Senior in mask receiving bandage after vaccination

A forthcoming decision on high-dose influenza shots for seniors could mean a welcome change inspired by pandemic lessons learned, long-term care stakeholders say.

Advisers to the Centers of Disease Control and Prevention are considering whether to specifically endorse enhanced flu vaccines for adults aged 65 years or older over standard vaccines.

The CDC currently does not state a preference. But in late February, its independent Advisory Committee on Immunization Practices (ACIP) met to review evidence on whether the enhanced versions are better for seniors — and whether it was time to signal a preference.

In addition to standard-dose flu vaccines approved for most adults, three are designed for the senior age-group. These include Fluzone High-Dose, which carries four times the amount of antigens to help provoke a stronger immune response, and Fluad quadrivalent and trivalent, which use an adjuvant ingredient to stimulate additional immune response.

A welcome first

The enhanced shots offer extra protection for a population that is more vulnerable to severe flu outcomes such as pneumonia and death. If the CDC decides to highlight these vaccines, it will be a welcome first, Chad Worz, PharmD, chief executive of the American Society of Consultant Pharmacists, told McKnight’s Clinical Daily

One of the lessons of the pandemic was the need to prioritize individuals for treatment based on risk, Worz said. And ACIP’s move to consider the specific characteristics of older adults in making vaccines recommendations is encouraging, he added.

“Making healthcare decisions based on individual characteristics and risk factors should be part of any approach, and recognizing the vulnerability associated with age and other risk factors makes guidance more impactful — especially to long-term care and other higher risk groups,” Worz said.

High-dose shot is safer, LTC doc says

A long-term care physician agreed. “In view of the fact that older adults have a less vigilant immune system and are more susceptible to serious complications from influenza,” it is likely that the enhanced vaccines will be recommended over the standard dose vaccines, said Kevin O’Neil, M.D., FACP, CMD, chief medical officer of ALG Senior, headquartered in Hickory, N.C. 

The implications for senior living providers are clear, he said.

“In ALG Senior assisted living communities, we have provided the high-dose influenza vaccine because it elicits a more robust antibody response and previous studies show a significant reduction in clinical illness,” he told McKnight’s.

In fact, one trial found that seniors who received the enhanced vaccine had 24% fewer illnesses from flu than their peers who received a standard dose, according to the CDC.

Fewer hospitalizations, happier residents

“The COVID pandemic has clearly demonstrated the vulnerability of older adults, especially those in long-term care settings, to infectious diseases,” O’Neil added. Influenza typically causes many thousands of deaths and hospitalizations annually in at-risk populations, he said.

“The cost of vaccinating residents in senior living settings will be greater with the enhanced influenza vaccine than with the standard dose vaccines, but the return on the investment will be less hospitalizations and deaths due to influenza — which means happier residents, happier families and a stable occupancy,” he said.

ACIP has not yet made a decision, and is scheduled to meet again in June.