Next year, the ACIP may be recommending high-dose flu vaccine for those ≥ 65 years of age, based on the results of a new study. High-dose trivalent inactivated vaccine was compared to standard-dose inactivated vaccine to evaluate flu protection in those ≥ 65 years of age. The high-dose strain has four times the antigen of the standard dose. Nearly 32,000 adults in the United States and Canada were randomized to standard-dose or high-dose trivalent flu vaccine. In the intention-to-treat analysis, 1.4% of high-dose recipients and 1.9% of low-dose recipients developed laboratory-confirmed influenza (relative efficacy, 24.2%; 95% confidence interval, 9.7-36.5). Antibody titers were significantly higher in the high-dose group, and adverse events were slightly higher in the high-dose group. The authors conclude that among those ≥ 65 years, high-dose trivalent flu vaccine induced higher antibody responses and better protection against laboratory-confirmed influenza compared to standard-dose vaccine (N Engl J Med 2014;371:635-645).