Randomized Trial of High Dose Influenza Vaccine in Long Term Care Setting
Randomized Trial of High Dose Influenza Vaccine in Long Term Care Setting
The purpose of the study is to compare the performance of two currently available influenza
 (flu) vaccines. This study will try and determine if the high dose flu vaccine provides
 protection that is the same or better than that of regular dose flu vaccine. Both the regular
 dose and the high dose flu vaccines are approved by the FDA for use in older adults.
Influenza and pneumonia are the fifth leading cause of death in the United States, the
 leading cause of vaccine preventable death, and the leading cause of infection related deaths
 among nursing home residents(Nace, Drinka et al.2010). Each year, an estimated 36,000
 individuals die from seasonal influenza and over 90% of these deaths occur among older
 adults, primarily the frail older adults residing in LTC settings(Fiore,Uyeki et al.
 2010).Vaccination is the most effective means of preventing influenza (Nichol and Treanor
 2006). Despite increasing success in immunizing LTC residents though, outbreaks continue to
 occur annually with case fatality rates ranging between 5-55% (Nace 2008). Older adults have
 a reduced response to influenza vaccination, in part due to age related immunosenescence
 (Keitel, Atmar et al. 1121; Skowronski, Tweed et al. 2008). It is widely recognized that more
 effective vaccine options are needed for frail older adults. One option is to increase the
 hemagglutinin (HA) dose in influenza vaccines in an effort to increase antibodies to
 hemagglutinin. To date, no studies have evaluated the effectiveness of the HDIV among LTC
 residents.
Inclusion Criteria:

 -  Residents of one of the participating LTC sites

 -  65 years or older at the time of consent

 -  require assistance in two or more Instrumental Activities of Daily Living and/or one
 or more Activities of Daily Living as identified by facility staff

 Exclusion Criteria:

 -  Age less than 65 years

 -  Life expectancy less than 6 months

 -  History of allergic reaction to influenza vaccine, its components, or eggs

 -  History of severe allergic reaction to latex

 -  History of Guillian-Barre Syndrome

 -  Actively undergoing chemotherapy

 -  Actively undergoing radiation therapy

 -  Use of prednisone (or other steroid) at prednisone-equivalent dosages of 10mg or
 higher within the past 14 days

 -  Serious current immunosuppression or immunosuppression expected in the next 6 weeks

 -  Any condition that, in the opinion of the investigator,might interfere with the
 evaluation of study objectives