Rodney E. Rohde, PhD, MS, SM (ASCP) CM, SVCM, MBCM, FACSc: We’ve talked about some of these topics concerning older age, younger age, and things like that. Are there any other comments from the panel about why high-dose flu vaccines are reserved for patients older than 65 years of age? Have we covered that?

Chad Worz, PharmD, BCGP, FASCP: I feel like we’ve covered it. To reiterate, we have a population that has a blunted immune response. We’re trying to elicit a higher response from them. These higher-dose vaccines present more antigen, or they present the antigen in a way that accelerates the response. That’s why we’re seeing the recommendation. That’s why we’re getting the response we’re getting.

Randy McDonough, PharmD, MS, BCGP, BCPS, FAPhA: As much as anybody in the medical world, pharmacy needs to be evidence based. If you go to the literature and look at how effective these are, you said 24% better. But you might reduce morbidity and mortality by 30% for some of these patients. That’s a big percentage. If we get more patients vaccinated—we’ll talk more about vaccine hesitancy—who need to be vaccinated, we may be doing some good things out there. These vaccines have the evidence for the older patients. They’ve been compared with standard dosing, whether it’s adjuvant or recombinant or high dose. They’ve been compared, and they’ve demonstrated that they are better and have a better immune response for older patients.

Rodney E. Rohde, PhD, MS, SM (ASCP) CM, SVCM, MBCM, FACSc: We’ve talked a lot about patients ages 65 and older. What about younger patients or other high-risk populations?

Chad Worz, PharmD, BCGP, FASCP: I like where we’ve been going over the past decade or so in terms of how we make recommendations, whether it’s a medication or a vaccine. We start looking at subsets of the population and we follow the evidence. If we’ve got an immunocompromised population just younger than age 65, we may want to give a higher-dose vaccine. Other risk factors could fall into that category. If you have uncontrolled diabetes, these are the things that take your reserve away and make an infection that much more difficult for you to manage. If you’re the clinician making recommendations about the flu vaccine, who’s the patient in front of you? What’s their risk? In terms of a broad recommendation, we wait for evidence. We make good decisions about an individual’s medications based on who they are.

I tell the story of working in the Midwest with third-shift autoworkers. How does that change how you approach medication use? They’re not used to going to bed at 9 or 10 o’clock at night. They’re used to getting up at 9 or 10 o’clock at night. Why are we giving them a medication to help them fall asleep? Maybe we should be looking at them differently. I don’t think it’s any different for vaccines. Look at that individual. What are their comorbidities? What do you think their risk is? Then make a decision on what vaccine you recommend.

Rodney E. Rohde, PhD, MS, SM (ASCP) CM, SVCM, MBCM, FACSc: To be totally open about this with our audience, when we’re speaking about special populations, we’re talking about medical researchers are going to start [developing trials] For example, patients with cystic fibrosis who have respiratory issues. Let’s develop studies. Let’s have them very strongly designed so we can get something out of that to move forward.

Randy McDonough, PharmD, MS, BCGP, BCPS, FAPhA: From a community pharmacy perspective, I look at our pharmacy and say we’re a 50-plus pharmacy. We see older patients. But during flu season, we’re seeing the gamut. We work with pediatrician offices because our statewide protocol goes down to only 6 years of age. I can go all the way down to 6 months for patients who need a flu shot. We have collaborative practice agreements with pediatric offices because they order only so much, and they may not even get the patient at the time they need to be given a flu shot. We become 1 of their primary providers for providing a flu shot for that very young age of patients. There is a comfort level in giving it to a young child. There’s also a technique to it, especially when the child is fighting you and the parents are trying to keep everybody calm. We have certain times of day set aside for pediatric patients for that reason. We know there’s going to be some chaos, and we try to separate them.

Rodney E. Rohde, PhD, MS, SM (ASCP) CM, SVCM, MBCM, FACSc: This is off to the side a little, but some of the exciting things you see happening with RSV [respiratory syncytial virus] and other types of respiratory-based disease, especially with pediatric populations, is the idea of patches. Sometimes there are intranasal sprays and things like that. It’s interesting to see how we’ve evolved over the last 50 years to delivery.

Randy McDonough, PharmD, MS, BCGP, BCPS, FAPhA: I agree. There’s always a concern with the needle coming at you.

Rodney E. Rohde, PhD, MS, SM (ASCP) CM, SVCM, MBCM, FACSc: Especially for a child.

Randy McDonough, PharmD, MS, BCGP, BCPS, FAPhA: Having alternative methods is always a good thing.

Transcript edited for clarity.