Higher Influenza Vaccination Uptake Associated With Provider Recommendations

Increasing Flu Vaccination Rates
Increasing Flu Vaccination Rates
A new study indicates that early-season influenza vaccination coverage was significantly higher among adults aged ≥18 years with a provider visit and recommendation/offer for vaccination.

In a new study published in Vaccine, survey data revealed that provider recommendation was significantly associated with influenza vaccination, but that 67% of adults either did not visit a doctor or did not receive a provider recommendation during visits within the vaccination period.1

Seasonal influenza vaccinations are recommended for all persons ≥ 6 years old annually and remain the most effective means of preventing influenza. Vaccination uptake is known to be increased in pregnant women by doctor recommendations and referrals,2-4 but the effect of these recommendations and referrals among the general population is limited. This study used data from the 2016 National Internet Flu Survey to assess this association in the general population during the 2016 and 2017 flu season among adults age ≥18 years.

Of the 4305 individuals who completed the National Internet Flu Survey questionnaire, most (59.4%) did not receive a vaccination. Most participants did not have children ≤5 years old in the house (93.1%), did not have a high-risk medical condition (67.4%), had private medical insurance (60.8%), and had a usual place for medical care (86.1%).

Overall, 24.0% of participants visited a provider who recommended and offered influenza vaccination, 9.0% visited a provider who recommended but did not offer, 25.1% visited a provider who did neither, and 41.9% did not visit a health provider.

Those who reported that a provider had recommended and offered vaccination had significantly higher vaccination coverage (66.6%) than those who reported a provider who recommended but did not offer (48.4%), those who received neither (32.0%), and those who did not visit a doctor (28.8%). Higher vaccination coverage was significantly associated with having received a recommendation, with or without offer, after controlling for demographics and access to care factors.

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Because this study was internet based and used self-reporting, the results have several limitations, but evidence suggests that a provider recommendation increases patient vaccination. However, according to investigators, “further research is needed to understand the role of knowledge and awareness of influenza vaccination recommendation on vaccination seeking and accepting behavior.”


  1. Lu P-J, Srivastav A, Amaya A, et al. Association of provider recommendation and offer and influenza vaccination among adults aged ≥18 years – United States [published online January 10, 2018]. Vaccine. doi: 10.1016/j.vaccine.2017.12.016
  2. Ding H, Black CL, Ball S, et al. Influenza vaccination coverage among pregnant women–United States, 2014-15 influenza season. MMWR Morb Mortal Wkly Rep. 2015;64:1000-1005.
  3. Centers for Disease Control and Prevention. Flu Vaccination Coverage Among Pregnant Women – United States, 2015-16 Flu Season. https://www.cdc.gov/flu/fluvaxview/pregnant-coverage_1516estimates.htm. Updated November 2, 2017. Accessed February 7, 2018.
  4. Benedict KM, Santibanez TA, Black CL, et al. Recommendations and offers for adult influenza vaccination, 2011–2012 season, United States. Vaccine. 2017;35:1353-1361.