What’s Up Doc? Flu shot, high dose for those older than 65

Question: The pharmacist recommended a different flu shot for my 72-year-old mom than for me. Why is that?

Answer: Flu symptoms include fever, body aches, cough, sore throat, runny nose, fatigue, stomach ache, headache and/or other symptoms. Complications can include breathing compromise, for example from pneumonia, dehydration, altered mental status, seizures, others. People over 65 are at a much higher risk of developing flu complications, and around three-quarters of flu deaths occur in people over age 65 even though they account for only about 15% of the population.

The Centers for Disease Control, CDC, recommends everyone over 6 months of age who has no contraindications, such as a severe allergy, others, get a flu shot every year. The flu virus mutates quickly, and it is an educated "guess" which strain of flu will be going around -- this guess is based on flu data from countries where it hits earlier than in the U.S. Therefore, the flu shot is not completely protective, especially if the vaccine is not a good match to the actual endemic flu strain of that year, although still minimizes symptoms and severity.

Our immune system weakens as we get older, so people over age 65 may not respond to the standard dose of flu vaccine as well as younger people. Therefore, it is recommended that people over age 65 get a higher-dose flu shot -- it contains about four times the amount of antigen -- to more strongly stimulate an immune response. The overall mortality from flu is not that high, so it would take a huge clinical trial to show the higher dose vaccine saves lives, but it has been shown to reduce the incidence of flu in those over 65 by almost 25%.

One tradeoff for this increased protection is a higher rate of mild side effects such as injection site redness/soreness, headache, muscle aches and malaise. However, there does not appear to be a significant increase in severe side effects -- such as severe allergic reactions.

In addition to the flu shot, people over age 65 -- and certain others, so speak to your health care provider -- should also get the pneumococcal vaccine, often called the "pneumonia shot," as bacterial infection from pneumococcus is more common in those over 65 -- and pneumococcal pneumonia can be a complication of the flu.

Although recommendations are that people get their flu shots by the end of October, it is still not too late to be vaccinated -- peak flu season varies from year to year but is most often in January to February. In addition, everyone should minimize "passing the flu around" by covering their coughs -- cough into the inside bend of your elbow as coughing into your hand can increase transmission when you "pass" the virus to a doorknob, etc. -- wash your hands often and minimize contact with people who are sick. If you do get certain subtypes of the flu, there are medications to minimize the duration of your illness; these work best if started within 48 hours of getting sick, so see your health care provider promptly.

Jeff Hersh, Ph.D., M.D., can be reached at DrHersh@juno.com.

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