Relative to specific effectiveness in the population over 65 years, there continues to be potential evidence that a higher dose can overcome immunologic senescence. The results of the most recent study of nursing home residents—a comparative- effectiveness, cluster-randomized trial from 823 centers given either the HD or SD vaccine during the 2013-2014 predominantly A/H1N1 influenza season—showed a reduction of respiratory-related hospital admissions of 0.5%, with an adjusted relative risk of 0.87, (95% CI, 0.78-0.98, P
There were no laboratory data to confirm influenza, however. As a result, patient and provider preferences are the only deciding factors between low and high dose in elderly individuals.
As stated previously, the adult vaccine landscape remains ever changing, with an annual schedule recommendation in February plus interim recommendations for influenza in August of each year in addition to individual product updates as needed. To remain the most updated, review the ACIP’s excellent website and listserv resources, as well as releases from Morbidity and Mortality Weekly Report
and other major publications on vaccine effectiveness, as study results evolve.
Dr. McCoy is the associate director of the Antimicrobial Stewardship Program at Beth Israel Deaconess Medical Center in Boston, MA, as well as the PGY-2 program director for the Infectious Diseases Residency. He received a PharmD from Massachusetts College of Pharmacy in Boston. Dr. McCoy is board certified in pharmacotherapy (BCPS) with added qualifications in infectious diseases. He is an active member of SIDP.
- Kim DK, Riley LE, Harriman KH, Hunter P, Bridges CB. Advisory committee on immunization practices recommended immunization schedule for adults aged 19 years or older - United States, 2017. MMWR Morb Mortal Wkly Rep. 2017;66(5):136-138. doi: 10.15585/mmwr.mm6605e2.
- Active bacterial core surveillance report, emerging infections program network, Neisseria meningitidis, 2015. CDC website. www.cdc.gov/abcs/reports-findings/survreports/mening15.pdf. Accessed October 3, 2017.
- Stephens DS; Advisory Committee on Immunization Practices. Meningococcal vaccines session. CDC website. www.cdc.gov/vaccines/acip/meetings/downloads/slides-2017-06/meningococcal-01-stephens.pdf. Accessed June 21, 2017.
- McNamara LA, Topaz N, Wang X, Hariri S, Fox L, MacNeil JR. High risk for invasive meningococcal disease among patients receiving eculizumab (Soliris) despite receipt of meningococcal vaccine. MMWR Morb Mortal Wkly Rep. 2017;66(27):734-737. doi: 10.15585/mmwr.mm6627e1.
- Active bacterial core surveillance, emerging infections program network, Streptococcus pneumoniae, 2015. CDC website. www.cdc.gov/abcs/reports-findings/survreports/spneu15.html. Published March 8, 2016. Accessed October 3, 2017.
- van Deursen, HM, van Houten MA, Webber C, et al. Immunogenicity of the 13-valent pneumococcal conjugate vaccine in older adults with and without comorbidities in the Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA). Clin Infect Dis. 2017;65(5):787-795. doi: 10.1093/cid/cix419.
- Fluview weekly and annual influenza surveillance report. CDC website. www.cdc.gov/flu/weekly/summary.htm. Last updated May 26, 2017. Accessed August 16, 2017.
- Grohskopf LA, Sokolow LZ, Broder KR, et al. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices — United States, 2017–18 Influenza Season. MMWR Recomm Rep 2017;66(2):1-20. doi: 10.15585/mmwr.rr6602a1.
- Gravenstein S, Davidson HE, Taljaard, M et al. Comparative effectiveness of high-dose versus standard-dose influenza vaccination on numbers of US nursing home residents admitted to hospital: a cluster-randomised trial. Lancet Respir Med. 2017;5(9):738-746. doi: 10.1016/S2213-2600(17)30235-7.