Seasonal influenza can have serious morbid consequences and can even result in death, particularly in at-risk populations, including healthcare professionals (HCPs), elderly and those living with a medical risk condition. Although in Europe recommendations exist for annual influenza vaccination in these populations in most countries, the vaccination coverage rate (VCR) is often well below the World Health Organization target of 75% coverage. In our previous survey in 2009 we showed that some elements of national vaccination policies, e.g. reminder systems, strong official recommendation, and easy access, seemed to contribute to achieving higher influenza VCRs among elderly. We repeated the survey in 2016, using the same methodology to assess changes in influenza VCRs among the elderly and in the impact of policy elements on these VCRs. In addition, we collected information about VCRs among HCPs, and those living with a medical risk condition. The median VCR in the 21 countries that had recommendations for influenza vaccination in the elderly was 35.3%, ranging from 1.1% in Estonia to 74.5% in Scotland. The average VCRs for HCPs and those living with medical risk conditions, available in 17 and 10 countries, respectively, were 28.3% (range 7% in Czech Republic to 59.1% in Portugal) and 32.2% (range from 20.0% in the Czech Republic and Hungary to 59.6% in Portugal), respectively. Fewer countries were able to provide data from HCP and those living with medical risk conditions. Since the initial survey during the 2007-2008 influenza season, VCRs have decreased in the elderly in the majority of countries, thus, achieving high VCRs in the elderly and the other target groups is still a major public health challenge in Europe. This could be addressed by the identification, assessment and sharing of best practice for influenza vaccination policies.

b General Practitioner Amersfoort The Netherlands

c Valladolid National Influenza Center Microbiology and Immunology Department Hospital Clinicon Valladolid Spain

Department of Infectious Diseases Epidemiology National Institute of Public Health Prague Czech Republic

e Department of Epidemiology and Biostatistics 3rd Faculty of Medicine Charles University Prague Czech Republic

f Department of Social Medicine and Public Health Medical University of Warsaw Warsaw Poland

g Department of Paediatrics with Clinical Assessment Unit Medical University of Warsaw Warsaw Poland

h Department of Pediatrics Children's Clinic Hospital Faculty of Medicine Transilvania University Brasov Brasov Romania

i Hellenic Center for Disease Control and Prevention Athens Greece

j Department of Pediatrics Riga Stradins University Riga Latvia

k Faculty of Public Health Slovak Medical University Bratislava Slovak Republic

l Royal College of General Practitioners Wokingham Berkshire UK

University of Zurich Epidemiology Biostatistics and Prevention Institute Zürich Switzerland

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