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Vaccine . State-level progress and setbacks in influenza vaccination among adults ≥65: A fifteen-season analysis from 2009/10 to 2023/24

tetano

Editor, Senior Moderator
Vaccine


. 2025 Nov 13:69:127983.
doi: 10.1016/j.vaccine.2025.127983. Online ahead of print. State-level progress and setbacks in influenza vaccination among adults ≥65: A fifteen-season analysis from 2009/10 to 2023/24

Luigi Russo[SUP] 1 [/SUP], Sara Farina[SUP] 1 [/SUP], Raffaele Angelo Macri[SUP] 2 [/SUP], William Alan Pentecost[SUP] 2 [/SUP], Alessandra Maio[SUP] 1 [/SUP], Leonardo Villani[SUP] 3 [/SUP], Vittorio Maio[SUP] 4 [/SUP], Stefania Boccia[SUP] 5 [/SUP], Walter Ricciardi[SUP] 1 [/SUP]



Affiliations
Abstract

Introduction: Influenza is a contagious respiratory infection with substantial health and economic consequences worldwide. Annual vaccination is the most effective preventive strategy; however, coverage among older adults remains suboptimal and varies considerably across the United States. This study aimed to examine state-level trends in influenza vaccination coverage among adults aged ≥65 years across fifteen influenza seasons (2009/10-2023/24).
Methods: State-level vaccination coverage data for adults aged ≥65 years were obtained from the CDC FluVaxView platform, which reports annual estimates by influenza season. The analysis covered the 2009/10 through 2023/24 influenza seasons. Joinpoint regression was used to assess temporal trends and estimate Annual Percent Change (APC) and Average Annual Percent Change (AAPC) in vaccination coverage.
Results: In the 2023/24 season, all but one state reported coverage rates of at least 50 %; however, only 10 of 51 states reached the 75 % target. Coverage ranged from 49.8 % in Mississippi to 80.6 % in Massachusetts. Over the study period, AAPC significantly increased in three states (Rhode Island, District of Columbia, and Washington) and decreased in four states (Alabama, Mississippi, Louisiana, and Nevada). The COVID-19 pandemic coincided with a temporary increase in coverage in 48 states, but by the 2023/24 season, 44 states had coverages within ±10 % of their pre-pandemic 2019/20 baselines.
Conclusions: Influenza vaccination coverage among older adults remains uneven across states. Although the pandemic prompted short-term gains in vaccine uptake, these improvements were not maintained over time. The findings underscore the need for persistent, state-specific public health strategies to improve coverage in this vulnerable population.

Keywords: Elderly; Influenza; Public health; Trend analysis; Vaccination.

 
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