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- Overview
- On this page
- About
- Key findings
- Introduction
- Methodology
- Results
- Discussion
- Strengths and limitations
- Conclusion
(676 KB, 35 pages)
Organization:
Date published: 2023-09-20
Cat.: H14-315/2022E-PDF
ISBN: 2817-8483
Pub.: 230569
•About
•Key findings
•Influenza vaccine
•COVID-19 vaccines
•Introduction
•Methodology
This report summarizes the results from the 2022-2023 Seasonal Influenza Vaccination Coverage Survey. The survey is conducted annually to collect information on influenza vaccine uptake among adults in Canada. Respondents aged 18 years and older were questioned about their influenza vaccine uptake for the 2022-2023 season, as well as their reasons ...
Influenza vaccine
Influenza vaccination coverage increased from 39% in 2021-2022 to 43% in 2022-2023, bringing it back to the pre-pandemic level. Influenza vaccination coverage was higher in females (47%) than in males (39%). Only 43% of the adults aged 18-64 years with chronic medical conditions were vaccinated. Vaccination coverage among seniors (74%) is closer to the coverage goal of 80% but had not improved significantly in recent years. The most common reason for getting the flu vaccine was to prevent infection (47%), whereas the most common reason for not getting the flu vaccine was not getting around to it (21%). Most adults received their vaccine in October (38%) or November (36%). An increased number of adults received their flu vaccine in a pharmacy (52%) compared to the pre-pandemic seasons, highlighting the importance of this setting as point of vaccination. Despite most people agreeing that the flu vaccine is safe, 40% of adults mistakenly believed that they could get the flu from the flu vaccine.
COVID-19 vaccines
About one-third of the adults vaccinated against flu (30%) had received a COVID-19 vaccine at the same time. A majority of adults (66%) stated that getting COVID-19 and flu vaccines at the same time would not affect their likelihood of getting the flu vaccine. In total, 68% of adults had received at least one additional dose of a COVID-19 vaccine, while 16% had been reluctant to get one. The most common reason for having been reluctant to receive an additional dose was concerns about the side effects of having an additional dose. The most important reason for getting a COVID-19 additional dose despite the initial reluctance was the perception that the benefits are more important than risks.
Influenza, commonly known as the flu, is a contagious respiratory illness caused by influenza viruses that can infect the nose, throat, and lungs.Footnote 1 About 5 to 10% of adults and 20 to 30% of children are infected with influenza each year.Footnote 2,Footnote 3 The flu viruses are constantly changing and can cause a wide spectrum of illness ranging from asymptomatic to severe, complicated illness.Footnote 1 Moreover, influenza it is ranked among the top 10 leading causes of death in Canada with an average of 12,200 hospitalizations and 3,500 deaths per years according to data from before the COVID-19 pandemic.Footnote 2 Annual influenza vaccination is the most effective way to help prevent infection and to reduce the morbidity and mortality associated with influenza. The flu vaccine is updated every year to target the specific flu virus strains expected to circulate during the upcoming influenza season. Even if the strains have not changed, it is still necessary to get vaccinated annually as immunity wanes within a year.Footnote 1,Footnote 2 For the 2022–2023 influenza season, it is especially important for people to get the influenza vaccine to not only reduce the morbidity and mortality associated with influenza, but also to minimize any further pressure on the health care system during the respiratory virus season, particularly in the context of ongoing COVID-19 activity.Footnote 1 The optimal time to receive the influenza vaccine in Canada is between October and December, before the virus begins spreading in the community.Footnote 2,Footnote 4
The National Advisory Committee on Immunization (NACI) recommends that all individuals aged 6 months and older get the annual seasonal influenza vaccine, especially for populations at increased risk for influenza-related complications or hospitalization including:
•Pregnant people
•Children 6 months to less than 5 years of age
•Adults and children with certain chronic medical conditions (CMC), such as heart conditions, diabetes, cancer or immune disorder, anemia, renal diseases and morbid obesity
•Seniors 65 years and older
Survey sampling
The survey was conducted by Léger Marketing using a stratified regional sampling approach. Survey respondents from each province and territory were selected through random digit dialing of landlines and known cellphone-only household numbers. A comprehensive description of the quantitative methodology can be found elsewhere.Footnote 6 Sample weights were calculated by Léger Marketing based on age, gender, region, language (mother tongue), education level, and whether the respondent lives in a cellphone-only household.
Data collection
Data collection took place between January 5 and February 20, 2023, and interviews were conducted in English and French. A computer-assisted telephone interviewing (CATI) system was used to conduct the interviews. A total of 3,558 adults were surveyed regarding their influenza vaccination status, reasons for vaccination or non-vaccination, KAB regarding flu vaccine and vaccination in general, their uptake and intent to receive additional COVID-19 vaccine doses, and select demographic information. Respondents who were unsure of their vaccination status for a specific vaccine were excluded from subsequent analyses related to that vaccine.
Statistical analysis
Influenza vaccination coverage was estimated by calculating the weighted proportion of survey respondents who reported receiving the influenza vaccine in the 2022–2023 season, among those who provided a definitive response (i.e., responded "yes" or "no" to the influenza vaccination status question). Simple weighted proportions and 95% confidence intervals were calculated for categorical variables. Chi-squared tests with a p-value <0.05 were used to determine significant differences in vaccination coverage between genders within each age or risk group. The precision of estimates was assessed using the coefficient of variation. Estimates with a coefficient of variation ranging from 16% to 33%, or greater than 33% were associated with higher sampling error and should be interpreted with caution. Estimates based on a count less than 10 were considered unreliable and not reported.
Seasonal influenza vaccine
Influenza vaccination coverage In the 2022-2023 flu season, 43% of adults aged 18 years and older received the influenza vaccine. The overall coverage was significantly higher in females (47%) than in males (39%, p<0.001). Only 43% of the adults aged 18-64 years with CMC received a flu vaccine, falling significantly short of the national influenza vaccination coverage goal for those at high risk of influenza-related complications or hospitalization (80%). The coverage among seniors aged 65 years and older were much higher (74%), which brings them closer to the target coverage goal. The vaccination rate was lowest among adults 18-64 years of age without any CMC (31%). A significant difference in influenza vaccine uptake between females and males was observed among those 18–64 years of age without CMC. (Table 1.1). In all adults, influenza vaccination coverage increased from 39% in 2021-2022 to 43% in 2022-2023 and is now back to the pre-pandemic level. (Figure 1.1).Footnote 7,Footnote 8,Footnote 9 Among high-risk groups, vaccination coverage for adults 18-64 years of age with CMC and seniors 65 years of age and older remained steady over the past seasons. Consistent with the previous cycles of the survey, the proportion of vaccinated individuals was highest among seniors aged 65 years and older (74%), lower among those 18–64 years of age with a CMC (43%), and lowest in those 18-64 years of age without CMC (31%). (Figure 1.1). Figure 1.1. Seasonal influenza vaccination coverage, by risk group and influenza season Figure 1.1 - Text description Month and place of vaccination Among respondents who recalled the month they received their influenza vaccination (n=1,811), the majority received the vaccine in October (38%) or November (36%) 2022 (Table 2.1). In general, optimal protection is achieved by two weeks following vaccination.Footnote 2 Therefore, it is best to be vaccinated before the influenza season begins to allow time for the development of antibodies against the influenza viruses before they begin spreading in the community. September and October are generally good times to be vaccinated against flu.Footnote 2,Footnote 4 However, vaccination is still recommended until November or later because flu most commonly peaks in February, and significant activity can continue into May.Footnote 2 Consistent with previous seasons, the most commonly reported place of vaccination among adults was pharmacies (52%). 17% of adults got vaccinated at their doctor's office and 12% went to temporary vaccine clinics. (Table 2.2). When analyzing the place of vaccination over the past flu seasons between 2016-2017 and 2022-2023, an increasing number of people reported receiving their flu vaccine in pharmacies. In 2016-2017, the most common place of vaccination was doctor's office (33%), while only 28% were vaccinated in pharmacies. In contrast, in 2022-2023, the proportion of individuals vaccinated in pharmacies nearly doubled, reaching 52%. (Figure 2.1). However, it should be kept in mind that the respondents were asked about their place of vaccination, not the professional who vaccinated them. Therefore, some of those vaccinated "in a pharmacy" may in fact have been vaccinated by a nurse in the premises of a pharmacy. This rise can be attributed to the growing number of jurisdictions that allow pharmacists to administer the influenza vaccine.Footnote 10 Influenza vaccines were primarily administered by nurses and physicians in Canada, but several provinces have implemented policies permitting pharmacists to administer influenza vaccines in community pharmacies aiming to improve accessibility to flu vaccination. Community pharmacists who have been authorized to administer influenza vaccines could help to overcome issues with accessibility given their ubiquitous distribution, extended working hours, walk-in policies and availability to people without a primary care provider.Footnote 11 Studies have demonstrated that influenza vaccine uptake has modestly increased in Canadian jurisdictions where pharmacists were allowed to administer influenza vaccines.Footnote 10,Footnote 12 Figure 2.1. Place of influenza vaccination among vaccinated individuals by influenza season Figure 2.1 - Text description Figure 2.1: Text description Reasons for vaccination Among adults aged 18 years and older who provided a reason for receiving the vaccine (n=1,798), 47% were vaccinated because they wanted to prevent infection or avoid getting sick. Among adults aged 18-64 years with CMC, being at higher risk because of their health condition was also a commonly reported reason for receiving the vaccine (26%). Among seniors aged 65 years and older, the most commonly reported reasons for receiving the influenza vaccine were receiving it yearly without specific reasons (50%) and being at risk because of age (19%). This suggested that these vaccinated individuals have adopted yearly influenza vaccination as a preventive health practice, potentially recognizing their increased risk for influenza-related complications.Footnote 13 (Table 3.1). Reasons for non-vaccination Among unvaccinated individuals (n=1,724) who provided their main reason for not getting the vaccine (n=1,701) this year, the most common answer was that they did not get around to it (e.g. too busy, lack of time) (21%). The most commonly provided reasons for non-vaccination did not vary significantly among those aged 18 to 64 years old with or without CMC. Among seniors, the most common reason for not getting vaccinated was that they have never received a flu vaccine before (21%). Concerns about the safety or side effects of the vaccine were also commonly reported among seniors (15%). Additionally, 17% of younger adults with CMC and 15% of seniors did not receive the vaccine because they did not believe they needed it. The unawareness of being at high risk of flu-related complications could be one of the important factors contributing to low flu vaccination coverage among these groups. (Table 4.1). Barriers to get the influenza vaccine Overall, only 15% of adults stated that they encountered difficulties in scheduling an appointment to receive the flu vaccine this year. The most common difficulty reported was limited appointment availability (e.g., no flu vaccine available, hard to book an appointment), which affected 6% of the adults. The second most common barrier was the vaccine not being offered at a convenient or nearby location (4%). (Table 5.1). Impact of having the flu on getting the influenza vaccine During the data collection period between January and February 2023, the majority of adults in Canada stated that they did not have the flu this season (78%). Only 12% reported having the flu, while 9% had some flu-like symptoms but were unsure if it was flu or something else. (Table 6.1). Among those who had the flu (n=394), 20% had a severe case such as hospitalization or pneumonia, 50% had a moderate case, including sinus or ear infections, and 30% had a mild case with sudden onset of fever, sore throat, cough, muscle pain, etc. The majority (66%) stated that having the flu this season would not affect their likelihood of getting the flu vaccine next year. About one-third (30%) were more likely to get the flu vaccine next year, while 5% were less likely. When examining the likelihood of getting the flu vaccine based on the severity of the flu case, 41% of those who reported having a severe case were more likely to get the flu vaccine next year, whereas only 24% of those who had a mild case were more likely to get vaccinated next year. (Table 6.2). Impact of the healthcare providers on getting the influenza vaccine Overall, 84% of the adults (n=3,077) reported having a regular family doctor, general practitioner, nurse or pharmacist. Among them, 69% had visited their healthcare providers (HCP) at least once since September 1, 2022, around the beginning of the flu season. Less than half of the adults (44%) stated that their HCP had recommended they get the flu vaccine. This proportion is higher among younger adults with CMC (49%) and seniors (52%) compared to younger adults without CMC (36%). (Table 7.1). In addition, the flu vaccination coverage is significantly higher among individuals who were recommended to get the flu vaccine (67%), compared to 40% among those who did not receive such a recommendation. Significant differences in coverage between individuals who received recommendation from their HCP and those who did not were observed in each risk group. (Table 7.2) Influenza and COVID-19 vaccines co-administration This season, among those vaccinated against flu (n=1,811), about one-third of the adults (30%) had received a COVID-19 vaccine at the same time. Additionally, all the respondents were asked if receiving a COVID-19 vaccine at the same time as the flu vaccine would affect their likelihood of getting the flu vaccine. The majority of adults (66%) stated that receiving both vaccines at the same time would not affect their likelihood of getting vaccinated against the flu. 16% were more likely to get vaccinated, while 18% were less likely. (Table 8.1). The most important reason for being more likely to receive the flu and COVID-19 vaccines together was to save time (53%). 15% of the individuals were recommended to do so by a health care professional, and 10% found it easier to book an appointment. (Table 8.2). Whereas the most common reason for being less likely to receive the flu and COVID-19 vaccines together was the concerns about a higher number of adverse reactions or side effects (42%), followed by the perception that receiving both vaccines at the same time could overload the immune system (23%). (Table 8.3). Impact of the COVID-19 pandemic on influenza vaccination With the ongoing COVID-19 pandemic, the 2022-2023 influenza vaccination coverage survey also aimed to identify the potential impact of the pandemic on flu vaccine uptake. All the respondents were asked if their likelihood of getting vaccinated against the flu had been affected due to the COVID-19 pandemic. Among those who provided a valid answer to the question (n=3,486), the majority (70%) stated that the COVID-19 pandemic did not impact their likelihood of getting the flu vaccine this year. However, 19% were more likely to receive the flu vaccine, while 11% were less likely. A higher proportion of younger adults with or without CMC (12% and 13%, respectively) reported being less likely to get the seasonal influenza vaccine due to the pandemic compared to seniors (6%). (Table 9.1).
COVID-19 vaccines
COVID-19 vaccination coverage Alongside the seasonal influenza vaccination, the survey also collected information on COVID-19 vaccination. During the data collection period (January 5 to February 20, 2023), the majority of adults in Canada (92%) had received at least one dose of a COVID-19 vaccine, and 91% had received two doses or more. However, 8% of adults reported never receiving a COVID-19 vaccine. The proportion of unvaccinated individuals was higher among younger adults with or without CMC (8% and 9%, respectively) compared to seniors (3%). (Table 10.1). COVID-19 additional dose uptake Additional dose of COVID-19 vaccines is defined as any dose(s) received after the completion of a 1-dose or 2-dose vaccine primary series. They are mostly booster doses but may include additional doses given for other reasons (e.g. for travel purposes, being immunocompromised). Additional doses received after completing the primary series are important because they can increase protection by activating immune response to restore protection that may have decreased over time.Footnote 14 Overall, 68% of adults had received at least one additional dose of a COVID-19 vaccine. About one-third of the adults (29%) had received one additional dose, 26% had received two additional doses and 13% had received three additional doses or more. Notably, seniors had a much higher proportion (37%) of receiving three or more additional doses compared to younger adults with or without CMC (8% and 5%, respectively). (Table 11.1). COVID-19 additional dose reluctance Among individuals who received at least one additional dose (n=2,273), 16% have been reluctant to get one. The proportion was higher among young adults with or without CMC (17% and 20%, respectively) compared to seniors (9%). (Table 12.1). The most commonly cited reason for being reluctant to get a COVID-19 additional dose was concerns about the side effects of having an additional dose (52%). Other reasons included having already had COVID-19 (19%) and believing that the primary vaccine series provided enough protection (17%). (Table 12.2). The most common reason for getting a COVID-19 additional dose despite the initial reluctance was the perception that the benefits are more important than risks (29%), followed by the recommendation of a healthcare professional (20%). (Table 12.3). COVID-19 additional dose intent Among individuals who had not received an additional dose of a COVID-19 vaccine (n=893), only 16% stated being very likely to get one in the future. About half (48%) were very unlikely, and 18% were somewhat unlikely to receive an additional dose. A higher proportion of younger adults without any CMC (50%) expressed being very unlikely to receive an additional dose compared to seniors (37%). (Table 13.1). Overall, almost half of the adults (47%) stated that they were very likely to continue receiving the COVID-19 doses as they become eligible for another additional dose. The proportion was significantly higher among seniors (70%) compared to younger adults with or without CMC (51% and 36%, respectively). (Table 13.2). The most commonly stated reasons among individuals who received at least one additional dose, or likely to receive one in future or to keep additional doses up to date was to protect themselves from getting infected (37%), and to protect their family members (24%) from COVID-19. 16% wanted to prevent the spread of the virus in their community. (Table 13.3). On the other hand, the main reason for not being willing to get a COVID-19 additional dose was concerns about the side effects of having too many COVID-19 vaccines. 15% of the individuals thought that they were well protected with the current dose received and 13% stated that they already had COVID-19. (Table 13.4).
Knowledge, attitudes and beliefs regarding vaccination
The majority of adults (92%) reported considering vaccines to be important for their health, and 93% believed they knew enough about vaccines to make informed decisions. Additionally, 90% believed that the flu vaccine is safe, and a similar proportion (90%) understood why the flu vaccine is recommended annually. (Table 14.1). While most people believed that the flu vaccine is safe, there were still a high proportion of adults (40%) who mistakenly believed that they might get the flu from the flu vaccine, which is not true. Flu vaccines cannot cause flu illness since flu vaccines are made with inactivated viruses that cannot cause disease.Footnote 2 Moreover, 39% felt that the flu vaccine does not protect them against getting the flu. In addition, more than half of the adults believed that it is good for children (64%) or adults (58%) to get natural immunity against the flu by being exposed to the virus. In fact, when an individual is exposed to viruses or bacteria naturally, the developed immune response and symptoms are typically greater. However, when scientists are designing vaccines, they determine the smallest amount of virus or bacteria needed to generate a protective immunologic response. In this situation, vaccines afford protection with better control of the exposure. Moreover, any flu infection can carry a risk of serious complications, hospitalization or death, even among otherwise healthy children and adults. Therefore, getting vaccinated is a safer choice than risking illness to obtain immune protection.Footnote 15 Despite the majority of the adults (67%) agreeing that it is safe to get the flu vaccine and a COVID-19 vaccine at the same time; more than a quarter of the adult population (26%) thought that the flu vaccine or a COVID-19 vaccine could be less effective if getting them together. Overall, 67% of the population strongly or somewhat agreed that the opinion of their family doctor, general practitioner or nurse practitioner is an important part of their decision for getting the flu vaccine. This indicates that there is public trust in health care professionals and suggests that advice from a health care provider and the frequency of interaction with the health care system may play an important role in influenza vaccine uptake. Regarding COVID-19 vaccines, almost half of the adults (46%) thought that it is a good thing for children to get natural immunity against COVID-19 by being exposed to coronavirus. Moreover, a similar proportion 45% believed that it is good for adults to get natural immunity against COVID-19 by being exposed to coronavirus. A previous COVID-19 infection or COVID-19 vaccination can both provide immunity and protection from serious outcomes. However, alike the flu vaccine, COVID-19 vaccination provides a higher, more robust, and more consistent level of immunity to protect people from COVID-19 than infection alone.Footnote 16 Additionally, 74% strongly or somewhat agreed that it is important to stay up to date with COVID-19 vaccinations including additional doses.
The results of the survey provided valuable insights into the influenza vaccination coverage and factors influencing vaccination decisions among adults in Canada during the 2022-2023 flu season. The overall influenza vaccination coverage among adults aged 18 years and older was 43%, which indicated an increase from the previous season (39%) and a return to pre-pandemic levels. However, this coverage falls significantly short of the national vaccination coverage goal of 80% for adults aged 18-64 years with CMC. Among this high-risk group, only 43% received the flu vaccine. Individuals unaware that they are considered at high risk of influenza-related complications may contribute to low coverage.Footnote 17 Seniors aged 65 years and older had a much higher vaccination coverage of 74%, bringing them closer to the target coverage goal.
The results also revealed a significant gender difference in influenza vaccination coverage, with females having a higher coverage (47%) than males (39%). This finding emphasizes the importance of targeted strategies to address the lower vaccination rates among males and promote gender equity in vaccination coverage.
The survey identified a notable trend in the place of influenza vaccination, with an increasing number of people reporting receiving their flu vaccine in pharmacies. This rise can be attributed to the growing number of jurisdictions allowing pharmacists to administer the influenza vaccine. The expanded role of community pharmacists in vaccine administration can help improve accessibility to flu vaccination.
The most common reason for being vaccinated against flu was to preventing infection or avoid illness. Whereas the most common reason reported by unvaccinated individuals was not getting around to it, indicating barriers related to time constraints and lack of prioritization. Among seniors, concerns about the safety or side effects of the vaccine were more prevalent, suggesting the need for targeted communication strategies to address vaccine hesitancy and address misconceptions.
Difficulties in scheduling an appointment and limited availability of the vaccine were reported by a small proportion of adults. However, the overall impact of these barriers on vaccine uptake was low, with only 15% of adults experiencing difficulties. This finding suggests that access to vaccination services was generally satisfactory during the flu season.
The impact of having the flu on future vaccination decisions varied among individuals. While the majority stated that having the flu this season would not affect their likelihood of getting the flu vaccine next year, a significant proportion expressed increased intention to vaccinate. Notably, those who had a severe case of the flu were more likely to seek vaccination in the future, highlighting the potential impact of personal experiences with the disease on vaccination behavior.
The major strength of this survey was the timely reporting of seasonal influenza vaccination coverage across Canada. The timeliness of this survey allows Canada to meet its international reporting obligations and help identify priorities for future vaccination program planning. Additionally, the Seasonal Influenza Vaccination Coverage Survey is flexible in allowing question modules to be added or removed on an annual basis in light of changing priorities.
Limitations of this survey included the relatively low response rate of 10%. This response rate can increase the potential for non-response bias, as survey respondents may differ from those who chose not to complete the survey.
The 2022-2023 influenza vaccination coverage survey in Canada revealed that 43% of adults received the influenza vaccine, with higher coverage among females and seniors. Ongoing efforts to promote and educate the adult population on the benefits of recommended vaccines is required to increase uptake, particularly among the population who are consid...
Nov 18, 2016 · Search strings were developed to identify potentially relevant sources based on incidence, prevalence, morbidity and mortality of influenza in Canada, along with costs and cost-effectiveness or cost-utility analyses.
Jan 9, 2024 · Prices can stretch as high as $8000+ if it’s a top-of-the-line furnace, if it’s a complex installation (or conversion from, say, oil to propane), if you live farther from a large city, or if there are added other costs like financing interest over a period of many years.
