Thursday, June 23, 2022

ACIP Votes (15-0) To Preferentially Recommend High-Dose/Adjuvanted Flu Vaccines For Seniors


Although I've gotten the seasonal flu shot every year for the past 2 decades - and have successfully avoided the flu 18 out of the past 20 years - I'm quite aware that as I grow older, flu shots will provide me with less and less protection. 

To help combat that loss in effectiveness, last year (see #NatlPrep: Giving Your Preparedness Plan A Shot In The Arm) I elected to get the Hi-Dose vaccine (for those 65 and older) for the very first time.

I consider getting my seasonal flu shot each year part of my overall preparedness plan. During a disaster or prolonged emergency - like, say a pandemic or a hurricane - the last thing I need is to be laid up with the flu.  

But even without an external crisis to deal with, influenza can ruin your whole day (see NEJM: Acute Myocardial Infarction After Laboratory-Confirmed Influenza Infection).

And given what little we know about the risks of dual infection with COVID and Flu, it makes sense to avoid that viral double-whammy if one can. 

But the reality is, the seasonal flu vaccine (most years, anyway) only provides a moderate (50%-60%) level of protection against getting the flu. And that is for adults under the age of 65.  Older people, who arguably need the protection the most, usually see lower Vaccine Effectiveness (VE). 

Which is why, about a dozen years ago, the FDA approved a high-dose flu vaccine for seniors (see MMWR Report), followed by an adjuvant-enhanced vaccine in 2015 (see FLUAD™: An Adjuvanted Flu Vaccine Option For Those Over 65).  

Until now, these enhanced vaccines have been offered without official recommendation over the standard flu shot, but as more data has come in, the increased benefits of these formulations - and the less-than-stellar performance of standard flu shots in seniors - has become more apparent. 

Yesterday the CDC's ACIP panel voted unanimously to preferentially recommend these newer, enhanced flu shots to seniors.  The CDC generally endorses ACIP recommendations, but has not issued a statement as of this writing. 

Even though these enhanced vaccines appear to provide better protection for seniors, they are still a long way from where they need to be (see J.I.D.: NIAID's Strategic Plan To Develop A Universal Flu Vaccine).  

Credit NIAID

Until that `holy grail' of vaccinology becomes a reality, we have to use the vaccines available to us.  My experience with the high-dose vaccine last year was good (although I've no idea how much protection it afforded me), so I'll opt for it again this fall. 

The case for making a preferential recommendation for enhanced flu vaccines for seniors was presented at yesterday's ACIP meeting in a 63-page slide presentation (see below). 

                                        (Continue . . . )

Given the speed at which influenza viruses mutate - and the need for six months lead time to create, produce, and deploy a vaccine - it is inevitable that some years these flu vaccines (both enhanced and standard) will miss their mark.

Still, even with the limitations of our current flu vaccine technology, with an uncertain and unpredictable flu/COVID season ahead of us, I'll take any advantage I can get.