Flu Shot Season: What’s New for the 2017-18 Season?
According to the Centers for Disease Control (CDC), a few things are new this season:
- The recommendation not to use the nasal spray flu vaccine (LAIV) was renewed for the 2017-2018 season. Only injectable flu shots are recommended for use again this season.
- Flu vaccines have been updated to better match circulating viruses (the influenza A(H1N1) component was updated).
- Pregnant women may receive any licensed, recommended and age-appropriate flu vaccine.
- Two new quadrivalent (four-component) flu vaccines have been licensed: one inactivated influenza vaccine (“Afluria Quadrivalent” IIV) and one recombinant influenza vaccine (“Flublok Qudrivalent” RIV).
- The age recommendation for “Flulaval Quadrivalent” has been changed from three years-old and older to six months and older to be consistent with Food and Drug Administration(FDA)-approved labeling.
- The trivalent formulation of Afluria is recommended for people five years and older (from nine years and older) in order to match the FDA package insert.
What Vaccines are Recommended?
Again, according to the CDC, only injectable flu vaccines (flu shots) are recommended. Some flu shots protect against three flu viruses and some protect against four flu viruses. Options this season include:
- Standard dose flu shots. Most are given into the muscle (usually with a needle, but one can be given to some people with a jet injector). One is given into the skin.
- High-dose shots for older people.
- Shots made with adjuvant for older people.
- Shots made with virus grown in cell culture.
- Shots made using a vaccine production technology (recombinant vaccine) that does not require the use of flu virus.
A Flu Shot is The Best Shot at Prevention for People 65 and Older
The medical community has recognized for many years that people 65 years and older are at greater risk of serious complications from the flu compared to young, healthy adults because human immune defenses become weaker with age. While flu seasons can vary in severity, during most seasons, people 65 years and older bear the greatest burden of severe flu disease. In recent years, estimates show that between 71 percent and 85 percent of seasonal flu-related deaths have occurred in people 65 years and older and between 54 percent and 70 percent of seasonal flu-related hospitalizations have occurred among people in that age group.
For millions of people, the flu can mean a fever, cough, sore throat, body aches and fatigue for a week or more. However, those 65 years or older are at increased risk of serious flu-related complications, like pneumonia. “People’s immune systems can become weaker with age, which places older adults at high risk of serious flu-related complications,” says Dr. Lisa Grohskopf, a medical officer with CDC’s Influenza Division. Data from recent seasons shows that between about 70 percent and 90 percent of seasonal flu-related deaths in the United States have occurred among people 65 years and older. For hospitalizations, this number is between about 50 percent and 70 percent. This is why flu vaccination is especially important for people 65 years and older.
While flu vaccines can vary in how well they work, scientific data show that flu vaccination prevents illness and hospitalizations, even among people 65 and older for whom the vaccine may not work as well. A new CDC study published this summer in the journal Clinical Infectious Diseases (CID) found that flu vaccination reduced the risk of flu-related hospitalizations among people 65 to 74 years by 61 percent. Vaccinated people 75 and older were similarly protected (57 percent). During 2015-2016, an estimated 66 percent of people 65 and older received a flu vaccine. While this is among the highest vaccination rates for any age group, that still leaves about 11 million people 65 and older unvaccinated. Recent analysis at the CDC has found that if vaccinations among people in this age group increased by 5 percent, an additional 35,000 illnesses and about 3,200 hospitalizations would be prevented. CDC estimates that last season’s flu vaccines reduced the risk of having to go to the doctor for flu illness by 45 percent among people 65 and older.
Four types of flu vaccines are approved for use in people 65 and older: some standard dose flu shots (including inactivated and recombinant shots), a “high dose” flu shot (Fluzone® HighDose) and an adjuvanted flu vaccine (Fluad™). The latter two vaccines are approved only for use in people 65 and older and both are designed to promote a stronger immune response in the person being vaccinated. However, the CDC has not expressed a preference for any one injectable flu vaccine over another. “The important thing is to get vaccinated,” says Dr. Grohskopf.
Why a Higher Dosage for Seniors?
Data from clinical trials comparing Fluzone to Fluzone High-Dose among persons aged 65 years or older indicate that a stronger immune response (i.e., higher antibody levels) occurs after vaccination with Fluzone High-Dose. Whether or not the improved immune response leads to greater protection has been the topic on ongoing research. A study published in the New England Journal of Medicine indicated that the high-dose vaccine was 24.2 percent more effective in preventing flu for adults 65 years of age and older relative to a standard-dose vaccine. The confidence interval for this result was 9.7 percent to 36.5 percent. A separate study published in The Lancet Respiratory Medicine reported that more immunogenic, high-dose vaccines can reduce the number of hospital admissions for people aged 65 years or older, especially those living in long-term care facilities. The study compared hospitalization rates among more than 38,000 residents of 823 nursing homes in 38 states during the 2013-14 flu season. It should be noted that the CDC and its Advisory Committee on Immunization Practices have not expressed a preference for any flu vaccine indicated for people 65 and older. CDC recommends flu vaccination as the first and most important step in protecting against the flu.
Education materials like this flyer/poster are available for your senior patients from the CDC: http://www.cdc.gov/flu.