What information is there about using the newer high-dose flu vaccine in patients with cancer? — Name withheld on request

The high-dose flu vaccine (Fluzone High-Dose) contains 4 times the amount of flu antigen than the regular flu vaccine. It has been shown to produce higher antibody levels than the regular flu vaccine in patients aged 65 years or older. Some studies have shown that this correlated with reduced cases of the flu (1.9% vs 1.4% of patients who received standard dose), and can reduce the risk of respiratory-related hospitalizations in elderly patients who are residents of long-term care facilities.1-2Although much of the clinical literature supporting the high-dose flu vaccine involves patients older than 65 who were not receiving chemotherapy, currently the vaccine is recommended for use in that population.

One small study of 105 patients younger than 65 compared the standard dose with the high-dose flu vaccines.3This study found improvements in some flu antibody titers, but did not report on the number of patients who developed the flu. At this time there is not sufficient data to support routine use of the high-dose flu vaccine in patients younger than 65 who are receiving chemotherapy. The Centers for Disease Control and Prevention (CDC) recommend reserving the high-dose flu vaccine for patients aged 65 or older.

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Both the high-dose and regular flu vaccine injections contain inactive viral components, thus are safe to use in patients receiving chemotherapy. Take note, however, that the intranasal flu vaccine contains live, weakened virus and should not be used in patients receiving chemotherapy or who are otherwise immunocompromised. If patients have other questions about the flu vaccine, the website www.cdc.gov/flu/prevent/keyfacts.htm contains helpful information and resources.


1. DiazGranados CA, Dunning AJ, Kimmel M, et al. Efficacy of high-dose versus standard-dose influenza vaccine in older adults. N Engl J Med.2014;371(7):635-645.

2. 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.

3. Jamshed S, Walsh EE, Dimitroff LJ, Santelli JS, Falsey AR. Improved immunogenicity of high-dose influenza vaccine compared to standard-dose influenza vaccine in adult oncology patients younger than 65 years receiving chemotherapy: a pilot randomized clinical trial. Vaccine.2016;34(5):630-635.

DEA Drug Take Back Day: October 27

The 16th biannual Drug Enforcement Agency (DEA) Prescription Drug Take Back Day is scheduled for October 27, 2018. These take-back events are hosted in many local communities and have collected 4982 tons of unused medications since they were implemented, with more than 474 tons of unused medications collected during the most recent event in April 2018. For more information or to find an event near you, visit: www.deadiversion.usdoj.gov/drug_disposal/takeback/index.html.

If patients are not able to make the take back day in October, they can search for other locations to dispose of unused medications at https://apps.deadiversion.usdoj.gov/pubdispsearch/spring/main?execution=e1s1.