Data extracted in October 2025
Planned article update: November 2026
Highlights
In 2023, almost half (47.1%) of the people aged 65 years or over in the EU were vaccinated against influenza.
Denmark had the highest vaccination rate in the EU in 2023, with 77.5% of people aged 65 years or over vaccinated against influenza.
There were 7 589 deaths of EU residents from influenza in 2022.
Influenza vaccination rate, people aged 65 years or over, 2023
Source: Eurostat (hlth_ps_immu)
This article presents an overview of European Union (EU) statistics related to influenza. It includes the following data:
- influenza vaccination rates among people aged 65 years or over, for 2009 to 2023 [1]
- standardised death rates from influenza, by age group, for 2022.
Data on influenza vaccination for 2020-2022 may have been impacted by the COVID-19 pandemic and its related restrictions. For this reason, particular attention should be paid when comparing data across time. In some EU countries, healthcare resources were placed under intense pressure (particularly at the start of the pandemic) from an influx of patients with COVID-19. The pandemic also resulted in a range of knock-on effects including, among others, some services being curtailed/postponed due to the number of COVID-19 patients, staff shortages within hospitals and day care centres due to infection/quarantine procedures, and patients being hindered access to medical services due to their own infection/quarantine as well as lockdown or travel restrictions. The COVID-19 vaccination programmes may also have increased awareness of other preventive measures, such as vaccination for influenza.
This article is included in a set of statistical articles concerning specific health conditions in the EU which forms part of an online publication on Health in the European Union – facts and figures.
Influenza vaccination rates – based on vaccination programme data
The rate of vaccination increased during pandemics
In the EU, just under half (47.1%) of people aged 65 years or over were vaccinated against seasonal influenza in 2023. As can be seen from Figure 1, between 2009 and 2023 (data not available for 2012 and 2013), the rate of vaccination against influenza in the EU fluctuated. The rate was highest at the beginning of this time series, 52.4% in 2009. It then fell to its lowest level in 2015 (39.9%) and remained around this level for 2 years. In 2018, 2019 and 2020, the rate increased by 1 or 2 percentage points each year. The largest increase (during the time series available) was recorded in 2021, with the vaccination rate increasing from 43.5% in 2020 to 50.7% in 2021. The rate fell back somewhat in 2022 and again in 2023 but remained relatively high, at 47.1%.
In general, the influenza seasons with the highest vaccination rates occurred during the same periods as World Health Organisation (WHO) declared pandemics. An outbreak of swine flu occurred in 2009 and 2010, and the influenza seasons 2020, 2021 and 2022 occurred during the COVID-19 pandemic.
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Source: Eurostat (hlth_ps_immu)
Vaccination rates vary between EU countries
Among the EU countries, there are various policies to make influenza vaccines available to the general public. Often these vaccines are targeted at older age groups or other people who have a higher risk of poor health outcomes if they catch influenza (such as people who are immunocompromised).
Figure 2 shows considerable differences between EU countries in relation to the overall uptake of influenza vaccinations among people aged 65 years or over in 2013 and 2023. More than three quarters of people aged 65 years or over in Denmark (77.5%) and in Ireland (75.7%) were vaccinated against influenza in 2023, as were 71.8% in Portugal. By contrast, less than a fifth of older people were vaccinated in Slovenia (17.6%), Latvia (15.8%), Bulgaria (15.2%), Slovakia (11.7%) and Poland (9.6%), the latter recording the lowest rate across the EU.
In 19 of the EU countries, the share of older people vaccinated against influenza was higher in 2023 than it had been in 2013 (see Figure 2 for more information on the different coverage and reference years used in some countries).The proportion of the population aged 65 years or over vaccinated against influenza was more than 25.0 pp higher in 2023 than in 2013 in Denmark (up 32.5 pp), Estonia (up 27.4 pp) and Portugal (up 26.9 pp). By contrast, the biggest declines were recorded in Malta (down 10.6 pp), Hungary (down 8.5 pp) and the Netherlands (down 5.7 pp).
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Source: Eurostat (hlth_ps_immu)
Deaths from influenza
There were 7 589 deaths of EU residents from influenza in 2022, equivalent to 1.52 deaths per 100 000 inhabitants. Among these, 6 886 deaths occurred in people aged 65 years or over, equivalent to 7.01 deaths per 100 000 inhabitants of the same age. Note that the number of deaths from influenza can vary greatly between years. For example, in 2018 there were 12 705 deaths from influenza, 35 times more than in 2021. This large fall may reflect, at least in part, the impact of measures introduced against COVID-19, as some of these (such as social distancing, a greater focus on hand washing and the use of masks) also reduced the spread of influenza (see the Data sources section for information on influenza mortality).
Among EU countries, the highest standardised death rate for influenza in 2022 was reported in Austria, with 3.73 deaths per 100 000 inhabitants. The Netherlands (with 3.56 deaths from influenza per 100 000 inhabitants) and Belgium (with 3.07 deaths per 100 000 inhabitants) were the only other EU countries to report standardised death rates over 3.00. By contrast, there were 4 EU countries which reported fewer than 0.20 deaths from influenza per 100 000 inhabitants: Hungary (0.13), Slovakia (0.12), Romania (0.11) and Cyprus (where the lowest rate was recorded, at 0.10 deaths per 100 000 inhabitants).
The standardised death rate for influenza was considerably higher among people aged 65 years or over than people aged less than 65 years. Among EU residents, the rate for older people was 7.01 deaths per 100 000 inhabitants in 2022, compared with 0.19 deaths per 100 000 inhabitants among people aged less than 65 years. As for the population as a whole, Austria and the Netherlands reported the highest standardised death rates for influenza among those aged 65 years or over with, respectively, 18.00 and 16.41 deaths per 100 000 people aged 65 years or over. There were also double-digit standardised death rates for this age group in Belgium (14.43 deaths), France (11.53), Estonia (10.90) and Denmark (10.74). The lowest standardised death rates were recorded for people aged 65 years or over in Cyprus (0.00 deaths)[2], Hungary (0.39), Romania (0.51) and Slovakia (0.62).
In 2022, the standardised death rate from influenza among people aged less than 65 years was highest in the Netherlands (0.45), France (0.37), Estonia (0.36) and Belgium (0.32). There were no deaths from influenza among this younger age group in Malta or Slovakia.
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Source data for tables and graphs
Data sources
Key concepts
The number of deaths from a particular cause of death can be expressed relative to the size of the population. A standardised (rather than crude) death rate can be compiled which is independent of the age and sex structure of a population: this is done as most causes of death vary significantly by age and according to sex and the standardisation facilitates comparisons of rates over time and between countries.
Influenza vaccinations
This article presents data on influenza vaccinations, largely derived from administrative sources that are linked to vaccination programmes (see further information in the background article on the methodology of healthcare non-expenditure statistics). For country specific notes on these data collections, please refer to the annexes at the end of the national metadata reports, which are accessible from links at the beginning of the European metadata report.
The Healthcare non-expenditure statistics manual provides an overview of the classifications, both for mandatory variables and variables provided on a voluntary basis.
Vaccination programme data
The extent of influenza vaccinations is based on the percentage of people aged 65 years or over who have been immunised against influenza during the reference period (defined as 1 July to 30 June, which ended in the reference period).
The vaccination rate is calculated by influenza season or by calendar year. Some countries may use European health interview (EHIS) survey data to calculate the vaccination rate for influenza; the last round of the EHIS was in 2019. Please see the table below for more information on sources.
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Data for the EU are calculated using the reference year data for each EU country. If data are not available for a particular reference year, the most recent available data from the previous 5 reference years is used. The EU data are population-weighted averages.
Causes of death
This article also includes statistics on causes of death. These are documented in more detail in a background article on the methodology of causes of death statistics. This provides information on the scope of the data, its legal basis, the methodology employed, as well as related concepts and definitions.
The Eurostat causes of death data collection is based on confirmed death certificates established by medical experts assessing the underlying cause of death. There is a difference in the coding of cases of influenza deaths: these concern cases where influenza was the established underlying cause of death or where death occurred in someone who had influenza at or close to the time of death. There may be differences in how countries determined the underlying cause of death, particularly in cases where the deceased had multiple morbidities, or coinfections with other respiratory diseases (for example, COVID-19 or pneumonia); see the article on respiratory diseases statistics for more information.
The significant decrease in influenza deaths in 2021 and increase in 2022 could be attributed, at least in part, to a combination of public health measures in 2021, such as enhanced vaccination strategies, social distancing, mask mandates and enhanced hygiene practices enacted to tackle the COVID-19 pandemic. It should also be taken into account that at the beginning of the pandemic, WHO guidelines recommended the use of ICD-10 codes for COVID-19 for all deaths from clinically compatible illnesses and where COVID-19 contributed to the death; this may play a part in the underreporting of influenza deaths.
For country-specific notes, please refer to the national metadata reports, which can be accessed through the links at the beginning of the European metadata report.
Context
Vaccination is vital for primary prevention and offers the most cost-effective, long-term strategy for reducing the burden of diseases across the EU. Immunisation through vaccination is the best available defence against serious, preventable, and sometimes deadly, contagious diseases. Thanks to widespread vaccination, smallpox has been eradicated, Europe made polio-free and many other diseases almost eliminated. That said, vaccination rates for various diseases are showing signs of decline across many EU countries, including for childhood vaccinations.
Influenza is an annual, seasonal virus that affects Europe in the winter. The majority of people who die from influenza are aged 65 years or over, many of whom face other complications/illnesses, such as heart disease or chronic lung disease. During an influenza epidemic, there may be significant costs for health services (associated with caring for those who fall sick) and for businesses in general (lost production as a result of time taken off work).
To help countries prepare their response to a likely increase of COVID-19 and influenza in the autumn and winter 2022/23, the European Commission published a Communication on preparing for this period, including recommendations to combine COVID-19 and influenza vaccination campaigns where possible.
Integrating population-based surveillance systems for influenza, SARS-CoV-2 (the virus that causes the COVID-19 illness) and other respiratory viruses to monitor the spread and intensity of respiratory viruses is a key recommendation published by WHO/Europe in its strategy recommendations to protect the most vulnerable.
The European Centre for Disease Prevention and Control (ECDC) was set up to help strengthen Europe’s defences against infectious diseases, such as influenza, SARS, COVID-19 and HIV/AIDS. The ECDC works in partnership with national health protection bodies in Europe to develop continent-wide disease surveillance and early warning systems.
The European Vaccination Information Portal (EVIP) was developed by the ECDC, in partnership with the European Commission and the European Medicines Agency (EMA) and includes information of influenza vaccination.
Footnotes
- For most countries, the year corresponds to the influenza season which ended in the year mentioned; alternatively it corresponds to the calendar year. Hence, the year 2023 corresponds to the influenza season 2022/23 or calendar year 2023. See the section on data sources for more information. ↑
- Eurostat uses confidentiality rules when there are very few deaths in a group, to ensure that disseminated data are confidential. These data are noted with ':' and a 'c' indicator. Consequently, when expressed as standardised death rates, certain causes of death are reported as 0.0 per 100,000 people, even if there are a few cases, to ensure individuals can't be identified. ↑
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Other articles
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Causes of death
- Causes_of_death_statistics
- Causes of death statistics by age group
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- Cardiovascular diseases statistics
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Methodology
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Database
- Health (hlth), see:
- Health care (hlth_care)
- Preventive services (hlth_prev)
- Vaccination against influenza of population aged 65 and over (hlth_ps_immu)
- Self-reported vaccination against influenza by sex, age and educational attainment level (hlth_ehis_pa1e)
- Preventive services (hlth_prev)
- Causes of death (hlth_cdeath)
Thematic section
Publications
Methodology
- Healthcare non-expenditure statistics manual and guidelines for completing the Joint questionnaire on non-monetary healthcare statistics – 2025 edition
- Healthcare resources (ESMS metadata file – hlth_res_esms)
- Causes of death (SIMS metadata file – hlth_cdeath_sims)
- Revision of the European Standard Population – Report of Eurostat’s task force – 2013 edition