Childhood Influenza Vaccine Rates Decreased From 2017 to 2023

New research shows that influenza vaccination rates have seen a steady decline since the COVID-19 pandemic, disrupting progress made in increasing vaccination rates in the 3 years prior to the pandemic. The study, which was published in JAMA Network Open,¹ specifically focused on vaccination rates in the Bronx, New York City, from 2017 to 2023.

The study retrospectively collected data from patients aged 18 years or younger to perform the analysis. Data were collected for each influenza season, defined as September 1 to August 31 of the following year. Seasons included in the analysis ranged from 2017-2018 to 2022-2023. Individuals who were aged 2 months to 18 years as of the start of each season were included. All patients came from the Montefiore Medical Group (MMG) in the Bronx, and the New York State Immunization Information System data were used.

Age, sex, race and ethnicity, and insurance type at the visit were all included in the demographic data. Patients who received 1 or more doses of the influenza vaccine were considered as having vaccine coverage along with 1 or more visits to the MMG in that season. Risk ratios (RRs) were estimated using the Poisson regression model.

There were 138,500 children aged 2 months to 18 years who attended the MMG primary care clinics between 2017 and 2023. The median (IQR) age of the participants in 2017 was 6.4 (0.9-12.4) years, and 49.8% were girls. The median (IQR) number of visits was 2 (1-4).

The researchers found that vaccination coverage for influenza increased between the 2017-2018 and 2019-2020 seasons (7.4%; 95% CI, 6.9%-7.9%). However, the influenza vaccination coverage decreased by 12.9% between the 2019-2020 and 2022-2023 seasons (95% CI, –13.5% to –12.4%). This amounted to a 16% decrease in influenza vaccine coverage in those aged 10 to 14 years between the 2017-2018 and 2022-2023 influenza seasons (RR, 0.84; 95% CI, 0.82-0.86). Patients aged 5 to 9 years had a 15% decrease in influenza coverage (RR, 0.85; 95% CI, 0.83-0.87), and children aged 0 to 4 years had a 2% decrease (RR, 0.98; 95% CI, 0.97-0.99).

Children using Medicaid had 12% lower coverage (RR, 0.88; 95% CI, 0.87-0.89), and those using self-pay had 20% lower coverage (RR, 0.80; 95% CI, 0.70-0.92). Children using self-pay (adjusted RR [aRR], 0.84; 95% CI, 0.73-0.97) and Medicaid (aRR, 0.91; 95% CI, 0.86-0.97) had greater decreases compared with those on private insurance in the 2022-2023 season compared with the 2017-2018 season. Those aged 5 to 9 years (aRR, 0.86; 95% CI, 0.84-0.89) and aged 10 to 14 years (aRR, 0.86; 95% CI, 0.83-0.88) also had greater decreases in vaccination coverage compared with those aged 0 to 4 years.

There were some limitations to this study. The study used a single-center design, where the cohort mainly lived in an urban setting. Vaccinations that were not reported to the New York State Immunization Information System were not included, including those that were received out of state.

This data builds on previous reports that have shown that childhood vaccination rates are declining across the country.² The measles-mumps-rubella vaccine, the diphtheria-tetanus-pertussis vaccine, and polio vaccines have all declined in adherence, which has led to outbreaks across the country of different viruses previously thought to be eliminated. Declining vaccination rates for influenza could lead to a widespread increase in complications surrounding influenza in this vulnerable population.

“Encouraging primary care physicians to strongly recommend influenza vaccination and expanding access by providing alternative vaccination sites such as school-based health centers may improve influenza vaccination coverage in school-aged children and adolescents,” the authors concluded.¹

References

1. Rane MS, Gopalan G, Nahmias J, Rinke ML, Teasdale CA. Influenza vaccination trends among children and adolescents, 2017-2023. JAMA Netw Open. 2026;9(6):e2617332. doi:10.1001/jamanetworkopen.2026.17332
2. Across the U.S., childhood vaccination rates continue to decline. Johns Hopkins Bloomberg School of Public Health. August 20, 2025. Accessed June 8, 2026. https://publichealth.jhu.edu/ivac/2025/across-the-us-childhood-vaccination-rates-continue-to-decline