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Bottom Line Summary

Effectiveness of the High-Dose Influenza Vaccine in Older Adults

Bottom Line: 

Both standard dose and high-dose trivalent influenza vaccine are effective in reducing laboratory
confirmed influenza in adults over age 65. Older patients should be encouraged to receive the
influenza vaccine in either form, though the high-dose vaccine is slightly superior and preferable
when readily accessible and affordable for the patient.

Why is this important?
Seasonal influenza causes an estimated 30,000 deaths per year in the United States. Adults over age 65 account for most deaths and hospitalizations. A high dose vaccine for adults over age 65 which is more immunogenic than the
standard vaccine in this age group, was approved in 2009. The clinical effectiveness of this high-dose vaccine compared with a standard-dose vaccine has not been well established.

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1. Diaz Granados CA, Dunning AJ, Kimmel M et al. Efficacy of high-dose versus standard-dose influenza vaccine in older adults.
N Engl J Med 2014; 371: 635-45.
2. Osterholm MT, Kelley NS, Sommer A et al. Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis.
Lancet Infect Dis. 2012;12(1): 36-44.
3. Wong K, Campitelli MA, Stukel TA et al. Estimating influenza vaccine effectiveness in community-dwelling elderly patients using the
instrumental variable analysis method. Arch Intern Med. 2012;172(6): 484-491.

Written by the Evidence-Based Medicine Task Force

Bill Kormos, MD
Devan Kansagara, MD
Zackary Berger, MD, PhD
Michael E. Bowen MD, MPH, MSCS
Harry B. Burke, MD, PhD
Jocelyn A. Carter, MD, MPH
Jamie A. Jarmul, BS
Rani Nandiwada, MD
Heather Sateia, MD
Jeff Tice, MD
Clark Veet, MD
James Yeh, MD, MPH
M.E. Beth Smith, DO, MCR

The Bottom Line summaries reflect the expertise and opinions of the SGIM EBM Task Force as of the date of release of this summary.