---
title: "Seasonal influenza vaccination coverage and population health burden in Europe: ecological panel a"
id: "pubmed-42759249"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42759249"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42759249/"
doi: "10.1016/j.vaccine.2026.129163"
published_at: "2026-10-24T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Seasonal influenza vaccination coverage and population health burden in Europe: ecological panel a
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42759249
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42759249/)
- **DOI:** [10.1016/j.vaccine.2026.129163](https://doi.org/10.1016%2Fj.vaccine.2026.129163)
- **Published At:** 2026-10-24T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The authors conducted an ecological panel analysis across EU/EEA countries, Switzerland, and Israel using SHARE Waves 8 (2019–2020) and 9 (2021–2022) to evaluate country-level **seasonal influenza vaccination coverage** among adults aged ≥55 years. - Survey-weighted vaccination rates rose from 34.5% in 2019–2020 to 47.6% in 2021–2022, but most countries remained below the 75% EU target. - Country-level outcomes were all-cause mortality, all-cause **DALYs**, lower respiratory tract infection (LRTI) DALYs, and selected chronic disease DALYs for the same age group, sourced from the Global Burden of Disease database. - Investigators summarized correlated structural covariates with principal component analysis (PCA) on the pooled country-season dataset. - Associations were estimated with linear mixed-effects models including country-specific random intercepts and adjustment for period and PCA-derived covariates. - A 1-percentage-point higher vaccination coverage associated with 14.9 fewer all-cause deaths per 100,000 adults ≥55 years (95% CI: -22.8 to -7.1). - The same 1-point coverage increase associated with 328.1 fewer all-cause DALYs per 100,000 (95% CI: -480.4 to -175.8) and 6.3 fewer LRTI DALYs per 100,000 (95% CI: -10.6 to -2.0). - Subgroup analysis showed an inverse association between coverage and diabetes DALYs (−12.1 per 100,000; 95% CI: −20.3 to −3.8). - The authors emphasized these are population-level associations and framed results as hypothesis-generating rather than causal; the source did not present individual-level clinical data, vaccine product details, or dosing schedules. - The study used two survey periods only; residual confounding and ecological inference limits were noted by the authors.
## Clinical Analysis & Structured Key Points
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Epub 2026 Sep 18. # Seasonal influenza vaccination coverage and population health burden in Europe during the 2019/2020 and 2021/2022 influenza seasons: an ecological panel analysis using principal-component-adjusted multivariable regression [Bin Zhou](https://pubmed.ncbi.nlm.nih.gov/?term=Zhou+B&cauthor_id=42759249)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42759249/#full-view-affiliation-1 "Chair of Model-based Environmental Exposure Science, Environmental Health Sciences Institute, Faculty of Medicine, University of Augsburg, Augsburg, Germany. Electronic address: Bin.Zhou@med.uni-augsburg.de."), [Jiancong Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+J&cauthor_id=42759249)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42759249/#full-view-affiliation-2 "Chair of Model-based Environmental Exposure Science, Environmental Health Sciences Institute, Faculty of Medicine, University of Augsburg, Augsburg, Germany. Electronic address: Jiancong.Wang@med.uni-augsburg.de."), [Christoph Knote](https://pubmed.ncbi.nlm.nih.gov/?term=Knote+C&cauthor_id=42759249)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42759249/#full-view-affiliation-3 "Chair of Model-based Environmental Exposure Science, Environmental Health Sciences Institute, Faculty of Medicine, University of Augsburg, Augsburg, Germany. Electronic address: Christoph.Knote@med.uni-augsburg.de.") Affiliations Expand ### Affiliations * 1 Chair of Model-based Environmental Exposure Science, Environmental Health Sciences Institute, Faculty of Medicine, University of Augsburg, Augsburg, Germany. Electronic address: Bin.Zhou@med.uni-augsburg.de. * 2 Chair of Model-based Environmental Exposure Science, Environmental Health Sciences Institute, Faculty of Medicine, University of Augsburg, Augsburg, Germany. Electronic address: Jiancong.Wang@med.uni-augsburg.de. * 3 Chair of Model-based Environmental Exposure Science, Environmental Health Sciences Institute, Faculty of Medicine, University of Augsburg, Augsburg, Germany. Electronic address: Christoph.Knote@med.uni-augsburg.de. * PMID: **42759249** * DOI: [ 10.1016/j.vaccine.2026.129163 ](https://doi.org/10.1016/j.vaccine.2026.129163) Free article Item in Clipboard # Seasonal influenza vaccination coverage and population health burden in Europe during the 2019/2020 and 2021/2022 influenza seasons: an ecological panel analysis using principal-component-adjusted multivariable regression Bin Zhou et al. Vaccine. 2026. Free article Show details Display options Display options Format Abstract PubMed PMID Vaccine Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Vaccine%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Vaccine%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42759249/) . 2026 Oct 24:92:129163. doi: 10.1016/j.vaccine.2026.129163. Epub 2026 Sep 18. ### Authors [Bin Zhou](https://pubmed.ncbi.nlm.nih.gov/?term=Zhou+B&cauthor_id=42759249)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42759249/#short-view-affiliation-1 "Chair of Model-based Environmental Exposure Science, Environmental Health Sciences Institute, Faculty of Medicine, University of Augsburg, Augsburg, Germany. Electronic address: Bin.Zhou@med.uni-augsburg.de."), [Jiancong Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+J&cauthor_id=42759249)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42759249/#short-view-affiliation-2 "Chair of Model-based Environmental Exposure Science, Environmental Health Sciences Institute, Faculty of Medicine, University of Augsburg, Augsburg, Germany. Electronic address: Jiancong.Wang@med.uni-augsburg.de."), [Christoph Knote](https://pubmed.ncbi.nlm.nih.gov/?term=Knote+C&cauthor_id=42759249)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42759249/#short-view-affiliation-3 "Chair of Model-based Environmental Exposure Science, Environmental Health Sciences Institute, Faculty of Medicine, University of Augsburg, Augsburg, Germany. Electronic address: Christoph.Knote@med.uni-augsburg.de.") ### Affiliations * 1 Chair of Model-based Environmental Exposure Science, Environmental Health Sciences Institute, Faculty of Medicine, University of Augsburg, Augsburg, Germany. Electronic address: Bin.Zhou@med.uni-augsburg.de. * 2 Chair of Model-based Environmental Exposure Science, Environmental Health Sciences Institute, Faculty of Medicine, University of Augsburg, Augsburg, Germany. Electronic address: Jiancong.Wang@med.uni-augsburg.de. * 3 Chair of Model-based Environmental Exposure Science, Environmental Health Sciences Institute, Faculty of Medicine, University of Augsburg, Augsburg, Germany. Electronic address: Christoph.Knote@med.uni-augsburg.de. * PMID: **42759249** * DOI: [ 10.1016/j.vaccine.2026.129163 ](https://doi.org/10.1016/j.vaccine.2026.129163) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Background:** Few studies have examined whether country-level seasonal influenza vaccination coverage is associated with population health burden. We assessed the associations of influenza vaccination coverage with all-cause mortality and disability-adjusted life years (DALYs) across countries participating in the Survey of Health, Ageing and Retirement in Europe (SHARE). **Methods:** We conducted an ecological panel analysis using SHARE Waves 8 (2019-2020) and 9 (2021-2022) across participating EU/EEA countries, Switzerland, and Israel. Survey-weighted vaccination coverage and structural indicators were derived among adults aged ≥55 years. All-cause mortality, all-cause DALYs, lower respiratory tract infection (LRTI) DALYs, and chronic disease-specific DALYs were obtained from the Global Burden of Disease database for the same age group. Principal component analysis (PCA) was performed on the pooled country-season dataset to summarize correlated structural covariates. Associations were estimated using linear mixed-effects models with country-specific random intercepts. **Results:** Mean vaccination coverage increased from 34.5% to 47.6% but remained below the EU target of 75% in many countries. After adjustment for period and PCA-derived covariates, a 1-percentage-point higher vaccination coverage was associated with 14.9 fewer all-cause deaths per 100,000 adults aged ≥55 years (95% CI: -22.8 to -7.1), 328.1 fewer all-cause DALYs per 100,000 (95% CI: -480.4 to -175.8), and 6.3 fewer LRTI DALYs per 100,000 (95% CI: -10.6 to -2.0). Subgroup-specific vaccination coverage was also inversely associated with diabetes DALYs (-12.1; 95% CI: -20.3 to -3.8). **Conclusions:** In this two-period ecological analysis, higher country-level influenza vaccination coverage was inversely associated with mortality and DALY burden among adults aged ≥55 years. These findings should be interpreted as hypothesis-generating population-level associations rather than causal effects. **Keywords:** Diabetes; Disability-adjusted life years; Ecological panel analysis; Europe; Lower respiratory tract infection; Mortality; SHARE; Seasonal influenza vaccination coverage. Copyright © 2026 The Authors. Published by Elsevier Ltd.. All rights reserved. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. ## Similar articles * [ Underreported influenza mortality in Central and Eastern Europe hinders the extension of seasonal influenza vaccination programs in older adults. ](https://pubmed.ncbi.nlm.nih.gov/40318354/) Pitter JG, Mihajlović J, Nagy D, van der Schans J, Vokó Z, Kaló Z.Pitter JG, et al.Vaccine. 2025 May 22;56:127184. doi: 10.1016/j.vaccine.2025.127184. Epub 2025 May 2.Vaccine. 2025.PMID: 40318354 * [ Surveillance of influenza vaccination coverage--United States, 2007-08 through 2011-12 influenza seasons. ](https://pubmed.ncbi.nlm.nih.gov/24157710/) Lu PJ, Santibanez TA, Williams WW, Zhang J, Ding H, Bryan L, O'Halloran A, Greby SM, Bridges CB, Graitcer SB, Kennedy ED, Lindley MC, Ahluwalia IB, LaVail K, Pabst LJ, Harris L, Vogt T, Town M, Singleton JA; Centers for Disease Control and Prevention (CDC).Lu PJ, et al.MMWR Surveill Summ. 2013 Oct 25;62(4):1-28.MMWR Surveill Summ. 2013.PMID: 24157710 * [ Public health and economic benefits of seasonal influenza vaccination in risk groups in France, Italy, Spain and the UK: state of play and perspectives. ](https://pubmed.ncbi.nlm.nih.gov/38702667/) de Fougerolles TR, Baïssas T, Perquier G, Vitoux O, Crépey P, Bartelt-Hofer J, Bricout H, Petitjean A.de Fougerolles TR, et al.BMC Public Health. 2024 May 3;24(1):1222. doi: 10.1186/s12889-024-18694-5.BMC Public Health. 2024.PMID: 38702667Free PMC article. * [ Disparities in Seasonal Influenza Vaccination in Europe. ](https://pubmed.ncbi.nlm.nih.gov/40626870/) Giezeman-Smits KM, Palache B, van Essen GA, Jeseňák M, Castro-Sánchez E, Steinberg AE, van Vugt J.Giezeman-Smits KM, et al.Immun Inflamm Dis. 2025 Jul;13(7):e70186. doi: 10.1002/iid3.70186.Immun Inflamm Dis. 2025.PMID: 40626870Free PMC article.Review. * [ Mortality and Morbidity Effects of Long-Term Exposure to Low-Level PM2.5, BC, NO2, and O3: An Analysis of European Cohorts in the ELAPSE Project. ](https://pubmed.ncbi.nlm.nih.gov/36106702/) Brunekreef B, Strak M, Chen J, Andersen ZJ, Atkinson R, Bauwelinck M, Bellander T, Boutron MC, Brandt J, Carey I, Cesaroni G, Forastiere F, Fecht D, Gulliver J, Hertel O, Hoffmann B, de Hoogh K, Houthuijs D, Hvidtfeldt U, Janssen N, Jorgensen J, Katsouyanni K, Ketzel M, Klompmaker J, Hjertager Krog N, Liu S, Ljungman P, Mehta A, Nagel G, Oftedal B, Pershagen G, Peters A, Raaschou-Nielsen O, Renzi M, Rodopoulou S, Samoli E, Schwarze P, Sigsgaard T, Stafoggia M, Vienneau D, Weinmayr G, Wolf K, Hoek G.Brunekreef B, et al.Res Rep Health Eff Inst. 2021 Sep;2021(208):1-127.Res Rep Health Eff Inst. 2021.PMID: 36106702Free PMC article. 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