Friday, July 01, 2022

CDC Director Endorses ACIP Recommendation On High-Dose/Adjuvanted Flu Vaccines For Seniors

ACIP Presentation


Just over a week ago ACIP Voted (15-0) To Preferentially Recommend High-Dose/Adjuvanted Flu Vaccines For Seniors and sent their recommendations to the CDC.  Although it took a week, yesterday the CDC's Director Rochelle P. Walensky, M.D., M.P.H. issued the following endorsement. 

First the statement from the CDC, after which I'll have a bit more.

CDC Director Adopts Preference for Specific Flu Vaccines for Seniors
Media Statement

For Immediate Release: Thursday, June 30, 2022
Contact: Media Relations
(404) 639-3286

CDC Director Rochelle P. Walensky, M.D., M.P.H., adopted the Advisory Committee on Immunization Practices’ (ACIP) recommendation to preferentially recommend the use of specific flu vaccines for adults 65 years and older, including higher dose and adjuvanted flu vaccines. The preference applies to Fluzone High-Dose Quadrivalent, Flublok Quadrivalent and Fluad Quadrivalent flu vaccines.

While flu seasons vary in severity, during most seasons, people 65 years and older bear the greatest burden of severe flu disease, accounting for the majority of flu-related hospitalizations and deaths. Additionally, changes in the immune system with age mean that older adults often do not have as strong an immune response to vaccination as younger, healthy people. “Given their increased risk of flu-associated severe illness, hospitalization, and death, it’s important to use these potentially more effective vaccines in people 65 years and older,” said José R. Romero, M.D., Director of CDC’s National Center for Immunization and Respiratory Diseases. Additionally, data has shown that racial and ethnic health disparities exist in populations that receive a high-dose flu vaccine compared with standard-dose flu vaccines. “This recommendation could help reduce health disparities by making these vaccines more available to racial and ethnic minority groups,” said Dr. Romero.

Last Thursday, ACIP voted to preferentially recommend the use of higher dose flu or adjuvanted flu vaccines over standard-dose unadjuvanted flu vaccines for people 65 years and older. This recommendation was based on a review of available studies which suggests that, in this age group, these vaccines are potentially more effective than standard dose unadjuvanted flu vaccines. Dr. Walensky’s adoption of the ACIP recommendation makes this recommendation official CDC policy, which will be further detailed in an upcoming Morbidity and Mortality Weekly Recommendation Report later this summer.

In recent years, CDC has not recommended any one flu vaccine over another for any age group, and there is still no preferential recommendation for people younger than 65. People 65 and older should try to get one of the three preferentially recommended vaccines, however, if one of these vaccines is not available at the time of administration, people in this age group should get a standard-dose flu vaccine instead.

Influenza has always been unpredictable, but following the emergence of COVID and two year's of pandemic mitigation efforts, it has demonstrated increasingly unusual behavior.  

There are also genuine concerns over the health impacts of dual (COVID and flu) infection (see The Lancet: SARS-CoV-2 Co-infection With Influenza Viruses, RSV, or Adenoviruses), although nobody is quite sure how common that might be. 

While the seasonal flu vaccine generally provides a moderate (40%-60%) level of protection against flu, last year it only prevented about 35% of infections.  Better than originally reported, but still disappointing. 

But most of this protection went to those under the age of 50 (see chart below), with those over 50 - a cohort that generally has a less robust immune response to vaccines -  seeing statistically little protection. 

While it is uncertain how much more protection these newer high-dose/adjuvanted vaccines will afford seniors in any given flu season, it is expected to be better than the standard dose vaccine. 

And with an uncertain flu/COVID season ahead, we can use any advantage we can get.