This year, there are three basic kinds of flu vaccine: 1. The messenger RNA (mRNA) Moderna vaccine 2. High-dose egg-produced vaccine 3. Standard-dose egg-produced vaccine. The FDA-approved indications are: 1)The mRNA Moderna vaccine for individuals between 50 and 65 years of age with tentative approval for those over age 65 2) Standard dose egg-produced flu vaccine for individuals 6 months to 65 years of age and 3) High-dose egg-produced vaccine for those over 65. I know that’s clear as mud, so let’s look at the FDA’s reasoning.
A clinical trial looking at 41,000 participants in adults over age 50, with half getting the mRNA vaccine and half getting the standard-dose egg vaccine, showed that the mRNA vaccine was more effective, with only 2% getting flu versus 2.8% getting flu with the egg vaccine. Those over age 65 were not separated out but were included in this over-50 age group. The mRNA vaccine showed protective antibodies persisting longer than the egg vaccine. Both are advantages for the mRNA vaccine over the egg vaccine. However, minor side effects with the mRNA vaccine, such as fever after injection, sore arm, headache, and muscle aches, were twice as common versus the egg vaccine. Both groups had a low rate of serious side effects.
Historically, those over 65 have a greater incidence of flu infections, with more serious complications, such as hospitalizations and death. Since the study mentioned above was done only in those over age 50, without a separate analysis of those over age 65, the FDA gave tentative approval to those over age 65 for the mRNA vaccine. “Tentative” approval was given because past studies on the high-dose and standard-dose egg-produced vaccine showed that both were effective in those over 65.
The ace in the hole for mRNA vaccine is that it can be mass-produced very rapidly, for instance, in as little as six weeks for any change in the strain of flu that is circulating. Egg vaccines require six months.
The guideline published by the American College of Physicians, which I agree with, is that, if given a choice, use the egg-produced vaccine, with a standard dose for those under 65 and a high dose for those over 65. The mRNA vaccine will have its heyday during an epidemic with a rapidly spreading new flu strain.
For those refusing the flu vaccine, I would recommend checking your company’s sick leave policy, stocking up on ibuprofen and Gatorade (for hydration), and choosing which hospital you would prefer for treating your complications.
Dr. Charlie Barnett contributes to KnoxTNToday, where he writes a weekly column, DocTalk, sharing his expertise in health and wellness management.
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