Influenza statistics

Data extracted in July 2024.

Planned article update: December 2025.

Highlights

In 2022, almost half (48.2%) of the people aged 65 years and over in the EU were vaccinated against influenza.

Denmark had the highest vaccination rate in the EU in 2022, with 78.0% of people aged 65 years and over vaccinated against influenza.

There were 363 deaths of EU residents from influenza in 2021.

Influenza vaccination rate, people aged 65 years and over, 2022
(%)
Source: Eurostat (hlth_ps_immu)

This article presents an overview of European Union (EU) statistics related to influenza. It presents the following data:

influenza vaccination rates among people aged 65 years and over, for 2009 to 2022 ^[1]
standardised death rates from influenza, by age group, for 2021.

Data on influenza vaccination for 2020-2022 may have been impacted by the COVID-19 pandemic and its related restrictions. For this reason, particular attention should be paid when comparing data across time. In some EU countries, healthcare resources were placed under intense pressure (particularly at the start of the pandemic) from an influx of patients with COVID-19. The pandemic also resulted in a range of knock-on effects including, among others, some services being curtailed/postponed due to the number of COVID-19 patients, staff shortages within hospitals and day care centres due to infection/quarantine procedures, and patients being hindered access to medical services due to their own infection/quarantine as well as lockdown or travel restrictions. The COVID-19 vaccination programmes may also have increased awareness of other preventive measures, such as vaccination for influenza.

This article is 1 of a set of statistical articles concerning healthcare activities in the EU which forms part of an online publication on Health in the European Union – facts and figures.

Influenza vaccination rates – based on vaccination programme data

The rate of vaccination increases in times of pandemics

In the EU, just under half (48.2%) of people aged 65 years and over were vaccinated against seasonal influenza in 2022. As can be seen from Figure 1, between 2009 and 2022 (data not available for 2012 and 2013), the rate of vaccination against influenza in the EU varied. The rate was highest at the beginning of this time series, 54.6% in 2009. It then fell to its lowest level in 2015 (40.0%) and remained around this level for 2 years. In 2018, 2019 and 2020, the rate increased by 1 or 2 percentage points each year. The largest increase during the time series available was recorded in 2021, as the rate increased from 43.8% in 2020 to 50.8% in 2021. The rate fell back somewhat in 2022 but remained relatively high, at 48.2%.

In general, the influenza seasons when higher rates of vaccinations were reported occurred in the same periods as the World Health Organisation (WHO) declared pandemics. The outbreak of swine flu occurred in in 2009 and 2010, and the influenza seasons 2020, 2021 and 2022 occurred during the COVID-19 pandemic.

Figure 1: Influenza vaccination rate, people aged 65 years and over, EU, 2009–22
(%)
Source: Eurostat (hlth_ps_immu)

Vaccination rates vary between EU countries

Among the EU countries, there are various policies to make influenza vaccines available to the general public. Often these vaccines are targeted at older age groups or people who have a higher risk of poor health outcomes if they catch influenza (such as people who are immunocompromised).

Figure 2 shows considerable differences between EU countries in relation to the overall uptake of influenza vaccinations among people aged 65 years and over in 2022 and 10 years earlier (in 2012). More than three quarters (78.0%) of people aged 65 years and over in Denmark in 2022 were vaccinated against influenza, as were 75.8% in Portugal and 75.4% in Ireland. Less than a fifth of older people were vaccinated in Slovenia (19.1%), Austria (18.3%; 2019 data), Latvia (16.9%), Bulgaria (10.4%), Poland (8.6%) and Slovakia (5.6%).

In 18 of the EU countries, the share of older people vaccinated against influenza was higher in 2022 than it had been in 2012 (see Figure 2 for more information on the different coverage and reference years used in some countries).The proportion of the population aged 65 years and over vaccinated against influenza was more than 20.0 percentage points higher in 2022 than in 2012 in Portugal (up 32.4 points), Estonia (up 30.6 points), Denmark (up 30.0 points), Sweden (up 23.9 points) and Finland (up 23.1 points; note that there is a break in series). By contrast, the biggest declines were recorded in Germany (down 15.3 percentage points 2013–22; note that there is a break in series), Malta (down 11.3 points 2014–22), Slovakia (down 9.8 points) and Hungary (down 9.0 points).

Figure 2: Influenza vaccination rate, people aged 65 years and over, 2012 and 2022
(%)
Source: Eurostat (hlth_ps_immu)

Deaths from influenza

There were 363 deaths of EU residents from influenza in 2021, equivalent to 0.07 deaths per 100 000 inhabitants. Among these, 290 deaths occurred in people aged 65 year and over, equivalent to 0.30 deaths per 100 000 inhabitants. Note that the number of deaths from influenza can vary greatly between years. For example, in 2019 there were 10 098 deaths from influenza, 28 times more than in 2021. This large fall may reflect, at least in part, the impact of measures introduced against COVID-19, as some of these (such as social distancing, a greater focus on hand washing, the use of masks), also reduced the spread of influenza (please see Data sources section for information on influenza mortality in 2021).

Among EU countries, the highest standardised death rate for influenza in 2021 was reported in Bulgaria, with 0.69 deaths per 100 000 inhabitants. Sweden (with 0.46 deaths from influenza per 100 000 inhabitants) was the only other EU country to report a standardised death rate of over 0.20 deaths from influenza per 100 000 inhabitants. By contrast, there were 6 EU countries which reported no deaths from influenza in 2021: Estonia, Ireland, Cyprus, Latvia, Lithuania and Luxembourg.

The standardised death rate for influenza was considerably higher among people aged 65 years and over than people aged less than 65 years. Among EU residents in 2021, the rate for older people was 0.30 per 100 000 inhabitants, compared with 0.02 per 100 000 inhabitants among people aged less than 65 years. Bulgaria and Sweden reported the highest standardised death rates for influenza among those aged 65 years and over with, respectively, 2.84 and 2.12 deaths per 100 000 people aged 65 years and over. As well as the 6 EU countries which reported no deaths at all from influenza in 2021, Hungary also recorded no deaths from influenza among people aged 65 years and over (and only 1 death among younger people).

In 2021, the standardised death rate from influenza among people aged less than 65 years was also highest in Bulgaria (0.17 deaths per 100 000 inhabitants) and Sweden (0.06 deaths per 100 000 inhabitants). As well as the 6 EU countries which reported no deaths at all from influenza in 2021, there were 8 more which reported no deaths from influenza among people aged less than 65 years.

Figure 3: Standardised death rate from influenza, 2021
(per 100 000 inhabitants)
Source: Eurostat (hlth_cd_asdr2)

Source data for tables and graphs

Influenza statistics: tables and figures

Data sources

This article presents data on influenza vaccinations from administrative sources, usually linked to vaccination programmes (see further information in the article Healthcare non-expenditure statistics – methodology). For country specific notes on these data collections, please refer to the annexes at the end of the national metadata reports accessible from links at the beginning of the European metadata report.

The Healthcare non-expenditure statistics manual provides an overview of the classifications, both for mandatory variables and variables provided on a voluntary basis.

Vaccination programme data

The extent of influenza vaccinations is based on the percentage of people aged 65 years and over who have been immunised against influenza during the reference period (defined as July 1 to June 30, which ended in the reference period).

The vaccination rate is calculated by calendar year or by influenza season. Some countries may use European health interview (EHIS) survey data to calculate the vaccination rate for influenza; the last round of the EHIS was in 2019. Please see the table below for more information on sources.

Table 1: Data sources for immunisation against influenza (among population aged 65 years and over), 2022
Source: Eurostat

Data for the EU are calculated using the reference year data for each EU country. If data aren't available for a particular reference year, the most recent available data from the previous 5 reference years is used. The EU data are population-weighted averages.

Causes of death

This article also includes statistics on causes of death. These are documented in more detail in a background article on Causes of death statistics - methodology. This provides information on the scope of the data, its legal basis, the methodology employed, as well as related concepts and definitions.

The Eurostat causes of death data collection is based on confirmed death certificates established by medical experts assessing the underlying cause of death. There is a difference in the coding of cases of influenza deaths: these concern cases where influenza was the established underlying cause of death or where death occurred in someone who had influenza at or close to the time of death. Data for 2020 on causes of death may also be influenced by the coding for deaths from COVID-19. There may be differences in how countries determined the underlying cause of death, particularly in cases where the deceased had multiple morbidities, or coinfections with other respiratory diseases (for example, COVID-19 or pneumonia); please see the article respiratory diseases statistics for more information.

The significant decrease in influenza deaths in 2021 could be attributed, at least in part, to a combination of public health measures, such as enhanced vaccination strategies, social distancing, mask mandates and enhanced hygiene practices enacted to tackle the COVID-19 pandemic. It should also be taken into account that at the beginning of the pandemic, WHO guidelines recommended the use of COVID-19 ICD-10 codes for all deaths from clinically compatible illnesses, and where COVID-19 contributed to the death , which may play a part in the underreporting of influenza deaths.

Legal basis

Heath care non-expenditure statistics

Regulation 1338/2008 on Community statistics on public health and health and safety at work, implemented through
Regulation 2294/2022 as regards statistics on healthcare facilities, healthcare human resources and healthcare utilisation.

Causes of death

Regulation 1338/2008 on Community statistics on public health and health and safety at work, implemented through
Regulation 0328/2011 on Community statistics on public health and health and safety at work, as regards statistics on causes of death.

Context

Vaccination is vital for primary prevention and offers the most cost-effective, long-term strategy for reducing the burden of diseases across the EU. Immunisation through vaccination is the best available defence against serious, preventable, and sometimes deadly, contagious diseases. Thanks to widespread vaccination, smallpox has been eradicated, Europe made polio-free and many other diseases almost eliminated.

Influenza is an annual, seasonal virus that affects Europe in the winter. The majority of people who die from influenza are aged 65 years and over, many of whom face other complications/illnesses, such as heart disease or chronic lung disease. During an influenza epidemic, there may be significant costs for health services (associated with caring for those who fall sick) and for businesses in general (lost production as a result of time taken off work).

To help countries prepare their response to a likely increase of COVID-19 and influenza in the autumn and winter 2022/23, the European Commission published a Communication on preparing for this period, including recommendations to combine COVID-19 and influenza vaccination campaigns where possible.

Integrating population-based surveillance systems for influenza, SARS-CoV-2 (the virus that causes the COVID-19 illness) and other respiratory viruses to monitor the spread and intensity of respiratory viruses is a key recommendation published by WHO/Europe in its strategy recommendations to protect the most vulnerable.

The European Centre for Disease Prevention and Control (ECDC) was set up to help strengthen Europe's defences against infectious diseases, such as influenza, SARS, COVID-19 and HIV/AIDS. The ECDC works in partnership with European national health protection bodies to strengthen and develop continent-wide disease surveillance and early warning systems.

The European Vaccination Information Portal (EVIP) was developed by the ECDC, in partnership with the European Commission and the European Medicines Agency (EMA) and includes information of influenza vaccination.

Notes

↑ For most countries, the year corresponds to the influenza season which ended in the year mentioned; alternatively it corresponds to the calendar year. Hence, the year 2022 corresponds to the influenza season 2021/2022 or calendar year 2022. See the section on data sources.

Explore further

Database

Health (hlth), see

Health care (hlth_care)

Preventive services (hlth_prev)

Vaccination against influenza of population aged 65 years and over (hlth_ps_immu)

Self-reported vaccination against influenza by sex, age and educational attainment level (hlth_ehis_pa1e)

Causes of death (hlth_cdeath)

Thematic section

Health

Publications

Atlas

Health statistics – Atlas on mortality in the European Union

News releases

Preventive care: 6% of EU's health expenditure in 2021

Methodology

Healthcare resources (ESMS metadata file – hlth_res_esms)
Causes of death (SIMS metadata file – hlth_cdeath_sims)
Revision of the European Standard Population – Report of Eurostat's task force – 2013 edition

External links

[1] For most countries, the year corresponds to the influenza season which ended in the year mentioned; alternatively it corresponds to the calendar year. Hence, the year 2022 corresponds to the influenza season 2021/2022 or calendar year 2022. See the section on data sources.

[1]