines will be quadrivalent , most will be thimerosal-free or thimerosal-reduced vaccines and about 18% of flu vaccines will be free of eggs.

Ii4 Efficacy Effectiveness And Immunogenicity

Efficacy and effectiveness

Influenza vaccine has been shown in randomized controlled clinical trials to be efficacious in providing protection against influenza infection and illness. However, the effectiveness of the vaccine-that is, how it performs in settings that are more reflective of usual health care practice-can vary from season to season and by influenza vaccine strain type and subtype. Influenza vaccine effectiveness depends on how well the vaccine strains match with circulating influenza viruses, the type and subtype, as well as the health and age of the individual receiving the vaccine. Even when there is a less-than-ideal match or lower effectiveness against one strain, the possibility of lower VE should not preclude vaccination, particularly for people at high risk of influenza-related complications and hospitalization, since vaccinated individuals are still more likely to be protected compared to those who are unvaccinated.


Antibody response after vaccination depends on several factors, including the age of the recipient, prior and subsequent exposure to antigens, and the presence of immune compromising conditions. Protective levels of humoral antibodies, which correlate with protection against influenza infection, are generally achieved by 2 weeks after vaccination however, there may be some protection afforded before that time.

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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.

Who Can Receive Fluzone High


In the United States, Fluzone High-Dose Quadrivalent is licensed only for people 65 years and older. Fluzone High-Dose Quadrivalent is not recommended for people with a history of severe allergic reaction to the vaccine or to ingredients other than eggs. Information about vaccine ingredients is located in package inserts from each manufacturer.

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Who Should Not Receive A Live Attenuated Influenza Vaccine

In addition to the above-mentioned contraindications, NACI also recommends that live attenuated influenza vaccine should not be given to:

  • people with immune compromising conditions due to underlying disease, therapy, or both
  • the exception is children with stable HIV infection on highly active antiretroviral therapy and with adequate immune function
  • people with:
  • severe asthma or
  • medically attended wheezing in the 7 days prior to the proposed date of vaccination due to increased risk of wheezing
  • LAIV is not contraindicated for people with a history of stable asthma or recurrent wheeze
  • children less than 24 months of age due to increased risk of wheezing
  • children 2 to 17 years of age currently receiving aspirin or aspirin-containing therapy
  • this is because of the association of Reye’s syndrome with aspirin and wild-type influenza infection
  • aspirin-containing products in children less than 18 years of age should be delayed for 4 weeks after receipt of LAIV
  • people who are pregnant because it is a live attenuated vaccine and there is a lack of safety data at this time
  • LAIV is not contraindicated in breastfeeding individuals however, there is limited data for the use of LAIV in lactating individuals
  • LAIV should not be administered until 48 hours after antiviral agents active against influenza are stopped, for example:

    • oseltamivir
    • zanamivir

    If these anti-viral agents are administered within this time frame :

    What Is The Difference Between Fluzone High

    Fluzone High-Dose Quadrivalent contains four times the antigen, the part of the vaccine that helps your body build up protection against flu viruses, than Fluzone Quadrivalent and other standard-dose inactivated flu vaccines. The higher dose of antigen in the vaccine is intended to give people 65 years and older a better immune response to vaccination, and therefore, better protection against flu. Both Fluzone High-Dose and Fluzone Quadrivalent are produced by the same manufacturer and are quadrivalent vaccines. There are a number of other flu vaccines produced by other manufacturers.

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    What Is In This Years High

    Fluzone High-Dose Quadrivalent the high-dose flu vaccine is an inactivated influenza vaccine. This means it contains a certain amount of dead flu viruses . Because the viruses in the shot are dead, you cannot get sick with influenza from the vaccine.

    The high-dose flu vaccine is a quadrivalent vaccine, meaning it contains four different strains of the influenza virus. The vaccines exact composition changes every year in an effort to match the strains expected to circulate during flu season .

    This years high-dose flu vaccine includes the following strains:

    • Two type A influenza viruses H1N1 and H3N2

    • Two type B influenza viruses Victoria and Yamagata lineages

    Fluzone High-Dose Quadrivalent is an egg-based vaccine, meaning chicken eggs were used to create the vaccine. If you have an egg allergy, its best to discuss this with your healthcare provider before getting your flu vaccine.

    Most people with egg allergies are still able to receive egg-based flu vaccines. But if you are advised to avoid egg-based vaccines, there are flu vaccine options available that are made without eggs .

    The vaccine also includes the following inactive ingredients to help create and stabilize the shot:

    • Formaldehyde an ingredient that kills the virus during vaccine production

    • Sodium chloride the liquid that the virus is placed in to allow it to be injected

    The syringe the vaccine comes in is not made with rubber latex, so its safe for people with latex allergies to receive it.

    Increased Interest In Vaccinations

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

    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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    Should I Get A Flu Shot

    Yes! An annual flu vaccine is the best way to protect yourself against influenza. Flu vaccines are very safe and help lower the risk of severe illness and death due to the flu. Thats why an annual flu vaccine is recommended for everyone over the age of 6 months, including pregnant people and people with weakened immune systems.

    Excess Vaccine Doses Among Pregnancy Reports

    We identified and reviewed 51 reports where an excess dose of a vaccine was given to a pregnant woman. Vaccines given in excess were inactivated influenza vaccine , Tdap , hepatitis B , human papilloma virus vaccine , and MMRII . In the latter two, the provider did not know the woman was pregnant. Most reports did not describe an adverse health event. Among the 13 reports with an AE, some of the diagnoses included injection site reaction/arm soreness , scabies , headache/dysuria , and Taussig-Bing anomaly-infant-birth defect in a woman vaccinated with Tdap in the third trimester .

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    People At High Risk Of Influenza

    • 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
  • Live Attenuated Influenza Vaccine

    Manufacturing delay causes shortage of high

    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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    So It Offers More Protection From The Flu

    Exactly. A 2014 study published in The New England Journal of Clinical Medicine, which involved more than 30,000 adults aged 65 and older, found that participants who received the high-dose flu vaccine had 24% fewer flu illnesses compared to those who got the standard flu vaccine.

    Another study, carried out during the 2013-2014 flu season and published in The Lancet Respiratory Medicine in 2017, found that the high-dose flu shot was associated with a lower risk of hospital admissions compared with the regular flu shot in people age 65 and over. This was particularly true for those living in long-term care facilities.

    Which Flu Vaccine Should I Get

    Both the high-dose and standard flu vaccines are designed to protect against four different flu viruses. Individuals between 6 months old and 64 should typically get the standard quadrivalent flu vaccine, while the Fluzone High-Dose Quadrivalent vaccine is licensed and recommended for anyone over the age of 65. The high-dose vaccine contains four times the antigen as the standard dose to elicit a stronger immune response.

    With most health insurance plans, you can get a free flu shot at your doctorâs office, several pharmacies, or an urgent care center. If you donât have insurance, Mira can help you access affordable health coverage for preventative care, urgent care, prescriptions, lab tests, and more.

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    How Does A High

    Fluzone High-Dose Quadrivalent contains four times the amount of antigen as the regular dose flu vaccine. As we get older, our immune systems have a harder time fighting off infections and learning from vaccines. The higher amount of antigen in the high-dose flu vaccine helps an older adults immune system better recognize and react to the vaccine.

    The influenza strains and inactive ingredients in Fluzone High-Dose are the same as Fluzone Quadrivalent one of the available regular dose flu vaccines. However, a few other regular dose flu vaccines are available which vary more from the high-dose vaccine than Fluzone Quadrivalent.

    The following are other FDA-approved flu vaccines for the 2021/2022 flu season and how they differ from the high-dose flu vaccine:

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

    Local pharmacists report limited supply of high-dose flu vaccine

    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.

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    Iii2 People Capable Of Transmitting Influenza To Those At High Risk Of Influenza

    People who are potentially capable of transmitting influenza to those at high risk should receive annual vaccination, regardless of whether the high-risk individual has been vaccinated. Vaccination of HCWs decreases their own risk of illnessFootnote 52,Footnote 53, as well as the risk of death and other serious outcomes among the individuals for whom they provide careFootnote 54,Footnote 55,Footnote 56,Footnote 57. Vaccination of HCWs and residents of nursing homes is associated with decreased risk of ILI outbreaksFootnote 58.

    People who are more likely to transmit influenza to those at high risk of influenza-related complications or hospitalization include:

    • HCWs and other care providers in facilities and community settings who, through their activities, are capable of transmitting influenza to those at high risk and
    • Contacts, both adults and children, of individuals at high risk, whether or not the individual at high risk has been vaccinated.

    Health care workers and other care providers in facilities and community settings

    Vaccination of health care workers and other care providers
    Outbreak management in health care facilities

    Contacts of individuals at high risk of influenza complications

    Can Inactivated Influenza Vaccine Be Given At The Same Time As Other Vaccines Such As Pneumococcal Polysaccharide Or Zoster Vaccines

    Yes if other vaccines are indicated, they can be administered during the same clinical encounter as inactivated influenza vaccine. When giving several injections at a single visit, administer each vaccine at a separate injection site. The injection sites should be separated by 1 inch or more, if possible, so that any local reactions can be differentiated.

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    Ii5 Choice Of Seasonal Influenza Vaccine

    The decision to include specific influenza vaccines as part of publicly funded provincial and territorial programs depends on several factors, such as cost-effectiveness evaluation and other programmatic and operational factors, such as implementation strategies. Not all products will be made available in all jurisdictions and availability of some products may be limited therefore, officials in individual provinces and territories should be consulted regarding the products available in individual jurisdictions.

    With the availability of influenza vaccines that are designed to enhance immunogenicity in specific age groups or given through a different route of administration, the choice of product has become more complex.

    Choice of influenza vaccine by age group

    Recommendations for individual-level decision making
    • NACI recommends that influenza vaccine should be offered annually to anyone 6 months of age and older who does not have contraindications to the vaccine. Table 2 provides age group-specific recommendations for the age-appropriate influenza vaccine types authorized for use in Canada.
    Recommendations for public health program-level decision making
    • NACI recommends that any of the age-appropriate influenza vaccine types available for use may be considered for people without contraindications to the vaccine. Table 2 provides age group-specific recommendations for the age-appropriate influenza vaccine types authorized in Canada.

    I1 New Or Updated Information For 2020


    NACI recently reassessed the wording for the recommendation on the vaccination of health care workers and other care providers as a group for whom influenza vaccination is particularly recommended. The existing evidence on HCW influenza vaccination and the reduction of morbidity associated with influenza in patients being cared for by a HCW in health care settings was considered in the context of ethics and acceptability. NACI continues to recommend that, in the absence of contraindications, HCWs and other care providers in facilities and community settings should be vaccinated annually against influenza, and recommends the inclusion of this group among the particularly recommended recipients of influenza vaccine. NACI considers the receipt of influenza vaccination to be an essential component of the standard of care for all HCWs and other care providers for their own protection and that of their patients. This group should consider annual influenza vaccination as part of their responsibilities to provide the highest standard of care.

    Recommendation on the use of LAIV in HIV-infected individuals

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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.

    /2022 Universal Influenza Immunization Program

    The following provides information about the Ontario Ministry of Health Universal Influenza Immunization Program for the 2021/2022 influenza season. The UIIP offers influenza vaccine free of charge each year to all individuals six months of age and older who live, work or go to school in Ontario.

    Vaccination against influenza will be important this fall given the potential for the co-circulation of COVID-19. Preventing the flu will be important not only to protect individual health and the health of families and communities, but also to protect and mitigate impacts on our health care system.

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