The flu vaccine that’s best for older Australians

High-dose, immune-boosting or four-strain? A guide to flu vaccines for older Australians.

flu shot

Flu vaccines work by exposing the body to a component of the virus so it can “practise” fighting it off, without risking infection. The immune system can then mount a more rapid and effective response when faced with a “real” virus.

Three types of influenza vaccines are available in Australia:

  • “standard” vaccines that contains four different strains of influenza
  • a “high-dose” vaccine (Fluzone High Dose) that contains three strains of influenza at a higher dose than standard vaccines
  • an “adjuvanted” vaccine (Fluad) that contains the standard dose of three strains of influenza, along with MF59, an immune stimulant designed to encourage a stronger immune response to the vaccine.

The high-dose and adjuvanted vaccines are designed for use only in people aged 65 and over because they can stimulate a better immune response than the standard vaccine. Standard vaccines should be used by those younger than 65 years.

This year, the Australian Government is offering the adjuvanted vaccine for free for over-65s. The standard vaccine is available for free for some groups under 65 under national and state programs. The high-dose vaccine will only be available to buy through pharmacies and general practices on prescription.

Is the high-dose vaccine better?

Clinical trials have compared the high-dose vaccine with older forms of the standard vaccine that contained three strains.

One US study in over-65s found 1.4 per cent of recipients who were given the high-dose vaccine were diagnosed with influenza, compared with 1.9 per cent of those who received the standard vaccine.

A flu vaccination doesn’t completely eliminate the risk of getting the flu, but it’s likely to make the illness less severe. From shutterstock.com

Subsequent studies also found people who got the high-dose vaccine were less likely to be hospitalised with influenza-related complications. A similar trial in nursing home residents also found a reduced risk of hospitalisation.

Although clinical trials are generally regarded as the gold standard when testing vaccines, it’s also important to consider data from other studies, where different flu strains circulate and where the vaccine may be used in groups that were excluded from clinical trials.

These studies have generally found that the high-dose vaccine is better than the standard vaccine. However, some studies have shown a lesser degree of benefit.

What about the adjuvanted vaccine?

Clinical trials have not been designed to show the different rates of flu infection after taking the adjuvanted vaccine compared with the standard vaccine. But studies have examined the effectiveness of this vaccine in preventing hospitalisations with influenza.

One trial found a small decrease in influenza infection in people who had been given adjuvanted vaccine, compared with standard vaccine, but this difference was not statistically significant.

Another recent trial has been performed in nursing home residents. Preliminary results suggest a very small reduction in hospitalisations compared with those who took the standard vaccine.

With different vaccination options available, it can be hard to work out which is likely to provide the most protection. From shutterstock.com

Despite a lack of clinical trial data, several observational studies have found getting the adjuvanted vaccine means you’re less likely to be hospitalised with influenza than if you receive the standard vaccine.

As with the studies of the high-dose vaccine, the estimated degree of protection varies between studies, reflecting differences in circulating strains, study types, and populations.

Which is better?

There is not yet sufficient data to know whether one enhanced vaccine is better than the other.

One observational study suggests the high-dose vaccine is more effective than the adjuvanted vaccine at preventing hospital admissions with influenza. But this study was not designed to address this question specifically, and the differences observed were small.

Both enhanced vaccines are safe. Although a higher proportion of patients who receive enhanced vaccines report a sore arm, compared to those who receive the standard vaccine, this is generally mild and rarely requires medical attention.

Immunisation expert groups in Australia, the United States, Canada and the United Kingdom have not recommended either enhanced vaccine over the other.

Can you get two for better coverage?

The currently available enhanced vaccines protect against three flu strains, whereas the standard vaccine protects against four.

But for most people, there is no evidence that receiving multiple doses of different vaccines in any one year is any better than getting a single dose of vaccine.

There’s no evidence that two shots are better than one. By Nyvlt-art

In theory, the four-strain vaccines protect against one more strain than the enhanced three-strain vaccines. But in most seasons, few infections are caused by the fourth strain.

There are some specific groups of people for whom two doses may be recommended, including young children receiving the vaccine for the first time, and some people with bone marrow or organ transplants. Seek advice from your doctor if this describes you or your children’s situation.

It’s important to note that none of the standard or enhanced flu vaccines are completely protective; they reduce, but don’t completely eliminate, the risk of getting influenza.

A single dose of any influenza vaccine in each season is the most effective strategy to reduce your chance of getting influenza.

Allen Cheng, Professor in Infectious Diseases Epidemiology, Monash University and Christopher Blyth, Paediatrician, Infectious Diseases Physician and Clinical Microbiologist, University of Western Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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    Disclaimer: This article contains general information about health issues and is not advice. For health advice, consult your medical practitioner.





    COMMENTS

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    Paddington
    25th Apr 2019
    11:13am
    Apparently it is going to be a bad season and many will die, so get your flu shot. The more people who have the vaccine the better off everyone will be.
    Everyone needs it,unless a specified reason applies, to protect the community.
    Cowboy Jim
    25th Apr 2019
    12:56pm
    Have a shot every year. Tried to get my mates to do the same, but so many of them have no personal physician, no doctor's visits for 30 years or so, others are simply afraid of needles. As Paddington says: everyone should have it and it is free for over 65 year olds and only $20 for everyone else at the chemist here where I live.
    Diogenes
    25th Apr 2019
    1:51pm
    Excellent advice. I make sure I get the flu shot every year as everyone our age should. Had the real 'flu once in 1986 and boy is it an illness that knocks you off your feet and makes you feel toxic. Never want that again. Not sure I would trust someone in a pharmacy to give me an injection though.
    musicveg
    25th Apr 2019
    2:22pm
    They say that every year Paddington, scare mongering to sell their product. And no it does not make it better for everyone and protect the community. My 82 year old mum does not get a vaccine and yet all her friends do and they all get the flu.
    Sceptic
    25th Apr 2019
    2:48pm
    musicveg; there's a story to not believe.
    musicveg
    25th Apr 2019
    3:00pm
    What don't you believe Sceptic, I do not tell lies.
    Diogenes
    25th Apr 2019
    3:06pm
    No musicveg you may not tell lies (from your point of view) but you are sadly misinformed and misguided and a danger to the health of many. iI am sure your Mum and her friends are lovely people, but that is hardly a scientific study.Also how can we know you are qualified to say what is and isn't flu. So many people with what is merely a cold call it the flu. The flu proper is a vastly different illness. Just imagine if all those poor soldiers etc in the 1918 outbreak had access to vaccines as we do today. So as you can see i agree entirely with sceptic
    KSS
    25th Apr 2019
    3:09pm
    An anecdote from a single person (particularly one who is basically anti-vax) is not scientific evidence. No amount of fruit and veg will prevent infection by a virulent virus.
    musicveg
    25th Apr 2019
    3:17pm
    I agree I am not qualified, but I do a lot of reading from many sources,and I am not misinformed and definitely not misguided. I have read a lot of articles from immunologists too which doctors are not and yet people believe in doctors even though they know nothing about vaccines or medicines other than what they read too or are told to read and told what to say. KSS, I was not saying anything about fruit and veg, I said if you take care of yourself properly you will not get sick, and it takes a lifetime to make sure you are looking after yourself.
    I just wanted to present another option and help people realize that the flu vaccine is not going to prevent them getting the flu, and not to be complacent, even the articles mentions that.
    Elizzy
    25th Apr 2019
    12:10pm
    You should also make sure you are up to date with pneumonia vaccination - both the 23 valent and 13 valent (ask your doctor). In combination with the annual flu shot you then have good protection. This year I also had a booster for tetanus (recommended for gardeners), whooping cough, and a few other things (can't remember) all in the same shot.
    Paddington
    25th Apr 2019
    12:52pm
    That is good. The other one is shingles vac. We have both had that one too.
    Cowboy Jim
    25th Apr 2019
    1:02pm
    Doc told me that the pneumonia vaccination lasts the distance. Had it last year with the flu shot.
    Diogenes
    25th Apr 2019
    2:53pm
    Again such excellent advice Elizzy. I shall book in to have all those vaccinations, and I believe there is also a haemophilus influenzae vaccine (causing meningitis) available.
    musicveg
    25th Apr 2019
    2:31pm
    These trials are minimal and do not convince me they work.There are many studies to suggest otherwise. Why put poisons into your body when you can build up natural immunity. I never even get a cold, have not had one for years. They continue to scare people into having this unnecessary vaccine that does not work because it helps the pockets of shareholders in big pharma. Read these informative articles:
    http://www.greenmedinfo.com/blog/shocking-lack-evidence-supporting-flu-vaccines
    http://www.greenmedinfo.com/blog/8-damn-good-reasons-not-get-flu-shot
    http://www.greenmedinfo.com/blog/flu-vaccine-increases-your-risk-infecting-others-6-fold-study-suggests
    Sceptic
    25th Apr 2019
    2:49pm
    idiot.
    Diogenes
    25th Apr 2019
    2:51pm
    There are extensive trials showing they do work. e.g. all the NHMRC trials.., Lipcott et al Lancet, April 2018. There are more trials showing they do work than don't at least in the respected journals. Your thinking makes life much more dangerous for the immuno-comprimised, and those who are unable to have the vaccines. I have seen and looked after people dying of the flu (and other preventable illnesses), and it's so unnecessary. Plenty of people die from the flu, no-one has ever died from the flu vaccine (proven to have died)
    Diogenes
    25th Apr 2019
    2:54pm
    Agree with sceptic, such an idiot.
    musicveg
    25th Apr 2019
    3:05pm
    Digby and Sceptic, no need for name calling, did you read the posts? I was after sensible comments, no one dies from the flu they die from complications and having a weakened immune system which is all preventable if you are looking after yourself properly. Food is thy medicine. The trials showing they work is not always accurate and they are often have changed results and never are they using healthy people, always using unhealthy people for their trials. My way of thinking is not dangerous for immuno-compromised people, quite the opposite. Once you attack your body with foreign substances it is then compromised even more. But you are welcome to believe what you want and respect my beliefs too please.
    KSS
    25th Apr 2019
    3:17pm
    Music eg, you really need a lesson in scientific immunology research 101.

    If there is any criticism to be made it is that trials and most research is done on healthy males, not the sick or immuno-compromised.

    You might like to look up the death rates for flu each year. They are quite horrific.
    And mostly so unnecessary.
    You are entitled to your opinion but you must also accept what you say can be lethal for most. And it is irresponsible to exhort others to your one sided view if the world. And yes I too am a vegetarian iof almost 50 years, get no colds, flu or have any other illnesses, and yes I am fully vaccinated and will be getting the flu Vax as recommended.
    Diogenes
    25th Apr 2019
    3:18pm
    I am sorry musicveg, but as a doctor I suspect you are well intentioned ( probably ) but you are talking unmitigated nonsense. No people die from the flu, what you call complications are the direct consequences of encountering the virus. How you quantify what is a compromised immune system, what test do you think are necessary to establish that? And the trial s showing they work in the reputable journals do show they work and are extensively peer reviewed under the auspices of ethic committees from prestigious universities etc. What evidence do you have that it is not so.Using unhealthy people , what errant nonsense. I have looked at what you call (and I use the term advisedly and laughingly) references and articles, and they are from a greatly discredited antivaxx pamphlet, not from a reputed medical journal at all. They can hardly claim to have any scientific merit. It is your right to decide to not have a vaccine, but please don't go near those who those who are ill and whose immune system is compromised., you are a danger to them. Your understanding is limited. I respect your beliefs and my belief is (as you should respect ) is that your are misguided and uninformed.
    musicveg
    25th Apr 2019
    3:22pm
    Just read the articles and I can find many more like these too. I am not one sided either, I look at all sides and weigh things up. Big pharma is big business and they will recommend everything and anything, taking away our natural immunity to be replaced by artificial immunity I believe is not the answer, sure some vaccines may work, but not all of them do, this is the point I was trying to make. Do not be complacent and ask questions.
    Diogenes
    25th Apr 2019
    3:26pm
    That should read : No, people do die from the flu.

    "Food is thy medicine", except when there's typhoid or cholera bacteria in it....oh wait there's a vaccine for that.And I suppose when when you need a heart transplant
    because of viral induced cardiomyopathy you can eat your way out of that.
    musicveg
    25th Apr 2019
    3:26pm
    Digby, the references are not from antivaxx pamphlets, they are from many research studies that have been ignored or hidden. And how can I be a danger to anyone, I do not carry any disease, I am never sick.That belief is just pure nonsense. Shall I go get my blood tested to see if I am carrying anything? Last time I did I had no viruses.
    Diogenes
    25th Apr 2019
    3:30pm
    I have read your articles, and I stand by my comments. Such unmitigated unscientific rants. their value is dubious. Big pharma had it's faults....agreed, but without it, you would have far more chance of not being alive today or disabled or impaired.
    Diogenes
    25th Apr 2019
    3:32pm
    Oh really and what tests did they do to show you had no viruses. We are all covered in viruses, and bacteria, or didn't your articles tell you that?
    musicveg
    25th Apr 2019
    3:36pm
    Sorry you don't believe the articles Digby that is if you read them thoroughly. Pharmaceuticals and doctors have never helped me, but I have high respect for surgeons. How do explain the rise in disabilities and disease in children who should be healthy then?
    Diogenes
    25th Apr 2019
    4:04pm
    I am sorry musicveg but I don't understand your question. What rise in disabilities and disease in children, who otherwise should be healthy???? What on earth are you talking about? If you look at polio alone the rate of disability is far less than it was in 40's and 50's. And yes I did read read your articles thoroughly , have you ever read an article from a reputed medical journal.? I am sorry music veg I am being so harsh on you, I appreciate that at least you have thought about the subject but I disagree vehemently with your conclusion.I regret that your selection of doctors and pharmaceuticals have not helped you in particular but that hardly applies to the population in general. A series of one is not scientific but is anecdotal , and surgeons are doctors, we all go to medical school, and then specialise as I did. I appreciate also that of course you probably do not have access to medical journals or libraries, probably just the internet and we all know what fine source of reliable information that is.
    Diogenes
    25th Apr 2019
    4:14pm
    And one more thing musicveg, you reference to greenmedinfo.com/blog are just that blogs (!) under a green antivaxx influence, they are not scientific articles published in well respected, peer reviewed medical journals, affiliated to to highly respected universities, or medical research institutions. I appreciate you have researched and thought, but your sources are tainted.
    musicveg
    25th Apr 2019
    5:02pm
    Digby thank you for your comments, but I still have my doubts that even medical journals are often influenced by big pharma, even if I did have access or the time to read them. I do believe though if we never question anything nothing can change for the better. I have a lot of doubts about vaccines in general because I do not like some of the ingredients and methods that are used to make them. I know we could discuss this further but this is not getting us anywhere. I am just glad I still have a choice not to inject poisons into my body, I feel sorry for the kids who are having way too many, further transparency is needed.
    What I meant by the rise in disability and disease in children, is that more recently we have seen a rise, not comparing to the polio days that is another subject which I do not want to go into here. I could not find any statistics for you but here is a short article.
    https://www.gmoscience.org/top-five-childhood-diseases-rise/
    Diogenes
    25th Apr 2019
    5:41pm
    And music veg , thank you for your comments, as I have said , I am glad you have done some research. We doctors know how to look for influence of big pharma by looking the end of articles in medical journals in the medical libraries. I know I have the bias of my training and profession, but I do believe that the well respected medical journals are more likely to have the reliable evidence and research. I agree we cannot get any further in this discussion, we shall have to agree to disagree. Our conclusions based on our research ( and dare I say training and knowledge) has led us to very different conclusions. And by the way immunologists are doctors too (by and large), immunology is a branch of medicine ( a general physician who has specialised in immunology). Of course you have a choice, and clearly I do not regard vaccinations as poisons but effective preventative beneficial medications. Unlike you I am so glad to see our children being injected with them, there is no evidence (as yet) that there are too many. If not for those vaccines I may have had polio (as I have seen in my peer group), or rheumatic heart disease, or tuberculosis, tetanus, or smallpox. What you call transparency, is something I wish I could see in the anti-vaxxer movement. Questioning you refer to, is what medical researchers do each and every day, knowing we will never have all the answers, but also knowing that anti-vaxxers certainly won't either. I have found our discussion stimulating , my very best to you, and I hope we get the chance to interact again perhaps on a topic we agree about (stranger things have happened.)
    Cowboy Jim
    25th Apr 2019
    6:25pm
    Musicveg is into coconut water, herbal tea etc. No vaccinations. I know people like that in my neighborhood and I worry about the people they mix with. I am alright Jack! And in the meantime spreading all the illnesses they pick up on the way without having inoculations.
    musicveg
    25th Apr 2019
    6:35pm
    I never said I was totally against vaccinations! I do not spread disease, how can I when I don't have them. I was vaccinated as a child, I just don't want the flu vaccine as I feel I don't need it.
    Thoughtful
    25th Apr 2019
    6:47pm
    Vaccination. Always a topic for invoking intense feelings. Big Pharma does have a lot to answer for but generally their research and opinions are more reliable than any other. This is because they are the ones who are investing money for proper clinical trials. Are they always accurate? Probably not but nobody else invests enough money in research for me to take an opposing opinion. The MAIN benefit of vaccination is the herd immunisation effect. This is often overlooked when discussing individual cases.
    McGroger
    25th Apr 2019
    7:36pm
    My grandmother died, aged 23, of the Spanish Flu, along with more than 50 million others or up to about 5% of the then population of the world. If vaccinations had been available back then, my father might not have lost his mother at the age of 3 and I might have known her as an elderly grandma.

    The Australian Department of Health says, “Since the introduction of vaccination for children in Australia in 1932, deaths from vaccine-preventable diseases have fallen by 99 per cent, despite a threefold increase in the Australian population over that period.”

    A problematic aspect of social media is that there is no editing before publishing.
    Elizzy
    25th Apr 2019
    10:52pm
    McGroger, that is very sad about your grandmother. I would have been dead in my twenties had it not been for antibiotics that were not available to your grandmother. I've had flu shots each year for a long time now and would recommend them to everyone unless you have a proven allergy to the vaccine. Stay well

    25th Apr 2019
    8:17pm
    Quackwatch is a useful authoritative site. Search flu on that site.

    https://www.quackwatch.org/

    Copy and paste to your browser if that link doesn't work
    musicveg
    25th Apr 2019
    9:30pm
    Not much there about flu, only this:
    https://www.quackwatch.org/03HealthPromotion/immu/thimerosal_veto.html

    Makes me wonder if those receiving flu vaccines here in Australia are still getting the ones with thimerosal.
    Paddington
    25th Apr 2019
    10:17pm
    It is a bit like global warming, even if you do not believe or are unconvinced, it is simply not worth the risk to ignore it. Get the flu vaccine for you and for the benefit of everyone else. 4000 deaths are predicted and we should do all we can to prevent that!
    Sundays
    26th Apr 2019
    12:14pm
    I once had the flu vaccine free through work, and was very sick with flu like symptoms for a week. I haven’t had it since. Fortunately, I rarely get sick and haven’t had a cold for around seven years, even if I’m not a vegetarian. However, I am pro vaccination for children having seen first hand the effects of polio and whooping cough. On reading these comments below, I think this year, I might have The flu vaccine after all, as I had not considered the effect on others.
    musicveg
    26th Apr 2019
    1:37pm
    Be interesting to see if you get another reaction. Having the flu vaccine will not help others at all, you can't spread what you don't have. If people just stayed home when they got sick it might help them recover quicker and not spread germs, but many just carry on, go to work, go on public transport etc.
    Thoughtful
    26th Apr 2019
    5:42pm
    Well said Sundays.

    Musicveg I agree if everybody lead a completely isolated life we would not have the problem. But then again we would not have an existence either.
    Paddington
    28th Apr 2019
    12:10pm
    Yes Sundays, this year is predicted to be bad. I recall many years ago I had a reaction and vowed never to have the flu vaccine again. However, because we are old, it is different.
    I have been having the vaccine for quite a few years now. You can still get the flu or a
    part of it so that is why it is important that everyone gets the vaccine to stop that happening.
    Jannie
    28th Apr 2019
    10:33am
    They say flu spreads by just breathing. What is being done to introduce masks during the flu season. My immune system is compromised as I do not have a spleen and I would like to be able to protect myself against others germs by wearing a mask. Planes should be sprayed regularly to kill off any nasties that are lurking. No monitoring of travellers from overseas what is our health department doing??? Seems they are doing fuck all.
    casey
    28th Apr 2019
    12:16pm
    Went on a cruise, a lot of people were coughing and sneezing. Sure enough I got the worst case of flu I have ever had, took 3 weeks to get over it. Didn't put me off cruising though. I am due to have my flu shot next week. Maybe I should have one before my next cruise too.


    Tags: health, flu, vaccine

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