Influenza Vaccine Recommendations for Adults

Vaccine Type and Dosage

The Centers for Disease Control and Prevention recommends that adults aged 61 years receive the standard-dose inactivated influenza vaccine (IIV3) containing 15 μg of hemagglutinin per strain in a 0.5 mL dose 1
All standard-dose influenza vaccines for adults over 36 months of age are administered as a 0.5 mL dose, as recommended by the Centers for Disease Control and Prevention 2
Available standard-dose options include egg-based vaccines and cell culture-based vaccine, according to the Centers for Disease Control and Prevention 2

The Centers for Disease Control and Prevention recommends high-dose influenza vaccine and adjuvanted influenza vaccine for adults aged ≥65 years 1, 3
At 61 years of age, the patient does not yet qualify for the high-dose or adjuvanted vaccines based on age alone, as stated by the Centers for Disease Control and Prevention 2
The patient should wait until age 65 to receive the high-dose vaccine or adjuvanted vaccine, according to the Centers for Disease Control and Prevention 3

Solid organ transplant recipients aged 18-64 years who are receiving immunosuppressive medications may receive high-dose or adjuvanted vaccines, as recommended by the Centers for Disease Control and Prevention 1, 3
Patients with rheumatic and musculoskeletal diseases aged >18 and <65 years who are taking immunosuppressive medication may benefit from high-dose or adjuvanted influenza vaccines, according to the American College of Rheumatology 4, 5

If the patient has specific risk factors such as immunosuppression or chronic medical conditions, consultation with a healthcare provider may be warranted to determine if early high-dose vaccination would be beneficial, as recommended by the American College of Rheumatology 6, 7
Vaccination should not be delayed if only standard-dose vaccine is available, as any influenza vaccine is preferred over no vaccination, according to the American College of Rheumatology 5
The vaccine should be administered intramuscularly into the deltoid muscle, as recommended by the Centers for Disease Control and Prevention 2

When the patient reaches age 65, the Advisory Committee on Immunization Practices (ACIP) recommends preferential use of higher-dose or adjuvanted influenza vaccines 3

High-dose influenza vaccine (HD-IIV4) is specifically licensed only for adults aged 65 years and older 8
The dose volume for all inactivated influenza vaccines for persons aged ≥36 months (≥3 years) is 0.5 mL per dose, with the exception of Fluzone High-Dose Quadrivalent which is only for those ≥65 years 8

The American College of Rheumatology conditionally recommends high-dose or adjuvanted influenza vaccination for patients with rheumatic and musculoskeletal diseases (RMD) aged >18 and <65 years who are taking immunosuppressive medication 9
This recommendation is based on very low to moderate evidence that suggests these patients may benefit from enhanced immune response 9
Insurance barriers may inhibit implementation of high-dose influenza vaccine for RMD patients <65 years of age taking immunosuppressive medications 9

For healthy individuals under 65 years: Use standard-dose influenza vaccine 8
For immunocompromised individuals under 65 years: Consider high-dose vaccine only if the patient has specific conditions like rheumatic disease with immunosuppressive therapy 9
Any such use of high-dose vaccine in immunocompromised individuals under 65 years would be off-label and may require prior authorization from insurance 9