Weqaya preferably
recommend HD vaccine for their Older adults within the Adult National immunization schedule
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Gulf Regional Recommendations
High-Dose Influenza vaccine (HD-IIV) is recommended by different Gulf Health authorities and medical associations for their older adults co-morbid populations
*HD recommended to be used over SD in specific at-risk groups in most of the regions.
HD: high-dose; SD: standard-dose.
Cut off date: May 2026
- Germany: Preferential reco HD 60+
STIKO Epidemiologisches Bulletin. Available at: https://www.rki.de/DE/Aktuelles/Publikationen/Epidemiologisches-Bulletin/2025/04_25.pdf?__blob=publicationFile&v=6 (Accessed February 2025). - Latvia: Tiered Reco (HD preferred to SD)
Immunization Committee. Available at: https://www.spkc.gov.lv/lv/media/18069/download?attachment - Czech Republic: NICO – 2025 Reco (65+)
Vaccinology society: Vakcinace.eu - Recommendation of the Czech Vaccinological Society of the Czech Medical Society for Influenza Vaccination (Accessed May 2025)
The HD-IIV vaccine can be given to vaccinated persons aged 60 years and older or immunocompromised adult patients. Persons aged 65 years and older should be vaccinated with the HD-IIV vaccine as a priority. If it is not available, persons aged 65 years and older should be vaccinated with the IIV vaccine. - Austria: MoH – 2024/2025 Tiered reco (aQIV & HD recommended first line option, only aQIV reimbursed in the NIP)
Available at: https://broschuerenservice.sozialministerium.at/Home/Download?publicationId=506 (Accessed May 2025) - Romania: Tiered reco in 65+ with at least 2 co-morbidities (HD first line solution)
Afişare Ordin 3278 din 2023-09-22 / 804 din 2023-09-25, MO PI 875/2023-09-28 https://legislatie.just.ro/Public/DetaliiDocument/274834 (Accessed May 2025) - Cyprus: MoH – 2024 Reco in 60+
National Advisory Committee: available at: https://www.gov.cy/ygeia/emvoliastiko-plano-tou-ypourgeiou-ygeias-enanti-tis-nosou-covid-19-kai-tis-gripis/ (Accessed May 2025) “the National Immunization Advisory Committee for the Fall 2023 - Winter 2024 seasonal flu campaign has recommended that the vaccine Efluelda to be given to people over 70 years of age. The vaccine will be given to all structures, the vaccination centers of the Ministry of Health and to the Personal Doctors (Adults) of the NHS" The Health Insurance Organization wishes to inform the Personal Physicians of Adults and Children about the new decision of the National Vaccination Advisory Committee of the Ministry of Health regarding the expansion of the age limits for vaccination against seasonal influenza. Specifically, from 29/11/2023 onwards the following applies: Vaccination against the seasonal flu with the Efluelda vaccine will be possible for beneficiaries aged 60 and over.” - Australia: ATAGI – 2025
https://www.health.gov.au/sites/default/files/2025-03/atagi-statement-on-the-administration-of-seasonal-influenza-vaccines-in-2025_0.pdf
"For adults aged ≥65 years, both the adjuvanted (Fluad® Quad) and high dose influenza vaccine (Fluzone High Dose Quadrivalent) are equally preferentially recommended over standard influenza vaccine." "Standard influenza vaccination is recommended for all people aged 6 months to 64 years" - New Zealand : Immunization Advisory Committee – 2022 Tiered Reco (HD & aIIV preferred to SD)
https://pharmac.govt.nz/assets/2022-09-Immunisation-Advisory-Meeting-Record.pdf (Accessed May 2025) - United Arab Emirates: Preferential Reco 65+ (not a national reco)
Abu Dhabi Public Health Centre - Circular n° 2023/159: https://www.doh.gov.ae/-/media/A350695766F547B4AAEF90C30270EDE4.ashx (Accessed May 2025) - Saudi Arabia: MoH – 2025-Preferential Reco 60+
https://www.moh.gov.sa/en/Ministry/MediaCenter/Publications/Pages/Guide-Vaccination_Services-Home_Healthcare-Specialized_Geriatric_Medicine_Adminstration-English.pdf (Accessed May 2025) - Israel: MoH – 2023 Tiered reco (HD, aQIV & recombinant recommended first line solution)
https://www.gov.il/BlobFolder/reports/committee-infectious-diseases-vaccines-summary-2023/he/files_committees_committee-infectious-diseases-vaccines_CMV_08022023.pdf (Accessed May 2025) - Greece: National Vaccination Committee – 2024/2025 Tiered reco 65+ (HD & aQIV preferred to SD)
https://diavgeia.gov.gr/doc/%CE%A8%CE%96%CE%962465%CE%A6%CE%A5%CE%9F-%CE%A6%CE%992?inline=true (Accessed May 2025) - Italy: MoH – 2024/2025 Tiered reco (HD & aQIV recommended first line solution) https://www.trovanorme.salute.gov.it/norme/renderNormsanPdf?anno=2024&codLeg=100738&parte=1%20&serie=null (Accessed May 2025)
- Switzerland: Federal Office of Public Health (FOPH) – 2025; HD is preferentially recommended for 75+ and 65+ with an additional risk factor https://www.bag.admin.ch/dam/bag/en/dokumente/mt/infektionskrankheiten/grippe/empfehlung-grippeimpfung-kurz.pdf.download.pdf/empfehlungen-grippeimpfung-kurz-en.pdf « The vaccine Efluelda®, also inactivated and for i.m. administration, contains a higher antigen quantity and is more effective for older people. Therefore, persons aged 75 and older, and persons aged 65 and older with an additional risk factor as per the above list, should preferentially receive a high-dose influenza vaccine for better protection.» (Accessed May 2025)
- Portugal: DGS-2024
https://www.portugal.gov.pt/download-ficheiros/ficheiro.aspx?v=%3d%3dBQAAAB%2bLCAAAAAAABAAzNDEyMQMATV5VdgUAAAA%3d (Accessed May 2025) - France: Reco HD 65+ – 2025
HD Reco CTV: https://www.has-sante.fr/jcms/p_3604446/en/vaccination-contre-la-grippe-saisonniere-des-personnes-de-65-ans-et-plus-place-des-vaccins-efluelda-et-fluad (Accessed June 2025) - UK: JCVI – 2025 Advice for 2024/2025: https://www.gov.uk/government/publications/national-flu-immunisation-programme-plan-2025-to-2026/national-flu-immunisation-programme-2025-to-2026-letter#order%20%E2%80%8B%20%E2%80%9CFirst%20line%20vaccines%20for%20this%20age%20group%20(65+)%20include%20the%20adjuvanted%20influenza%20vaccine%20(aTIV),%20the%20high-dose%20influenza%20vaccine%20(TIV-HD/QIV-HD)%20and%20the%20recombinant%20influenza%20vaccine%20(TIVr/QIVr).%E2%80%8B%20There%20is%20strengthening%20evidence%20of%20additional%20benefit%20of%20the%20recombinant (Accessed March 2026)
- Belgium: Conseil Superieur de la Santé- 2026-2027 influenza season
https://www.hgr-css.be/en/report/9897/vaccination-against-seasonal-influenza-season-2026-2027
Both enhanced vaccines demonstrated clinical superiority over standard-dose vaccines, but the evidence quality is better for HD-IIV3 compared to aIIV3 - US: ACIP-2024-2025 Tiered reco 65+ (higher doses & adjuvanted recommended preferentially vs SD)
https://www.cdc.gov/mmwr/volumes/73/rr/rr7305a1.htm (Accessed May 2025) - Canada: Tiered Reco HD 65+
NACI 2025/2026 reco: https://www.canada.ca/en/public-health/services/publications/vaccines-immunization/national-advisory-committee-immunization-statement-seasonal-influenza-vaccines-2025-2026.html#a5.1 (Accessed May 2025) - Spain: MoH
https://vacunasaep.org/profesionales/noticias/vacunacion-antigripal-2024-25-recomendaciones-actualizadas-del-ministerio-de-sanidad (Accessed May 2025) HD recommended to be used over SD in specific at-risk groups in most of the regions - Denmark: Health Authority – 2026
https://www.sst.dk/media/btwfgzmz/sundhedsstyrelsens-indstilling-til-maalgrupper-for-saesonvaccination-2026.pdf#:~:text=Sundhedsstyrelsen%20har%20efter%20anmodning%20fra%20Indenrigs-%20og%20Sundhedsministeriet,sæson%202026%2C%20herunder%20også%20et%20estimat%20for%20målgruppestørrelser - Qatar: Ministry of Health Authority 2024-2025
Data on file - internal circular sent to all HCPS
« High-dose flu vaccines generally help prevent flu-related hospital stays better than the standard-dose flu vaccines. Studies also have found higher antibody levels in older adults who received high-dose flu vaccines. Hence high-dose flu vaccination is highly recommended for elderly individuals.”
“Ministry of Public Health indicates the High-Dose Quadrivalent Influenza Vaccine for active immunization against influenza in elderly population; 60 years and above.” - Taiwan: CDC – 2025
Taiwan CDC, data on file and 114年3月27日ACIP第1次會議紀錄.pdf
« According to existing literature, adjuvanted influenza vaccines or high-dose influenza vaccines provide better protection for the elderly aged 65 and above compared to traditional standard-dose influenza vaccines.
Furthermore, the evaluation by the Taiwan Center For Drug Evaluation has shown that they are cost-effective. Taiwan CDC is requested to comprehensively evaluate and prioritize adjuvanted influenza vaccines or high-dose influenza vaccines as new vaccine policy initiatives and actively seek funding.” - Japan: MHLW Vaccination Basic Policy committee – 2025
001639557.pdf
Gulf Countries Health Authorities preferentially recommend influenza high-dose vaccine for the Older adults
UAE MOHAP Preferably
recommend HD for their older adults.
Bahrain MOH Preferably
recommend HD for their older adults.
Qatar MOHP Preferably
recommend HD for their older adults.
In addition to scientific societies, independent expert groups advocate for the adoption of the HD vaccine to enhance protection for older adults- example
MENA-ISN and researchers from GCC countries have published an article advocating the implementation of HD seasonal influenza vaccine in these countries to improve the protection of individuals aged 65 years and older
- Al Awaidy ST, et al. J Epidemiol Glob Health. 2024;14(3):524-528. doi: 10.1007/s44197-024-00292-8.
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The Saudi Heart Association (SHA) has published a landmark Position Statement acknowledged HD cumulative evidence. |
The Saudi Heart Association (SHA) has published a landmark Position Statement on Adult Vaccinations for Cardiovascular Disease Patients – a testament to the power of HD evidence.
Influenza vaccination has been consistently associated with a reduction in mortality and hospitalizations" and highlights a 28% reduction in MACE and 41% reduction in cardiovascular mortality when vaccination is administered within three days of hospitalization for myocardial infarction
"For patients aged 60 and above, particularly those at increased risk such as individuals with cardiovascular conditions, the high-dose influenza vaccine is preferred as it offers superior immunogenicity and effectiveness compared to the standard dose. Lowering the eligibility age for high-dose vaccination to 60 years ensures enhanced protection in this vulnerable group. "
"In the context of Saudi Arabia, it is particularly important to advise patients to consult their healthcare provider prior to Hajj or Umrah in order to assess their medical fitness and reduce the risk of infection during these mass gatherings. SHA stated influenza, COVID-19, and meningococcal (quadrivalent ACWY) vaccination is mandatory for Hajj.
Weqaya preferably
recommend HD vaccine for their Older adults within the Adult National immunization schedule
UAE MOHAP Preferably
recommend HD for their older adults.
Bahrain MOH Preferably
recommend HD for their older adults.
Qatar MOHP Preferably
recommend HD for their older adults.
The Emirates Diabetes and Endocrine Society (EDES) has released its updated Type 2 Diabetes guideline, now recommending High-Dose influenza vaccination for older adults — recognizing this population's heightened vulnerability to influenza-related complications. This milestone reinforces the growing scientific consensus on tailored protection for those who need it most. Explore the full guideline recommendations here:
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