High-Dose Influenza Vaccination in Mexican Adults Aged 60 Years and Older. High-Dose Influenza Vaccination in Mexican Adults Aged 60 Years and Older: A Position Statement Based on Contemporary Evidence and the Emerging Role of Enhanced Immunogenic Strategies

Abstract

Influenza remains a major cause of preventable morbidity, hospitalization, cardiovascular events, frailty progression, and mortality among older adults. Individuals aged ≥60 years represent a biologically vulnerable population due to age-related immune dysfunction, multimorbidity, chronic inflammation, endothelial dysfunction, and increased susceptibility to severe respiratory infections. Conventional standard-dose influenza vaccines demonstrate reduced immunogenicity in older populations because of immunosenescence, resulting in suboptimal vaccine effectiveness precisely in those at greatest risk. High-dose influenza vaccines (HD-IIV), containing increased hemagglutinin antigen concentration, have emerged as a rational and evidence-based strategy to overcome age-related limitations in vaccine response. Over the past decade, randomized trials, real-world effectiveness studies, meta-analyses, and, more recently, the FLUNITY-HD evidence program have consistently demonstrated superior immunogenicity and clinically meaningful reductions in influenza-related complications, hospitalization, cardiorespiratory outcomes, and mortality among older adults. This position statement critically reviews the biological rationale, contemporary evidence, comparative effectiveness, safety profile, and implementation considerations of high-dose influenza vaccination in adults aged ≥60 years. Particular emphasis is placed on the implications of recent FLUNITY-HD findings and their relevance for vulnerable populations, including patients with cardiometabolic disease, chronic kidney disease, frailty, obesity, diabetes, and established cardiovascular disease. Based on cumulative evidence, we support the preferential use of high-dose influenza vaccination in adults aged ≥60 years, especially in individuals with elevated cardio-renal-metabolic risk. In regions where high-dose vaccines are unavailable, adjuvanted vaccines should be prioritized over conventional standard-dose formulations.