Enhanced flu vaccines?

10 October 2025

Premed does not recommend the use of the so-called enhanced flu vaccines for the working population.

Last week, the media communicated about an advice from the Superior Health Council (9879 of 14/7/2025). That advice gives the classic recommendations regarding flu vaccines for risk groups. Classic in the sense of “nothing new under the sun”.

There is one paragraph that could use a little more explanation.

Specific recommendations for enhanced vaccines in persons ≥ 65 years: For all persons aged 65 years and older, an enhanced flu vaccine (with adjuvant or high-dose) is preferably recommended over standard-dose vaccines.

Now there are some problems associated with this: these “stronger” vaccines are only available to a very limited extent and moreover they are considerably more expensive and only reimbursable by the RIZIV in a select number of cases, and then only with a very specific, stringent reimbursement procedure.

The RMG (Risk Management Group, you may remember it from the Covid pandemic, under the wings of the Federal Department of Public Health and Sciensano) clearly states these limitations in its advice of 4/9/2025.

This year, all available vaccines are trivalent. They are proven effective, and the already planned vaccination campaigns with these vaccines can simply proceed as foreseen. High-dose or adjuvant-containing vaccines (Efluelda®, Fluad®) can be useful for specific patient groups, such as the elderly with an additional immunodeficiency. However, these vaccines are not intended to be used as a standard solution for all over-65s. These vaccines must therefore be reserved for patients for whom the potential benefit is greatest. If access to high-dose or adjuvant vaccines proves difficult for this category of high-risk over-65s, the standard vaccine should be administered without delay. The core message remains that vaccination, regardless of which vaccine is used, is the most important factor in achieving health benefits.

Conclusion

The enhanced vaccines are reserved for people with the highest risks. These are not to be found among the working population. The most vulnerable patients are immunocompromised patients over 65 years of age, and persons who no longer come for consultation but are seen during home visits, such as residents of assisted living facilities, and home-dwelling over-85s.

The most important thing is that the target groups receive a flu vaccine. This does not necessarily have to be an enhanced vaccine.

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