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Expert advice on seniors, pregnant women and flu shots

Oct 21, 2022

Influenza strains vary from year to year, but one thing remains constant: everyone six months and older should get an annual flu shot. “We've been fortunate the last two flu seasons have been mild, but we have no way of knowing what to expect for this season,” according to Sandra A. Fryhofer, MD, the AMA's liaison to the Advisory Committee on Immunization Practices (ACIP) and a member of ACIP’s COVID-19 Vaccine Workgroup.

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The U.S. so far has avoided a severe flu season amid the COVID-19 pandemic. However, Australia is experiencing its worst flu season in five years, which may serve as a warning for the Northern Hemisphere.

“Your best way to protect yourself and those around you is to get vaccinated. Now's the time,” said Dr. Fryhofer, who chairs AMA Board of Trustees.

Specific considerations and exceptions apply to people over 65 and pregnant women, Dr. Fryhofer said in an episode of “AMA Update” in which she outlined the latest vaccination options for these two patient groups.

 

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All flu vaccines available this year cover four flu strains: two flu As and two flu Bs. Influenza vaccination recommendations haven’t changed for most people. But for those 65 or older, it’s now recommended that patients get one of three vaccines: either one of two higher-dose flu shots or an adjuvant vaccine.

ACIP is recommending one of these for older adults because they are at increased risk for severe influenza-associated illness, hospitalization and death. And flu vaccines are often less effective in older adults.

The two higher-dose shots—Flublok and Fluzone High-Dose, are three and four times stronger than regular flu shots, respectively. The adjuvant vaccine marketed as FLUAD is the same strength as the standard flu shot but contains an adjuvant, MF59, to boost its immune response.

Flublok can be given to adults 18 or older. “And for older adults, a regular flu shot’s fine if a higher dose or adjuvanted flu vaccine is not available. It's better to get any flu shot than no flu shot at all,” advised Dr. Fryhofer.

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Bodily changes make pregnant women more prone to severe illness from flu. Vaccination has been shown to cut risk of flu-related respiratory infections in pregnant women by 50% and reduce risk of hospitalization with flu by 40%.

Pregnant women are eligible to receive any age-appropriate inactivated or recombinant vaccine. The exception is the live attenuated influenza vaccine (LAIV) or the nasal flu vaccine, which is made from live—but weakened—virus.

“It’s fine to give LAIV postpartum,” Dr. Fryhofer noted.

Generally speaking, “it is very important for pregnant women to receive the flu shot,” she added. “As for timing, the flu shot can be given at any time during pregnancy.”

Those in the second or third trimesters of their pregnancy will be encouraged to get vaccinated as early as July or August, but otherwise the idea is to get it once fall arrives.

“That way, mom’s antibodies can be passed on to baby and provide protection to during the first few months of life when baby’s too young to be vaccinated,” Dr. Fryhofer said. .”

AMA Update” covers health care topics affecting the lives of physicians and patients. Hear from physicians and experts on public health, advocacy issues, scope of practice and more—because who’s doing the talking matters. You can catch every episode by subscribing to the AMA’s YouTube channel or the audio-only podcast version, which also features educational presentations and in-depth discussions.

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