Flu & People 65 Years and Older
People 65 years and older are at higher risk of developing serious flu complications compared with young, healthy adults. This increased risk is due in part to changes in immune defenses with increasing age. While flu seasons vary in severity, during most seasons, people 65 years and older bear the greatest burden of severe flu disease. In recent years, for example, it’s estimated that between 70 percent and 85 percent of seasonal flu-related deaths have occurred in people 65 years and older, and between 50 percent and 70 percent of seasonal flu-related hospitalizations have occurred among people in this age group.
A Flu Vaccine is the Best Protection Against Flu
Flu vaccination has many benefits. It has been shown to reduce the risk of getting sick with flu and also to reduce the risk of more serious flu outcomes that can result in hospitalization or even death. Although immune responses to vaccination may be lower in older people, studies have consistently found that flu vaccination has been effective in reducing the risk of medical visits and hospitalizations in older people. Higher dose and adjuvanted flu vaccines are potentially more effective than standard dose unadjuvanted flu vaccines for people in this age group and are therefore recommended preferentially over a regular dose flu vaccine.
The best way to protect against flu and its potentially serious complications is with a flu vaccine. Flu vaccines are updated each season because flu viruses are constantly changing. Also, immunity wanes over time. Annual vaccination helps to ensure the best possible protection against flu. A flu vaccine protects against the flu viruses that research indicates will be most common during the upcoming season. (More information about this season’s exact vaccine composition is available at Vaccine Virus Selection.) Flu vaccines for the 2022-2023 flu season have been updated from last season’s vaccine to better match circulating viruses. Immunity from vaccination fully sets in after about two weeks.
Flu vaccination is especially important for people 65 years and older because they are at higher risk of developing serious flu complications. Three specific flu vaccines are preferentially recommended for people 65 years and older over other flu vaccines. People 65 and older should get a higher dose or adjuvanted flu vaccine, including: Fluzone High-Dose Quadrivalent, Flublok Quadrivalent, or Fluad Quadrivalent vaccine. These vaccines are preferred for people 65 years and older because a review of existing studies suggested that, in this age group, these vaccines are potentially more effective than standard dose unadjuvanted flu vaccines.
When should I get vaccinated?
For most people who need only one dose of flu vaccine for the season, September and October are generally good times to be vaccinated against flu. Ideally, everyone should be vaccinated by the end of October. Additional considerations concerning the timing of vaccination for certain groups of people include:
- Most adults, especially those 65 years and older, and pregnant people in the first or second trimester should generally not get vaccinated early (in July or August) because protection may decrease over time. However, early vaccination can be considered for any person who is unable to return at a later time to be vaccinated.
- Some children need two doses of flu vaccine. For those children it is recommended to get the first dose as soon as vaccine is available, because the second dose needs to be given at least four weeks after the first. Vaccination during July and August also can be considered for children who need only one dose.
- Vaccination during July and August also can be considered for people who are in the third trimester of pregnancy during those months, because this can help protect their infants for the first few months after birth (when they are too young to be vaccinated).
For the 2022-2023 season, CDC and ACIP preferentially recommend the use of higher-dose flu vaccines (Fluzone High-Dose Quadrivalent inactivated influenza vaccine and Flublok Quadrivalent flu vaccine) or adjuvanted flu vaccine (Fluad Quadrivalent vaccine) over standard-dose unadjuvanted flu vaccines for people 65 years and older. This recommendation is 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. More information is available at Flu Vaccines Worked Better than Initially Estimated this Past Season & CDC’s Advisory Council Recommends Specific Flu Vaccines for Seniors. If one of these vaccines is not available at the time of administration, people in this age group should get a standard-dose unadjuvanted inactivated flu vaccine instead. There are other flu vaccines approved for use in people 65 years and older. People 65 years and older should not get a nasal spray vaccine. More information about preferentially recommended flu vaccines is below:
Fluzone High-Dose Quadrivalent vaccine (manufactured by Sanofi Pasteur) contains four times the amount of antigen (the inactivated virus that promotes a protective immune response) as a regular flu shot. The higher dose of antigen is intended to give people 65 years and older a better immune response to vaccination, and therefore, better protection against flu. Fluzone High-Dose has been approved for use in people 65 years and older in the United States since 2009. Learn more about high dose flu vaccine.
Flublok Quadrivalent (manufactured by Sanofi Pasteur) is a recombinant protein influenza vaccine approved for use in people 18 years and older. It is made using different production technology than inactivated influenza vaccines and contains three times the antigen dose compared with standard-dose inactivated flu vaccines. Recombinant flu vaccine became available for the first time in the United States during the 2013-2014 influenza season as a trivalent vaccine, Flublok. Flublok Quadrivalent became available during the 2017-2018 influenza season. Learn more about recombinant influenza vaccine.
Fluad Quadrivalent flu vaccine (manufactured by Seqirus) is made with MF59 adjuvant, an additive that helps create a stronger immune response. Adjuvanted flu vaccine became available for the first time in the United States during the 2016-2017 flu season, when a trivalent version of Fluad was approved. Fluad Quadrivalent because available during the 2020-21 season. Learn more about adjuvanted flu vaccine.
High Dose and Adjuvanted Flu Vaccine Side Effects
The high dose and adjuvanted flu vaccines may result in more of the temporary, mild side effects that can occur with standard-dose seasonal flu shots. Side effects can include pain, redness or swelling at the injection site, headache, muscle ache and malaise, and typically resolve with 1 to 3 days.
Get pneumococcal vaccines
- People who are 65 years and older also should be up to date with pneumococcal vaccination to protect against pneumococcal disease, such as pneumonia, meningitis, and bloodstream infections. Talk to your health care provider to find out which pneumococcal vaccines are recommended for you.
- Pneumococcal pneumonia is an example of a serious flu-related complication that can cause death. You can get the pneumococcal vaccine your provider recommends when you get a flu vaccine.
In addition to getting a flu shot, people 65 years and older should take the same everyday preventive actions CDC recommends for everyone, including avoiding people who are sick, covering coughs, and washing hands often.
Because you are at higher risk of developing serious flu complications, if you get flu symptoms, call your health care provider right away. There are antiviral drugs that can treat flu illness and prevent serious flu complications. CDC recommends prompt treatment with a flu antiviral medication for people who have flu or suspected flu infection and who are at higher risk of serious flu complications.
Flu symptoms include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and fatigue. Some people may also have vomiting and diarrhea, though this is more common in children than in adults. People may be infected with flu and have respiratory symptoms without a fever.
- Influenza antiviral drugs are medicines that fight against flu by keeping flu viruses from making more viruses in your body.
- Antiviral drugs can make your flu illness milder and make you feel better faster. They may also prevent serious health problems that can result from flu illness.
- Treatment with an influenza antiviral drug should begin as soon as possible because these medications work best when started early (within 48 hours after symptoms start).
- You need a prescription from a health care provider for an influenza antiviral medication.
- There are four FDA-approved flu antiviral drugs recommended by CDC this season that can be used to treat the flu.
People experiencing these warning signs should obtain medical care right away.
- Fast breathing or trouble breathing
- Bluish lips or face
- Ribs pulling in with each breath
- Chest pain
- Severe muscle pain (child refuses to walk)
- Dehydration (no urine for 8 hours, dry mouth, no tears when crying)
- Not alert or interacting when awake
- Fever above 104°F
- In children less than 12 weeks, any fever
- Fever or cough that improve but then return or worsen
- Worsening of chronic medical conditions
- Difficulty breathing or shortness of breath
- Persistent pain or pressure in the chest or abdomen
- Persistent dizziness, confusion, inability to arouse
- Not urinating
- Severe muscle pain
- Severe weakness or unsteadiness
- Fever or cough that improve but then return or worsen
- Worsening of chronic medical conditions
These lists are not all inclusive. Please consult your medical provider for any other symptom that is severe or concerning.
- Influenza vaccination of health care providers in long-term care: Letter from the Assistant Secretary for Health [121 KB, 2 pages]
- People at Higher Risk of Developing Flu–Related Complications
- Treating Flu Fact Sheet [308 KB, 2 Pages, 8.5″ x 11″]
- CDC Healthy Aging Website
- Influenza and Pneumonia Vaccination in Older Adults
- NEJM: Efficacy of High-Dose versus Standard-Dose Influenza Vaccine in Older Adults
- Print Materials: Adults 65 Years and Older
- Preventing Flu in Older Adults
- National Council for Aging Care: A Guide to Seasonal Flu for Seniors