Identification of groups at high risk for under-coverage of seasonal influenza vaccination: A national study to inform vaccination priorities during the COVID-19 pandemic

PURPOSE: Seasonal influenza vaccination is an important public health strategy to reduce preventable illness, hospitalization, and death. Because of overlapping risk factors for severe illness from seasonal influenza and COVID-19, uptake of the seasonal influenza vaccination has heightened importance during the COVID-19 pandemic. We analyzed receipt of seasonal influenza vaccination among COVID-19 priority groups and further examined socio-demographic and behavioral factors associated with receiving the seasonal influenza vaccine among US adults. METHODS: Using the 2018 National Health Interview Survey, we classified 24,772 adults into four COVID-19 priority groups: healthcare workers, medically vulnerable, non-healthcare essential workers, and the general population. We performed multiple logistic regression to compare the relative odds of receiving the influenza vaccine by COVID-19 priority group, socio-demographics, and health-related factors. RESULTS: Healthcare workers, medically vulnerable adults, essential workers, and the general population comprised 8.9%, 58.4%, 6.6%, and 26.1 % of the US population, respectively. Compared with healthcare workers, the adjusted odds ratio (aOR) of receiving influenza vaccine were significantly lower in medically vulnerable adults (aOR=0.43, 95% CI=0.37, 0.48), essential workers (aOR=0.28, 95% CI=0.23, 0.34), and the general population (aOR=0.32, 95% CI=0.28, 0.37). Being young, male, Black, and having no health insurance were associated with lower relative odds of receiving the flu vaccine. CONCLUSIONS: Patterns of influenza vaccine cause concern for under-coverage of populations at high risk for both seasonal influenza and COVID-19. Achieving optimal protection against vaccine-preventable respiratory illness in US adults will require emphasis on those employed outside of the healthcare sector, younger age groups, and adults with lower socioeconomic resources.