Confusion persists over timing of flu shots for older adults

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in NextAvenue.com, Journal of Active Aging, Cancer Today, Kaiser Health News, the Connecticut Health I-Team and other outlets. She is a senior fellow at the Center for Health Policy and Media Engagement at George Washington University and co-produces the HealthCetera podcast.

Photo: KOMUnews via Flickr

Photo: KOMUnews via Flickr

Fall has arrived so it’s time for older adults to get their flu shots. Or is it?

Older adults are at greater risk of serious complications of the disease than those under age 65, according to the Centers for Disease Control and Prevention. They recommend that everyone get vaccinated by the end of October, if possible, as the best way to prevent the flu.

But it may be better to wait a little while longer to benefit from the vaccine’s full protection through the height of flu season, according to a recent NPR report. And KHN’s Julie Appleby reports that even vaccine experts are unclear whether it’s best to get the shot sooner rather than later, because waiting may sometimes mean a missed opportunity for vaccination. In another story, from WHSV-Harrisonburg, Va., a local doctor said it’s better not to wait.

It’s not surprising that so many people are confused. Some media outlets are partnering with pharmacies and retail clinics to encourage people to get the shots – although it’s still September. And in a “why didn’t anyone think of this before,” Boston story, Uber is bringing flu shots (and a nurse to administer them) to people who need them.

Regardless of when it’s given, there’s still some controversy surrounding the flu shot’s actual protective benefits for older adults against higher odds of death during the winter months. This Scientific American article from 2012 provides an excellent overview of research showing flu shots can help reduce winter deaths among the elderly and other studies that contend it doesn’t really make a difference.

Good to Know

The CDC says there are two vaccines designed specifically for people 65 and older:

  • The “high dose vaccine” contains four times the amount of antigen as the regular flu shot. It is associated with a stronger immune response following vaccination (higher antibody production). Results from a clinical trial of more than 30,000 participants showed that adults 65 years and older who received the high dose vaccine had 24 percent fewer flu infections compared with those who received the standard dose vaccine.
  • Fluad, an adjuvanted flu vaccine, is designed to help create a stronger immune response to vaccination. This vaccine is available for the first time in the United States for the 2016-17 season. In a small Canadian observational study conducted the 2011-12 season, Fluad was 63 percent more effective than regular-dose unadjuvanted flu shots in those 65 and older. There are no randomized studies comparing Fluad with Fluzone High-Dose.

The CDC cautions that these two vaccines may cause more of the mild side effects than standard-dose seasonal shots. This can include pain, redness or swelling at the injection site, headache, muscle ache and listlessness. They also warn that people age 65 and older should not get the nasal spray flu vaccine, the intradermal flu shot, or jet injector flu vaccine.

Questions to Ask

  • What is the conventional wisdom among health providers where you live about the best time to get vaccinated?
  • Are there unique partnerships in your community to encourage/assist older adults to get flu shots?
  • What are the trends at local hospitals for elderly flu-related deaths over the past 5 to 10 years? Have awareness campaigns, offering more retail locations, or other factors affected morbidity and mortality?
  • Is there sufficient stock of age-specific vaccines available?

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