Barriers to pandemic influenza vaccination and uptake of seasonal influenza vaccine in the post-pandemic season in Germany

Merle M Böhmer, Dietmar Walter, Gerhard Falkenhorst, Stephan Müters, Gérard Krause, Ole Wichmann, Merle M Böhmer, Dietmar Walter, Gerhard Falkenhorst, Stephan Müters, Gérard Krause, Ole Wichmann

Abstract

Background: In Germany, annual vaccination against seasonal influenza is recommended for certain target groups (e.g. persons aged ≥60 years, chronically ill persons, healthcare workers (HCW)). In season 2009/10, vaccination against pandemic influenza A(H1N1)pdm09, which was controversially discussed in the public, was recommended for the whole population. The objectives of this study were to assess vaccination coverage for seasonal (seasons 2008/09-2010/11) and pandemic influenza (season 2009/10), to identify predictors of and barriers to pandemic vaccine uptake and whether the controversial discussions on pandemic vaccination has had a negative impact on seasonal influenza vaccine uptake in Germany.

Methods: We analysed data from the 'German Health Update' (GEDA10) telephone survey (n=22,050) and a smaller GEDA10-follow-up survey (n=2,493), which were both representative of the general population aged ≥18 years living in Germany.

Results: Overall only 8.8% of the adult population in Germany received a vaccination against pandemic influenza. High socioeconomic status, having received a seasonal influenza shot in the previous season, and belonging to a target group for seasonal influenza vaccination were independently associated with the uptake of pandemic vaccines. The main reasons for not receiving a pandemic vaccination were 'fear of side effects' and the opinion that 'vaccination was not necessary'. Seasonal influenza vaccine uptake in the pre-pandemic season 2008/09 was 52.8% among persons aged ≥60 years; 30.5% among HCW, and 43.3% among chronically ill persons. A decrease in vaccination coverage was observed across all target groups in the first post-pandemic season 2010/11 (50.6%, 25.8%, and 41.0% vaccination coverage, respectively).

Conclusions: Seasonal influenza vaccination coverage in Germany remains in all target groups below 75%, which is a declared goal of the European Union. Our results suggest that controversial public discussions about safety and the benefits of pandemic influenza vaccination may have contributed to both a very low uptake of pandemic vaccines and a decreased uptake of seasonal influenza vaccines in the first post-pandemic season. In the upcoming years, the uptake of seasonal influenza vaccines should be carefully monitored in all target groups to identify if this trend continues and to guide public health authorities in developing more effective vaccination and communication strategies for seasonal influenza vaccination.

Figures

Figure 1
Figure 1
Seasonal vaccination coverage by age group and target group, season 2009/10.
Figure 2
Figure 2
Trends in seasonal vaccine uptake in target groups in Germany for seasons 2007/08−2010/11 according to GEDA09 and GEDA10(filled symbols)and a follow-up sample of GEDA10(empty symbols).1 Data source: GEDA09 (n=15,552) [12]; 2 Data source: GEDA10 (n=22,009); 3 Data source: GEDA10 (n=13,040); 4 Data source: GEDA follow-up survey (n=2,492).

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