{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T20:25:38Z","timestamp":1789676738903,"version":"4.0.1"},"reference-count":19,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T00:00:00Z","timestamp":1750118400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Introduction<\/jats:title>\n Influenza vaccination is a critical public health measure, especially amidst the challenges of the COVID-19 pandemic. This study uses Epic\u2019s Cosmos database to analyze influenza vaccination trends across demographic groups in the United States, examining the effects of the COVID-19 pandemic and \u201cvaccine fatigue\u201d on influenza vaccination rates.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This retrospective cross-sectional study analyzes influenza vaccination rates pre- (1 May 2018\u201331 May 2019), peri- (1 May 2020\u201331 May 2021), and post-COVID-19 (1 May 2023\u201331 May 2024). A two-proportion z-test and Cohen\u2019s h test were calculated to assess statistical significance.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Influenza vaccination rates increased peri-COVID (+1.99% point change, h\u2009=\u20090.04, p\u2009<\u20090.001) and decreased post-COVID (\u22126.41% point change, h\u2009=\u20090.14, p\u2009<\u20090.001) relative to pre-COVID. The largest changes were observed in the following groups: 5\u221218 year olds (\u221213.92% point change, h\u2009=\u20090.31, p\u2009<\u20090.001), 19\u221226 year olds (\u22129.91% point change, h\u2009=\u20090.25, p\u2009<\u20090.001), American Indian or Alaska Native (\u22128.11% point change, h\u2009=\u20090.18, p\u2009<\u20090.001), Other Races (\u22127.36% point change, h\u2009=\u20090.17, p\u2009<\u20090.001), White (\u22126.89% point change, h\u2009=\u20090.15, p\u2009<\u20090.001), and the South U.S. census region (\u22127.21% point change, h\u2009=\u20090.17, p\u2009<\u20090.001).<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Post-pandemic influenza vaccination compliance decreased relative to pre-pandemic, especially among younger age groups, certain racial groups, and in the southern U.S. These findings suggest that the COVID-19 pandemic negatively impacted influenza vaccination compliance. While overall trends aligned with publicly available data, absolute counts may be\u00a0under-reported\u00a0within Epic due to incomplete documentation of vaccine administrations outside of Epic-affiliated systems.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0326098","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T13:25:47Z","timestamp":1750166747000},"page":"e0326098","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":12,"title":["Vaccine fatigue and influenza vaccination trends across Pre-, Peri-, and Post-COVID-19 periods in the United States using epic\u2019s cosmos database"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2319-528X","authenticated-orcid":true,"given":"Tyler B.","family":"Nofzinger","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy T.","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1213-3876","authenticated-orcid":true,"given":"Christopher Eduard R.","family":"Lingat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7238-7131","authenticated-orcid":true,"given":"Gaurang M.","family":"Amonkar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily E.","family":"Edwards","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0049-6707","authenticated-orcid":true,"given":"Alexander 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