Latest U.S. Flu Vaccination Coverage Estimates Continue to Show Concerning Drops in Coverage Among People at Increased Risk for Flu Complications

February 25, 2002 — CDC’s systems for monitoring during-season flu vaccination uptake continue to show some concerning trends. From mid-October 2021 to the end of January 2022, flu vaccination coverage is lower so far this season compared with last season for most groups, including some groups who are at higher risk for severe flu or complications of flu, such as pregnant people and infants and young children. Coverage was lower as well among racial and ethnic minorities compared with both last season and seasons prior to the COVID-19 pandemic. Understanding and reversing these drops in coverage will be important.

Vaccination coverage was 44.3% as of Jan. 29, 2022, for all adults 18 years and older, and by age group, it was:

  • 33.7% for adults 18-49 years,
  • 49.3% for adults 50-64 years, and
  • 66.6% for adults 65 years and older.

These are similar to coverage rates from the end of January during the 2020-2021 flu season, when coverage was 44.6% for all adults 18 years and older, 33.5% for adults 18-49 years old, 48.5% for adults 50-64 years old, and 66.7% for adults 65 years and older.

The latest in-season vaccination coverage estimates for adults also show that there are large racial/ethnic disparities compared with coverage for White, non-Hispanic adults (49.3%),

  • 14 percentage points lower for Black, non-Hispanic adults (35.3%)
  • 15 percentage points lower for Hispanic adults (34.0%)
  • 13 percentage points lower for Other/Multiple Races, non-Hispanic adults (36.4%)
  • 15 percentage points lower for American Indian/Alaskan Native, non-Hispanic adults (34.8%)
  • 14 percentage points lower for Pacific-Islander/Native Hawaiian, Non-Hispanic adults (35.7%)

These disparities among adults are similar to those seen during the 2020-2021 flu season, indicating that work still needs to be done to address lower flu vaccination coverage rates among racial and ethnic minority groups, but that there were not additional drops this season, which is good news.

As of Feb. 12, 2022, coverage among children 6 months to 17 years overall was down by just about 3 percentage points compared to the 2020-2021 season (52.5% compared to 55.3%), it is down by 7.4 percentage points compared with the most recent flu season before the COVID-19 pandemic (52.5% compared to 59.9). Additionally, like with adult coverage, there are disparities among children in certain ethnic and racial minority groups, the largest of which (11.0 percentage points) can be seen in coverage among non-Hispanic Black children (42.9%) compared with non-Hispanic White children (53.9%) children. Again, however, this is an improvement from the 2020-2021 flu season, when the disparity in coverage between non-Hispanic White children and non-Hispanic Black children was 14.7 percentage points.

The group at higher risk for flu that saw perhaps the largest drop in uptake of flu vaccine was pregnant people. Coverage is lower now than at the same time than last season overall by about 9 percentage points and across all racial and ethnic groups.

Among  pregnant people, flu vaccination coverage as of the end of January 2022 is estimated at 51.4%, which is lower than the 60.1% estimated as of the end of January 2021. However, this is an improvement from early season coverage estimates from October 2021, which suggested coverage was down by about 18 percent compared to the same time the year prior.

Within racial and ethnic minority groups, coverage decreased:

  • From 60.7% in 2020-2021 to 52.2% in 2021-2022 for non-Hispanic White pregnant people.
  • From 60.9% in 2020-2021 to 50.3% in 2021-2022 for Hispanic pregnant people.
  • From 75.9% in 2020-2021 to 68.0% in 2021-2022 for non-Hispanic Asian pregnant people.
  • From 58.9% in 2020-2021 to 50.7% in 2021-2022 for non-Hispanic Other pregnant people.
  • From 35.7% in 2020-2021 to 29.6% in 2021-2022 for non-Hispanic Black pregnant people.

These coverage estimates also show that a large disparity (22.6 percentage points) remains between flu vaccination coverage for non-Hispanic White pregnant people and non-Hispanic Black pregnant people, but is lesser compared to the season before, when there was a 25.2 percentage point difference in coverage.

Drops in vaccination coverage are concerning, but especially worrisome when those drops occur in people who are at higher risk of developing serious flu complications. Pregnant people, for example, are more vulnerable to serious flu due to changes in the immune system, heart, and lungs that happen during pregnancy (and up to two weeks after delivery). Other higher-risk groups include adults 65 years and older, children younger than 5 years but especially those younger than 2 years, and people of any age with certain chronic health conditions and people from certain racial and ethnic minority groups.

The reasons for drops in vaccination coverage so far are not known. Vaccine supply has been ample and unlikely to be the reason for lower vaccination coverage so far this season. Lower than usual flu activity during the 2020-2021 flu season could be a reason, as well as other factors related to vaccine fatigue caused by ongoing COVID-19 vaccination efforts, such as:

  • Confusion about the need for a flu vaccine this season or a belief that a COVID-19 vaccine will protect against flu.
  • Changes in health care seeking behavior that result in people making fewer visits to vaccine providers.
  • Fewer flu vaccination clinics compared with previous years.

The 2021-2022 flu season has been relatively mild so far, which may be another factor impacting people’s vaccination decisions. CDC will field research over the coming months to try to better understand the drops in coverage with the hope of reversing these concerning findings.

During the 2021-2022 flu season, flu activity increased from November 2021 through late December 2021, and then declined through late January 2022. During the first two weeks of February, however, some flu indicators again showed increases, including the percent of respiratory specimens testing positive for influenza at clinical laboratories and the reported numbers of flu hospitalizations. It is unclear at this time whether significant influenza circulation will occur again this season. CDC continues to recommend flu vaccination as long as flu viruses are circulating.

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