Do I Need a High-Dose Flu Vaccine? - GoodRx


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Do I Need a High-Dose Flu Vaccine?

August 12, 2021

Key takeaways:

  • The high-dose flu vaccine is an option for people over 65 when getting an annual flu vaccine.

  • The high-dose flu vaccine offers more protection for people over 65 than the regular dose flu vaccine.

  • Annual flu vaccines are recommended for everyone over the age of 6 months.

Doctor cleaning a male patient's arm with a cotton swab before giving him a shot while he sits in a wheel chair.
PixelsEffect/E+ via Getty Images

Influenza — more commonly known as the flu — is a viral infection that affects roughly 9 to 45 million people in the U.S. every year. With symptoms like muscle aches, a cough, and severe fatigue, no one wants to get sick with the flu. So it’s important to do all you can to prevent catching it, and that includes getting your annual flu shot.

If you’re over 65, your healthcare provider or pharmacist may have mentioned the words “high-dose flu shot” when discussing your vaccine options. It’s likely all you took away from that conversation is that it’s a stronger vaccine meant for older adults. But if you’re left wondering how it compares to the regular flu vaccine and if you really need it, you’re not alone.

Stick with us as we discuss what the high-dose flu vaccine is, if it’s more effective than the regular dose vaccines, and whether you should get it.

What is in this year’s high-dose flu vaccine?

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 (called antigens). 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 vaccine’s exact composition changes every year in an effort to match the strains expected to circulate during flu season (October to May in the U.S.).

This year’s 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, it’s 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 (more details on these options below).

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

  • Octylphenol ethoxylate — a stabilizing agent to help keep the virus evenly distributed in the vaccine

  • Formaldehyde — an ingredient that kills the virus during vaccine production (the amount in the vaccine is very small and not dangerous to your health)

  • Sodium chloride (saline solution) — 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 it’s safe for people with latex allergies to receive it.

How does a high-dose flu vaccine differ from a regular dose vaccine?

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 adult’s 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:

  • Afluria Quadrivalent— This is a regular dose vaccine that is egg-based.

  • Fluarix Quadrivalent — This is a regular dose vaccine that is egg-based.

  • FluLaval Quadrivalent — This is a regular dose vaccine that is egg-based.

  • Flucelvax Quadrivalent — This is a regular dose vaccine that is not egg-based, making it a safer option for people with life-threatening egg allergies.

  • Flublok Quadrivalent — This is a recombinant flu vaccine. This type of flu vaccine is made with a synthetic (lab-made) antigen that our immune systems think is the influenza virus. It doesn’t contain any flu virus, and it is made without eggs.

  • FluMist Quadrivalent — This nasal spray vaccine is a live attenuated vaccine. This means the virus is very weak but not completely inactivated (dead). This type of vaccine can help provide longer-lasting protection than inactivated vaccines. However, it is not recommended for children under 2, adults over 50, and those with certain health conditions.

  • Fluad Quadrivalent — This is an adjuvant flu vaccine. Adjuvanted vaccines contain an extra ingredient — called an adjuvant — that promotes a stronger immune response than non-adjuvant vaccines. These types of vaccines also typically contain less antigen than non-adjuvant vaccines. Although this is another option for people over 65, adjuvanted vaccines aren’t considered to be high-dose.

Does the high-dose flu vaccine offer more protection?

Yes. In recent years, evidence has shown that high-dose flu vaccines are more effective than regular dose vaccines for people over 65. The Centers for Disease Control and Prevention (CDC) updated their flu vaccine guidelines in 2020 to reflect this.

Currently, people over 65 are recommended to be vaccinated with one of the following flu vaccines every year:

  • A high-dose flu vaccine

  • An adjuvant flu vaccine

  • A recombinant flu vaccine


What are the side effects of a high-dose flu vaccine?

Fluzone High-Dose Quadrivalent’s side effects are similar to those seen with other flu vaccines but happen more often. Side effects are generally mild. Pain where the vaccine was received is the most commonly experienced side effect.

Other common side effects include:

  • Muscle aches

  • Headache

  • Tiredness

  • A general feeling of discomfort

  • Redness or swelling where you received the vaccine

  • Shivering

It’s important to note that you cannot get sick with influenza from an inactivated flu vaccine. However, some people do experience flu-like symptoms after receiving their vaccine. This is expected and will get better within about 1 to 2 days.

Who needs to get a high-dose flu vaccine?

Fluzone High-Dose Quadrivalent is only FDA-approved for people over 65, so if you’re younger than that, you should stick to the regular dose vaccine. Speak with your healthcare provider to decide which available flu vaccine is the best option for you.

If you’re over 65 and questioning your flu vaccines options, contact your healthcare provider. They’ll let you know which of the three CDC-recommended flu vaccines for people over 65 is the best for you.

If your pharmacy or healthcare provider’s office doesn’t have high-dose flu vaccines in stock, it’s recommended to get vaccinated with a regular dose vaccine instead of waiting for Fluzone High-Dose Quadrivalent to be restocked. A regular dose vaccine will still offer you protection against the flu.

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. That’s why an annual flu vaccine is recommended for everyone over the age of 6 months, including pregnant people and people with weakened immune systems.


The bottom line

High-dose flu vaccines are one of several options for influenza vaccination for people over 65 years old. This vaccine contains a higher amount of the dead flu virus than the regular dose flu vaccine. This helps older adults’ immune systems react better to the vaccine, giving them better protection. 

Regardless of which option your and your healthcare provider decide is the best for you, getting your annual flu shot — in addition to other standard preventative measures — is one of the best ways to prevent yourself from getting sick with the flu.

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