CDC medical officer Lisa Groskopf, MD, MPH, answers questions about preferential vaccine recommendations for high-dose and adjuvant influenza vaccines for adults age 65 and older.
For the 2022-2023 influenza season, the CDC’s Advisory Committee on Immunization Practices (ACIP) recommends preferential use of specific influenza vaccines for adults 65 and older, including high-dose influenza vaccines and adjuvant influenza vaccines. Before now, there was no preferential recommendation for a specific vaccine in this population. The preference applies to Fluzone high dose tetravalent doseAnd the Tetravalent FlublokAnd the tetravalent fluoride influenza vaccines. There is still no preferential recommendation for people under 65 years of age. It is recommended that people 65 years of age or older receive one of the three recommended vaccinations preferentially; However, if one of these vaccines is not available at the time of administration, people in this age group should receive a standard, age-appropriate dose, a non-dialysis influenza vaccine.
Why were these updates made to influenza vaccine recommendations?
While flu seasons vary in severity, during most seasons, people 65 and older bear the brunt of acute influenza illness, accounting for the majority of flu-related hospitalizations and deaths. In recent years, it has been estimated that between 70% and 85% of deaths associated with seasonal influenza have occurred in people 65 years of age or older, and that between 50% and 70% of hospitalizations associated with seasonal influenza have occurred among people in this group. age. In addition, changes in the immune system with age mean that older people often do not have as strong an immune response to vaccination as younger, healthy people. Due to the higher risk of acute influenza illness and lower protective immune response after vaccination among the elderly, substantial research and development has led to the production of influenza vaccines aimed at providing better immunity to people in this age group. Evidence suggests that higher-dose and adjuvant influenza vaccines may be more effective in older adults whose immune systems are not as strong as those in younger, healthy people. given to them high risk For severe influenza-related illness, hospitalization, and death, these vaccines are recommended for people 65 years of age or older when available.
What evidence exists to support this preferential recommendation?
The CDC preferential recommendation is based on a Review the available studies This suggests that, for this age group, higher-dose and adjuvant influenza vaccines are likely to be more effective than uncorrected standard-dose influenza vaccines.
What are the high-dose flu vaccines?
High-dose flu vaccines include Fluzone High-Dose Quadrivalent and Flublok Quadrivalent.
Fluzone high dose tetravalent dose Approved for people 65 years of age or older. It contains four times more antigen, which is part of the vaccine that helps your body build protection against influenza viruses, compared to a standard dose of inactivated influenza vaccines. The higher dose of antigen in the vaccine is intended to give people 65 years of age or older a better immune response to vaccination, and thus better protection against influenza.
Tetravalent Flublok Recombinant influenza vaccine approved for adults 18 years of age or older. It contains three times the antigen, which is part of the vaccine that helps your body build protection against influenza viruses, compared to a standard dose of inactivated influenza vaccines.
What is adjuvant influenza vaccine?
tetravalent fluoride It is an inactivated standard-dose quadrivalent influenza vaccine approved for people 65 years of age or older. This vaccine contains an adjuvant called MF59. An adjuvant is an ingredient that is added to a vaccine and is intended to help create a stronger immune response to a vaccination.
What does this change mean for healthcare providers and vaccines?
Vaccine and health care providers should continue to make strong influenza vaccine recommendations for their patients and recommend higher doses or adjuvant influenza vaccines over a standard dose of uncorrected influenza vaccine for their patients 65 years of age or older.
How do the side effects of high-dose and adjuvant flu vaccines compare to those of standard-dose flu vaccines?
Common types of side effects from high-dose or adjuvant flu vaccines are similar to those from other flu vaccines. Common side effects of flu vaccines include things like soreness, redness, and swelling where the injection was given; Fever; muscle pain; and nausea. Some of these types of side effects may be more common with higher-dose and adjuvant vaccines than with standard-dose vaccines without adjuvants. But in studies with these vaccines, when these side effects did occur, they were usually mild. For the recombinant influenza vaccine, the side effects were similar to those of other injectable influenza vaccines.
Why is a differential recommendation for these vaccines necessary?
Because older adults have an increased risk of serious influenza-related illness, hospitalization, and death compared to younger populations, potentially more effective vaccines are recommended when possible. A preferential recommendation for the use of higher-dose or adjuvant vaccines over other age-appropriate vaccines for this population may increase the likelihood that these vaccines will be used, and may better protect the elderly from the more serious consequences of influenza.
Will there be a sufficient supply of high-dose influenza vaccines and adjuvants available to people 65 and older this season to meet any increase in demand resulting from this preferential recommendation?
We are not aware of any supply issues with high-dose or combination adjuvant influenza vaccines.
Are there any other flu vaccine updates for the 2022-2023 flu season?
There are a few more updates since last season’s recommendations were posted in August 2021. For the 2022-2023 influenza season, the influenza A (H3N2) and influenza B/Victoria components have been updated compared to the 2021-2022 season.
In addition, the age index for Flucelvax Quadrivalent was changed to an age of 6 months or older. Pre-approved for people 2 years of age or older.
Like last season, all flu vaccines available in the United States for the 2022-2023 flu season will be quadrivalent.
Can higher doses and adjuvant flu vaccines be given at the same time as COVID-19 vaccines?
During the 2022-2023 influenza season, the spread of SARS-CoV-2 in the United States is expected to continue, and COVID-19 vaccinations are expected to continue. Current guidance for the administration of COVID-19 vaccines Indicates that these vaccines can be given with influenza vaccines; Service Providers should refer to this page for updated information.
Do we know how severe the 2022-2023 flu season will be?
It can be difficult to predict flu activity. The last season (2021-2022) was mild, but influenza viruses circulated at higher levels than during the 2020-2021 season and hospitalization rates exceeded those reported during the 2011-2012 influenza season, which was the least severe season in the previous decade. The COVID-19 pandemic. The best way to protect against the potentially severe 2022-2023 flu season is with a flu shot.
Follow the CDC Twitter