FLUAD vs. FLUZONE HD Influenza Vaccine in Residents of Long Term Care

* > 65 years old

* Able to obtain consent from subject or legally authorized representative (subject to provide assent if cognitively/physically able to do so)

* Able to participate throughout the study period

* Recent illness (within 30 days) severe enough to require hospitalization or physician-directed outpatient pharmacotherapy

* Administration of immunomodulatory agents (e.g. oral corticosteroids except prednisone < 10 mg daily, cyclosporine, and biologics (DMARDS) for Rheumatologic/Dermatologic conditions) in the last 3 months

* Cancer requiring treatment in the past three years, except for non- melanoma skin cancers or cancers that have clearly been cured or carry an excellent prognosis including prostate cancer.

* Myocardial infarction, major heart surgery (i.e. valve replacement or bypass surgery), stroke, deep vein thrombosis or pulmonary embolus in the past 4 months

* Allergies or history of significant adverse reactions to any component of influenza vaccine including egg protein and latex or after a previous dose of any influenza vaccine.

* History of Guillian-Barré Syndrome within 6 weeks of a prior influenza vaccine.