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Flu Shots for Older Adults During COVID Times: What to Know & Do for 2022

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It’s that time of the year: fall, which I think of as flu vaccination time.

I always think getting a flu vaccine is a good idea for most older adults. In these COVID pandemic times, I think it’s even more important.  So I agree with the Centers for Disease Control (CDC), which is urging that people get vaccinated against influenza early in the fall (before the end of October 2022).

Now, vaccination against seasonal influenza can seem like a bit of a tricky topic. Many older adults are skeptical of the need to get a yearly vaccination against influenza. They aren’t sure it will help. Or they think that the vaccination will actually give them a mild case of the flu. Or they just don’t like needles.

Or maybe they aren’t sure which type of seasonal flu shot to get: the regular one or one of the newer “stronger” versions, designed for older adults?

And now that we have COVID-19 to contend with, vaccination for seasonal influenza might feel even more confusing for people. 

Don’t let yourself be confused. In this article, I will share with you what I know about influenza vaccination and what I’ve learned about influenza in COVID times. I also have updates on the new stronger flu vaccines that are now recommended for older adults.

But let me share the bottom line with you right now. In general, I have always supported the CDC’s usual recommendation that everyone over the age of 6 months should get their seasonal flu shot.

This year, I agree with the CDC that it’s important for people to get their seasonal flu shot,  and if you are an older adult, I recommend getting one of the three flu vaccines specifically recommended for older adults. (See below for more on these!)

Among other things: although we’ve had some milder flu seasons these past few years, Australia just had its worst flu season in five years and experts say we should be prepared to see more flu circulating this year.

Note: If you are age 65 or older and it’s been more than 2 months since your last COVID booster, you may be able to get your COVID fall booster shot at the same time. (For more on the new bivalent COVID booster , see COVID Vaccination & Boosters for Aging Adults: What to Know & Do.)

In “normal” pre-COVID times, the Centers for Disease Control (CDC) estimates that every year, influenza affects 9-45 million Americans, causes 140,000-810,100 hospitalizations, and results in 12,000-61,000 deaths. In most years, influenza vaccination does help reduce hospitalizations and deaths (I go into details below).

And now this fall, this will be our third winter dealing with COVID-19 as well. As of September 2022, we still have 400-500 people dying of COVID every day, and my recent review of CDC data suggested that over 80% of the deaths are in people over age 65. We don’t know for sure what will happen this fall, but since COVID seems to spread more when people are indoors and in proximity to the exhalations of others, it’s certainly possible that COVID could get worse again this winter.

So this year,  it’s important to do what you can to reduce respiratory illness, to protect yourself, and to protect others. And getting vaccinated against influenza is one of the things we can do.

In fact, I’m about to go get mine. As a healthy woman in her 40s, I’m not that concerned about getting dangerously ill from influenza. Instead, I get my annual flu shot because I want to minimize my chance of getting sick and perhaps exposing my older patients to influenza.

Here’s what I’ll cover in this article:

  • The basics of influenza and vaccination against the flu
  • What we know about influenza and COVID-19
  • What to know about flu shots for older adults & the CDC’s new recommendations specifically for older adults
  • What’s new and resources for the 2022-2023 flu season
  • Which influenza vaccination is probably best for most older adults
  • What to do if your older parent or relative is unwilling or unable to get vaccinated
  • Whether it’s more important to get a flu shot or a COVID vaccination (or a booster)

The basics of influenza and vaccination against the flu

Q: What is influenza?

A: Influenza is a contagious respiratory viral illness, caused by influenza A or influenza B virus. It usually causes symptoms such as sore throat, stuffy nose, cough, fever, and body aches. In the Northern hemisphere, influenza is most common in the winter. Peak influenza activity usually occurs between December and February, but it can start as early as October and occur as late as May.

In “uncomplicated” influenza, the flu causes symptoms similar to — but usually worse than — a very bad cold, and then these get better over 5-7 days. Most people who catch the flu experience uncomplicated influenza, with some people experiencing more significant symptoms than others. In fact, some people (14%, in one study) will catch the flu and shed some flu virus, yet not report any symptoms!

However, influenza does sometimes cause more serious health problems, which we call “complications.” These are more likely to happen to people who are older, have other chronic conditions, or have a weakened immune system.

The most common complication of influenza is pneumonia, which means a serious infection of the lungs. Such cases of pneumonia are sometimes purely viral. But it’s more common for them to be caused by bacteria, who are able to infect the lungs due to the body being weakened by influenza infection.

Many older adults also appear to experience worsenings of any chronic heart or lung conditions, when they experience influenza. These complications of influenza often cause hospitalization or even death.

To learn more about the basics of influenza, and for more on diagnosing and treating the flu, see:

Q: What is the usual impact of influenza, and is it worse for older adults?

Influenza is more severe in some years than others.  For instance, the 2017-2018 season was particularly severe, with an estimated 52,000 deaths related to the flu. The 2018-2019 season wasn’t as bad, but still had a real impact: the CDC estimates that there were 29 million flu illnesses that year, causing an estimated 28,000 flu deaths.  For 2019-2020, the CDC estimates that there were 35 million flu-related illnesses and 20,000 flu deaths.

Now, most people get better without needing hospitalization, but some people get very sick. Older adults are especially likely to get dangerously ill from catching the flu.

Note: The information above is from pre-COVID times. In the winter of 2020-2021, influenza cases were much much lower than usual, probably due to masking and social distancing associated with the coronavirus pandemic. The flu season for 2021-2022 was also relatively mild, with an estimated 8-13 million flu-related illnesses and an estimated 5000-14,000 flu deaths.

In comparison, as of Sept 2022, over 225,000 Americans have died of COVID since the beginning of 2022 (!).

Q: How does the flu shot help protect one from influenza, and how effective is it?

A: The flu vaccine works by stimulating the body to produce antibodies against whatever strains of influenza were included in that year’s vaccine.  After vaccination, it takes about two weeks for the body’s immune system to create its influenza antibodies.

Our bodies are able to fight off viral infections much more quickly if we already have matching antibodies available when a virus tries to create illness in our bodies. If we don’t have matching antibodies available, then we’ll experience more illness, and it will take longer for our immune systems to control the infection.

The tricky thing about influenza is this: both influenza A and B have a tendency to be constantly changing into slightly different strains. This means that every year, scientists must study what influenza strains are present, and try to predict which ones we’ll be exposed to, during the coming winter. Influenza vaccines are then developed, to match those strains. (This is why the flu shot has to be given every year.)

Sometimes the scientific prediction works out well. In this case, we say that the vaccine was well-matched to the influenza viruses circulating that winter, and influenza vaccination will have been more effective in preventing the flu.

But there are years in which the influenza strains that circulate the most in the winter are not the ones that scientists were expecting. These are the years in which the influenza vaccine is not well-matched, and there tends to be more illnesses and hospitalizations.

The CDC estimates that when the vaccine is well-matched to the circulating influenza viruses, flu vaccination reduces the risk of flu illness by between 40% and 60%, for the overall population.

Several different flu vaccines are available every year. Some vaccines used to be “trivalent”; these protected against two strains of influenza A and one strain of influenza B. “Quadrivalent” flu vaccines, available since 2012, protect against two types of influenza A and two strains of influenza B.

For 2022-2023, all flu vaccines are quadrivalent.

Vaccines also vary in terms of whether they are “standard-dose” versus “high-dose,” and one type includes an “adjuvant,” which is an additive designed to increase the immune system’s response to the vaccine. (More response is better, in that it means more protection from future infection.) I’ll discuss high-dose and adjuvant vaccines later in this article, in the section addressing flu shots for aging adults.

You can find a list of all available influenza vaccines in the Table listed below.

For more information:

Q: Can you get the flu from the flu shot? What are the risks and side effects of influenza vaccination?

A: No, you can’t get the flu from a flu shot. Most of the currently recommended vaccines are made with “inactivated” virus (which means the virus has been killed and can’t become alive again). There is also one vaccine available that was made using “recombinant” technology (which means they have cobbled together virus proteins). It is not possible for these vaccines to give you influenza.

There is also a “live attenuated” form of flu shot (FluMist), available for people ages 2-49, which is given by nasal spray. This contains a weakened form of influenza virus. It has historically been popular with children. 

The most common side-effect of the flu shot is arm soreness, and sometimes redness. People do sometimes report body aches, fever, or cough after the flu shot. But a randomized trial found that these are equally common in people who had just had saline injected, so these symptoms are either due to getting sick from something else after your flu shot, or perhaps to even expecting to feel lousy after your flu shot.

Serious adverse effects related to the flu shot are very rare.

For more information:

Q: What are the best ways to protect oneself from influenza and its complications?

A: To reduce your risk of getting sick from the flu or a flu-like illness, it’s best to combine two approaches:

  1. Minimize your exposure to people spreading the influenza virus in the winter.
  2. Take steps to bolster your immune system, so that if you do get exposed to the influenza virus, you’ll be less likely to get very sick.

Older adults should also make sure they are up-to-date on pneumococcal vaccination. (These are one-time, not yearly). Pneumococcal vaccination helps reduce the risk of certain types of bacterial pneumonia and other potential complications of influenza. A 2016 meta-analysis concluded that being vaccinated for both influenza and pneumococcus was associated with a lower risk of pneumonia and death.

For a very long time, the pneumococcal vaccine recommended for all adults aged 65+ was the pneumococcal polysaccharide vaccine (“PPSV23”), brand name Pneumovax. However, in 2021, the CDC updated its pneumococcal vaccination recommendations for older adults, in part to incorporate the use of some of the newer pneumococcus vaccines.

You can see the latest pneumococcal vaccination recommendations here: CDC Pneumococcal Vaccination. For more on pneumococcal vaccination, also see 26 Preventive Services for Older Adults (Vaccination section).

Pneumococcal vaccines can be administered at the same time as the annual influenza vaccination.

Minimizing your exposure to influenza virus

The main way people get exposed to influenza is when they breathe in air droplets containing the influenza virus. These droplets are created when people infected with influenza virus talk, sneeze, or cough. The CDC estimates that a person infected with the influenza virus may be contagious for one day prior to developing symptoms, and 5-7 days after getting sick.

Influenza virus can also survive for up to two days. The virus survives for much less time on soft surfaces, such as used tissues and bed linens.

Based on these facts, the best ways to minimize exposure to influenza are to:

  • Avoid exposure to people who may be infected with influenza.
  • Clean household surfaces, especially hard surfaces such as counters, and especially if someone living with you has been sick.
  • Wash your hands often, especially before touching your eyes, nose, or mouth.
  • Minimize your time near people who have not been vaccinated for influenza.
    • Your risk of influenza exposure is reduced if people around you — family members, co-workers, fellow residents of your living facility — are vaccinated for influenza.

COVID precautions, such as wearing an N95-type mask indoors and ventilating indoor spaces will also help minimize your exposure to influenza.

Bolstering your immune system

Since we are social creatures and live in communities, we all have a good chance of being exposed to the influenza virus at some point. Whether we get sick from this exposure, and how sick we get, depends on how well our immune system can fight off the influenza virus.

Ways to bolster your immune system are:

  • Be vaccinated against seasonal influenza. If the vaccine is a good match with circulating viruses and you have a good antibody response, this is probably the best way to prepare your immune system to beat influenza.
  • Take good care of your health and body. This includes addressing healthy lifestyle basics such as not smoking, getting adequate sleep, avoiding chronic stress, and more. For a good review of what’s known about strengthening the immune system, see: How to boost your immune system (Harvard Health Review)

What we know about COVID-19 and influenza

Q: How are COVID-19 and influenza similar and how are they different?

A: COVID-19 and influenza have many similarities, but also many differences.

The main similarities are:

  • Both viruses are mostly spread through an airborne route. This means that steps you take to protect yourself from COVID-19, such as social distancing measures and avoiding crowded indoor spaces, will likely reduce your risk of catching influenza as well.
  • The initial symptoms of infection have a lot in common. Namely, both often start with “upper respiratory symptoms” such as cough, runny nose, fatigue, fever, and body aches. This means it will be difficult to tell the two conditions apart, unless laboratory testing is used.
  • Both are more likely to cause severe illness in people who are older or frail.

Even though both viruses often cause viral pneumonia, there are significant differences between the two. They are actually quite different types of viruses. The differences include:

  • People appear to be infectious for longer, with COVID-19.
  • In “mild” COVID-19 (meaning hospitalization is not required), people seem to be sick for longer than with the flu.
  • The antivirals known to be active against influenza (such as oseltamivir) do not work against COVID-19.
    • Similarly, antivirals that work against COVID, such as Paxlovid, do not work against influenza.
  • COVID-19 has been noted to cause more severe and more varied illness in the body than influenza, including clotting disorders, inflammation of organs other than the lungs, persisting long-term symptoms in some patients, and more.
  • Although COVID-19 and flu viruses spread in similar ways, COVID-19 seems to be more contagious under certain circumstances.
  • Although the mortality rate for COVID-19 is still being debated (we still don’t know exactly how many people have had COVID-19), in adults of all ages, it appears to be higher than that of influenza.

In short, influenza and COVID-19 are similar in terms of how they spread and common initial symptoms. But COVID-19 has so far caused more serious disease, and at this time, remains harder to treat, in part because it seems to affect the body in more significant ways than influenza usually does.

For more on the similarities and differences between influenza and COVID-19:

Q: Is it possible to get influenza and COVID-19 at the same time? How do they affect each other?

A: Yes, over the few years, some people have been found to be co-infected with influenza and COVID-19 at the same time.

That said, our understanding of how these two viruses interact remains limited, as we haven’t yet had large numbers of people be co-infected. For instance, a Mayo Clinic study published in 2022 found only 120 co-infection cases (out of almost 200,000 COVID cases).

Since the arrival of COVID, the past two influenza seasons have been relatively mild in the US. It remains to be seen whether we’ll have a more significant influenza season for 2022-2023 (some experts think we will) and whether this results in a lot of co-infections.

What to know about flu shots for older adults

Q: Is the flu vaccine effective for older adults?

A: You may have heard people say that the flu shot doesn’t work in older people. This is not entirely correct.

Now, it’s true that flu vaccine is usually less effective in older adults because aging immune systems tend to not respond as vigorously to the vaccine. In other words, older adults tend to create fewer antibodies in response to vaccination. So if they are later exposed to flu virus, they have a higher chance of falling ill, compared to younger adults.

But “less effective” doesn’t mean “not at all effective.” For the 2017-2018 flu season, the CDC estimates that vaccination prevented about 700,000 influenza cases and 65,000 hospitalizations, for adults aged 65 and older.

For more on the effectiveness of influenza vaccination in older adults, see:

To provide more effective vaccination to aging immune systems, vaccine makers have developed “stronger” vaccines against the flu, which I explain in the next section.

Q: Are there flu shots specifically designed for older adults?

Yes! Over the past several years, vaccine makers have developed vaccines that are designed to work better with an aging immune system. Most research studies to date show that these stimulate aging immune systems to produce more antibodies to influenza. There’s also some evidence that these vaccines reduce the risk of being hospitalized for influenza.

In 2022, for the very first time, the CDC’s Advisory Committee on Immunization Practices (ACIP) decided to recommend certain influenza vaccines specifically for older adults. You can read about this exciting development here: ACIP Flu Meeting Update: Flu Vaccines Worked Better than Reported & ACIP Recommends Specific Vaccines For Seniors.

For 2022-2023, there are three influenza vaccines that are specifically recommended for people aged 65 and older:

  • Fluzone High-Dose Quadrivalent: This vaccine contains four times the amount of antigen, compared to Fluzone standard-dose. It is approved for adults age 65+. Fluzone High-Dose has been trivalent in past years but is now quadrivalent.
    • Studies have found that the high-dose vaccine does improve antibody response. A study published in 2017 also found that use of the high-dose vaccine in nursing-homes was associated with a lower risk of hospitalization during flu season.
  • Fluad Quadrivalent: This vaccine contains an “adjuvant,” which is an additive meant to stimulate a better immune response to the vaccine. It is a newer vaccine in the U.S., but had been licensed in Canada and several European countries prior to receiving approval here in 2015. The quadrivalent version was licensed by the FDA in February 2020.
  • Flublok Quadrivalent: This is a recombinant protein influenza vaccine. It is approved for use in people 18 years and older, and as of 2022, it’s also specifically recommended for older adults.
    • Per the CDC announcement, “It is made using different production technology than the inactivated influenza vaccines and contains three times the antigen dose compared with standard-dose inactivated flu vaccines. The higher dose of antigen is intended to give people 65 years and older a better immune response to vaccination, and therefore, better protection against flu.”

For more on why the ACIP decided to recommend these three influenza vaccines for older adults, you can view the ACIP slides from June 2022 here.

Note: The ACIP says there is not yet enough data available to say which of the above three vaccines is better for older adults. Also, if none of these three are available to you, it’s fine to get a standard flu shot for adults.

For more information on flu shots for older adults, see:

Q: Does Medicare cover the cost of influenza vaccination?

Yes, yearly influenza vaccination is 100% covered by Medicare, with no deductible or co-pay. So if you get your flu shot from a health provider that accepts Medicare payment, there should be no cost.

Q: Is it more important to get a flu shot or a COVID vaccine/booster?

Don’t choose between them, just get both! Per the CDC, you can get a flu vaccine and a COVID vaccine (or a COVID booster) at the same visit.

That said, if you’re reluctant to get both and really want to know which is more likely to make a difference to your risk of being hospitalized this winter…

If for some reason, you haven’t yet gotten vaccinated against COVID: I’d go with COVID vaccination. And if you are older: make sure you get a booster too!  COVID is just much more dangerous than influenza.

Also, the mRNA COVID vaccines (Moderna, Pfizer) have proven to be extremely effective at protecting older adults against hospitalization due to COVID, especially if you stay up-to-date on boosters. (See my COVID vaccination article for more.)

Now, if you have been vaccinated against COVID and are wondering if a booster or a flu shot is more likely to help you…well, we don’t really know. Australia just had its worst flu season in five years,  so we might finally be in for a bad flu season this winter.

Really: the best is to just get updated protection again both influenza and COVID. (And then take precautions to minimize exposure to respiratory illnesses this winter.)

What’s new and resources for the 2022-2023  flu season

The CDC maintains a page dedicated to the current flu season. There is a section for the public and also a section for providers. This is a good place to get up-to-date information on influenza and influenza vaccination. You can find it here:

Note that the CDC’s Flu FAQ page currently includes lots of information about influenza and COVID-19, such as how to tell them apart, why it’s safe to be vaccinated for both at the same time, and more.

The CDC also provides information specific to older adults here:

Which influenza vaccination is best for older adults?

Looking at the list of available flu shots can be overwhelming. In looking at this year’s CDC table of available influenza vaccines, I counted eight options that are available for people aged 65 or older:

  • 4 standard-dose quadrivalent inactivated vaccines (Afluria Quadrivalent, Fluarix Quadrivalent, FluLaval Quadrivalent, Fluzone Quadrivalent)
  • 1 standard-dose quadrivalent inactivated vaccine manufactured with a newer “cell culture-based” technology (Flucelvax Quadrivalent)
  • 1 high-dose quadrivalent inactivated vaccine (Fluzone High-Dose Quadrivalent)
  • 1 standard-dose quadrivalent adjuvanted inactivated vaccine (Fluad Quadrivalent)
  • 1 quadrivalent recombinant vaccine (Flublok Quadrivalent)

Only Fluzone High-Dose Quadrivalent and Fluad Quadrivalent are restricted to people 65 years or older.

As of 2022, the CDC is now recommending these three influenza vaccines for adults aged 65 and older:

  • Fluzone High-Dose Quadrivalent
  • Fluad Quadrivalent
  • Flublok Quadrivalent

So if you are an older adult, or if you’re trying to arrange a flu shot for an aging relative, which flu vaccine should you try to get?

My take is this: if you have a choice, go for one of the three vaccines listed above.

Why? Because we know that as people get older, their immune systems tend to respond less vigorously to immunization. And because research suggests that the high-dose flu shot generates higher antibody titers and has been associated with better influenza outcomes.

You may have also heard that the New England Journal of Medicine published a study in 2017, about a newer influenza vaccine in older adults. That study, funded by the manufacturer of recombinant influenza vaccines, compared the effectiveness of a recombinant quadrivalent vaccine with a standard-dose quadrivalent inactivated vaccine, in adults aged 50 and older. Confirmed influenza cases were 2.2% in the group receiving recombinant vaccine and 3.2% in the group receiving inactivated vaccine.  Hence the probability of influenza-like illness was 30% lower with the recombinant vaccine than with the inactivated vaccine. But again, this study did not compare the recombinant vaccine against a high-dose inactivated vaccine.

Bottom line:

  • What is most important is to get any type of flu vaccination that is approved for your age.
  • Research suggests that older adults are more likely to benefit from an influenza vaccine designed to provide a stronger stimulus to the immune system, such as Fluzone High-Dose, Fluad, or Flublok.
  • If you are under age 65, you might get better protection from a vaccine that is recombinant (Flublok) rather than made from an inactivated vaccine.
  • Flumist, the nasally administered vaccine, is available only to people age 2-49, and so is not an option for older adults.

What to do if your older parent or relative is unwilling or unable to get vaccinated

Now, what if your older parent won’t, or can’t, get a flu shot?

Some older adults just don’t want to get it. Here are some things you can try:

  • Ask them to clarify what their concerns are. It’s important to start by listening, in order to understand what an older person believes about the flu and the flu shot.
  • Provide information to dispel myths and misunderstandings. Sometimes all people need is a little of the right kind of information.
  • Point out that it can benefit an older person’s family members and neighbors. Getting a flu shot can reduce the risk that we pass the flu on to another person. People are sometimes more willing to take action to protect others than to protect their own health.
  • Make sure they know they won’t have to pay for the flu shot. If you get the shot from a provider who takes Medicare, it shouldn’t cost anything.
  • Offer to go together to get your flu shots. Sometimes it helps to make it a family outing.

There are also some older adults for whom it’s hard to get a flu shot, such as people who are homebound or have very limited transportation options.

If this is your situation, the main thing to do is encourage flu shots (and COVID vaccination!) for family and others coming to the house. For older adults who don’t get out much, their main source of exposure to influenza and other dangerous viruses will be from those who come to them.

Above all, don’t panic if your older loved one can’t or won’t get a flu shot.

Although I’ve just written a long article encouraging flu vaccination for older adults, the truth is this: most years, the chance of getting very sick or dying from influenza are small. Although some seasons, such as the 2017-2018 season, are unusually severe; most years are less severe. (I fully expect that more respiratory illnesses will be related to COVID-19, so prioritize COVID vaccination and boosters!)

Being vaccinated certainly helps make this chance smaller. But not every older person is interested in doing everything possible to reduce the danger of illness. Vaccination is important from a public health perspective, but most people survive flu season whether or not they’ve been vaccinated.

Personally, I think it’s worth getting vaccinated because there’s a small chance that you’ll avoid the misery of having influenza.  And, there’s maybe an even better chance that you’ll help reduce the spread of influenza to people around you.

The downsides of getting a flu shot are small. You’ll have to get to a place where they are offering the flu shot. The needle poke will hurt for a moment. Your arm might be sore for a day or so.

And then that’s it! You’ll have done your small part to protect yourself and others.

So, have you decided where to go to get your flu shot? You can find a place to get one here: VaccineFinder.org.

Questions about influenza vaccination for older people? Comments? Post them below!

This article was reviewed and updated in September 2022.

Note: Over the past few years there have been occasional comments from readers complaining that my information on vaccination is inaccurate. I’ve decided to stop approving and responding to these comments. BetterHealthWhileAging.net exists to share what I consider “mainstream geriatrics,” which concurs with the public health recommendations from the CDC. People who disagree with these expert recommendations are free to hold their own opinions and can find other spaces online to post such opinions. 

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Comments

  1. Q. What do you recommend for Cancer patients undergoing chemo or radiation or surgery or other therapies… please share qualified links (not ads) on this topic. It will be helpful and increase sucessful outcomes that are far reaching. Oxox Thank you! So thorough research based … with clear pros/cons options and probability consequences. This speaks well of not just your professionalism … but compassion. You have found your calling!

    Reply

    • Thank you, I’m glad you find the research references helpful.

      The CDC and other experts recommends influenza vaccination for people with cancer: https://www.cdc.gov/cancer/flu/index.htm. This is because having cancer or another serious illness increases one’s risk of having serious complications, if one catches the flu.

      For anyone currently undergoing chemotherapy or other treatment, the best would be to ask one’s cancer specialists for their recommendation, regarding influenza vaccination.

      Reply

    • A few years ago I had the senior flu vaccine and had a high temperature over 103. I just get the regular vaccine now. I do have some allergies to certain drugs so this much stronger vaccine may just be another one for me.

      Reply

      • Hi Elise, I have a 50YOA daughter who makes the same claim.
        What you have is a correlation is NOT causation issue. Just because you got a high temp doesn’t necessarily mean it was related to a vaccine. If you are a senior you already have immunosenescense so you need a better flu shot. Most flu deaths are seniors. Use your head get your shots. If you get a high temp call your doctor or take ibuprofen.
        Be safe. Death is coming no need to hurry it along.
        Sincerely,
        Bob McCullough

        Reply

        • I’m sorry to hear that you felt unwell after your shot! Unfortunately, a small proportion of people will have side effects from the vaccine like a sore arm, fever or fatigue, but thankfully, these are usually minor.

          Reply

    • I’m 78 with low resistance but I had the reg flu shot in Late sept. I didn’t know about the strong shot. Can I still get the new flu shot or because I had the other one I can’t?

      Reply

  2. Dear Dr. K,

    This is an extraordinarily informative, clearly written article that will be helpful to people of all ages.

    Thank you very much!

    I’m so glad you are out there, sending sensitive, practical, compassionate advice to all of us!

    Reply

    • I have sensitive skin as a nhlympoma patient and have had multiple treatments. I have had regular shot for many years with no side effects.
      I’m reluctant to have the stronger Senior shot and so is my husband especially during this pandemic we always wear masks and rarely go out.

      Reply

      • I’m glad to hear that you’re taking precautions to prevent infection. The high-dose vaccine is safe for older adults and is designed to give a higher level of protection than the regular vaccine by amplifying the immune response. The main thing is to just get a flu shot, and I’m happy to hear that you get one every year!

        Reply

  3. In view of the fact that “older adults tend to create fewer antibodies in response to vaccination”, is there any validity in an older adult getting a “booster” shot in a few months (say January)?

    Reply

    • It’s true that older adults tend to create fewer antibodies, and the immunity that is created by the vaccine will wane over the next several months.

      Despite this, at this time the ACIP does not recommend a booster later in the season. They also don’t recommend that people try to get immunized later in flu season. See here for more info: http://www.immunize.org/askexperts/experts_inf.asp

      Reply

  4. Would the flu vaccines for older adults be thimerosal free? My mother is afraid of mercury since she already has dementia? Also we heard that last year they picked the wrong strain to vaccinate against? Is it still worthwhile to get the vaccine?

    Reply

    • The CDC table listing all available influenza vaccines also lists whether or not there is thimerosal:
      TABLE 1. Influenza vaccines — United States, 2017–18 influenza season

      Generally it depends on whether the vaccine formulation is a single prefilled syringe versus a multidose vial. A preservative such as thimerosal is usually used in multidose vials.

      The CDC considers thimerosal very safe: Thimerosal in Vaccines.

      I am not aware of any correlation between thimerosal and dementia. If your mother is concerned about mercury exposure, she should bear in mind that seafood is usually a much more significant source of exposure to mercury. A 2016 autopsy study found that people who consumed more seafood did have higher levels of mercury in the brain. However, this did not correlate with higher levels of Alzheimer’s pathology; instead, people who consumed more seafood had FEWER plaques and tangles in the brain.
      Association of Seafood Consumption, Brain Mercury Level, and APOE ε4 Status With Brain Neuropathology in Older Adults

      If your mother has dementia and wants to minimize her risk of cognitive decline, the medical things that are most important to avoid are delirium and medications that slow brain function (e.g. anticholinergics and benzodiazepines). Delirium in particular has been associated with acceleration of cognitive decline, in people with dementia. Getting her annual flu shot can reduce her risk of getting very sick from influenza.
      A common problem that speeds Alzheimer’s decline, and how to avoid it

      In terms of the vaccine’s effectiveness last year, apparently the CDC considered it a “good match”, see here:
      http://www.cnn.com/2017/02/16/health/flu-shot-effective-cdc-study/index.html

      But it doesn’t really matter whether last year was a good match or not. The vaccine is a good enough match most years. Getting vaccinated is safe, and does reduce one’s risk somewhat during flu season.

      Reply

  5. I wasn’t aware that you request a type of influenza vaccine – that adds another level of complexity. Can you clarify about how to use the information on the different types of influenza vaccines available. If I go to the CVS for a shot, should an older person ask for a certain type?

    Reply

    • Sorry if all the detail above has caused confusion. There are indeed several types of flu shot being manufactured, but my guess is that most providers of flu shots will only have a few flu shot options available…probably whatever they decided to purchase for this year’s flu shot season.

      If you are interested in a high-dose flu shot for older adults, then you should definitely ask your doctor or the drugstore if they can provide it. Otherwise, you can ask them what other types of flu shots they are offering.

      Reply

      • This week I had my annual physical with my GP and another annual appointment with my gynecologist. Both had ordered flu vaccines in advance of the season, neither received even a tenth of what was ordered, no high-dose were delivered at all.
        This is upper East Side in Manhattan, “Bedpan Alley” because of all the medical facilities and pharmacies.
        None of the Duane Reade stores had high-dose.
        Found FLUAD at a CVS, got my shot, brought my husband back there hours later.
        We are so fortunate to live in a country where “shortage” doesn’t mean “nothing, nowhere, for anyone.” I am thinking about all the places in the world where medicine cannot be found, where people die for lack of what we have in abundance.

        Reply

        • Love how persistent and resourceful you were! Thank you for sharing this comment and also for reminding us how fortunate we are.

          Reply

  6. When you write “the downsides of getting a flu shot are small”, or “getting vaccinated is safe” you are ignoring the fact that the majority of dangerous reactions, (like Guillaine-Barre paralysis, severe immune dysregulation, flu like illnessses) reported by doctors to VAERS =Vaccine Adverse Events Reporting System are from the influenza vaccine. Since the CDC estimates that fewer than 1-10 of these reactions are reported by doctors, the FDA says 1-100, it’s simply not possible to estimate safety.
    The adjuvant is usually aluminum, even more neurotoxic than mercury, which at least in seafood has selenium and Omega 3’s to reduce inflammation and bioavailability in crossing the blood brain barrier.

    Reply

    • It’s true that Guillain-Barre syndrome (GBS) has been associated with influenza vaccination. But this is a rare condition (1-2 cases per 100,00) and furthermore, you can get GBS as a consequence of influenza or other viral infections. (GBS is so serious that I can’t imagine many cases not being reported to VAERS.)

      The CDC and other researchers DO try to estimate safety. When they do randomized trials of influeza vaccine, all participants are monitored for adverse events. And then they also do other analysis, to determine whether the likelihood of benefit outweighs the likelihood of harm.

      Most people are far far more likely to experience harm from influenza than they are to experience harm from the vaccine. For GBS, a 2014 analysis concluded that the attributable risk was 1.03 GBS cases per 1 million vaccinations.

      As for the adjuvant, we don’t have much clinical experience with it in the US and I’m not able to research alumnimum at this time. Honestly I prefer to have people exposed to fewer drugs and other synthetic substances, so I would have a personal preference to avoid adjuvants unless they were shown to have a dramatically better effectiveness than Fluzone High-Dose, which has a more established track record.

      Reply

      • That’s true: the risk of getting Guillain-Barré syndrome after an influenza infection is several times higher than the risk of getting it after a flu vaccination. If you’d like to read more, here’s a paper that was published in 2014, looking at rates of GBS after flu vaccination.

        Reply

  7. Thank you for this useful advice. Since my parents and I receive influenza vaccination every year, we seldom get infected except that my mom still got Flu A and sent to the hospital in 2015, which worsen her cognitive problem with delirum.
    Talking about vaccines, our government (Hong Kong) advised that one dose of PCV13 will be needed for elderly persons with high-risk conditions, followed by one dose of 23-valent pneumococcal polysaccharide vaccine (23vPPV) one year after. What are the differences between these two vaccines? Is it enough if one has received only PCV13? Can one dose of 23vPPV only in order to get sufficient protection? I also heard that if one gets one dosage in a year, then a few years later he has to receive an “additional” or sort of “enhanced” jab so as to maintain the number of antibody. Is it true?
    Many thanks.

    Reply

    • In the U.S., a one-time vaccination with PPSV23 (Pneumovax) has been recommended for older adults for quite some time, to protect against Streptococcus pneumoniae, a bacterium that can pneumonia and also other serious infections outside the lungs. Pneumovax provides protection against 23 serotypes of this bacterium. In 2014, the CDC decided to also start recommending that older adults be vaccinated with PCV13 (Prevnar), which is another type of pneumococcal vaccination. Prevnar protects against 13 serotypes of the bacteria, and offers complementary protection to Pneumovax.

      Some people are vaccinated with PPSV23 earlier in life, due to having certain health problems. The CDC recommends that those individuals be re-vaccinated with PPSV23 after age 65.

      For more information, see here: Pneumococcal Vaccine Timing for Adults
      Pneumococcal Vaccination

      Reply

  8. M.Hill November 3, 2017

    If your primary care doctor tells you that you are on the verge of Hashimoto’s disease because I have autoimmune disease .( Fibmaligialia rheumaticia 2010 thru 2012). Doctor is keeping a watch on this before medication. My question is; Will the elderly flu shot increase my autoimmune disease and cause other diseases such as lupus etc. I read this somewhere from a rheumatic doctor. Is this true?

    Reply

    • The CDC and other experts generally recommend that people with autoimmune diseases get the seasonal flu vaccine. This is because people with autoimmune conditions are at higher risk of having flu complications, and it’s estimated that the overall risk of being harmed by the flu is higher than the small risk of developing an autoimmune exacerbation related to the vaccine.

      People with autoimmune conditions should not get the live attenuated flu vaccine. (But that one is not recommended in the US this year, anyway.)

      I think there are certainly some doctors who believe it’s risky for people with autoimmune issues to get the flu shot. I was not able to find much scientific evidence regarding the risk, however, so I’m not sure we really know what the risk is.

      I would recommend you discuss your questions regarding the likely benefits and risks of flu vaccination with your own doctors. You may want to discuss this question with a rheumatologist, as they may have a better understanding of the guidelines and research evidence on this topic.

      Good luck!

      Reply

  9. Thanks for your research on this. I will check with the rheumatologist that treated me in 2010 for fib rheumatic. He tole me not to take the flu shot then but I was on high doses of predisione at the time. Maybe that was the reason. I just saw your post on flu shots and wanted to know your thoughts. Thanks again. I enjoy your posts.

    Mary Hill

    Reply

    • Glad you are finding this site helpful.

      Forgot to mention earlier: some experts hypothesize that vaccines with adjuvants are more likely to overstimulate a sensitive immune system. You may want to ask your rheum specialists for their opinion on this matter, as it relates to your personal health history.

      Otherwise: the trouble with prednisone is that it suppresses the immune system, so I would expect it to render vaccination much less effective, rather than enabling vaccination to prompt an autoimmune attack on the body. But again, talk to your rheum specialists! Good luck!

      Reply

  10. Thank you so much for this information. We are both 77. I haven’t had any flu since childhood. I don’t get shots every year. Before I found Azelastine I would get sinus infections every year. It’s been at least 10 years since I’ve caught anything. This year we bothe got flu shots & pneumonia shots & now we both have Influnza B which we probably got from 17 yr old grandson. Just for “FYI”

    Reply

    • Oh, too bad that you got sick just the year you got the flu shot. Sounds like bad luck. Hopefully you will make a quick recovery.

      Azelastine is an antihistamine available as a nasal spray and also as eye drops, for people prone to get allergic inflammation of their nasal passages or eyes. Great that it’s been working well for you.

      Reply

  11. It’s startling to think that the flu can hospitalize and even kill people. As an adult, I’ve never gotten a flu shot, but now I think I may. How can I know which vaccine to get this year?

    Reply

    • The CDC’s take is that any flu vaccine on the list for this year is acceptable.

      In the “Bottom line” part of the article, I list some considerations to help people make an informed choice, if they have one.

      Reply

  12. Im 54 years never had a flu and NEVER will i put that rubbish into my HEALTHY body god knows what they are putting in those vaccines no thankyou

    Reply

    • Some people do prefer to avoid the flu vaccine, for various reasons. Sorry but I had to delete much of your comment as it hinted at profanity and also said some disparaging things about older adults.

      Reply

  13. My 75 year old mother was diagnosed with Alzheimer’s over 5 years ago and is in the moderate stage. She lives in a memory care facility and needs help bathing and dressing, sometimes with eating. She can’t find her room and doesn’t know what happened 5 minutes ago. She sees things that aren’t there. It is not safe for her to be alone at all. She has recently fallen twice, and now has multiple fractures of her pelvis. She’s in a nursing home for rehab and we don’t know if she’ll walk independently again. She has a POLST and also a healthcare directive and does not want any interventions, comfort care only. I am her power of attorney. She is no longer herself, and is miserable at times when she recognizes that she is not herself. She has previously received a flu vaccine every year, but I’m considering no longer getting her vaccinated, believing that, should she get the flu, it is more humane for her misery to end sooner rather than later.

    Reply

    • Thanks for sharing your story. Well, it sounds like based on your mother’s declining health and what you perceive as her preferences, your goals for her medical care are that it keep her comfortable, rather than postpone death. That’s often a very reasonable approach.

      I explain addressing goals of care and how one might scale back life-prolonging medical care in this article: How to Plan for Decline in Alzheimer’s Dementia:A 5-Step Approach to Navigating Difficult Decisions & Crises with Less Stress.

      Good luck and take care, it’s wonderful that you’re carefully thinking about what kind of medical care is the best fit for your mother, given her values and her condition.

      Reply

      • Thank you Dr. Kernisian for your reply and the link to the article. It was extremely validating, particulary as my mom was readmitted to the hospital with a raging urinary tract infection. She is doing better and likely going back to rehab, but only until I can find a new living situation for her and begin hospice. She did/does not want the revolving door of hospital admissions. I wish there were more geriatricians willing to be so honest and pragmatic.

        Reply

  14. My 85 yo Mthr has the over 65 vaccine today along with me. Her BP is 181/78-191/82. Is there some ingredient in the vaccine 2018 that might cause this increase???? She takes 2 type of BP
    Meds.

    Reply

    • For unusually high BP associated with vaccination, I would say it’s more likely that the high BP is due to pain or anxiety about the medical encounter, rather than due to the vaccine itself. It is fairly common for people to spike their blood pressure when they are upset, hurt, or anxious.

      You could try checking her BP at home every day for a few days. If it remains higher than expected, then it would be a good idea to contact her usual health providers to ask for advice.

      I have more on managing BP here: 6 Steps to Better High Blood Pressure Treatment for Older Adults. Good luck!

      Reply

  15. Is there an advantage to waiting and getting the flu shot closer to the flu season…maybe in late November or early December?

    Reply

    • See this comment above, which is closely related to your question.

      Although influenza activity usually peaks between December and February, there is often a fair bit of influenza activity in November. It takes about two weeks for the body to respond to the flu vaccine. The CDC and other experts recommend being vaccinated by the end of October.

      Reply

  16. Dr. Kernisian, I just want to say how amazing it is that you respond to all questions! So great.
    Thanks for all of your hard work.

    Reply

    • I do this in hopes that my answering the question publicly will be useful to other readers. Thank you for your comment, I appreciate it!

      Reply

  17. Hello, I work as an RN in a large clinic system that is only offering Flublok Quadrivalent vaccine for individuals 65 years and older this year (in the past they have always offered Fluzone High-Dose). My husband is 72 years old and has several chronic medical conditions and does not leave the house very often. He could go to a pharmacy in order to get the Fluzone High-Dose vaccine. He is hesitating in making a decision because it will require about 2-3 hours more effort and time to go to the pharmacy for the High Dose vaccine than if I just bring the Flublok vaccine home to him. Do you have a suggestion in this circumstance? Thank you for this excellent web site and pod cast— I always learn so much!

    Reply

    • Hm, interesting dilemma. Well, my interpretation of the data is that in general, the high-dose vaccine is more likely to provide protection from influenza or serious influenza complications.

      That said, it’s hard to quantify just how much additional protection your husband, as an individual, is likely to get from Fluzone high dose vs Flublok, and whether that is worth 2-3 hours of his time and effort. The CDC, after all, does not particularly recommend the vaccines developed for older adults; they say that what is most important is to get a flu vaccine. It’s also currently impossible to know whether this year’s vaccine will be a good match for the flu, and what kind of flu season we’ll have.

      Really, I think you could go either way. In general, the absolute benefit of vaccination for an older person who doesn’t leave the house much is small. So if he’s unwell and it’s a burden to leave the house, it sounds reasonable to just go with Flublok. But if you and he want to feel you’ve done more to minimize his risk, then it’s also reasonable to try to get Fluzone high-dose. Good luck!

      Reply

      • “Really, I think you could go either way. In general, the absolute benefit of vaccination for an older person who doesn’t leave the house much is small. ”

        Does this response mean if a older person, age 89 doesn’t leave the house very often, only occasional visits to doctor, would you recommend they NOT have the vaccine at all. Someone is telling me to do that for my mother. It kind of makes sense, but I want to do the right thing.

        If you could respond to this, I’d be grateful!. Thank you.

        Reply

        • So, I can’t make a recommendation for your situation in particular. In general, when considering whether to recommend something or recommend against it, what I consider is:
          – what are the likely benefits of getting this intervention?
          – What are the likely burdens?
          – What are the risks?
          – What are the goals for this person’s medical care? How important is it to try to prolong life, versus minimizing distress?

          For instance, an older person who has advanced dementia, is bedbound, and whose family has opted to stop trying to prolong life, in this case vaccinating against the flu probably doesn’t make much sense.

          Generally we do recommend vaccination, unless it’s quite distressing or burdensome to an older adult, or unless the goals of medical care are really focused on comfort. Hope this helps.

          Reply

  18. Dr. Kernisan, Thank you for taking the time to write this very detailed account of the Flu vaccine.
    I am a 73 yo prostate cancer patient who wants to prevent dying from vaccine preventable diseases.

    Q. Is it true that the again approved nasal spray (vaccine)? using an inactivated virus could cause the
    flu infection on immune compromised patients? Especially non vaccinated patients?

    Q. I hope you can find some info on the aluminum adjuvant used in vaccines because of the antivax
    objections.

    Q. You mentioned the thimerosal required by the FDA in the 5 shot vaccines vials. The needles
    breaking the seal to remove the vaccine can, and have, injected other dangerous germs with bad
    consequences. My understanding is that the mercury used is ethyl mercury which the human
    body quickly and safely eliminates. The more dangerous mercury is methyl mercury which was
    used in dental work. It is called amalgam and here is the FDA’s reference: https://www.fda.gov/medical-devices/dental-devices/dental-amalgam-fillings
    Because of the naïve mercury objections, most Flu vaccine are the more expensive single dose vials.

    Q. The CDC recommends against getting both the HD trivalent vaccine and a quadrivalent flu vaccine.
    I was thinking that even a standard extra B Flu antigen in the quadrivalent vaccine would be better
    then only the one B antigen of the trivalent. Any suggestions as to why they are against double
    shots?

    Q. The CDC use to recommend the flu shots especially for American Indians, Eskimos and other
    indigenous peoples. (Now the recommend flu shots for everyone over 6 months old with few
    exceptions,) I wonder why the HD Flu vaccine is not recommended for other immunocompromised
    patients?

    Q. The herd immunity for the Flu is 95% To achieve this high rate would you agree that these shots
    should not only be free but one days worth of unemployment should be awarded to all who have
    successfully had their shot?

    Q. Can you tell us about the Universal Influenza vaccine? I understand that there is one soon to be
    available.

    Q. Do you know about an upcoming RSV vaccine especially tailored for the elderly?

    Q. Would you recommend the Shingrix vaccine, which has an adjuvant, be given at the same time as
    the flu vaccine?

    Q. It is recommended that seniors get a Tdap vaccine because of the pertussis issue with newborns.
    Do you see a problem with getting the Tdap with the Flu vaccine?

    Q. Do you recommend getting an MMR vaccine booster shot? Could the MMR also be done with the
    flu shot?

    Thank you for your valuable time.

    Q.

    Reply

    • Appreciate your interest in the article, however you have asked a lot of detailed questions and I’m afraid I just don’t have the time and bandwidth to respond to them all. Answering many of your questions would require reviewing the scientific literature, the CDC guidance, and more. Briefly:
      – The nasal vaccine (which contains live virus) is not approved for people aged 50 or older, so I don’t spend much time researching the details.
      – Most influenza vaccines do not contain alumnium. The Fluad vaccine probably does. The CDC comments on the risks of adjuvants here.
      – I don’t generally question the CDC’s guidance or another expert society’s guidance (unless it falls into one of those domains where geriatricians sometimes draw different conclusions that other specialists do). So I can’t comment on why the CDC is against double immunization, or why they are not recommending HD flu vaccine for certain populations.
      – I don’t know much about the Universal Influenza Vaccine initiative, but interested people can learn more on this NIH site: Universal Influenza Vaccine Research
      – I have not been following research on a potential RSV vaccine
      – I have not yet decided what position to publicly declare, if any, regarding Shingrix and the adjuvant. I generally prefer to recommend interventions and vaccines that have a proven track record, which Shingrix won’t have for a few years.
      – Yes, it’s generally considered ok to get influenza vaccine at the same time as Tdap, see here.
      – The CDC says that people born before 1957 do not need the MMR, because almost everyone is presumed to have been exposed to measles, mumps and rubella during childhood.

      Hope this helps!

      Reply

  19. Thanks so much for your comprehensive and understanding information about flu shots (and many other subjects).

    Reply

    • Thank you, I’m so glad you find the site informative. Appreciate this feedback as it helps me keep going.

      Reply

  20. I never have had a flu shot. Last year I had the flu for the first time I can remember(I am 66) It was a rather classic case and was followed by a UTI. My husband(69) also got it and was followed by infected saliva glands. I did a bit of flu research while convalescing and am under the impression that having had the flu last year can afford me as much protection from future flu as an unmatched flu shot. What do you think? I’ve read a lot about my older compromised immune system so was pretty impressed with its performance last year. I dud get the pneumonia vaccine this year after I understood it’s a life time immunity, unlike the flu shot. However I am considering a flu shot, but was informed to wait until the second half of October. I’ve been fortunate to be extremely healthy all my life but am surprised at the different results I get when researching if I google in “geriatric”. It’s a totally different field with different results and it seems to me not that fewer ” geriatrics” are included in drug trials yet they are the largest population of recipients of prescribed meds. I am appalled that there’s not more warnings about the use of OTC meds that are brain disruptive to the elderly. Thank you for your website and the issues you address.

    Reply

    • Thank you for sharing your story and these comments. I’m so glad you find the site helpful.

      Agree that OTC medications that are brain disruptive (namely anticholinergics such as Benadryl, PM painkillers, and OTC sleep aids) should be more clearly labeled as risky for older adults. So glad you are aware of this issue!

      Re including older adults in research, this is indeed an important issue. There have been some influenza vaccination studies done in older adults, although how they define “older” varies.

      I’m not aware of much research on how having the flu the year prior might protect against influenza the following season. The safest approach is to get the annual flu shot.

      Since you are 66 and describe yourself as “extremely healthy,” I would guess that your immune system is still doing pretty well, even though it’s probably not as vigorous as it was 30 years ago. This means you’re likely to have a good response to the flu vaccine. good luck!

      Reply

  21. You mentioned that being young you don’t think you will get seriously ill from the flu…. that’s not true… a TV broadcaster from Cleveland Ohio got the flu and died last year.. she was 37!!! She became septic and died quickly.. Her name was Kathleen Cochran from Fox 8 News…

    Reply

    • Yes, it’s true that even younger healthy people can get sick and die from the flu. This happened several times last year, it was very sad.

      That said, these deaths are statistically an unusual event. Even last year, when the strain of flu going around was particularly bad, the vast majority of younger healthy people infected with influenza did not get hospitalized.

      Hence as I write in the article, I’m not that concerned about getting dangerously ill from influenza. I get myself vaccinated because it does reduce my chances of getting sick and feeling miserable for several days, and also because it helps protect my patients and others. It also reduces my risk of getting dangerously ill, but in absolute terms, it’s a very small reduction in risk for healthy younger people.

      Reply

  22. My Doctor’s nurse gave me (age 79) regular flu vaccine by mistake even tho I asked for high dose Fluzone. Should I proceed with the Fluzone shot? Will the 2 shots cause any harm?

    Reply

    • Hm. The CDC says that any flu shot approved for your age is acceptable, and experts generally recommend against revaccinating during the flu season. I don’t know what harm might be expected from two shots concurrently, I’m not aware of that being studied.

      I would recommend discussing your concerns with your doctor. It’s probably reasonable to just stick with the one flu vaccine you received.

      Reply

  23. It is good that you mentioned that as we grow older, our immune systems are inclined to respond less to immunization. If that is the case, the younger we are, the better we take advantage of the flu shots to avoid influenza virus that can be dangerous to our health and body. To make sure we are safe from that virus, I will advise my husband and children to have a flu shot annually to bolster our immune system.

    Reply

  24. I am 83 years old and have diabetes, atrial fibrillation, polymyalgia rheumatica, osteoarthritis and hypertension, all of which have been fairly well controlled with medication. I am on Xarelto, glipizide, metformin, sotalol, small amount of prednisone, metoprolol, vitamin D3 and vitamin B12. Ten days ago I received the Fluzone high-doze flu vaccination. My arm was quite sore for the next few days and my arm was blotchy red. I also had a runny nose and pretty severe frontal headache with a cough at night and fairly severe increased muscle aches for several days. Today (the 10th day after receiving) I am still just really tired and sometimes get out of breath just doing small chores. I received my vaccine at the CVS local pharmacy. I have not contacted anyone yet, neither my internal medicine doctor or my cardiologist. I have recently had extensive heart tests and lab tests which were all good. Each doctor seems to blame my complaints when I call them on “stress.” I am a fairly recent widow and I think that is probably a common complaint of widows. I am hesitating to call them to be told again that my problem is stress. I don’t feel like what is happening to me Is life-threatening but I am just concerned that I am still so tired–like I am just getting over the flu. Have you had any experience with this in an older person? Thanks for your help.

    Reply

    • Well, some people do feel like they have a reaction to the flu shot. That said, if you are still feeling so tired and also short of breath, I would be careful about attributing this to the flu shot, especially since it’s been 10 days since you had it. There are number of health problems that could cause the symptoms you’re experiencing, and just because your tests were fine recently doesn’t mean something can’t have happened or evolved since then.

      Given your age, your chronic conditions, and your many medications, if you are feeling tired and short of breath it’s entirely reasonable to ask to be evaluated by your usual doctor or even in urgent care. Good luck!

      Reply

      • Thank you very much for responding so quickly. I agree with all of your comments. I did get out of the house today and found that I had a little more energy than I thought. Maybe I needed some fresh air. My blood sugar is good, my blood pressure within normal limits, the redness is much better on my arm–no blotching anywhere else. If my symptoms of tiredness and shortness of breath continue tomorrow, I will seek out a nearby urgent care center to listen to my lungs and possibly check my platelets and/or blood counts. I try to avoid ER because my last trip there in April resulted in a shockingly horrendous bill. I have been on Xarelto for about 6 months this time (after trying Pradaxa, Equilis, Jantoven, etc. with complications); and sometimes I feel that Xarelto may be responsible for some of my shortness of breath but I have no choice but to stay on it. Thanks again

        Reply

        • Today is 18 days past my flu shot, and I still am feeling badly. I became so tired last evening and had somewhat of a nervous meltdown about my condition that my son insisted on taking me to an ER near my house. I have been very worried about my condition. I was not treated very well by the NP in the ER. His first question was why did I not return to the place where I received the vaccine, which I had administered at a CVS pharmacy. I had talked with them on Monday and they had no reports so far about such extreme effects. And a pharmacy cannot treat me. I called the CDC in Atlanta on Tuesday and they would give me no medical results or recommendations, would send me a complaint card. In the ER, a lot of blood work was done and the results were all good as far as CBC, sed rate (which is normally elevated because of PMR), c-reactive protein, etc. He dismissed me to home with recommendation to just drink plenty of liquids. I’m still feeling so tired and occasionally having headaches. I have no appetite and still have loose bowels. I am at my wit’s end. I don’t know what to do. If I could just communicate with someone who has been through this and could hear them say that: “You will be OK, just have patience and don’t be scared.” Can anyone give me advice?

          Reply

          • Sorry you’re still feeling unwell. Many things get better eventually, with time and especially with rest and a restorative environment. But I cannot say what’s likely for you. I hope you start feeling better soon and if not, I hope you find a health provider who can be helpful.

          • It is now 6 weeks past my having received the over-65 flu vaccine as I have stated above. I have had two trips to the ER, one visit to a walk-in clinic, a visit with my ophthalmologist and a visit to my rheumatologist. All tests at 3 different times have been “within normal limits” except for my C-reactive protein, which was 1.39 mg/dL with normal being 0.00 to 0.50 mg/dL. My extensive research tells me that this is apparently not enough to indicate that I have a recurrence of my temporal arteritis. I have definitely had a flare of my polymyalgia rheumatica. I still have headaches and an abnormal intestinal tract. My life has certainly been affected by the vaccine. What really concerns me is the lack of concern shown by most people I have seen. Like, “Just give it some time.” It has been 43 days of misery for me, being scared that I will not be able to continue taking care of myself. I have read extensively about the problems this has caused older people who have an autoimmune disease and especially the writings of a physician at the Cleveland Clinic. I wish that I had read these writings before I received the vaccine. I think the CDC or the FDA or some regulatory agency should give more warnings to the public about this. The agencies that I have called do not seem to be interested in my opinions. They say they will send me a form to complete. Well, truthfully, I don’t have the energy to complete those forms. Thank you for listening to my complaints.

          • Sorry you have been feeling unwell. Perhaps you can share some links to what you are reading regarding the flu vaccine in older adults with autoimmune disease?

            It is too bad if you feel people haven’t shown enough concern. I imagine that even if they are concerned, they don’t see any reason to hospitalize you and they aren’t sure what they can do to further evaluate you or help you feel better. Although we know a lot about the body (compared to 100 years ago), in some cases it still seems mysterious and we are unable to explain what might be going on.

            Hope you start feeling better soon!

          • To put your mind at rest, you will feel better. I’m 70 with autoimmune Hashimoto’s and Fibromyalgia and mild asthma. No other health issues and no medications other than for thyroid and asthma. I didn’t connect it to the flu shot until the fourth time. I decided at 65 it was good to start given seniors are more susceptible. The first year I had a sore arm and fever for a couple of days. The second year, within five days, I experienced extreme lethargy and aches and pains, fever and sweating, among other things, for almost 3 months. The third and fourth years were repeats of the second. I considered a common denominator. The doctors just shook their heads and cut me off mid sentence rhyming off death statistics from flu. Last year 2019 I did not get the shot and did not experience any of the symptoms. Nor did I get the flu. Could it be something in the flu shot? The adjuvant maybe? Now, 2020, another push to vaccinate for flu. It’s a terrible dilemma. I’m afraid to risk it again and now there’s Covid19. Instead, I’m taking all precautions that I can and boosting my immune system. I had the new pneumonia vaccine with no side effects.

          • Sorry to hear about your experiences with the flu vaccine. It’s always hard to know if there’s a link between the vaccine and a person’s symptoms, or if they’re due to something else and it’s just a coincidence. Remember, the vaccine is not 100% effective, especially in older adults.

            I think it’s always a good idea to use infection control precautions, as we’ve learned so much about in the last several months! You may be interested in a video I made about the aging immune system, you can watch it here.

  25. I had an autoimmune disease (polymaligia rheumatica } for 2 years in 2010 – 2012. I was diagnosed with autoimmune antibodies of RA, Lupus, and Syrogyn antibodies. I have not had elderly flu shot or other since and afraid the toxins from it and the shot messing with my immune system will cause flareup of the antibodies. Have you any information on this?

    Reply

    • Someone has already asked about the flu shot and autoimmune disease, please see my response above.

      Basically, the CDC and many other experts recommend that people with autoimmune disease get the seasonal influenza vaccine.

      If you have concerns, I would recommend discussing with a rheumatologist or with your usual health provider.

      Reply

    • Mary, you may be wise not to get the stronger vaccine. If you are interested, read my various writings above what the vaccine has done to me. Each person has to make his own decision, but I wish that someone would have warned me about the possible outcome with getting the stronger vaccine especially about all of the antigens it contains. I have been sick for 43 days, but I am slowly improving. I occasionally will have a relapse of one of my symptoms, seems to be never-ending.

      Reply

      • Anna, although you have had a difficult time with your health since getting the flu vaccine, overall the number of such reactions (if what you are having truly is a reaction to the flu shot) is much smaller than the number older adults who are hospitalized due to influenza every year.

        For most older adults, the likely benefits of the flu vaccine outweigh the likely risks.

        Reply

        • Dr. Kernisan, I realize what you say is true, and I have wanted to be careful that I do not encourage anyone to neglect getting the flu vaccine. My concern is that there should be more warnings for people who suffer from autoimmune diseases to avoid the over-65 vaccine. I had received regular flu vaccines for more than 15 years without any problems at all. I had listed all of my health problems and medications on the form that I completed at the facility where I received the vaccine. If the pharmacist had read it, she should have known not to give me the stronger dose had she been educated about the possible results. I asked her if I would have any side effects from the vaccine she gave me, and her reply was “possibly only a sore arm and a low-grade fever.” Well, I wish that would have been all. It’s now 8 weeks and I am still having problems, but I am much better; so hopefully one day I will recover completely. Thank you for all of your help.

          Reply

          • As far as I know, the CDC and other authorities have not yet issued any warnings that the stronger flu shot should not be given to people with autoimmune diseases. It is not clear to me that this is a known risk yet. So I would not expect a pharmacist or generalist to counsel you regarding this issue.

            Furthermore, even if there was an increased risk of illness in people such as yourself, before issuing a blanket caution, the CDC would want to determine whether the risk was greater than the risk of serious flu-related illness. For instance, the CDC has determined that there may be a small increased risk of Guillan-Barre syndrome with the flu vaccine, however the increased risk is very small (the CDC estimates it at one to two additional GBS cases per million doses of flu vaccine administered), and so for most people, the likely benefit of influenza vaccination vastly outweighs the risk.

            I am very sorry for your prolonged recent illness, but I have to again say that from a science perspective, it’s impossible to know whether it was due to your influenza vaccination or not. I try to allow people to express themselves in the comments but I’m not comfortable with readers drawing medical conclusions from their single experience and advising others on this basis. An individual’s experience can generate a hypothesis but no more; when such hypothesis are subjected to rigorous medical study, many of them do not hold up.

            The take away that I would recommend, from your story, is that people with a history of autoimmune disease should consider consulting their rheumatologist or personal physician, for help assessing the risks and benefits of vaccination with the standard flu vaccine or stronger one.

            I do appreciate your being part of our community and hope you continue your recovery.

  26. Dr. Kernisan: I certainly understand all of your above statements and respect you as a scientist and professional. When I recover more fully, I will retrace my many steps in trying to find answers to giving the stronger flu vaccine to patients with autoimmune diseases and try to give you some citations of research that has been done. At the present time, I get very nervous and agitated when I try to overextend my foggy brain and trying to understand scientific data. There is a website in which lay people like me express their opinions about the vaccine, not necessarily perhaps about the over-65 one. There are several people who have had situations similar to mine. It makes me feel somewhat better to know that I was not the only person affected (misery loves company!!!)

    You might find this interesting. Have a great New Year!!

    https://www.medicinenet.com/flu_vaccination/patient-comments-859.htm

    Reply

  27. “But not every older person is interested in doing everything possible to reduce the danger of illness. Vaccination is important from a public health perspective, but most people survive flu season whether or not they’ve been vaccinated.”

    Wow, Guilt trip? I’m 70 years old and happen to be one of “those” who in not “interested” in getting a flu shot. In fact, I have never received a flu shot and neither has my husband, nor my parents or grandparents. None of my children or grandchildren have either. Every “season” when others around us, have received a shot and get sick, we all skate through with nary a cold or problem. I have refused vaccines for the past 55+ years and see no reason to not continue to do so. In my mind, it’s all poison, and I’m not “interested.”

    Reply

    • Sorry for delayed reply, we had a glitch in our system that we have just resolved.

      Well, you have a right to opt to not get a flu shot. I do believe vaccination reduces symptomatic flu in the population during years when there’s a good match, so I’d say you are gaining some small reduction in flu risk if enough people around you do get vaccinated.

      I hope you continue to skate through as you have done.

      Reply

  28. One of the most informative articles regarding flu vaccines. Thank you! Two comments: I have heard that the reason the CDC doesn’t recommend a given flu shot for seniors is that it may not be available in their area — and they fear some will opt not to get a shot as a result. Second, why is there no high-dose quadrivalent shot available? It would seem that would provide the ultimate protection to those over 65?

    Reply

    • Thank you, I’m glad you found it helpful. I will actually be updating it next week, for the 2019-2020 flu season.

      I don’t know why there is no high-dose quadrivalent shot available…presumably there is a reason the manufacturer Sanofi doesn’t make a Fluzone high dose quadrivalent.

      Reply

    • Thank you, I’m glad you found it helpful. An updated version will be available in about 10 days, but I don’t expect there will be any major changes to the information.

      Reply

  30. Thanks for all the info on the flu,I had flu shot in late Dec 2018,do i need another one now.No one has given me any answers,tnks.

    Reply

    • Yes, you should get another flu shot now. The flu vaccines are recreated every year (this begins in early spring), with antigens based on what flu experts expect will be the main circulating strains for the coming flu season.

      Reply

  31. My husband and I, 71 & 70 years old, get the flu shot every Fall. This year, no one had the vaccine recommended for seniors in stock and no information about when it would become available again, so we took the regular vaccine, We decided that some protection was better than none. If the senior vaccine becomes available later, should we take it or get a 2nd of the regular strength vaccine?

    Reply

    • Per this expert Q&A, the Advisory Committee on Immunization Practices does not recommend revaccination later in the season.

      So if you’ve already been vaccinated, I would leave it at that. Remember, the likelihood that flu vaccination will prevent hospitalization or death for any single individual is actually fairly small. Also, although I think it makes sense for older adults to get the high-dose vaccination when possible, the CDC’s official take is that any approved influenza vaccination is acceptable. Good luck and take care!

      Reply

  32. Dr. Kernisan,
    Your advice re influenza vaccination is a “tour de force.”
    Your efforts remind me of the person in a recent ProPublica article who has been a selfless backstop against computer ransomware.
    Thank You!

    Reply

  33. Is there any reason for administering injections into the arm? I have had to have B12 injections every month for 30 years, and I found as I aged that injections into the hip are much less painful. Last year every one I knew who got a flu shot, did get a sore arm or shoulder.
    Thank you for your sensitive and caring way of imparting information and dealing with the wide range of responses to your articles. Your work is deeply appreciated!

    Reply

    • Hm, interesting question!
      The vaccine is supposed to be injected intramuscularly. The ACIP’s guidance recommends the deltoid for adults (including older adults) but notes that the anterolateral thigh can also be used: https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/administration.html

      Since many people feel some soreness after influenza vaccination, I think I’d prefer being injected in the arm than the leg. But you could certainly ask your health provider if an injection in the thigh is an option.

      Reply

  34. I am 89, independent and always get a flu shot but am afraid to this year. Last year I immediately had a pain in lower back and down my legs and couldn’t navigate. They say me down called EMS My blood pressure shot up to 180s. After 1/2 hour to 45 minutes, I gradually regained legs etc and eventually went home. I didn’t know anything about Willis Barre until researching. Also a few weeks later I developed many different types of sore and rashes. Don’t know if it was related. I didn’t know I should report it so didn’t. Asking my Dr this year let’s just say he wouldn’t believe me! I didn’t go to him but to a dermatologist when I developed skin problems. They were unsuccessful treating me and sent me to Oncologist who took me off aspirin 81 and a blood pressure medication and through prednisone for quite awhile. I went back periodically for observation and released couple weeks ago.
    I feel I’m between a rock and hard place! I believe in flu shot. Scared to take strong elderly shot. Think I had Fluad but may have forgotten. Do you think I dare get the regular shot for younger adults? No use asking my Dr. The pharmacist who witnessed the event said to see my Dr. I understand not wanting them to give advice. Your thoughts? Barbara

    Reply

    • Hi Barabra, I’m sorry to hear about the challenges you have had! It can be difficult to sort out a cause and effect sometimes, so I understand you feeling concerned about getting the flu shot this year.
      I am going to assume that you mean “Guillain-Barré” syndrome when you mention Willis-Barre. This is a neurological condition that affects the nerves that extend into the limbs and other parts of the body from the brain and spinal cord. The symptoms include numbness, tingling and weakness in the limbs. Most people with GBS make a complete recovery but it is a serious condition. The cause or triggering event in GBS is not known, but it may be related to an immune system process.
      In the US, the Food and Drug Administration, and the Centers for Medicare & Medicaid Services, reviewed how many Medicare recipients who got the flu vaccine also developed GBS (1), and found that there was no increased risk of GBS for the standard vaccine and a very slight increased risk for the high dose vaccine (an additional 1 case per million people). Unfortunately this study did not look at the Fluad vaccine, however, in the Italian study that Dr. K refers to, there was no increased risk of getting GBS in those who had the Fluad.
      Bottom line: all flu vaccines appear to be extremely safe and for most, the risk of the vaccine is far outweighed by the potential benefit to the individual and to society. However, caution should be used in those who have had GBS within 6 weeks of a flu vaccine, and in Canada, where I practice, the recommendation is to avoid the flu vaccine in that case. Anyone who has had a serious reaction to the flu shot (more than a sore arm or mild flu-like symptoms) should talk to their health care provider to balance the risk and benefit in their particular case,

      1. Vaccine Volume 37, Issue 43, 8 October 2019, Pages 6543-6549 Surveillance for Guillain-Barré syndrome after 2015–2016 and 2016–2017 influenza vaccination of Medicare beneficiaries
      Deepa P.Aryaa1Maria A.Saida2Hector S.IzurietaaSilviaPerez-Vilara, et.al.

      Reply

  35. I’m not going to become an obnoxious presence but having just reviewed this long piece on flu shots I want to add, to a question I submitted a few minutes ago, this: As a former and longtime magazine editor and writer, I appreciate clarity, structure, thoughtful, detailed content and all the other good stuff that goes into excellent writing. This flu-shot post is a model of not just extremely helpful medical advice but solid journalism. And it’s typical of what I’m finding as I browse through other recent posts. Don’t know how you find the time to produce so much first-rate material in addition to treating patients, but sure glad you do. So commendable! Thank you.

    Reply

      • Dear Dr. Kiernisan,
        I am 84 and have avoided flu shots for a decade, because of the likelihood that I may have a sore arm. I get B12 injections monthly in my buttock specifically to avoid the arm pain. Is it possible to get the flu shot there, also?
        Thank you,
        Irene

        Reply

  36. My husband and I are in our late 50s, we had the flu shot (regular from the Giant store/pharmacy) last October. We planned a trip to Southeast Asia this early March. After all what is going on with this ” flu virus” do you think we should get a second dose of flu shot before going on our trip. I will feel better if we got it but I want your opinion on this. Thanks for your time.

    Reply

    • You are probably wondering about the current pandemic of novel coronavirus that originated in Wuhan, China. There is no vaccine against this virus currently, and an additional flu shot will not add any type of protection. I would consult the travel advisories on the US department of state website, here, or here if you are in Canada, like me.

      Reply

  37. I had the PPSV23 shot when I was 57 years old and will be 65 years old in November. I read on the CDC website that I should get it again since it’s been over 5 years. Do I need to do this?

    Also, I’ve been told that I should also get the older pneumonia shot (PCV13). Is this true? If so, when do I get this vaccine.? It’s very confusing.

    Reply

    • PPSV is pneumococcal polysaccharide vaccine and PCV is pneumococcal conjugate vaccine. The numbers in the names of the vaccines refers to the number of pneumococcal polysaccharides in the vaccine. The PCV -13 is not usually given to older adults, as most pneumococcal infections are not caused by the serotypes covered by this vaccine.

      A revaccination with PPSV23 is recommended as immunity can wane over time. This should be done every 5 to 10 years depending on underlying health conditions. You don’t need a revaccination with the PCV 13, so if a person has had it once, they don’t need it again.

      The PCV-13 might be recommended for someone 65 or over who has had prior pneumococcal disease, or who has a higher risk condition, like immunocompromise, np spleen, cerebrospinal fluid leak, cochlear implant, chronic cardiac, lung, and/or liver disease, diabetes mellitus, smoking, and/or alcohol use disorder. In those cases, the PCV 13 might be offered (only if the person has never had it before), and then the PPSV23 could be given 8 or more weeks later.

      Reply

  38. I live in South Africa. We had a very heavy lockdown here dating back to March. We entered Southern Hemisphere winter still in lockdown and even as it loosened we were/are still required to wear masks and at every shop hands are sterilized etc So end result is we skipped flu season altogether. In fact, the Southern Hemisphere has experienced no flu season and this has been documented. We are now in spring. Thought that might be of interest.

    Reply

    • Hello Joyce and thanks for sharing this information. It is amazing what we’re seeing as we’ve had these unprecedented public health interventions, isn’t it? It appears that some strains of the flu may be eliminated as a result of the enhanced handwashing and masking, etc. and the ban on travel. It’s nice to hear some good news. Stay well.

      Reply

  39. It would be nice to have the bottom line answer to the tout of the article. The information in detail is nice but just looking for “which one for old people” first off would save a lot of time and effort. Reading in more detail beyond that is easier to appreciate at leisure. And I do thank you for your detailed, informative articles. It is a terrific resource.

    A note: the links you give are sometimes not helpful. Occasionally are not there or are not available to general readers. For example, I looked for locations to find vaccinations. For flu shots over 65 category it listed many sites, many doctors’ offices, even Costco, but all said, “sorry, vaccines not available…”

    CVS and Walgreen’s are both pushing their flu shots, I realize you are not responsible for this, but I don’t know if you realize they are not necessarily as helpful as I anticipate.

    Reply

    • Hello Judy and thanks for reading, and for taking the time to give some feedback.

      I agree with Dr. Kernisan’s bottom line: “This year, I agree with the CDC that it’s especially important for people to get their seasonal flu shot, as soon as you can, and if you are an older adult, I recommend getting one of the higher-dose vaccines.”. The best vaccine is the one that you get, and if your doctor or pharmacy doesn’t have a high dose vaccine, a regular vaccine is a good option and is better than avoiding vaccination altogether.

      I understand that some websites are not up to date, or may accurately reflect that the high dose vaccine is not widely available, and that’s frustrating. I hope those who don’t know where to get a vaccine can still use that link to find a place to get a shot, even it’s just the regular flu immunization.

      Thanks again for reading and I hope you have a healthful flu season!

      Reply

    • Thanks for the feedback, and that’s certainly something we can look into changing. I would add that you’d be surprised the number of questions that recur year after year, so looking at old comments and answers is far from worthless.

      Reply

  41. Last year and this year , I received the high dose flu shot. Last year, my arm hurt quite badly after the injection, but not this year. Both last year and this year, I went about my normal life, and became extremely tired. I remember thinking, why do I feel so tired and blah! Last year it was at least a week before I felt back to normal. This year, I felt really tired, but then I started feeling better, so I put on my PPE and went out. Within an hour, I felt so tired, I had to come back home and lie down. I became frightened, and started wondering if I had covid symptoms. Then, I realized, oh yeah. Last year, I ran the gamut of very mild flu symptoms, so that’s what’s going on still.

    I had the flu in 1987, and I’ve gotten the shot every year since. I never had any side effects until getting the high-dose, but that’s not going to stop me from getting the shot. The flu was bad enough at age 37. And yes, I know those side effects are real from the flu shot are real.

    Barbara

    Reply

    • I know I made some mistakes above in my typing/composing. If I could just remember how long it takes until the side effects subside, I would be so happy!

      Reply

    • Thanks for sharing your experience and I’m so happy to hear that you got your shot! I’m not sure how the flu shot would cause fatigue like you describe, but soreness at the injection site is definitely common and can be very uncomfortable. I appreciate that you’re making an effort to get out and be active, and that would help to get back to a normal energy level as soon as possible.

      Reply

      • I actually found this page from google trying to find out why my symptoms are worse this year than ever before (I get the flu shot every year). Barbara Pelletier commented about how tired she is – YES!!! I AM SOOOO TIRED after getting the shot this year, and I only got the regular dose! I also feel stronger side effects this year than in previous years, including the injection site redness was very large at 3.5″ x 1.5″. Very glad I got my shot Friday night so I had all weekend to rest, although being at work today I still am so tired and feel like crud. I just wanted you to know you aren’t alone with your symptoms this year Barbara, and I sure wish I knew how long it will be until I feel better!

        Reply

  42. My mother is 97 years old. She has been under home hospice care for two years having a diagnosis of Congestive Heart Failure. She now relies on a Nebulizer and round-the-clock oxygen to keep her comfortable. A recent episode of paranoid delusion lasted about 3 weeks but is no longer active thanks to a psychotropic drug. She has some cognitive decline but is not demented. Hospice will NOT provide a flu shot.
    She’s been housebound for 10 months and has CNA caregivers 24/7. Does she need the flu shot? If she does, how would we get it for her?
    Thank you for your thoughts.

    Reply

    • Hi Linda and I’m sorry to hear that your mom is living with Congestive Heart Failure. I can understand the hospice not giving a flu shot, as the goal is usually comfort above all else. A flu shot might prevent the flu, but could cause some discomfort for your mom. If she got the flu, she might pass away from its effects, but being in hospice care, the hospice team could control all of her symptoms so that it would cause a minimum of suffering.

      On the other hand, a person who is living with CHF and frail is more likely to get the flu and become ill with it, so many would advocate for someone like your mother to get immunized.

      It wouldn’t be reasonable to expect her to go out to a flu clinic, so in such a situation I would recommend calling the primary care provider or the local public health unit to see how a shot could be dispensed from a pharmacy and administered by a community nurse. This may not be covered by insurance.

      Reply

  43. Given that the last flu season ended early due to social distancing, if we are strictly quarantined to prevent the more infectious coronavirus, why is it “extra important” to get a flu vaccine? A person strictly quarantined for coronavirus won’t ever be exposed to the flu.

    Reply

    • I’ve heard similar comments from my patients and I’m happy for the chance to address this idea.

      Despite best efforts at quarantine and isolation, there are still unavoidable risks that can expose a person to a virus like the flu or COVID. The CDC frequently asked questions section on flu season 2020-2021 provides a helpful summary, which you can read here.

      Both the flu and COVID are in the community and both can lead to serious illness and hospitalization, and even death. The best way to stay well is to combine good infection control practices and immunization.

      Reply

  44. Only Flublok, a recombinant vaccine, and Flucelvax, which uses a cell-based manufacturing process, do NOT use eggs to produce the viruses used for flu vaccines. Egg-based vaccines encounter “drift” during the incubation process which can greatly impair the effectiveness of the vaccine.

    E.g.:

    “The two other ways of growing viruses for flu vaccines don’t have this problem because they don’t use eggs to replicate. In recombinant vaccine technology—the most recently developed of the three methods—scientists take antigens from the WHO-supplied viruses, transcribe them into DNA, then use a plasmid to insert the sequences into the cells of Spodoptera frugiperda, commonly called the fall armyworm, says Litjen Tan, chief strategy officer at the Immunization Action Coalition (IAC). The armyworm cells produce large amounts of the flu antigens, which are exact copies of the ones in the viruses from the WHO. Scientists separate and collect the antigen proteins, purify them, and put them in flu vaccines in place of inactivated viruses. The pharmaceutical company Sanofi Pasteur makes this type of vaccine under the name Flublok.”

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7047267/#:~:text=Growing%20influenza%20viruses%20in%20eggs,to%20make%20the%20flu%20vaccine.

    Flublok produces 45, or three times the HA protection of 15 offered by all other vaccines, according to the CDC 2020 vaccine guide. Fluzone high-dose vaccine produces 60 HA, but its egg-based manufacture increases the risk it won’t match the targeted viral strains.

    https://www.cdc.gov/mmwr/volumes/69/rr/rr6908a1.htm?s_cid=rr6908a1_w

    CDC discussions of Flublok and recombinant vaccines note that it is not subject to incubation drift.

    So, as a senior, I’ve selected Flublok Quadrivalent as my primary flu vaccine the last two years. I get a second booster shot in December or January, hopefully Flucelvax, which is the only other vaccine manufactured not using eggs (however, it produces only 15 HA).

    https://pubmed.ncbi.nlm.nih.gov/27020713/

    Reply

    • Thanks for sharing the research that you’ve done into the recombinant vaccine! Here’s what the CDC has to say about Flublok. Theoretically, a recombinant vaccine can better match the strain of seasonal flu. In practice, it appears to be superior to a standard dose of inactivated flu vaccine, but hasn’t been compared to the high dose vaccine, which is what we currently recommend for older adults.

      Reply

  46. My 86 yo mother thinks she received a flu shot in August 2020. Her pharmacy has no records & her primary care has no records. What would happen if she is correct & gets another flu shot for her age group? She does not drive & my Uncle doesn’t believe she received the injection.

    Reply

    • I’m not sure if a provider would have had flu shots to give out as early as August 2020, and the CDC recommends that July or August is too early for a flu vaccine. If someone accidentally got an additional flu shot, the risk would be almost negligible, and definitely less risky than not getting vaccinated at all.

      Reply

    • According to what I’ve read, the Flumist is a quadrivalent, live attenuated influenza vaccine. It can be given intranasally. The most recent large scale (or meta-) analysis that I came across, reported that there are no randomized controlled trials (those are well-designed scientific trials) of this type of vaccine in individuals over the age of 8. The best evidence seems to indicate that it’s most effective for small children (aged 7 or under). So, I suspect that the Flumist isn’t recommended because of lack of evidence.

      Reply

  48. I would like to know what is in the flue shot. After reading what was in the last one .I am a little scared to get one this year I am 74 years old

    Reply

  49. 67 year old senior. We were given our senior quad flu shots at the beginning of Sept (first week available).This is earlier than past years. We’re in average good health. What is this years expected duration of protection? Should or could we consider another (booster)shot ,even if we pay for it ourselves. Thinking about March to April when hopefully Covid Quarantine Is easing. Our exposure could significantly increase at that point as the world possibly lifts restrictions. Any possible benefit?

    Reply

    • I’m so glad to hear that you got your flu shot! Remember that it takes a couple of weeks for the flu shot to be effective, and it’s recommended that individuals get the shot before the end of October, before flu season really begins. I couldn’t find any recommendations for booster shots, although if the shot is given too early, it could “wear off” before the end of the season, and the duration of a given flu season is difficult to predict. Still, I can’t say that getting a booster is necessary based on current information.

      Also, even if restrictions about infection control practices ease, individuals can continue to maintain social distancing, masking, hand hygiene and other measures to stay well, whether it’s mandated by government or not. Hope you stay safe and healthy this season!

      Reply

  50. Last year I asked the RN provider if they had the “high dose flu shot that’s for elderly people” for my 86-year-old mother, and she said “yes, that’s what this is”. But later Mom’s chart revealed she had received Flublok. We were disappointed, and researched it again this year. This time, both my mother and I spoke directly to the MD, saying “will this be the high-dose flu shot that’s for seniors”, and he said “yes, that’s what we have for you today”. But according to her chart, she again got the Flublok. I sent an inquiry to the MD’s nurse, asking her to ask the MD which shot she actually got. The nurse called my mother and assured her she got “the high dose” flu shot. I sent a message back, asking if she meant Mom got the Fluzone High-Dose that is approved for 65 and over”. She said Mom got the Flublok, and she claimed that WAS the high-dose shot just for 65 and over. Same thing happened for my elderly mother-in-law. They said it would be the High-Dose, but she got Flublok. Clearly, the providers giving the shots don’t know that the High-Dose version exists. They must think that “quadrivalent” means “high dose”. So for the second year, my mother didn’t get the requested shot and is less protected than she could be. Next year, we will be sure to say the words FLUZONE HIGH-DOSE QUADRIVALENT, and ask to see the vial. Have you found this to be a universal problem? That providers don’t know what you are talking about when you say “High-dose Flu shot especially for Seniors”?

    Reply

    • I can’t say that I’ve had a lot of experience with providers misunderstanding the types of flu shots, but there are a lot of shots out there. It sounds like your experience has been frustrating! I’m so glad that you have so much knowledge about the flu shot and can advocate in such an informative way.

      Reply

  51. If I was exposed to Covid-19 (went to a country club for a short time for lunch; servers all wore masks, then we received an email that multiple employees had tested positive a couple days later; one had gone home & started feeling bad the night after his shift on the day I was there), would it be wise to wait 14 days to go get a flu shot and my pneumovax 23 shot? It’s been 5 days, and of course I’m watching for any symptoms.
    Also, I do have Sjögren’s and Raynauds, but don’t currently have a doctor. Last year I received my very first flu vaccine, a quadrivalent,- opted not to have high dose-from Costco with no side effects. I’d like to get the high dose this year (but no adjuvant), and I’m a bit nervous because of my autoimmune issue. I guess there’s no real answer?

    Reply

    • As far as I know, a possible exposure to COVID is not a reason to avoid the flu shot. If a person was having fevers or other signs of illness, I would advise that they not get a flu shot until feeling better. I’m glad to hear you’re getting your flu immunization and I hope you stay well.

      Reply

  52. Hi,
    Thank you for your excellent article and excellent replies to comments! I had the flu shot 6 weeks ago in my right arm and I STILL have pain in the injection site. It’s not as intense as it was the first few days but it’s definitely still there (feels like I got punched in the arm). I have read about people having long-term problems if the injection is given to high up on the arm (Shoulder injury related to vaccine administration (SIRVA)). Mine was about 3 inches from the very top of my arm. Do you think that could be the cause of the ongoing pain?

    Last year I had my flu shot in the same arm with zero issues. But in two prior years, I had the flu shot in my other (left) arm and both times, within hours, I developed a swollen gland under my left armpit that lasted for 6 months! This time there is no swollen gland, just pain at the injection site that feels like I got punched. What do you think is the cause of my sensitivity to the shots? I’m wondering if it’s something specific to FLU vaccines or if I’d likely have the same sort of reactions to ANY vaccines (i.e., pneumonia or shingles). Any thoughts?

    And one other question – I’m 61 so I got the “regular” flu shot. I have type-2 diabetes so I know I might tend to be more high-risk for various illnesses. It’s after the fact now but would it have been better to get the “senior” vaccine? I know they say 65+ but I’m assuming that’s kind of an arbitrary age? And then, of course, to my earlier question – would having the stronger Senior vaccine be even more likely to cause the types of side effects that I seem to be prone to with flu shots?

    Thank you VERY much!
    All the best to you. : )

    Reply

    • Great questions, Alisha! I’m so happy that you got your shot but I’m sorry about your arm pain.

      Shoulder bursitis can be triggered by a flu shot, at a rate of about 250 per 2.9 million (based on the 2016-17 data). The best way to prevent that complication is by the provider making sure to use the right length of needle and injecting the correct spot. Even with perfect technique, this can unfortunately occur. The “strength” of the vaccine does not seem to be related to the risk of bursitis, but the high dose vaccine carries a slightly higher risk of a mild to moderate local reaction (i.e. pain at the injection site).

      It’s hard to say if any vaccine would produce a sensitive reaction, and I would hate to see you avoid immunization for fear of getting a reaction.

      If someone has already received a flu shot, it’s not necessary to get the high dose one, even if it would have been more appropriate in the first place.

      Thanks for reading the article and for your wonderful questions!

      Reply

  53. I am over 75 and had a flu shot last week. After approximately 3-4 hours I had a sensation that someone had thrown acid in my eyes as they were both burning and very sore. When I looked in the mirror both eyes were Scarlett red both the eyeballs and membrane around the eye, I looked like I had a very bad case of German Measles. I put cold compresses over my eyes and it all cleared up in a few hours. Was this a reaction to Flu shot?

    Reply

    • That’s an unusual story and I’m glad your eyes are better. Conjunctivitis, or redness of the eye, is a rare side effect of a vaccination. Usually, the redness is reported as lasting no more than a few hours, though. It’s always possible that there was some other irritant that affected the eyes and the flu shot was just a coincidence.

      If a person thinks they have had an allergic reaction to a flu shot, I would recommend letting the primary care provider know about it so that appropriate caution can be used for future immunizations.

      Reply

  54. If I get a seasonal flu shot now, will I be ineligible to get a Covid-19 vaccine should one become available to the public in the coming months? If so how long would one have to wait after getting a normal seasonal flu shot before they could get a Covid-19 vaccine? Is it too early to know the answer to that question?

    Reply

    • Getting the flu shot will not make a person ineligible for a COVID vaccine and we are strongly encouraging everyone to get the shot this year. I’m not aware of how long one would need to wait between a flu shot and COVID shot, but I suspect that if a person gets the shot now, a COVID vaccine won’t be available for at least several more weeks, so there should be no problem.

      Reply

  55. Articles in AgingCell (https://onlinelibrary.wiley.com/doi/full/10.1111/acel.12750) , Frontiers in Immunology (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6191490/) and elsewhere suggest that immune system strength can vary quite a big in “older” people, with the key variable being fitness. There haven’t been many studies, probably because they’re not in the interests of Big Pharma. I would be skeptical of blanket statements about any aspect of health based on age (e.g., “Older adults are especially likely to get dangerously ill from catching the flu”), especially as the variation increases with age. Few studies (especially for Covid-19) separate out effects of comorbidities; most “elderly” with severe Covid cases also had at least one underlying condition. I’ve had several doctors acknowledge that they don’t know what to do with healthy, physically fit older adults. That might be worth a blog post, as other highly-fit older women in my gym have had similar experiences.

    Reply

    • Thanks for the idea for a blog post!

      There is definitely more emerging evidence that fitness is a big factor in health as we age. And I agree that it’s best to view older adults as a heterogenous group, rather than generalizing.

      Reply

  56. I am from India and 65 years old visiting my daughter in US. I shall be here in USA for about next six months. Kindly advise if I should get a flu vaccine here in USA.

    Reply

    • I would advise anyone who’s going to be living in North American in the next 6 months (through the Western hemisphere flu season) to get the flu vaccine that’s available to them in their region (in the US).

      Reply

  57. 1) If the CDC told me I was alive I would get a second opinion. The CDC (and FDA) is a fraternity of failures. If they were competent they would be in practice not pushing papers. Their dismissing of effective and inexpensive Ivermectin while promoting new drugs is a crime against humanity and they should be prosecuted for it.

    2) I got my first case of flu when I was 33, in great shape, running 30 miles a week et cetera, and was extremely ill. More so, after the main symptoms lessened I was too weak for several weeks to walk more than a few feet or do anything else. Lost a job over it. Being young didn’t offer any protection. I am now 71 and that was by far the sickest I ever have been. So I do get the seasonal shot and be damned the CDC and FDA.

    3) My step father got a flu shot every year and he was always very sick from it for three days… fever, chills, vomiting, weakness, a robust man confined to the bed. He couldn’t go to work so it had to be timed just right every year. He view it as three days of controlled misery vs three weeks of extreme misery.

    Reply

    • Thanks for sharing your opinion.

      Sorry to hear about your horrible flu experience and I hope you never have to go through that again. The flu can cause serious illness and definitely costs a lot in terms of lost work. In 2007, direct medical costs related to the flu averaged $10.4 billion US, and projected lost earnings due to illness and loss of life was $16.3 billion US annually. I’m glad to hear that you’re getting your annual flu shot.

      Fortunately, the reaction you describe in your step father is not common. Up to 10% of those who get the high dose flu vaccine can have gastrointestinal side effects which are severe. Most experience a sore arm, fatigue or slight fever.

      Reply

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