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Influenza-65 years and over

Enhanced flu vaccines give older Australians stronger protection.

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Key Summary

  • Why it matters: Adults aged 65+ face the highest risk of hospitalisation and death from influenza in Australia. In 2024, nearly half of flu hospitalisations and most flu-related deaths were in this age group.
  • Immune response: Older immune systems don’t respond as strongly to standard flu vaccines, so enhanced vaccines have been developed.
  • Enhanced vaccines available:
    • Fluad® Quad (adjuvanted) — free under the National Immunisation Program for people aged 65+.
    • Fluzone® High-Dose Quad — available privately and preferred over standard-dose vaccines, though not NIP-funded.
  • Effectiveness: Enhanced vaccines offer better protection in older adults, especially against A(H3N2) strains, which are more severe in this age group.
  • Recommendation: Annual flu vaccination is strongly recommended for all adults aged 65+. Speak with your GP or pharmacist about the best option.

About

Older people’s immune systems do not respond to flu vaccines compared to younger people so enhanced influenza vaccines have been developed. In Australia an adjuvanted influenza vaccine is registered for use in people aged 65 and over and is free under the National Immunisation Program (NIP). It is a quadrivalent vaccine (which covers 4 strains of the influenza virus), as well as an ingredient (the adjuvant) that helps boost the immune response.

Overview

Adults aged 65 years and over face the highest influenza-associated mortality rates in Australia1. Vaccination in this age group has been shown to significantly reduce hospitalisations from influenza and pneumonia, as well as all-cause mortality2.

In 2024, among adults hospitalised with influenza in sentinel hospitals, nearly half were aged 65 years or over, and the median age of adults admitted with influenza was 623. Of the 1,002 deaths involving influenza recorded in 2024, the majority occurred in older adults, with a median age of 83 years3.

Enhanced Influenza Vaccines for Older Adults

Older people’s immune systems don’t respond to flu vaccines as well as that of younger people so enhanced influenza vaccines have been developed. In Australia an adjuvanted influenza vaccine (Fluad® Quad)  is registered for use in people aged 65 and over and is free under the NIP. It is a quadrivalent vaccine (which covers 4 strains of the influenza virus), as well as an ingredient (the adjuvant) that helps boost the immune response.

Additionally, the high-dose quadrivalent influenza vaccine (Fluzone® High-Dose Quad) is also recommended for adults aged 65 and over, where available4. While not funded under the NIP, it may be offered privately and is preferred over standard-dose vaccines in this age group.

Vaccine Effectiveness

Flu vaccines significantly reduce the risk of serious outcomes such as hospitalisation, pneumonia, and death among older adults3. Enhanced vaccines in particular have demonstrated improved effectiveness in this age group, especially during seasons with high circulation of A(H3N2) strains which is more common and severe in older people5.

Recommendations

  • Annual influenza vaccination is strongly recommended for all adults aged 65 and over.
  • Individuals should consult their GP or healthcare provider to ensure timely vaccination and to discuss any other preventative measures or health concerns.

References

  1. Li-Kim-Moy J, Yin JK, Patel C, et al. Australian vaccine preventable disease epidemiological review series: influenza 2006 to 2015. Communicable Diseases Intelligence 2016;40:E482-95.
  2. Jefferson T, Di Pietrantonj C, Al-Ansary LA, et al. Vaccines for preventing influenza in the elderly. Cochrane Database of Systematic Reviews 2010;(2):CD004876. doi:10.1002/14651858.CD004876.pub3.
  3. Australian Government Department of Health and Aged Care. 2024 Annual Australian Respiratory Surveillance Report [Internet]. Canberra: Australian Government Department of Health and Aged Care; 2025 [cited 2025 May 8]. Available from: https://www.health.gov.au/resources/publications/annual-australian-respiratory-surveillance-report-2024
  4. Australian Technical Advisory Group on Immunisation (ATAGI). Influenza (flu): Adults [Internet]. Canberra: Australian Government Department of Health and Aged Care; 2024 [cited 2025 May 8]. Available from: https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/influenza-flu#adults
  5. Australian Technical Advisory Group on Immunisation (ATAGI). Influenza (flu): Influenza vaccines in adults aged ≥60 years [Internet]. Canberra: Australian Government Department of Health and Aged Care; 2024 [cited 2025 May 8]. Available from: https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/influenza-flu#influenza-vaccines-in-adults-aged-60-years