OBJECTIVES: The aim of the current study was to determine influenza vaccination rates among high and non-high risk adults across Europe (UK, France, Germany, Italy, and Spain). METHODS: Data from the 2008 EU National Health and Wellness Survey (NHWS) were used. Demographics, comorbidities, and vaccination behavior in the past year were assessed for all respondents.  Health-related quality of life (SF-12v2) and resource use (number of emergency room visits, hospitalizations, and physician visits) in the past six months were also measured. RESULTS: Only 23.7% of respondents received an influenza vaccine in the past year (UK: 25.3%, Germany: 25.2%, France: 20.2%, Italy: 24.8%, Spain: 24.1%).  A total of 28,158 respondents (52.6%) were at high risk for influenza complications (i.e., over age 50, had chronic conditions such as asthma, diabetes, COPD, cardiovascular conditions, or HIV/AIDS). Those at high risk reported significantly lower levels of both physical quality of life (Mean=45.88 vs. Mean=52.10) and health utilities (Mean=0.72 vs. Mean=0.73), and significantly higher levels of emergency room visits (Mean=0.21 vs. Mean=0.17), hospitalizations (Mean=0.22 vs. Mean=0.12), and provider visits (Mean=5.96 vs. Mean=4.14) in the past 6 months relative to those not at high risk, all ps<0.0001. Despite the significantly worse health profile, only 35.9% of high risk respondents received the vaccine.  High risk status was the strongest driver of vaccination in the UK (high risk: 42.2% vaccinated vs. non-high risk: 5.4% vaccinated, Φ=0.42) and the weakest in Germany (high risk: 31.8% vaccinated vs. non-high risk: 16.2% vaccinated, Φ=0.18).  The most common reason for non-vaccination was a belief that the vaccine was unimportant (35.9%). CONCLUSIONS: Despite influenza vaccine recommendation guidelines, only a modest percentage of respondents in Europe were vaccinated. Even those at high risk for influenza complications, who reported significantly worse health outcomes than non-high risk respondents, were vaccinated at less than a 40% rate.