Influenza vaccination before and during the COVID-19 pandemic in the elderly in South Korea

Background: Influenza epidemics are a significant cause of mortality and morbidity in older adults; thus, vaccination is recommended. However, the coronavirus disease 2019 (COVID-19) pandemic could affect influenza vaccination. Methods: The influenza vaccination rate was estimated from the Korea Community Health Survey data from 2011 to 2021 using Joinpoint regression. We used multiple logistic regression analysis from each two flu seasons data before (2017–18 and 2018–19 seasons) and during (2019–20 and 2020–21 seasons) the COVID-19 pandemic to identify older adults who were not been vaccinated during the COVID-19 pandemic. Additionally, we stratified changes in influenza vaccination according to the flu season, demographic and socioeconomic characteristics, and health status. Results: The annual percentage change in influenza non-vaccination rate from 2010–11 to 2018–19 seasons and from 2019–20 to 2020–21 seasons was -8.31% (confidence interval (CI), -9.60 to ‐7.00) and 11.41% (CI, -3.22 to 28.25), respectively. Compared to before COVID-19, in the 2019–20 and 2020–21 seasons, the odds ratio (OR) of non-vaccination was 0.87 (CI, 0.83–0.91) and 1.18 (95% CI, 1.13–1.24), respectively. The decrease in influenza vaccination among older individuals with higher education (OR, 1.24; CI, 1.11–1.39) was greater than that among those with lower education (OR, 1.09; CI, 0.98–1.22). Older individuals with the lowest income level or poor self-rated health showed reduced influenza vaccination. Conclusions: We estimated the trends of influenza vaccination and identified subgroups with decreased vaccination rates during the COVID-19 pandemic among older adults in South Korea. Health policy decision-makers, practitioners, and researchers should consider the implications of COVID-19 on changes in influenza vaccination, particularly for older individuals at risk of influenza.