title: Influenza vaccination coverage rates in five European countries-a population-based cross-sectional analysis of two consecutive influenza seasons.
abstract: BACKGROUND
  Influenza continues to be a considerable health problem in Europe. Vaccination is the only preventive measure, reducing mortality and morbidity of influenza in all age groups.
  
  
  OBJECTIVE
  The objective of this survey was to assess the level of influenza vaccination coverage during two consecutive influenza seasons (2002/2003 and 2003/2004) in six European countries, to understand the driving forces and barriers to vaccination and to determine vaccination intentions for the following winter.
  
  
  METHODS
  We conducted a random-sampling, telephone-based household survey among non-institutionalised individuals representative of the population aged 14 and over. The surveys used the same questionnaire for two consecutive winters: 2002/2003 and 2003/2004 data were used for Germany, Italy, Spain and the United Kingdom. 2001/2002 and 2002/2003 data were used for France. The data were subsequently pooled. Four target groups were determined for analysis: (1) persons aged 65 and over; (2) people working in the medical field; (3) persons suffering from chronic illness and (4) a group composed of persons aged 65 and over or working in the medical field or suffering from a chronic illness.
  
  
  RESULTS
  The overall sample consisted of 20,118 individuals. The influenza vaccination coverage rate increased from 21.3% in the first season to 23.2% in the second season. The increase in coverage is statistically significant (p=0.01). The most frequent reasons for being vaccinated given by vaccines were: influenza, considered to be a serious illness which people wanted to avoid (55.8%), having received advice from the family doctor or nurse to be vaccinated (55.2%) and not wanting to infect family and friends (36.1%). Reasons for not being vaccinated mentioned by people who have never been vaccinated were: not expecting to catch influenza (40.4%), not having considered vaccination before (33.3%) and not having received a recommendation from the family doctor to be vaccinated (27.3%). Options encouraging influenza vaccination are: recommendation by the family doctor or nurse (53.1%), more available information on the vaccine regarding efficacy and tolerance (32.1%) and more information available about the disease (26.7%). Adjusted odds ratios for target group vaccination were between 3.6 (Germany) and 13.7 (UK). Vaccination rates among healthcare workers were generally very low. Adjusted odds ratios were between 0.7 (Germany) and 1.5 (Spain).
  
  
  CONCLUSIONS
  The vaccination coverage during the second season increased in comparison to the first season. The family doctor is the most important source of encouragement for people to be vaccinated against influenza. It seems that the public would be more likely to be vaccinated if they had more information on the efficacy and tolerance of the vaccine, as well as the disease. We, therefore, suggest that family doctors be better informed on influenza vaccine and the disease itself, so that they can actively inform their patients on these topics.
authors.affiliation: Institute for Social- and Preventive Medicine, University of Zurich, Department of Medical Economics, Gloriastrasse 18a, CH-8006 Zurich, Switzerland. thomas.szucs@ifspm.unizh.ch
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Szucs
authors.forename: Daniela
authors.initials: D
authors.lastname: Müller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006306:Health Surveys; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control*; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D007252:Influenza Vaccines