The influenza landscape and vaccination coverage in older adults during the SARS-Cov-2 pandemic: data from Several European Countries and Israel

Figures & data

Figure 1. Influenza vaccination coverage rates among older adults* in Europe, by country and influenza season (where data are available).

*Data are for ≥65-year-olds as per national regulation in each country except Germany and Netherlands (≥60 years), Slovakia (≥59 years) and Poland (>55 years)

The dotted line indicates the WHO and Council of the European Union target of 75% coverage for older adults.

Table 1. Burden of disease monitoring framework.

		Framework for national surveillance for influenza cases in older adults				Official recommendations for influenza vaccination for older adults		Is the influenza vaccine free of charge to older adults in your country?	Fee paid to vaccinators for administering the vaccine to older adults
	Weekly reports on influenza activity	Weekly	Hospitalisation rates	ICU admissions	Excess deaths (all causes)	Yes/No	Age definition	Yes/No	Yes/No	How much?	VCR in older adults*
Bulgaria	Yes [20]	Yes [20]	Yes	Yes	No	Yes	≥65 years [21]	Yes [21]	Yes	€2	14.0% (2021/22) [20]
Croatia	Yes [22]	Yes [22]	No	No	No	Yes	≥65 years [23–26]	Yes [23–26]	No	Not applicable	28.6% [22]
Czech Republic	Yes [27]	Yes	No	Yes	No	Yes	≥65 years [27]	Yes	Yes [28]	€7	20.8% (2021/22)
Estonia	Yes [29]	Yes [29]	Yes	Yes	No	Yes	≥60years [29]	Yes [29]	No	Not applicable	27.53% (65–79 years) 26.51% (≥80 years) [30]
France	Yes [31]	No [32]	Yes	Yes	Yes	Yes [33]	≥65 years	Yes [34]	Yes	€7.50–7.88 (nurses) €7.50–7.88 (pharmacists) €23 (doctors – included in consultation fee) [35,36]	56.2% [37–41]
Germany	Yes [42,43]	Yes [43]	Yes	Yes	Yes	Yes [44]	>60 years	Yes [45]	Yes [46]	€8	44.0% (2022/23)
Greece	Yes [47]	Not specified [47]	N/A	Yes	Yes	Yes	>60 years	Yes	No	Not applicable	73.0% (2020/21)
Italy	Yes	Yes	No	No	No	Yes	≥65 years	Yes	Yes	Varies	58.1%
Israel	Yes [48]	Yes [48]	No	No	Yes	Yes [49]	≥65 years	Yes [50]	Yes	Not applicable	58.8% [50]
Latvia	Yes [51]	No [51]	No	No	Yes	Yes [52]	≥65 years	Yes [53]	No	Not applicable	16.9%
Lithuania	Yes [54]	No [55]	No	No	No	Yes [56]	≥65 years	Yes [56,57]	Yes [58]	€2.34	23.0% [59,60]
Netherlands	Yes [61]	No [62]	No	No	Yes	Yes [63]	≥60 years	Yes [63]	Yes [63]	€11	74.1% (2020/21) [64]
Poland	Yes [65]	Yes [65]	Yes	No	Yes	Yes [65]	>55 years	Yes (free for all adults from November 2021) [66]	Yes [67]	PLZ 21.83	15–23% [68]
Portugal	Yes [69]	Yes [70]	Yes	Yes	Yes	Yes [71]	≥65 years	Yes [71]	No	Not applicable	83.2% (2022/23) [72]
Romania	Yes	No	No	No	Yes (integrated in annual influenza report)	Yes	>65 years	Yes	Yes	Not applicable	53.4% (2021/22)
Serbia	Yes	Yes	No (cases in older adults not reported publicly)	No	No	Yes [73]	≥65 years	Yes	No	Not applicable	14.21%
Slovakia	Yes [74]	Yes	No	No	No	Yes [74]	≥59 years	Yes	Yes	€5.60–6.32	5.6% [74]
Spain	Yes [75]	Yes [75]	Yes	Yes	Yes	Yes [76]	≥65 years (national threshold, with region variation)	Yes	No	Not applicable	64.0% (2021/22)
United Kingdom	Yes [77,78]	Yes [77,78]	Yes	Yes	Yes	Yes [79]	≥65 years	Yes [80]	Yes [81]	£10.06	79.9% [82]

*Data for 2022/23 season unless stated otherwise

Table 2. Source data for burden of disease.

Country	SOURCE OF DATA	REPORTED BURDEN	REFERENCES
Bulgaria	No data available
Croatia	Published literature available from open-access websites and databases, interviews with experts and individual hospital data	Reported cases (including deaths and deaths in ICU) GP visits/hospitalizations for circulatory diseases Hospitalizations for influenza in older adults	[22,83–87]
Czech Republic	Published literature obtained from open-access websites and databases, and interviews with experts	Reported cases in older adults (including deaths) Outpatient GP consultancy accounted for 35% of economic burden ICU admissions for severe influenza (including among older adults)	[88,89]
Estonia	National databases only	Reported cases, including older adults From 2012, the number of reported flu diagnoses among people ≥65 years increased owing to improved reporting, and 31.8% of all the diagnosed people in this age group needed hospitalization ICU admission and deaths decreased in older adults in 2019 (up to 2021) 94.7% of all deaths due to influenza in 2018 were in people aged ≥65 years; however, the proportion dropped to 84.2% in 2019	[90–94]
France	Published literature obtained from national databases (French Hospital information Database [PMSI], the French Sentinels Network and the Assistance Publique-Hôpitaux de Paris [AP-HP]) and from individual hospital data.	Between 2010/11 to 2017/18, the proportion of hospitalizations (influenza-associated respiratory), associated costs and excess mortality in older adults were 70%, 77% and >90% respectively Older adults had longer length of hospital stays, in-patient mortality and 3-month readmission rates (respiratory and cardiac) compared with younger patients Higher rates of excess hospitalization for pneumonia, influenza and respiratory causes in older adults from 2011/12 season However, lower cumulative incidence of influenza-like illness in older adults between 2014 and 2019, possibly due to previous exposure and greater vaccine coverage Older adults most affected in seasons where A(H2N2) was dominant In the 2016/17 season, patients aged ≥60 years accounted for 86% of the hospitalized days; in patients aged ≥80 years, the proportion of hospitalizations for severe influenza reached 48%, and the proportion of deaths was 10% (32% of deaths with ICU admission), with 54% of all deaths in this age group Age >65 years was an independent prognostic factor associated with 28-day mortality	[95–99]
Germany	Published literature obtained from national databases/registries and insurance claims databases and directly from national databases.	Older adults more likely to have at least one chronic condition over nine seasons (2010/11 to 2018/19) Incidence rate of influenza lowest in older adults, but this group had a higher probability of hospitalization and longer hospital stays due to influenza than younger age groups	[100–106]
Greece	National Public Health Organisation and a sentinel network in primary healthcare.	The majority of non-hospitalized, laboratory-confirmed deaths (2010/11 to 2017/18) were in unvaccinated patients aged >65 years	[107]
Israel	Israeli Ministry of Health seasonal influenza summaries.	Excess hospitalizations and hospitalization days were particularly high in very old patients (≥85 years) as well as in the youngest patients	[108–115]
Italy	Published literature and from the integrated findings of various surveillance systems of influenza-like illness.	Seasonal influenza up to 2020 representsed a significant burden in high-risk groups such as those aged ≥65 years This age group had significantly increased risk of influenza-related complications and six-times greater excess influenza-related deaths than the general population In the 2013/14 to 2016/17 seasons, death -rate peaks were especially prominent in older adults, and the majority of influenza related deaths were in older adults High incidence rates during 2016/17 to 2021/22 seasons in older adults and the majority of severe cases and deaths occurred in older adults (mean age 68 years)	[116–123]
Latvia	Latvian Centre of Disease Prevention and Control	Across the 2010/11 to 2019/20 seasons, the ≥65 year age group accounted for 23% of influenza or influenza plus pneumonia-related hospitalizations	[124]
Lithuania	Published literature and National Health Database	Age-specific seasonal influenza vaccine effectiveness over four influenza seasons (2014/15–2018/19) for in-patients aged ≥65 years suggested high vaccine effectiveness against influenza B in this elderly age group The collection of aggregated data prevents age-specific reporting	[125–127]
Netherlands	The State of Infectious Diseases in The Netherlands report	Influenza infection was negligible during COVID but a steep rise was observed following the end of the last lockdown period Influenza led to a high burden of disability-adjusted life years – no age-specific data available	[128]
Poland	Published reviews of the published literature, websites, databases, interviews with experts, and the Polish National Institute of Public Health	Between 2016/17 and 2019/20, more than half of deaths due to influenza occurred in those ≥65 years Owing to the large older adult population, there was a high clinical (GP and hospital care) burden Despite low influenza incidence rates (2011 and 2012) in the ≥65 year group, this group had the highest rate of influenza-related hospitalizations and a high fatality rate Between 2016/17 and 2018/19, people aged ≥65 years comprised around 30% of confirmed cases	[88,129–134]
Portugal	Data from the National Health Service	Between 2008/9 to 2017/19, 46% of influenza hospitalizations were in patients aged ≥65 years, increasing to 60% in 2017/18 62% of those hospitalized with influenza and comorbidities were in this age group Influenza-associated deaths were highest in the ≥65-year and ≥75-year groups	[135]
Romania	Published literature based on a health administrative database.	In the 2014/15 to 2018/19 seasons, the highest rates of incidence, hospitalization and presentation to the emergency department were in the age groups 0–4 years and ≥65 years, and the highest mortality rate was in the ≥65-year age group	[136]
Serbia	A published modelling study.	Estimated mean annual respiratory excess mortality rates were 6.6 per 100,000 in the 65–74-year age group and 17.9 in the >75-year age group	[137]
Slovakia	A case–control study using the administrative data of one health insurance company.	Influenza vaccine reported as protective in ≥65-year-olds, with a significant difference in the all-cause mortality rates between vaccinated and unvaccinated participants in this age group (2017/18–2021/22 [with the exception of the 2020/21 season and during the 2018/19 season])	[138]
Spain	Published literature and based on the Spanish Influenza Sentinel Surveillance System and from a retrospective study and a case-control study	Rates of severe hospitalized confirmed influenza cases were highest in older adults (2009/10 to 2015/16), whereas the rates of mild confirmed influenza cases were lowest in this group – fatality rate was 18% in those ≥65 years During 2008/9 to 2017/18, nearly 70% of hospitalizations with a diagnosis of influenza were in patients aged ≥65 years and mean in-patient fatality increased with age Patients ≥65 years accounted for 53% of the mean annual hospitalization costs and 76% of the mean annual cost of influenza-associated excess cardiac and respiratory hospitalizations Influenza vaccination was effective in preventing hospitalizations in elderly individuals	[139–141]
United Kingdom	Annual surveillance of influenza and other respiratory viruses and from the published literature.	Between 2012/13 and 2020/21, high levels of excess mortality were reported, with increased outbreaks in care homes across most seasons but particularly in the 2014/15, 2016/17 and 2018/19 seasons, during which influenza A(H3N2) was the predominant circulating strain The cumulative number of deaths in England associated with influenza was highest in those aged ≥65 years compared with the total for all age groups (2015/16 to 2019/20 seasons) Over ten seasons (2010/11 to 2019/20), the burden of influenza (hospitalizations and GP consultations) was prominent in populations with underlying clinical conditions and in relation to age	[19,142–150]

National Centre for Infectious and Parasitic Diseases. 2023 [cited 2023 Aug 14]. Available from: https://www.ncipd.org/index.php?lang=bg

 Google Scholar

Ministry of Health Bulgaria. 2023 [cited 2023 Aug 14]. Available from: https://www.mh.government.bg/en/

 Google Scholar

Croatian Institute of Public Health. Influenza in Croatia in the 2022/23 seasons (week 19, 2023). 2023 [cited 2023 Nov 1]. Available from: https://www.hzjz.hr/sluzba-epidemiologija-zarazne-bolesti/gripa-u-hrvatskoj-u-sezoni-2022-2023-19-tjedan-2023/

 Google Scholar

Státní zdravotní ústav. 2023 [cited 2023 Aug 14]. Available from: https://szu.cz/tema/a-z-infekce/ch/chripka/ockovani-proti-chripce-sezona-2022-2023-the-flu-vaccination-2022-2023-season/

 Google Scholar

Parlament České republiky. 2023 [cited 2023 Aug 14]. Available from: https://www.psp.cz/sqw/sbirka.sqw?cz=473&r=2021%20or%20https://www.zakonyprolidi.cz/cs/2021-473

 Google Scholar

Terviseamet. 2023 [cited 2023 Aug 14]. Available from: https://www.terviseamet.ee/et/nakkushaigused/tervishoiutootajale/nakkushaigustesse-haigestumine/gripp-ja-gripilaadsetesse

 Google Scholar

Meditsiini-Uudised. Gripi vastu lasi end vaktsineerida umbes iga kümnes inimene. MU. [cited 2023 Aug 14]. Available from: https://www.mu.ee/uudised/2023/05/29/gripi-vastu-lasi-end-vaktsineerida-umbes-iga-kumnes-inimene

 Google Scholar

Sante Publique. Flu epidemiological bulletin, week 18. Preliminary report. 2022-2023 season. 2023 [cited 2023 Aug 14]. Available from: https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-et-infections-respiratoires/grippe/documents/bulletin-national/bulletin-epidemiologique-grippe-semaine-18.-bilan-preliminaire.-saison-2022-2023

 Google Scholar

Sante Publique. Health monitoring of mortality. Weekly update of June 20, 2023. 2023 [cited 2023 Aug 14]. Available from: https://www.santepubliquefrance.fr/surveillance-syndromique-sursaud-R/documents/bulletin-national/2023/surveillance-sanitaire-de-la-mortalite.-point-hebdomadaire-du-20-juin-2023

 Google Scholar

Sante Publique. Flu. 2023 [cited 2023 Aug 14]. Available from: https://vaccination-info-service.fr/Les-maladies-et-leurs-vaccins/Grippe

 Google Scholar

l’Assurance Maladie. Vaccination campaign against seasonal influenza 2022-2023. 2023 [cited 2023 Aug 14]. Available from: https://www.ameli.fr/medecin/sante-prevention/vaccination-grippe-saisonniere

 Google Scholar

l’Assurance Maladie. Conventional rates for general practitioners in metropolitan France. 2023 [cited 2023 Aug 14]. https://www.ameli.fr/medecin/exercice-liberal/facturation-remuneration/consultations-actes/tarifs/tarifs-generalistes/tarifs-metropole

 Google Scholar

l’Assurance Maladie. Vaccination by the nurse. 2023 [cited 2023 Aug 14]. Available from: https://www.ameli.fr/infirmier/exercice-liberal/service-patient/vaccination-par-infirmier

 Google Scholar

Arbeitsgemeinschaft Influenza. Wochenberichte der AGI. 2023 [cited 2023 Aug 14]. Available from: https://influenza.rki.de/Wochenberichte.aspx

 Google Scholar

Arbeitsgemeinschaft Influenza. 2023 [cited 2023 Aug 14]. Available from: https://influenza.rki.de/Arbeitsgemeinschaft.aspx

 Google Scholar

Robert Koch Institut. Hochdosis-Impfstoff (Stand: 16.9.2022). 203. [cited 2023 Aug 14]. Available from: https://www.rki.de/SharedDocs/FAQ/Impfen/Influenza/Hochdosis-Impfstoffe/FAQ-Liste.html

 Google Scholar

Gemeinsamer Bundesausschuss. Schutzimpfungs-Richtlinie. 2023 [cited 2023 Aug 14]. Available from: https://www.g-ba.de/richtlinien/60/

 Google Scholar

Kassenärzliche Vereinigumg Bayerns. Informationen rund ums Impfen. 2023 [cited 2023 Aug 14]. Available from: https://www.kvb.de/mitglieder/verordnungen/impfungen/

 Google Scholar

National Public Health Organization. COVID-19 Guidelines. 2021 [cited 2023 Aug 14]. Available from: https://eody.gov.gr/

 Google Scholar

Ministry of Health Israel. Surveillance Report on morbidity due to respiratory viruses, weeks 14/2022 to 14/2022 (3/10/21-9/4/22). 2023 [cited 2023 Aug 14]. Available from: https://www.gov.il/en/departments/publications/?OfficeId=104cb0f4-d65a-4692-b590-94af928c19c0&limit=10&publicationType=9698793e-48f5-4941-8555-b67ca738db63&topic=430fb082-839f-43f3-a58f-3d4d59905e57&subTopic=f164f857-d211-41f1-9bf5-da7b5d1785ab&skip=0

 Google Scholar

Ministry of Health Israel. Vaccines in adulthood. 2023 [cited 2023 Aug 14]. Available from: https://www.health.gov.il/Subjects/Geriatrics/HealthPromotionAndPreventiveMedicine/Tests_drugs_and_vaccines/Pages/Vaccines_In_Elderly.aspx#:~:text=%D7%97%D7%99%D7%A1%D7%95%D7%9F%20%D7%9B%D7%A0%D7%92%D7%93%20%D7%A9%D7%A4%D7%A2%D7%AA%20%D7%9E%D7%95%D7%9E%D7%9C%D7%A5%20%D7%9C%D7%9B%D7%9C%D7%9C,%D7%9C%D7%90%D7%A0%D7%A9%D7%99%D7%9D%20%D7%A9%D7%9E%D7%98%D7%A4%D7%9C%D7%99%D7%9D%20%D7%91%D7%A7%D7%A9%D7%99%D7%A9%D7%99%D7%9D%20%D7%90%D7%95%20%D7%91%D7%97%D7%95%D7%9C%D7%99%D7%9D

 Google Scholar

Ministry of Health Israel. 2023 [cited 2023 Aug 14]. Available from: https://www.gov.il/BlobFolder/reports/flu-15042023/he/files_weekly-flu-corona_flu_he_flu_15042023.pdf.

 Google Scholar

Slimību profilakses un kontroles centrs. Pārskati par akūtu augšējo elpceļu infekciju, gripas un COVID-19 izplatību. 2023 [cited 2023 Aug 14]. Available from: https://www.spkc.gov.lv/lv/parskati-par-akutu-augsejo-elpcelu-infekciju-gripas-un-covid-19-izplatibu?utm_source=https%3A%2F%2Fwww.google.com%2F

 Google Scholar

Slimību profilakses un kontroles centrs. Imunizācijas valsts padome. 2023 [cited 2023 Aug 14]. Available from: https://www.vm.gov.lv/lv/imunizacijas-valsts-padome

 Google Scholar

Slimību profilakses un kontroles centrs. Vakcinācija pret gripu un Covid-19. 2023 [cited 2023 Aug 14]. Available from: https://www.spkc.gov.lv/lv/vakcinacija-pret-gripu-un-covid-19

 Google Scholar

National Public Health Center under the Ministry of Health. MorbIdity data. 2023 [cited 2023 Aug 14]. Available from: https://nvsc.lrv.lt/lt//uzkreciamuju-ligu-valdymas/uzkreciamosios-ligos/gripas-1/sergamumo-duomenys

 Google Scholar

National Public Health Centre under the Ministry of Health. [cited 2023 Aug 14]. Available from: https://nvsc.lrv.lt/en/

 Google Scholar

Ministry of Health Protection of the Republic of Lithuania. The flu. 2023 [cited 2023 Aug 14]. Available from: https://sam.lrv.lt/lt/veiklos-sritys/visuomenes-sveikatos-prieziura/uzkreciamuju-ligu-valdymas/gripas

 Google Scholar

National Public Health Center under the Ministry of Health. Flu vaccine. 2023 [cited 2023 Aug 14]. Available from: https://nvsc.lrv.lt/lt/uzkreciamuju-ligu-valdymas/uzkreciamosios-ligos/gripas-1/gripo-vakcina

 Google Scholar

Ministry of Health of The Republic of Lithuania. 2023 [cited 2023 Aug 14]. Available from: https://sam.lrv.lt/en/

 Google Scholar

Vakcinos nuo sezoninio gripo sunaudojimas 2022/2023. 2023 [cited 2023 Aug 14]. Available from: https://nvsc.lrv.lt/uploads/nvsc/documents/files/2023%2006%2013%20vakcin%C5%B3%20nuo%20sezoninio%20gripo%20sunaudojimas.pdf

 Google Scholar

Officailios statitikos portalas. Residents of Lithuania (2022 edition): population and composition. 2023 [cited 2023 Aug14]. Available from: https://osp.stat.gov.lt/lietuvos-gyventojai-2022/salies-gyventojai/gyventoju-skaicius-ir-sudetis

 Google Scholar

NIVEL. Flu: Influenza Newsletters. 2023 [cited 2023 Aug 14]. Available from: https://www.nivel.nl/nl/resultaten-van-onderzoek/griep-centraal-weekcijfers-en-meer/griep-influenza-nieuwsbrieven

 Google Scholar

Rijksinstituut voor Volksgezondheid en Milieu. Annual report Surveillance of COVID-19, influenza and other respiratory infections in the Netherlands: winter 2021/2022. 2023 [cited 2023 Aug 14]. Available from: https://www.rivm.nl/publicaties/annual-report-surveillance-of-covid-19-influenza-and-other-respiratory-infections-in-0

 Google Scholar

Nederlands Huisarten Genootschap. Practical Guide Flu Vaccination. 2023 [cited 2023 Aug 14]. Available from: https://www.nhg.org/praktijkvoering/vaccinatieprogrammas/praktijkhandleiding-griepvaccinatie/

 Google Scholar

NIVEL. Vaccination rate National Program Pneumococcal Vaccination Adults 2021: monitor in brief. 2021 [cited 2023 Aug 14]. Available from: https://www.nivel.nl/nl/publicatie/vaccinatiegraad-nationaal-programma-pneumokokkenvaccinatie-volwassenen-2021-monitor-het

 Google Scholar

Narodowy Instytut Zdrowia Publicznego. http://wwwold.pzh.gov.pl/oldpage/epimeld/grypa/index.htm

 Google Scholar

Wilcez M. Notes from Poland: Poland Launches free flu vaccine for all adults. [cited 2023 Sep 14]. Available from: https://notesfrompoland.com/2021/11/22/poland-launches-free-flu-vaccines-for-all-adults/#:~:text=Poland’s%20government%20has%20made%20influenza,the%20case%20–%20needing%20a%20prescription

 Google Scholar

Narodowy Fundusz Zdrowia. 2023 [cited 2023 Aug 14]. Available from: https://www.nfz.gov.pl/aktualnosci/aktualnosci-centrali/szczepienia-przeciwko-grypie-sprawdz-gdzie-sie-zaszczepisz,8255.html

 Google Scholar

Szczepienia. Jaki jest poziom zaszczepienia przeciw grypie w Polsce?. 2023 [cited 2023 Aug 14]. https://szczepienia.pzh.gov.pl/faq/jaki-jest-poziom-zaszczepienia-przeciw-grypie-w-polsce/

 Google Scholar

Serviço Nacional de Saúde. Flu surveillance. 2023 [cited 2023 Aug 14]. Available from: https://www.insa.min-saude.pt/?s=vigil%C3%A2ncia+da+gripe

 Google Scholar

Serviço Nacional de Saúde. Resultados da Pesquisa por: vigilância da gripe. 2023 [cited 2023 Aug 14]. Available from: https://www.insa.min-saude.pt//?s=vigil%C3%A2ncia+da+gripe

 Google Scholar

Serviço Nacional de Saúde. 2023 [cited 2023 Aug 14]. Available from: https://www.dgs.pt/

 Google Scholar

Sociedade Portuguesa de Pneumologia. VACCINÔMETRO® - final data for the 2022/2023 flu season reveal that 83.2% of Portuguese people aged 65 or over will have been vaccinated. 2023 [cited 2023 Aug 14]. Available from: https://www.sppneumologia.pt/noticias/vacinometro-dados-finais-da-epoca-gripal-de-2022-2023-revelam-que-832-dos-portugueses-com-65-ou-mais-anos-de-idade-terao-sido-vacinados

 Google Scholar

Institute of Public Health Serbia. Professional and methodological guidelines for implementation of mandatory and recommended immunization of population for 2023. 2023 [cited 2023 Aug 14]. Available from: https://www.batut.org.rs/download/SMUredovneImunizacije2023.pdf

 Google Scholar

Slovak Public Health Office. Flu. 2023 [cited 2023 Aug 14]. Available from: https://www.uvzsr.sk/web/uvz/chripka

 Google Scholar

Carlos III Health Institute. Sentinel surveillance of acute respiratory infection -. Weekly reports. 2023 [cited 2023 Aug 14]. Available from: https://www.isciii.es/QueHacemos/Servicios/VigilanciaSaludPublicaRENAVE/EnfermedadesTransmisibles/Paginas/VIGILANCIA-CENTINELA-DE-INFECCION-RESPIRATORIA-AGUDA.aspx

 Google Scholar

Sistema Nacional de Salud. Recomendaciones de vacunación frente a la gripe temporada 2022-2023. 2023 [cited 2023 Aug 14]. Available from: https://www.sanidad.gob.es/areas/promocionPrevencion/vacunaciones/programasDeVacunacion/docs/Recomendaciones_vacunacion_gripe.pdf

 Google Scholar

Public Health England. PHE influenza surveillance graphs. 2023 [cited 2023 Aug 14]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/860300/PHE_Influenza_Surveillance_graphs_2019_2020_week_4.pdf

 Google Scholar

GOV.UK. National flu and COVID-19 surveillance reports: 2022 to 2023 season. 2023 [cited 2023 Aug 14]. Available from: https://www.gov.uk/government/statistics/national-flu-and-covid-19-surveillance-reports-2022-to-2023-season?utm_medium=email&utm_campaign=govuk-notifications-topic&utm_source=8d133ecf-62b9-480a-803b-bfd9f7f518ab&utm_content=daily.

 Google Scholar

GOV.UK. National flu immunisation programme 2023 to 2024 letter. 2023 [cited 2023 Aug 14]. Available from: https://www.gov.uk/government/publications/national-flu-immunisation-programme-plan/national-flu-immunisation-programme-2023-to-2024-letter

 Google Scholar

GOV.UK. General medical services statement of financial entitlements directions. 2023 [cited 2023 Aug 14]. Available from: https://www.gov.uk/government/publications/general-medical-services-statement-of-financial-entitlements-directions

 Google Scholar

NHS England. Investment and Evolution: Update to the GP contract agreement 2020/21 – 2023/24. 2023 [cited 2023 Aug 14]. Available from: https://www.england.nhs.uk/publication/investment-and-evolution-update-to-the-gp-contract-agreement-20-21-23-24/

 Google Scholar

GOV.UK. Seasonal influenza vaccine uptake in GP patients: monthly data, 2022 to 2023. 2023 [cited 2023 Aug 14]. Available from: https://www.gov.uk/government/statistics/seasonal-influenza-vaccine-uptake-in-gp-patients-monthly-data-2022-to-2023?utm_medium=email&utm_campaign=govuk-notifications-topic&utm_source=d85f594d-ffa6-48c8-a65c-22803e71ae83&utm_content=daily

 Google Scholar

Kovács G, Kaló Z, Jahnz-Rozyk K, et al. Medical and economic burden of influenza in the elderly population in central and eastern European countries. Human Vaccines Immunother. 2014;10(2):428–440. doi: 10.4161/hv.26886

 PubMed Web of Science ®Google Scholar

Kynčl J. Chřipka v roce 2020. Med praxi. 2020;17(4):212–214. doi: 10.36290/med.2020.040

 Google Scholar

EODY. Annual epidemiological report. 2021 [cited 2023 Apr]. Available from: https://eody.gov.gr/epidimiologika-statistika-dedomena/etisies-epidimiologikes-ektheseis/#heading-4%20

 Google Scholar

Centre of Disease Prevention and Control. Latvia.

 Google Scholar

Rijksinstitut voor Volksgezondheid en Milieu. In: Ministerie van Volksgezondheid WeS, editor. Staat van infectieziekten in Nederland 2021. 2022. https://www.rivm.nl/publicaties/staat-van-infectieziekten-in-nederland-2022s.

 Google Scholar

Froes F, Carmo M, Lopes H, et al. Excess hospitalizations and mortality associated with seasonal influenza in Portugal, 2008–2018. BMC Infect Dis. 2022;22(1):726. doi: 10.1186/s12879-022-07713-8

 PubMed Web of Science ®Google Scholar

Pană A, Pistol A, Streinu-Cercel A, et al. Burden of influenza in Romania. A retrospective analysis of 2014/15 - 2018/19 seasons in Romania. Germs. 2020;10(4):201–209. doi: 10.18683/germs.2020.1206

 PubMedGoogle Scholar

Iuliano AD, Roguski KM, Chang HH, et al. Estimates of global seasonal influenza-associated respiratory mortality: a modelling study. Lancet (London, England). 2018;391(10127):1285–1300. doi: 10.1016/S0140-6736(17)33293-2

 PubMed Web of Science ®Google Scholar

Igtokovidova P, Szalay T, Kri§tafkova Z, et al. Effect of influenza vaccination on seasonal mortality. Zdravotnicke listy. 2023;11(4):6. accepted for publication 20 November.

 Google Scholar

Public Health England. Surveillance of influenza and other seasonal respiratory viruses in the UK Winter 2020 to 2021. 2021 [cited 2023 Mar]. Available from: https://webarchive.nationalarchivesgov.uk/ukgwa/20220401215804/https://www.gov.uk/government/statistics/annual-flu-reports

 Google Scholar