Should Seniors Wait to Receive the Flu Shot?

Pharmacists who launched marketing campaigns for flu shots in late summer may have jumped the gun for their older patients. In the future, pharmacists may want to consider finding a balance between ensuring that all patients receive the flu vaccine and optimizing the delivery time of the administration.

The Advisory Committee on Immunization Practices recommends that the flu vaccine should be offered as soon as it becomes available.

“While delaying vaccination might permit greater immunity later in the season, deferral could result in missed opportunities to vaccinate, as well as difficulties in vaccinating a large number of people within a more limited time period,” the Immunization Action Coalition summarized on its website.

However, a 2011-2012 study provided evidence that vaccine effectiveness among patients aged 65 years or older declined late in the influenza season. Laura Haynes, PhD, professor of immunology at the University of Connecticut Center on Aging, believes that these patients should wait until late September to get immunized against the flu.

“Older folks have an altered immune response to the vaccination, and the protection that the vaccine induces doesn’t last as long as it does in younger people,” Dr. Haynes told Pharmacy Times. “Thus, we recommend that they get the vaccine a bit later so that they are protected through the end of flu season in April or May.”

If an older patient comes into the pharmacy in August or September looking for a flu shot, Dr. Haynes recommended that the pharmacist tell the patient about the benefits of waiting.

“But, I would also inquire as to whether the senior patient can come back for the vaccine later,” she said. “If this is in doubt, I would vaccinate early rather than not at all. If someone is under 65 and healthy, it really doesn’t matter if they receive the vaccine in September.”

Dr. Haynes advised pharmacists to wait until around the middle of September to start their flu shot marketing campaigns.

“It is a good strategy to get people thinking about the vaccine and for younger people, too early is not an issue,” she said. “I would encourage individual counseling for older folks about timing of the vaccine.”

John J. Treanor, MD, of the University of Rochester Medical Center’s School of Medicine and Dentistry, told NPR that some evidence suggests that patients hold onto some flu protection from last year’s shot if the strains did not change drastically.

The CDC recommends that patients receive the inactivated influenza vaccine and the recombinant influenza vaccine, but not the nasal spray flu vaccine this year.

The 2016-2017 vaccines will protect against:

• A/California/7/2009 (H1N1)pdm09-like virus,
• A/Hong Kong/4801/2014 (H3N2)-like virus
• B/Brisbane/60/2008-like virus (B/Victoria lineage)

Pharmacists should also be aware that flu vaccines have been updated to match circulating viruses, there are some newly available vaccines this year, and recommendations for vaccinating patients with egg allergies have changed.

This season, patients who get hives in reaction to eggs should get any licensed flu vaccine “that is otherwise appropriate for their age and health,” the CDC stated. For those who exhibit other symptoms like angioedema or respiratory distress, patients should be given a flu shot in a physician’s office, hospital, clinic, or health department, and they should be supervised by a medical professional who can manage severe reactions.

“People with egg allergies no longer have to wait 30 minutes after receiving their vaccine,” the CDC stated on its website.

Patients may receive a standard flu shot, a high-dose flu shot or a shot made with adjuvant for older patients, an immunization that is made with virus grown in cell culture, or the recombinant vaccine this season.