Flu Vaccine for Seniors - The Flu Shot for Older Adults

As the human body ages, the immune system weakens, and adults 65 and older are more at risk for severe illness and complications from influenza. Because of these higher risks, there are specific flu vaccines created for seniors and particular measures to consider due to advanced age. MyFluVaccine is here to answer common questions related to influenza vaccines for older adults and provide information on which flu vaccine may have the most benefits for you. Before getting any influenza vaccination, your healthcare professional should always be consulted for more information and any health concerns.

What risks do seniors face from influenza?

Hospitalizations and deaths happen at a much higher rate amongst older adults (65+) each flu season. According to the Centers for Disease Control and Prevention (CDC), "In the United States, between about 70 percent and 85 percent of seasonal flu-related deaths and between 50 percent and 70 percent of seasonal flu-related hospitalizations have occurred among people 65 years and older."¹ These statistics illustrate the importance of protective measures against the flu, and according to experts, at the top of the list of protections—especially for seniors—is the flu vaccine.

Flu is a significant health threat to seniors because of the complications that can occur with flu alone, but flu complications can be especially compounded by other respiratory infections such as pneumonia and/or respiratory viruses like COVID-19 and/or Respiratory Syncytial Virus (RSV). These additional infections and viruses can be particularly harmful to older adults and other vulnerable populations due to their weakened immune systems, and cases are on the rise. Many of these cases could be avoided with a seasonal flu shot. MyFluVaccine uses CDC data to illustrate US flu activity, and the CDC tracks cases/spread of COVID-19 and RSV:

COVID-19 Tracking: CDC COVID Data Tracker | CDC²
RSV Tracking: RSV State Trends - NREVSS | CDC³

It is also important to note that even if seniors get influenza after flu vaccination, studies show that they are at a much lower risk of complications than those who are unvaccinated.

Are flu shots for older adults different than the regular flu shot?

There are many flu shot types available to help protect against the flu. For those younger than 65, the CDC does not recommend a particular flu vaccine over another, but for those over 65, three types of flu shots are strongly advised: Fluad^® Quadrivalent, Flublok^® Quadrivalent Recombinant, or Fluzone^® High-Dose Quadrivalent. These types of vaccines have been found to offer more protection and be more effective for people over 65 years. However, if for some reason, the above-recommended vaccines for those 65+ are not available in your area, any age-appropriate flu vaccine is advised.

It is also important to note that the nasal spray—or Live Attenuated (LAIV)—flu vaccine is not approved for use in individuals over 49 and should not be used for seniors.

In comparing Flublok^® Quadrivalent Recombinant vs Fluad^® Quadrivalent vs Fluzone^® High-Dose Quadrivalent, it is important to consider health conditions and any allergies or sensitivities (specifically, eggs). If you have an allergy or aversion to egg-based products, then Flublok® Quadrivalent Recombinant may be your best bet, and it is the egg-free flu shot approved for use in those 18+, including seniors 65 and over.

High-dose flu vaccine:

Licensed only for people 65 years and older, Fluzone^® High-Dose Quadrivalent contains 4 times the amount of antigen as a regular flu shot, which helps the body to build more immunity to flu viruses.

Adjuvanted flu vaccine:

Similar to the high-dose flu vaccine, the adjuvanted flu vaccine is licensed for people 65 and older and designed to create a stronger immune response by adding an extra ingredient—an adjuvant—to the vaccine. Adjuvants are added to vaccine formulations to enhance efficacy. In the case of Fluad^® Quadrivalent, MF59® is made from an emulsion of squalene oil (a substance that occurs in humans, animals, and plants, and is purified for vaccine manufacturing) that enhances the immune process. MF59® has been administered in flu vaccines to millions of people since 1997 (in Europe) and in the US since 2016. Adjuvants help in the manufacturing process as well because the amount of virus needed is reduced, which allows for greater production and, therefore, greater availability.

How does the flu vaccine for seniors affect those over age 65?

For the most part, the flu vaccine affects older adults the same as other flu vaccines affect people from any age group—mild, flu-like symptoms may occur soon after receiving the vaccine. However, the high-dose and adjuvanted flu vaccines may result in more temporary, mild side effects than those associated with standard flu shots.

What are the flu shot side effects most common for seniors?

Standard flu vaccine side effects may include pain, redness or swelling at the injection site, headache, muscle ache and discomfort; these side effects typically resolve within 1 to 3 days of receiving the flu shot. However, some studies have shown that the high-dose flu shot caused side effects⁴ like headache, soreness at the injection site, muscle aches, and fatigue about a week after the vaccine was administered. But overall, flu vaccines do not cause the flu.⁵ The health benefits of receiving a flu shot far outweigh the side effects, and some people do not have any side effects after receiving a flu vaccine.

Which influenza vaccine is best for older adults?

All vaccines used in the US are closely monitored by the CDC and Food & Drug Administration for safety and effectiveness, and flu vaccines are created for different purposes and populations. With that in mind, a vaccine that is best for one person might not be best for someone else. It is important to check with your healthcare provider to determine which flu vaccine is best for you based on age, allergies, health status and/or conditions, etc.

But, recently, the Advisory Committee on Immunization Practices (ACIP) did make a recommendation for the use of specific flu vaccines for the 65+ population. This recommendation gives preference to both the high-dose and adjuvanted flu vaccine over the standard flu vaccine for this age group. These include Fluad^® Quadrivalent, Flublok^® Quadrivalent Recombinant, and Fluzone^® High-Dose Quadrivalent. Because the elderly often carry the burden of flu and severe flu-related illnesses, this population is heavily encouraged to get a preferred flu shot created for those 65+. However, if the vaccines formulated for those 65 and older are not available in a particular area, a similar flu vaccine is recommended. The CDC, as well as the ACIP, "have not expressed a preference for any flu vaccine indicated for people 65 years and older."⁶

Is a high-dose flu vaccine the best protection against flu?

The CDC has collected data that shows standard flu vaccines likely don't work as well in people over age 65. Because of weakened immune systems (often due to aging), those 65+ are typically at higher risk for severe flu and complications.

Based on past flu data, researchers have found that among seniors, high-dose flu vaccines—commonly known as the senior flu shot—generally help prevent flu-related hospitalization better than standard-dose flu vaccines. Studies have also indicated higher antibody levels in older adults who receive a high-dose flu vaccine.

If you are eligible to get a high-dose flu vaccine but it is not available in your area or from your healthcare provider, get a flu vaccine that is accessible. Medical experts maintain that any flu vaccine is better than none. Like other flu vaccines, the high-dose flu vaccine is studied and updated yearly to best protect against the flu strains most likely to spread during the upcoming flu season.

How much stronger is the senior flu shot?

Fluzone^® High-Dose Quadrivalent includes 3 to 4 times more flu virus antigen than standard-dose flu vaccines, which stimulates and boosts the immune system's response. The CDC has found that standard-dose flu vaccines do not work as well for seniors, and the higher-dose flu vaccine has helped prevent severe flu and complications, as well as hospitalization and influenza-related death.

Like standard-dose flu vaccines, the high-dose flu vaccine is updated yearly to best combat the most anticipated circulating strains. Getting a high-dose flu vaccine does not mean you will be protected the following season—receiving a flu vaccine each season is the best way to prevent flu and flu-related complications.

Do seniors need the pneumococcal vaccine and an influenza vaccination?

Those 65 years and older should also be up to date with pneumococcal vaccination to protect against pneumococcal disease, such as pneumonia, meningitis, and bloodstream infections. There is a significant correlation between pneumococcal pneumonia and influenza, as pneumococcal pneumonia is an example of a serious flu-related complication that can lead to death. There are several types of pneumococcal vaccines: Pneumococcal conjugate vaccines (PCV13, PCV15, and PCV20) and pneumococcal polysaccharide vaccine (PPSV23). The CDC notes: "For those who have never received any pneumococcal conjugate vaccine, the CDC recommends PCV15 or PCV20 for seniors and adults 19 through 64 years old with certain medical conditions or risk factors. If PCV15 is used, this should be followed by a dose of PPSV23."⁷ The four pneumococcal vaccines available in the US are as follows:

PCV13 (Prevnar 13^®)
PCV15 (Vaxneuvance^®)
PCV20 (Prevnar 20™)
PPSV23 (Pneumovax23^®)

Speak with your healthcare professional about which pneumococcal vaccine is recommended for you according to age and health condition(s). Typically, seniors can get this vaccine at the same time as the flu vaccine.⁸ These vaccinations play an important role in avoiding preventable illnesses like flu and pneumococcal diseases.

Can seniors take the flu vaccine and covid vaccine at the same time?

In many cases, co-administration of vaccines is considered safe and effective. Both the flu and COVID-19 vaccines have been shown to be beneficial for older adults, as they are at higher risk for severe complications from these infections. However, individual health conditions and specific circumstances may influence the recommendations, so it's important for seniors to consult with their healthcare provider for personalized advice.

Currently, the Centers for Disease Control and Prevention (CDC) recommend that everyone age 5 years and older receive one dose of the updated Pfizer-BioNTech or Moderna COVID-19 vaccine.

Severe flu symptoms & complications

Seniors are one of the most influenza-affected populations and can face intense symptoms and high-risk complications. If you notice any of the following signs during a bout of the flu, seek medical attention right away:

Difficulty breathing or shortness of breath from flu congestion
Consistent dizziness or confusion
Pressure in the chest or abdomen
Seizures
Lack of urination
Severe muscle pain or weakness
Fever or cough that continues to return or worsen

Seniors should also be aware of symptoms of pneumonia⁹, especially following the flu or other respiratory viruses, such as SARS-CoV-2 (the virus that causes COVID-19). These signs might include:

Chest pain when you breathe and/or cough
Confusion or changes in awareness
Cough, which might produce phlegm
Fatigue
Fever, sweating and shaking chills
Lower than normal body temperature
Nausea, vomiting or diarrhea
Shortness of breath

See a healthcare professional if you have any of the above symptoms and seek immediate medical attention if you have difficulty breathing, chest pain, continual fever of 102̊ F or higher, or persistent cough, especially if you cough up pus.

Final Thoughts on the Senior Flu Shot

First, it is important to note that people 65 years and older are part of a very diverse group in terms of health condition(s), immune response, activity, and mobility. However, aging is known to weaken the immune system and its response, so the influenza vaccination is a significant way to boost immune response to the flu and prevent serious flu-related illness, hospitalization, complications, and death in older adults. Flu vaccines are an important consideration for health and wellness in this age group.

There are several vaccines from which to choose for the 65+ population, including a high-dose vaccine which has been found to better prevent flu-related complications and hospital stays, so speak with your doctor or healthcare professional to see which vaccine might be best for you and which flu shot is available in your area. The flu shot types specifically for seniors include: Fluad^® Quadrivalent, Flublok^® Quadrivalent Recombinant, and Fluzone^® High-Dose Quadrivalent, but in terms of mitigating flu symptoms and spread, experts also note that any flu vaccine (approved for your age range) is better than none.

The Flu Vaccines for Seniors: Should Older Adults Receive a Flu Shot?