Trends in influenza vaccine uptake before and during the COVID-19 pandemic in the USA

Objectives: To investigate trends of influenza vaccine uptake before and during the COVID-19 pandemic in the USA and explore the associated factors. Study design: This was a cross-sectional study. Methods: Using self-reported data from the National Health Interview Survey during 2014–2021 (response rates ranging from 50.7 to 70.1%), we estimated influenza vaccine uptake. Log-binomial regression models were used to test uptake changes with adjustment for and stratification by demographic and health factors. Results: We included 58,249 children (mean age: 8.7 years; male: 51.1%) and 205,034 adults (mean age: 47.6 years; male: 48.2%). The prevalence ratio (PR) of uptake change comparing the intra- (2020–2021) to the pre-COVID-19 period (2014–2019) was 0.72 among children, with a 10.7% reduction. Uptake changes were found across subgroups, with higher reduction among those aged 0–2 years, non-Hispanic Black and Hispanic ethnicity, from South and West regions, and with lower household income. For adults, uptake increased before and during COVID-19 (PR = 1.15, 95% confidence interval [CI]: 1.12–1.18) but a 2.3% reduction was found among healthcare personnel (PR = 0.95, 95% CI: 0.90–0.997). Conclusions: Influenza vaccination decreased during the COVID-19 pandemic among children and healthcare personnel. Structure inequality to influenza vaccination warrants measures to improve vaccine uptake among vulnerable groups.