Skip to content

Older Adults Should Opt for High-Dose Flu Shots

65 or over? The CDC has new influenza vaccine recommendations for you

a nurse is giving a woman a vaccine in her arm

Getty Images

En español

Health officials have new guidance for older adults this flu season, which is already off to a rough start: When you roll up your sleeve for the shot — and it’s not too late to do so if you haven’t already — skip the standard version and opt for one with more oomph.

The Centers for Disease Control and Prevention (CDC) is officially recommending that adults 65 years and older get immunized with what’s known as a high-dose or adjuvanted influenza vaccine. These shots can offer greater protection to older people, who, due to immune system changes that happen with age, do not have as strong a response to vaccination as younger, healthy people.

AARP Membership -Join AARP for just $12 for your first year when you enroll in automatic renewal

Join today and save 25% off the standard annual rate. Get instant access to discounts, programs, services, and the information you need to benefit every area of your life. 

Older adults are more susceptible to complications from the flu. The CDC estimates that between 70 and 85 percent of seasonal flu-related deaths and 50 to 70 percent of flu-related hospitalizations occur in people 65 and older.

“Given their increased risk of flu-associated severe illness, hospitalization and death, it’s important to use these potentially more effective vaccines in people 65 years and older,” José R. Romero, M.D., director of the CDC’s National Center for Immunization and Respiratory Diseases, said in a statement.

The three available vaccines

The more powerful flu shots have been available for several years. However, previous recommendations did not explicitly favor them over the standard flu vaccines, which help keep an influenza infection from progressing to a serious illness. “It was more of a soft recommendation,” says William Schaffner, M.D., a professor in the Division of Infectious Diseases at the Vanderbilt University School of Medicine and medical director of the National Foundation for Infectious Disease.

But data collected from studies over the years now shows that there’s “better protection for people ages 65 and older with one of these enhanced vaccines,” Schaffner says. “So basically, the signal has gone out to all the providers that [they need] to make an effort to stock these vaccines going forward for people aged 65 and older.”

The CDC’s recommendation didn’t come with a preference for any one of the three enhanced vaccines on the market. Schaffner’s advice is to get the one that’s available. “Don’t be too picky,” he says. “They’re all really enhanced vaccines.” Just make sure you’re asking for one of the versions that is specifically recommended for older adults.

  • Fluzone High-Dose Quadrivalent, an inactivated vaccine (meaning it uses the killed version of the germ that causes a disease) approved for people 65-plus, contains four times the antigen of standard-dose inactivated flu vaccines. Antigen is the part of the vaccine that helps your body build up protection against flu viruses, the CDC explains.
  • Fluad Quadrivalent, also an inactivated vaccine approved for people 65 and older, has the same amount of antigen as the standard shots but contains an adjuvant, or an ingredient added to a vaccine that helps create a stronger immune response to vaccination.
  • Flublok Quadrivalent, approved for people 18 and older, is made using a different vaccine technology (it’s a recombinant protein vaccine).

The high-dose and adjuvanted flu vaccines may result in more of the mild, temporary side effects that can occur with standard-dose seasonal flu shots, the CDC says. Expected side effects can include pain, redness or swelling at the injection site, headache, muscle ache and fatigue. These symptoms typically resolve within one to three days.

About 80 percent of Medicare beneficiaries already receive a higher-dose or adjuvanted flu vaccine, federal data shows. However, the CDC notes that racial and ethnic disparities exist. One study published in The Lancet Healthy Longevity found that minority groups were 26 to 32 percent less likely than whites to receive a high-dose flu vaccine.

“This recommendation could help reduce health disparities by making these vaccines more available to racial and ethnic minority groups,” the CDC’s Romero says.

The CDC recommends that everyone 6 months and older be vaccinated each year against the flu. If you’re 65 or older and one of the enhanced vaccines is not available when you go to get your flu shot, get a standard-dose flu vaccine instead, the CDC says.

“When you’re 65 and older and you’re talking about influenza, you need all the help that you can get,” Schaffner says. “So I have a very strong message to absolutely everyone 65 and older: Better to be vaccinated than not.” 

The vaccine is especially important this winter 

As of Dec. 3, nearly every state in the U.S. is experiencing high or very high levels of flu activity, CDC data shows. Already, about 120,000 Americans have been hospitalized with the illness — the highest number we’ve seen at this time of year in a decade. 

Meanwhile, cases of COVID-19 are spiking once again, and RSV (respiratory syncytial virus) is also spreading. “It’s a perfect storm for a terrible holiday season,” Sandra Fryhofer, M.D., board chair at the American Medical Association and an internal medicine physician in Atlanta, said in a recent CDC briefing on respiratory disease circulation. 

Health officials are urging all eligible Americans to get the latest COVID-19 booster — which targets some of the more recently circulating coronavirus variants — and the flu shot as soon as possible to help avoid the impending storm. There is no vaccine for RSV, but there could be one soon. 

You can take other precautions, as well, to help stay healthy — and these are measures we’ve all grown accustomed to over the last two years: Wash your hands often, avoid close contact with sick people, wear a mask in crowded indoor settings, and cover your coughs and sneezes. Also, don’t touch your face if you can help it. 

Editor’s note: This article, originally published July 1, 2022, has been updated to reflect new information.

Rachel Nania writes about health care and health policy for AARP. Previously she was a reporter and editor for WTOP Radio in Washington, D.C. A recipient of a Gracie Award and a regional Edward R. Murrow Award, she also participated in a dementia fellowship with the National Press Foundation.

Why Should I Get the High-Dose Flu Shot?