High-Dose Flu Vaccine in 2020

Betty Chaffee/ October 7, 2020/ Medication Management/ 9 comments

If you or someone you love is 65 or older, you may be wondering about the high-dose flu vaccine. Who should get it? Is it really more effective than the regular flu shot? What do you do if it's not available? Let's take a look at who the high-dose vaccine is intended for, whether it really provides better protection, and how that information can help you decide what's right for you.

Let's start at the beginning

Flu vaccines work by introducing inactivated particles of the flu virus into our bodies. Our bodies are great at recognizing these particles (antigens) as the enemy, even though they aren't the real virus. So we get an immune response, and we make antibodies against this enemy. Then, when the real flu virus invades a couple of weeks or a few months later, those antibodies are set and ready to fight off the invader. The immune response produced by the vaccination fights off the infection, and we're protected from the flu.

As we get older, though, our bodies aren't quite as effective at producing an immune response after a vaccine. Then, when the real flu virus is encountered, the body isn't as good at fighting it off. So researchers have been looking for ways to improve the immune response to the flu vaccine among older adults.

High-dose flu vaccine

The high-dose flu vaccine (FluZone High Dose) contains four times the amount of antigen in standard-dose flu vaccine. By introducing more antigen into the body, it can make the body respond better. And it's pretty clear that the high-dose flu vaccine is more effective than standard-dose among those who are 65 and older. Research has shown that the high-dose vaccine produces a better immune response in older adults. And a study in nursing home residents found that it decreased hospitalizations by 24% compared to standard-dose flu vaccine. There's little doubt that the high-dose flu vaccine offers an advantage over standard dose vaccine among older adults.

So what's the problem?

Fluzone High-Dose is in short supply this year. You're likely to find that your pharmacy or doctor's office doesn't have it in stock. Orders that were placed weeks go haven't been delivered yet, and it's not clear when they will be. So what do you do if you're told that the high-dose vaccine isn't available when you're ready for it?


It's really important to know that even the standard-dose flu vaccine will provide needed protection against the flu in older adults. You probably already know that the efficacy of the flu vaccine varies from year to year. That's because scientists have to guess at which versions of the virus will circulate during the flu season. After that decision's made, though, all flu vaccines contain the same versions of the virus. So high-dose or not, often the vaccine matches the common flu viruses, but sometimes it doesn't. When the vaccine matches the circulating viruses, the flu vaccine can decrease flu-related hospitalizations by around 50%. That's huge, and literally can be a life-saver. 

The adjuvanted flu vaccine (FluAd) has also been been studied in those age 65 and over. Adjuvanted flu vaccine uses the standard dose of antigen, but adds an ingredient that stimulates the body to produce a better immune response. It's been found to be more effective in decreasing flu-related hospitalizations than regular flu vaccine in oder adults. And it's currently available in most areas.

Get vaccinated against the flu now!

It's most important, especially this year, to just get vaccinated against the flu. And this year, it's best to make sure you're vaccinated before the end of October. Why? Because flu season often kicks off in the United States in November. And because of the COVID crisis, it's more important than ever to be protected from the flu. One reason is that symptoms of influenza and COVID-19 are similar. But maybe even more important, protection against the flu can keep you from needing to see a doctor. Staying away from the health system is one sure way of protecting yourself from exposure to COVID-19, and flu vaccination can help.

So getting any influenza vaccination is more important than the type of influenza vaccination you get. If you're 65 or older and you can find the high-dose vaccination, great, go ahead and get it. Or ask about the adjuvanted flu vaccine. But if neither of those are available, PLEASE, get whatever flu vaccine is offered. And do it soon! Having immunity before November hits is your best chance at staying away from the health system for preventable causes.

For more information about flu vaccination options for the entire family, see our post from last year, "Flu Vaccines - Which one is right for you?"  As always, we welcome your questions and comments below, or contact us directly at BetterMyMeds!


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About Betty Chaffee

Betty Chaffee, PharmD, is owner and sole proprietor of BetterMyMeds, a Medication Management service devoted to helping people get the maximum benefit from their medications.


  1. Thanks! I have gotten the FluAd shot. I kept wondering if they had sold me a “snake oil” medicine. You article is reassuring!

    1. Thanks for your comment Marjorie! I’m glad you were able to find the adjuvanted flu vaccine. And yes, pharmacists are reliable health professionals who always do their best to make sure patients get the care they need. It sounds like you have a good one! Question for you – did you have more pain, redness, or swelling at the injection site? Some adjuvanted vaccines cause such a good response that the arm may hurt for a few days.

  2. Thank you for sharing this, Betty! With everything else that many of us are experiencing, it’s very easy to overlook making time to get your flu shot. Fortunately, with pharmacies being able to provide these services on-demand (without an appointment) and most insurances fully covering the cost of the flu shot, one doesn’t need a lot of time to get this important task taken care of.

  3. Thank you, Betty.
    Do you happen to know which, if any, of the shots you mention above contain the preservative Thimerosal? (I’m allergic.) I’ve been told that the standard multi-dose vials that virtually every drugstore uses do contain it; and even the “preservative-free individual doses” may contain trace amounts, but it wasn’t enough to cause a reaction last time I had one of those.

    1. Thanks for asking that question Rhonda. Many people wonder about the ingredient thimerosal, which is a form of mercury and is used as a preservative in some vaccines. It is true that some of the multiple-dose vials of flu vaccines contain thimerosal. Most pharmacies that I’m aware of, though, DON’T use multiple dose vials. Single-dose shots are much more commonly used in pharmacies – they’re easier, more convenient, and there’s less waste. And usually the single-dose versions are thimerosal-free. For sure, Fluzone high-dose and FluAd are thimerosal-free. If you’re getting vaccinated with a different product, though, be sure to ask the pharmacist if it contains thimerosal.

    2. Thank you for your question, Rhonda.
      Betty gave an excellent answer to your question, essentially reporting that thimerosal is a common preservative generally used in multi-dose vials of flu vaccine, but not in individual-dose vaccines (which the majority of pharmacies use now). The pharmacy I work at has been administering individual-dose Fluarix and Fluad, which do not contain thimerosal.

      I’m including a couple of links to the Center of Disease Control (CDC) website that offers additional information about thimerosal in vaccines. If you have additional questions after reading them, please let us know.



  4. Great information, as usual! Since the high-dose vaccine is in short supply, does the pharmacist have control on who gets the shot? It would seem that those that are more at-risk should get it. Also, could the pharmacist be liable if it was found that they denied someone the high-dose shot? Is there such a thing as pharmacist best practices that would prevent possible litigation?

    1. Great questions Tony. Typically pharmacists will provide the high-dose vaccine (if they have it) to anyone 65 or older who asks for it. Since all of those individuals are at higher risk of complications from the flu, and since they rarely have access to complete medical information, pharmacists don’t make judgments about which older adults may be at higher risk than others. If a person is 65 or older, and the vaccine is available, they can get it.

  5. Betty, I had no problems. It was only when I took a shier and saw the bandage that I even thought about it. So, the adjuvanted vaccine gave me no issues at all.

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