replace for older adults

Certain flu shots can better protect older adults

Flu is ripping through our community. Now is the time to get vaccinated! If you are an older adult, you should know that some flu vaccines offer you better protection than others.

Influenza is a common infection with up to 20 percent of Americans infected in a bad flu season. It is the second most common cause of death from a vaccine-preventable illness with COVID-19 being No. 1. Flu vaccines are not great at preventing infections, but their value is in preventing severe complications. A lot of research effort has been put into upgrading flu vaccines, but there is still need for improvement.

Six types of flu vaccines are available and all cover four flu strains. So, even if recently infected with flu, it is a good idea to get vaccinated to protect against the other strains.

Children account for most infections. However, adults 65 years and older make up 90 percent of infection-related hospitalizations and deaths. Because of this, specific vaccines are formulated for older adults.

For the best protection, adults 65 years and older should preferentially receive Fluzone High Dose (HD) or Fluad. Fluzone HD is four times stronger than the standard flu shot and is 24 percent more effective in preventing infection. This vaccine has been approved since 2009 and is given to most older adults.

Fluad, which has been available since 2015, is the same strength as the standard flu shot. What sets it apart is that it also contains an immune-enhancing substance called an adjuvant. Adjuvants have been used safely in vaccines for more than 70 years. They make the immune response to a vaccine more robust and last longer. Fluad is better than the traditional vaccine in preventing flu, pneumonia (a complication of flu) and flu-related hospitalizations. It is unknown if Fluzone HD or Fluad is more effective, but studies are underway.

Both Fluzone HD and Fluad are made using eggs. However, the amount of egg protein is so tiny that even people with egg allergies can take these vaccines safely. For those who would rather stay away from eggs, there is Flublok with a dose three times that of the standard flu vaccine. It is 30 percent better at preventing infection in adults ages 50 to 64 than the traditional flu shot.

In summary, adults 65 and older should receive either Fluzone HD or Fluad. If they are not available, Flublok is the next best thing, and it is a good choice for adults 50 to 64 years of age. Still, if none of these three are available, a standard injected flu vaccine is much better than remaining unvaccinated. It is well worth your time to get vaccinated now.

Megan Berman
Richard Rupp
Vaccine Smarts is written by Sealy Institute for Vaccine Sciences faculty members Drs. Megan Berman, an associate professor of internal medicine, and Richard Rupp, a professor of pediatrics at the University of Texas Medical Branch. For questions about vaccines, email