Cross-Sectional Study on Influenza Vaccination, Germany, 1999-2000

Sybille Rehmet, Andrea Ammon, Günter Pfaff, Nikolaus Bocter, Lyle R. Petersen


Emerging Infectious Diseases. 2002;8(12) 

In This Article

Abstract and Introduction

To assess influenza vaccination coverage in Germany, we conducted a nationwide telephone survey in November 1999 in adults (≥18 yrs) using random-digit dialing. Overall, 23% of 1,190 survey participants reported having been vaccinated (adjusted 18%) with 16% (adjusted 15%) in former West Germany versus 35% (adjusted 32%) in former East Germany. Immunization rates for vaccination target groups were lower in West Germany (21%) than in East Germany (40%). Seven percent of health-care workers were immunized. Previous influenza vaccination, positive attitudes towards immunization, and having a family physician increased the rate of vaccination; fear of adverse effects lowered the rate. Family physicians performed 93% of the vaccinations, which suggests their key role in improving low vaccination coverage in Germany. The fact that >71% (850/1,190) of participants belonged to at least one of the vaccination target groups recommended by the German Standing Commission on Immunization emphasizes the need to focus the definition of target groups.

Ten years after the reunification of the former East and West Germany, the Federal Republic of Germany still shows the effects resulting from combining two different health-care systems after being apart for 50 years. Even though the health-care systems were merged soon after reunification, differences in health-care practices persist, especially in regard to preventive medicine and immunization, which had a much higher priority in the former East Germany. For example, a pilot study undertaken in Berlin, Stuttgart, and Chemnitz during the influenza season 1998-1999 showed much higher influenza vaccination rates in East Berlin and Chemnitz in the former East Germany (called former East in this paper) than in West Berlin and Stuttgart in the former West Germany (called former West in this paper)[1,2].

In general, population-based studies of influenza vaccination coverage for a country do not exist. A Canadian study found 13.8% influenza vaccination coverage in fall and winter 1990-1991[3]. Most studies on influenza vaccination coverage investigate specific groups such as the elderly[4,5,6,7,8,9,10,11,12,13], patients from general practices[14,15], or hospitalized patients[16].

This lack of nationwide, population-based studies, along with the findings of the pilot study showing markedly different vaccination rates in several German cities, prompted the nationwide, population-based survey reported here. The goals of our survey were to determine the influenza immunization rates in areas of the former East and West during the 1999-2000 influenza season, the proportion of the German population included in specific vaccination target groups recommended by the German Standing Commission on Immunization, the vaccination rates among these target groups, and factors that might influence immunization rates in areas of the former East and West.