OBJECTIVES: Despite clear recommendations from German public health authorities to vaccinate all adults aged 60 and older against influenza, vaccination coverage rates (VCRs) fall short of targets. This study explores gaps in influenza VCRs among older adults focusing on several population subgroups for which vaccination is particularly recommended.

METHODS: We conducted a retrospective study based on a large German statutory health insurance (SHI) claims database provided by GWQ ServicePlus AG. For the influenza seasons 2016-17 to 2022-23, we examined seasonal VCRs among adults aged 60 and older and for population subgroups defined by age, healthcare utilization, and the prevalence of underlying chronic diseases that indicate an increased risk of severe influenza infection. For the first time, we also explored the frequency of contacts with physicians during the influenza-vaccination-relevant period from September to February.

RESULTS: In each season, our study included up to 836,390 individuals aged 60+ of whom approximately 80% had at least one underlying chronic disease and 25% participated in at least one disease management program (DMP). In almost all groups, VCRs increased until 2020-21, but declined thereafter. Among individuals aged 60+ with underlying conditions and those participating in DMPs, seasonal VCRs ranged from 40.0% to 53.8% and 46.6% to 61.3%, respectively. VCRs exceeding 70% were observed only in age groups 70+ enrolled in DMPs for asthma and COPD, but not in those enrolled in DMPs for heart disease or type 2 diabetes. On average over all seasons a majority of unvaccinated adults aged 60+ had at least four contacts with physicians during the vaccination-relevant 6-month period.

CONCLUSIONS: Influenza VCRs remain low across risk groups. A notable share of unvaccinated individuals in risk groups had frequent contact to physicians, which could represent untapped vaccination opportunities. Tailored vaccination strategies need to be developed and implemented widely to ensure higher VCRs in vulnerable risk groups.