{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:32:29Z","timestamp":1785717149926,"version":"3.56.0"},"reference-count":27,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,6,29]],"date-time":"2025-06-29T00:00:00Z","timestamp":1751155200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Public Welfare Technology Application Research Funding Projects of Zhejiang Province","award":["LGF22H260020"],"award-info":[{"award-number":["LGF22H260020"]}]},{"name":"Public Welfare Technology Application Research Funding Projects of Zhejiang Province","award":["2025JK072"],"award-info":[{"award-number":["2025JK072"]}]},{"name":"Public Welfare Technology Application Research Funding Projects of Zhejiang Province","award":["2025JK077"],"award-info":[{"award-number":["2025JK077"]}]},{"name":"Public Welfare Technology Application Research Funding Projects of Zhejiang Province","award":["2025KY281"],"award-info":[{"award-number":["2025KY281"]}]},{"name":"Public Welfare Technology Application Research Funding Projects of Zhejiang Province","award":["20221CXJD030031"],"award-info":[{"award-number":["20221CXJD030031"]}]},{"name":"Zhejiang Science and Technology Plan for Disease Prevention and Control","award":["LGF22H260020"],"award-info":[{"award-number":["LGF22H260020"]}]},{"name":"Zhejiang Science and Technology Plan for Disease Prevention and Control","award":["2025JK072"],"award-info":[{"award-number":["2025JK072"]}]},{"name":"Zhejiang Science and Technology Plan for Disease Prevention and Control","award":["2025JK077"],"award-info":[{"award-number":["2025JK077"]}]},{"name":"Zhejiang Science and Technology Plan for Disease Prevention and Control","award":["2025KY281"],"award-info":[{"award-number":["2025KY281"]}]},{"name":"Zhejiang Science and Technology Plan for Disease Prevention and Control","award":["20221CXJD030031"],"award-info":[{"award-number":["20221CXJD030031"]}]},{"name":"Zhejiang Provincial Medical and Health Science and Technology Program","award":["LGF22H260020"],"award-info":[{"award-number":["LGF22H260020"]}]},{"name":"Zhejiang Provincial Medical and Health Science and Technology Program","award":["2025JK072"],"award-info":[{"award-number":["2025JK072"]}]},{"name":"Zhejiang Provincial Medical and Health Science and Technology Program","award":["2025JK077"],"award-info":[{"award-number":["2025JK077"]}]},{"name":"Zhejiang Provincial Medical and Health Science and Technology Program","award":["2025KY281"],"award-info":[{"award-number":["2025KY281"]}]},{"name":"Zhejiang Provincial Medical and Health Science and Technology Program","award":["20221CXJD030031"],"award-info":[{"award-number":["20221CXJD030031"]}]},{"name":"Ningbo Key Laboratory of Virus Research","award":["LGF22H260020"],"award-info":[{"award-number":["LGF22H260020"]}]},{"name":"Ningbo Key Laboratory of Virus Research","award":["2025JK072"],"award-info":[{"award-number":["2025JK072"]}]},{"name":"Ningbo Key Laboratory of Virus Research","award":["2025JK077"],"award-info":[{"award-number":["2025JK077"]}]},{"name":"Ningbo Key Laboratory of Virus Research","award":["2025KY281"],"award-info":[{"award-number":["2025KY281"]}]},{"name":"Ningbo Key Laboratory of Virus Research","award":["20221CXJD030031"],"award-info":[{"award-number":["20221CXJD030031"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background: Elderly patients with chronic lower respiratory diseases (CLRDs) demonstrate an increased susceptibility to complications arising from influenza. Influenza vaccination remains the most effective strategy against influenza-related diseases among elderly CLRD patients. This study aimed to evaluate the influenza vaccination status of older CLRD patients and the factors affecting influenza vaccination. Methods: Using population-based health registries, we analyzed the longitudinal uptake of influenza vaccination among elderly patients with CLRDs in Ningbo from the 2018\/19 season to the 2022\/23 season. A multivariate logistic regression analysis was performed to identify behavioral determinants influencing influenza vaccination among elderly CLRD patients under Ningbo\u2019s post-pandemic free vaccination policy. Results: An average of 487,309 older patients with CLRDs were included in our analysis for each season. The influenza vaccination rate increased from 3.59% in 2018\/19 to 43.32% in the 2022\/23 influenza season. There was a significant increase in the proportion of timely influenza vaccinations prior to November 15, rising from 3.01% before the COVID-19 pandemic to 33.90% during the pandemic period. The multivariate logistic regression analysis indicated that both the COVID-19 pandemic and free vaccination policy significantly promoted influenza vaccine uptake. Older CLRD patients with comorbidities such as diabetes, hypertension, or cancer exhibited higher influenza vaccination coverage, whereas those who have experienced acute cardiovascular events showed a lower vaccination rate. Additionally, a prior vaccination history significantly influenced uptake. Conclusions: Despite the significant improvement in vaccination rates, coverage among elderly patients with CLRDs remains below the WHO target. Addressing this gap requires integrated interventions that combine expanding the population eligible for free vaccinations, community mobilization efforts, and effective communication regarding cardiovascular safety to mitigate vaccine hesitancy within high-risk groups.<\/jats:p>","DOI":"10.3390\/vaccines13070705","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T07:42:06Z","timestamp":1751355726000},"page":"705","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Influenza Vaccination Coverage Among Elderly Patients with Chronic Lung Respiratory Disease in Ningbo, China: Impact of Free Vaccination Policies and the COVID-19 Pandemic"],"prefix":"10.3390","volume":"13","author":[{"given":"Xiaoqing","family":"Wu","sequence":"first","affiliation":[{"name":"School of Public Health, Ningbo University, Ningbo 315211, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jieping","family":"Chen","sequence":"additional","affiliation":[{"name":"Ningbo Municipal Center for Disease Prevention and Control, Ningbo 315010, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pingping","family":"Li","sequence":"additional","affiliation":[{"name":"Jiangbei District Center for Disease Prevention and Control, Ningbo 315021, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9971-5107","authenticated-orcid":false,"given":"Tianchi","family":"Yang","sequence":"additional","affiliation":[{"name":"Ningbo Municipal Center for Disease Prevention and Control, Ningbo 315010, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lixia","family":"Ye","sequence":"additional","affiliation":[{"name":"Ningbo Municipal Center for Disease Prevention and Control, Ningbo 315010, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,29]]},"reference":[{"key":"ref_1","unstructured":"Expert Committee of Consensus Opinion on Influenza Vaccine and Pneumococcal Vaccine, Vaccination for Elderly People with Chronic Respiratory Diseases, Respiratory Group of Chinese Geriatrics Society (2024). Expert consensus on influenza vaccine and pneumococcal vaccination in elderly people with chronic respiratory diseases (2024). Chin. J. Geriatr., 43, 1223\u20131235."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/j.jinf.2013.11.013","article-title":"The burden of influenza in England by age and clinical risk group: A statistical analysis to inform vaccine policy","volume":"68","author":"Cromer","year":"2014","journal-title":"J. Infect."},{"key":"ref_3","first-page":"e00194717","article-title":"Prevalence of influenza vaccination in adults and elderly with chronic respiratory diseases","volume":"34","author":"Bacurau","year":"2018","journal-title":"Cad. Saude Publica"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e94","DOI":"10.1093\/cid\/ciz1086","article-title":"Seasonal Influenza Vaccine Effectiveness in People with Asthma: A National Test-Negative Design Case-Control Study","volume":"71","author":"Vasileiou","year":"2020","journal-title":"Clin. Infect. Dis. Off. Publ. Infect. Dis. Soc. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1093\/infdis\/jiz419","article-title":"Influenza Vaccine Effectiveness in Preventing Hospitalizations in Older Patients with Chronic Obstructive Pulmonary Disease","volume":"221","author":"Gershon","year":"2020","journal-title":"J. Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"230034","DOI":"10.1183\/16000617.0034-2023","article-title":"The role of vaccination in COPD: Influenza, SARS-CoV-2, pneumococcus, pertussis, RSV and varicella zoster virus","volume":"32","author":"Simon","year":"2023","journal-title":"Eur. Respir. Rev."},{"key":"ref_7","unstructured":"World Health Orgnazation (2025, March 23). Influenza (Seasonal). Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/influenza-(seasonal)."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Yeo, M., Seo, J., and Lim, J. (2023). The impact of the COVID-19 pandemic and the expansion of free vaccination policy on influenza vaccination coverage: An analysis of vaccination behavior in South Korea. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0281812"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1080\/21645515.2019.1646577","article-title":"Decreasing influenza vaccine coverage among adults with high-risk chronic diseases in Spain from 2014 to 2017","volume":"16","year":"2020","journal-title":"Hum. Vaccin. Immunother."},{"key":"ref_10","first-page":"1508","article-title":"Progress in research of influenza vaccine and 23 valent pneumococcal polysaccharide vaccine immunization in patients with chronic obstructive pulmonary disease","volume":"43","author":"Sui","year":"2022","journal-title":"Chin. J. Epidemiol."},{"key":"ref_11","unstructured":"National Immunization Advisory Committee (NIAC) Technical Working Group (TWG), Influenza Vaccination TWG (2023). Technical guidelines for seasonal influenza vaccination in China (2023\u20132024). Chin. J. Epidemiol., 44, 1507\u20131530."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2503","DOI":"10.1016\/j.vaccine.2020.01.093","article-title":"Influenza vaccination rate and its association with chronic diseases in China: Results of a national cross-sectional study","volume":"38","author":"Fan","year":"2020","journal-title":"Vaccine"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2370999","DOI":"10.1080\/21645515.2024.2370999","article-title":"The impact of the COVID-19 pandemic and the free vaccination policy on seasonal influenza vaccination uptake among older adults in Ningbo, Eastern China","volume":"20","author":"Ye","year":"2024","journal-title":"Hum. Vaccin. Immunother."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1093\/eurheartj\/ehac737","article-title":"Primary prevention of acute cardiovascular events by influenza vaccination: An observational study","volume":"44","author":"Davidson","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1161\/CIRCULATIONAHA.118.036788","article-title":"Influenza Vaccine in Heart Failure","volume":"139","author":"Modin","year":"2019","journal-title":"Circulation"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e228873","DOI":"10.1001\/jamanetworkopen.2022.8873","article-title":"Association of Influenza Vaccination with Cardiovascular Risk: A Meta-Analysis","volume":"5","author":"Behrouzi","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1038\/s41541-024-00969-y","article-title":"Effectiveness of influenza vaccines in preventing acute cardiovascular events within 1 year in Beijing, China","volume":"9","author":"Ma","year":"2024","journal-title":"NPJ Vaccines"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.1093\/eurheartj\/ehm581","article-title":"Influenza vaccination in secondary prevention from coronary ischaemic events in coronary artery disease: FLUCAD study","volume":"29","author":"Ciszewski","year":"2008","journal-title":"Eur. Heart J."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Seo, J., and Lim, J. (2022). The impact of free vaccination policies under the Korean Influenza National Immunization Program: Trends in influenza vaccination rates in South Korea from 2010 to 2019. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0262594"},{"key":"ref_20","first-page":"432","article-title":"Analysis of the difference in free influenza vaccination rates between old people in ur-ban and rural areas in Beijing","volume":"45","author":"Wang","year":"2013","journal-title":"J. Peking Univ. (Health Sci.)"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Yeo, M., Seo, J., and Lim, J. (2025). Socioeconomic disparities in influenza vaccination uptake: Impact of the COVID-19 pandemic in South Korea. BMC Public Health, 25.","DOI":"10.1186\/s12889-024-21254-6"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e70057","DOI":"10.1111\/irv.70057","article-title":"A Missed Opportunity? Exploring Changes in Influenza Vaccination Coverage During the COVID-19 Pandemic: Data From 12 Countries Worldwide","volume":"19","author":"Guida","year":"2025","journal-title":"Influenza Other Respir Viruses"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.ypmed.2012.02.015","article-title":"The Vaccination Coverage Required to Establish Herd Immunity against Influenza Viruses","volume":"55","year":"2012","journal-title":"Prev. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1550","DOI":"10.1093\/cid\/ciz452","article-title":"Waning of Influenza Vaccine Protection: Exploring the Trade-offs of Changes in Vaccination Timing Among Older Adults","volume":"70","author":"Ferdinands","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.jagp.2021.09.010","article-title":"Severe Covid-19 Vaccine Side-Effects are Rare in Older Adults yet are Linked With Depressive Symptoms","volume":"30","author":"Hoffman","year":"2022","journal-title":"Am. J. Geriatr. Psychiatry"},{"key":"ref_26","first-page":"383","article-title":"Adverse events following immunization with a trivalent influenza split-virion vaccine among the elderly aged \u226560 years in communities of Taizhou city, 2018\u20132019","volume":"4","author":"Ding","year":"2020","journal-title":"Chin. J. Vaccines Immun."},{"key":"ref_27","first-page":"524","article-title":"Observation on the intervention on effect of influenza vaccination against chronic obstructive pulmonary diseases among elderly patients","volume":"7","author":"Mao","year":"2012","journal-title":"Chin. Prev. Med."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/13\/7\/705\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:01:09Z","timestamp":1760032869000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/13\/7\/705"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,29]]},"references-count":27,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["vaccines13070705"],"URL":"https:\/\/doi.org\/10.3390\/vaccines13070705","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,29]]}}}