High-Dose flu vaccine for 65 and over

Resaved Dr TLast year my husband and I were given the extra-strength flu shots intended for senior citizens. Are they available again this year?  Did any studies show they were better than regular flu shots? We haven’t heard anything about them this year.

(edited from the FDA website) The extra strength “Fluzone High-Dose” flu vaccine is again available and we have an ample supply in our office.  This is the fourth flu season that it has been available.  The vaccine is preservative free and is covered by Medicare.  It is not a live vaccine and can be given to those with compromised immune systems.

The High-Dose vaccine has four times the amount of “antigen” in the hopes that it will be more effective in stimulating the immune systems of those 65 years and older who do not always get the full protection from standard flu shots due to our immune systems not being quite as robust as we get older.

The vaccine was initially tested in in 3,837 subjects 65 years of age and older. The initial study showed the vaccine to be safe without serious side effects.  Those who received the higher dose produced more antibodies against the flu particularly the A strains and lesser so the B strain. As might be expected the greater amount of antigen caused more non serious side effects such as sore arm, headache and fever.  The study was not designed to see if it actually prevented more flu cases.  Based on the initial study the FDA approved the vaccine as an option for those over 65.  The manufacturer agreed to collect data on 30,000 patients over 3 years to see if the vaccine was actually more effective than the standard flu shot in preventing the flu.  An ongoing study designed to determine the effectiveness of the High-Dose vaccine in preventing illness from influenza compared to the regular strength is expected to be completed in 2014-2015.
The Bottom Line:  The High-Dose flu vaccine is a reasonable option for those over 65.  So far it appears promising and probably will be more effective in preventing the flu in those 65 and over though it may be another year or two before we can be more definitive.

Dr T


Who Should Get Hepatitis C Tested?

Resaved Dr TI heard that we should be tested for hepatitis C. Does that mean everyone?

(edited from the CDC) Hepatitis C virus (HCV) is an increasing cause of illness in the United States.  Untreated over many decades approximately 5% of people with chronic hepatitis C will die of complications such as cirrhosis or liver cancer.  Many persons with HCV infection do not recall or report having any specific risk factors such as injection-drug use, blood transfusion before July 1992 when a blood test was developed to protect the blood supply, having received chronic hemodialysis, being born to an HCV-infected mother, intranasal drug use, acquiring a tattoo in an unregulated establishment, being incarcerated, being stuck by a needle (e.g., in health care, emergency medical, home, or public safety settings) and multiple (>20) sexual partners.

At its peak in the 1960s there were a quarter of a million new cases per year in the United States.  Presently there are less than 20 thousand new cases a year.  The prevalence of HCV among persons born during 1945–1965 is 3.25% or five times higher than among adults born in other years.  With the advent of new therapies that can eliminate hepatitis C the CDC has proposed one-time testing for persons born during 1945–1965.

The bottom line:  if you have any of the risk factors listed above and have never been tested for hepatitis C you should consider a one time test.  If you were born between 1945 and 1965 your chances of carrying hepatitis C are low but much higher than in more recent years and you also might consider a one time test.  If you are a blood donor you do not need to be tested as you are tested each time you donate blood.  We can include testing for hepatitis C with your routine physical blood work if you request it.

Dr T