Last Updated:
March 9, 2026

Influenza_Older people

This factsheet provides information for influenza disease and vaccination in older people.

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Overview

References

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1. Mertz D, Kim TH, Johnstone J, Lam PP, Science M, Kuster SP, et al. Populations at risk for severe or complicated influenza illness: systematic review and meta-analysis. BMJ. 2013;347:f5061.

2. Kuster SP, Tuite AR, Kwong JC, McGeer A, Fisman DN. Evaluation of coseasonality of influenza and invasive pneumococcal disease: results from prospective surveillance. PLoS medicine. 2011;8(6):e1001042.

3. Fleming DM, Elliot AJ. The impact of influenza on the health and health care utilisation of elderly people. Vaccine. 2005;23:S1-S9.

4. Chen CI, Kao PF, Wu MY, Fang YA, Miser JS, Liu JC, Sung LC. Influenza Vaccination is Associated with Lower Risk of Acute Coronary Syndrome in Elderly Patients with Chronic Kidney Disease. Medicine. 2016;95(5):e2588.

5. Sung LC, Chen CI, Fang YA, Lai CH, Hsu YP, Cheng TH, et al. Influenza vaccination reduces hospitalization for acute coronary syndrome in elderly patients with chronic obstructive pulmonary disease: a population-based cohort study. Vaccine. 2014;32(30):3843-9.

6. Barnes M, Heywood AE, Mahimbo A, Rahman B, Newall AT, Macintyre CR. Acute myocardial infarction and influenza: a meta-analysis of case–control studies. Heart. 2015;101(21):1738-47.

7. Siriwardena AN, Gwini SM, Coupland CA. Influenza vaccination, pneumococcal vaccination and risk of acute myocardial infarction: matched case-control study. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2010;182(15):1617-23.

8. Fang YA, Chen CI, Liu JC, Sung LC. Influenza Vaccination Reduces Hospitalization for Heart Failure in Elderly Patients with Chronic Kidney Disease: A Population-Based Cohort Study. Acta Cardiologica Sinica. 2016;32(3):290-8.

9. Lin HC, Chiu HF, Ho SC, Yang CY. Association of influenza vaccination and reduced risk of stroke hospitalization among the elderly: a population-based case-control study. International journal of environmental research and public health. 2014;11(4):3639-49.

10. Chiang MH, Wu HH, Shih CJ, Chen YT, Kuo SC, Chen TL. Association between influenza vaccination and reduced risks of major adverse cardiovascular events in elderly patients. American heart journal. 2017;193:1-7.

11. Liu JC, Wang TJ, Sung LC, Kao PF, Yang TY, Hao WR, et al. Influenza vaccination reduces hemorrhagic stroke risk in patients with atrial fibrillation: A population-based cohort study. International journal of cardiology. 2017;232:315-23.

12. Vasileiou E, Sheikh A, Butler C, El Ferkh K, von Wissmann B, McMenamin J, et al. Effectiveness of Influenza Vaccines in Asthma: A Systematic Review and Meta-Analysis. Clin Infect Dis. 2017;65(8):1388-95.

13. Gill TM, Allore HG, Holford TR, Guo Z. Hospitalization, restricted activity, and the development of disability among older persons. JAMA. 2004;292(17):2115-24.

14. Thompson WW, Shay DK, Weintraub E, Brammer L, Cox N, Anderson LJ, Fukuda K. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA. 2003;289(2):179-86.

15. Mullooly JP, Bridges CB, Thompson WW, Chen J, Weintraub E, Jackson LA, et al. Influenza- and RSV-associated hospitalizations among adults. Vaccine. 2007;25(5):846-55.

16. Udell JA, Zawi R, Bhatt DL, Keshtkar-Jahromi M, Gaughran F, Phrommintikul A, et al. Association between influenza vaccination and cardiovascular outcomes in high-risk patients: a meta-analysis. JAMA. 2013;310(16):1711-20.

17. MacIntyre CR, Mahimbo A, Moa AM, Barnes M. Influenza vaccine as a coronary intervention for prevention of myocardial infarction. Heart. 2016;102(24):1953-6.

18. Vamos EP, Pape UJ, Curcin V, Harris MJ, Valabhji J, Majeed A, Millett C. Effectiveness of the influenza vaccine in preventing admission to hospital and death in people with type 2 diabetes. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2016;188(14):E342-E51.

19. Huang HH, Chen SJ, Chao TF, Liu CJ, Chen TJ, Chou P, Wang FD. Influenza vaccination and risk of respiratory failure in patients with chronic obstructive pulmonary disease: A nationwide population-based case-cohort study. Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi. 2019;52(1):22-9.

20. Cromer D, van Hoek AJ, Jit M, Edmunds WJ, Fleming D, Miller E. The burden of influenza in England by age and clinical risk group: a statistical analysis to inform vaccine policy. The Journal of infection. 2014;68(4):363-71.

21. McElhaney JE, Zhou X, Talbot HK, Soethout E, Bleackley RC, Granville DJ, Pawelec G. The unmet need in the elderly: how immunosenescence, CMV infection, co-morbidities and frailty are a challenge for the development of more effective influenza vaccines. Vaccine. 2012;30(12):2060-7.

22. Turner N, Pierse N, Bissielo A, Huang Q, Radke S, Baker M, et al. Effectiveness of seasonal trivalent inactivated influenza vaccine in preventing influenza hospitalisations and primary care visits in Auckland, New Zealand, in 2013. Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin. 2014;19(34).

23. Bagshaw SM, Stelfox HT, McDermid RC, Rolfson DB, Tsuyuki RT, Baig N, et al. Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2014;186(2):E95-102.

24. Brummel NE, Balas MC, Morandi A, Ferrante LE, Gill TM, Ely EW. Understanding and reducing disability in older adults following critical illness. Critical care medicine. 2015;43(6):1265-75.

25. Sacanella E, Pérez-Castejón JM, Nicolás JM, Masanés F, Navarro M, Castro P, López-Soto A. Functional status and quality of life 12 months after discharge from a medical ICU in healthy elderly patients: a prospective observational study. Critical care (London, England). 2011;15(2):R105.

26. Khouli H, Astua A, Dombrowski W, Ahmad F, Homel P, Shapiro J, et al. Changes in health-related quality of life and factors predicting long-term outcomes in older adults admitted to intensive care units. Critical care medicine. 2011;39(4):731-7.

27. Cruzeta AP, Schneider IJ, Traebert J. Impact of seasonality and annual immunization of elderly people upon influenza-related hospitalization rates. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases. 2013;17(12):e1194-7.

28. Sah P, Medlock J, Fitzpatrick MC, Singer BH, Galvani AP. Optimizing the impact of low-efficacy influenza vaccines. Proceedings of the National Academy of Sciences of the United States of America. 2018;115(20):5151-6.

29. Beyer WE, McElhaney J, Smith DJ, Monto AS, Nguyen-Van-Tam JS, Osterhaus AD. Cochrane re-arranged: support for policies to vaccinate elderly people against influenza. Vaccine. 2013;31(50):6030-3.

30. Darvishian M, van den Heuvel ER, Bissielo A, Castilla J, Cohen C, Englund H, et al. Effectiveness of seasonal influenza vaccination in community-dwelling elderly people: an individual participant data meta-analysis of test-negative design case-control studies. Lancet Respir Med. 2017;5(3):200-11.

31. Demicheli V, Jefferson T, Di Pietrantonj C, Ferroni E, Thorning S, Thomas RE, Rivetti A. Vaccines for preventing influenza in the elderly. Cochrane Database Syst Rev. 2018;2(2):CD004876.

32. Domnich A, Arata L, Amicizia D, Puig-Barberà J, Gasparini R, Panatto D. Effectiveness of MF59-adjuvanted seasonal influenza vaccine in the elderly: A systematic review and meta-analysis. Vaccine. 2017;35(4):513-20.

33. Goronzy JJ, Weyand CM. Understanding immunosenescence to improve responses to vaccines. Nature immunology. 2013;14(5):428-36.

34. Pera A, Campos C, López N, Hassouneh F, Alonso C, Tarazona R, Solana R. Immunosenescence: Implications for response to infection and vaccination in older people. Maturitas. 2015;82(1):50-5.

35. Andrew MK, Shinde V, Ye L, Hatchette T, Haguinet F, Dos Santos G, et al. The Importance of Frailty in the Assessment of Influenza Vaccine Effectiveness Against Influenza-Related Hospitalization in Elderly People. The Journal of infectious diseases. 2017;216(4):405-14.

36. Nicolay U, Heijnen E, Nacci P, Patriarca PA, Leav B. Immunogenicity of aIIV3, MF59-adjuvanted seasonal trivalent influenza vaccine, in older adults ≥65 years of age: Meta-analysis of cumulative clinical experience. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases. 2019;85S:S1-S9.

37. Essink B, Fierro C, Rosen J, Figueroa AL, Zhang B, Verhoeven C, et al. Immunogenicity and safety of MF59-adjuvanted quadrivalent influenza vaccine versus standard and alternate B strain MF59-adjuvanted trivalent influenza vaccines in older adults. Vaccine. 2020;38(2):242-50.

38. Lapi F, Marconi E, Simonetti M, Baldo V, Rossi A, Sessa A, Cricelli C. Adjuvanted versus nonadjuvanted influenza vaccines and risk of hospitalizations for pneumonia and cerebro/cardiovascular events in the elderly. Expert review of vaccines. 2019;18(6):663-70.

39. Coleman BL, Sanderson R, Haag MDM, McGovern I. Effectiveness of the MF59-adjuvanted trivalent or quadrivalent seasonal influenza vaccine among adults 65 years of age or older, a systematic review and meta-analysis. Influenza Other Respir Viruses. 2021;15(6):813-23.

40. McConeghy KW, Davidson HE, Canaday DH, Han L, Saade E, Mor V, Gravenstein S. Cluster-randomized Trial of Adjuvanted Versus Nonadjuvanted Trivalent Influenza Vaccine in 823 US Nursing Homes. Clin Infect Dis. 2021;73(11):e4237-e43.

41. Plans-Rubió P. The vaccination coverage required to establish herd immunity against influenza viruses. Preventive medicine. 2012;55(1):72-7.

42. Kim TH. Seasonal influenza and vaccine herd effect. Clinical and experimental vaccine research. 2014;3(2):128-32.

43. Casado I, Domínguez A, Toledo D, Chamorro J, Force L, Soldevila N, et al. Effect of influenza vaccination on the prognosis of hospitalized influenza patients. Expert review of vaccines. 2016;15(3):425-32.

44. Mosnier A, Daviaud I, Caini S, Berche H, Mansuy JM, van der Werf S, et al. Does seasonal vaccination affect the clinical presentation of influenza among the elderly? A cross-sectional analysis in the outpatient setting in France, 2003-2014. Vaccine. 2017;35(16):2076-83.

45. Lee WJ, Chen LK, Tang GJ, Lan TY. The impact of influenza vaccination on hospitalizations and mortality among frail older people. Journal of the American Medical Directors Association. 2014;15(4):256-60.

46. Heo JY, Song JY, Noh JY, Choi MJ, Yoon JG, Lee SN, et al. Effects of influenza immunization on pneumonia in the elderly. Human vaccines & immunotherapeutics. 2018;14(3):744-9.

47. Pott H, Andrew MK, Shaffelburg Z, Nichols MK, Ye L, ElSherif M, et al. Vaccine Effectiveness of non-adjuvanted and adjuvanted trivalent inactivated influenza vaccines in the prevention of influenza-related hospitalization in older adults: A pooled analysis from the Serious Outcomes Surveillance (SOS) Network of the Canadian Immunization Research Network (CIRN). Vaccine. 2023;41(42):6359-65.

48. Nowlan ML. Review of evidence to inform the New Zealand National Immunisation Programme, 2025: Influenza – enhanced vaccines. Auckland, New Zealand: Immunisation Advisory Centre, University of Auckland;  2025 October.

49. Chan TC, Fan-Ngai Hung I, Ka-Hay Luk J, Chu LW, Hon-Wai Chan F. Effectiveness of influenza vaccination in institutionalized older adults: a systematic review. Journal of the American Medical Directors Association. 2014;15(3):226 e1- e6.

50. Beyer WEP, Palache AM, Boulfich M, Osterhaus A. Clinical relevance of increased antibody titres in older adults upon vaccination with squalene-adjuvanted versus non-adjuvanted influenza vaccines. Vaccine. 2022;40(23):3098-102.

51. Modin D, Jørgensen ME, Gislason G, Jensen JS, Køber L, Claggett B, et al. Influenza Vaccine in Heart Failure. Circulation. 2019;139(5):575-86.

52. Marín-Hernández D, Schwartz RE, Nixon DF. Epidemiological evidence for association between higher influenza vaccine uptake in the elderly and lower COVID-19 deaths in Italy. Journal of medical virology. 2021;93(1):64-5.

53. Del Riccio M, Lorini C, Bonaccorsi G, Paget J, Caini S. The association between influenza vaccination and the risk of SARS-CoV-2 infection, severe illness, and death: a systematic review of the literature. medRxiv. 2020:2020.09.25.20201350.

54. Moa AM, Chughtai AA, Muscatello DJ, Turner RM, MacIntyre CR. Immunogenicity and safety of inactivated quadrivalent influenza vaccine in adults: A systematic review and meta-analysis of randomised controlled trials. Vaccine. 2016;34(35):4092-102.

55. Treanor JT, Albano FR, Sawlwin DC, Graves Jones A, Airey J, Formica N, et al. Immunogenicity and safety of a quadrivalent inactivated influenza vaccine compared with two trivalent inactivated influenza vaccines containing alternate B strains in adults: A phase 3, randomized noninferiority study. Vaccine. 2017;35(15):1856-64.

56. Feng S, Fowlkes AL, Steffens A, Finelli L, Cowling BJ. Assessment of Virus Interference in a Test-negative Study of Influenza Vaccine Effectiveness. Epidemiology (Cambridge, Mass). 2017;28(4):514-24.

57. Skowronski DM, Zou M, Clarke Q, Chambers C, Dickinson JA, Sabaiduc S, et al. Influenza Vaccine Does Not Increase the Risk of Coronavirus or Other Noninfluenza Respiratory Viruses: Retrospective Analysis From Canada, 2010-2011 to 2016-2017. Clin Infect Dis. 2020;71(16):2285-8.

58. Schmader KE, Walter EB, Talaat KR, Rountree W, Poniewierski M, Randolph E, et al. Safety of Simultaneous Vaccination With Adjuvanted Zoster Vaccine and Adjuvanted Influenza Vaccine: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(10):e2440817.

Cartoon image of a man showing his arm where he received a vaccination