Influenza Vaccination Coverage and Determinants of New Vaccinations During the COVID-19 Pandemic in Spain (ENE-COVID): Nationwide Population-Based Study.

Publication date: Jul 01, 2025

Influenza vaccination coverage is commonly suboptimal. However, the COVID-19 pandemic and consequent high exposure to health information may have changed population attitudes toward this vaccination. The aim of this study is to describe influenza vaccine uptake in Spain during the first influenza season following the start of the COVID-19 pandemic compared to the previous one and identify characteristics associated with vaccination among those previously unvaccinated. This was a population-based study of 28,987 adults included in influenza vaccination target groups (≥65 years old, with risk conditions, living with someone with risk conditions, health care workers, security or emergency workers) who were participants in the nationwide Seroepidemiological Survey of SARS-CoV-2 Infection in Spain (ENE-COVID) study. Information on vaccination and sociodemographic, health, and COVID-19-related factors was collected by interview. Coverage change from 2019 to 2020 and standardized prevalences of vaccination in 2020 among the population unvaccinated in 2019 were estimated using logistic model-based methods. Coverage rose from 31. 4% (95% CI 30. 5%-32. 2%) to 46. 8% (95% CI 45. 8%-47. 8%). People ≥65 years old showed the highest uptake in both periods (58. 3%, 95% CI 56. 8%-59. 8% and 74. 8%, 95% CI 73. 5%-76. 1%), while health care workers had the greatest increase (22%, 95% CI 17. 8%-26. 2%). Among people unvaccinated in 2019, factors associated with vaccination in 2020 were age, female sex, higher education, Spanish nationality, multimorbidity, being a former smoker, obesity, contact with COVID-19 cases, living with older adults, living in provinces with low COVID-19 incidence, wearing a face mask during family meetings, and using surgical/FFP2 masks. This study provides nationwide representative estimates of influenza vaccination coverage, which clearly increased between 2019 and 2020 in the 5 target groups. However, coverage goals were attained only in the ≥65 year old group, highlighting the importance of reinforcing influenza vaccination. Our detailed results on determinants of vaccination provide some clues to tailor vaccination strategies.

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