Background and purpose: Influenza continues to be a considerable health problem in Europe. Vaccination is the only preventive measure, reducing mortality and morbidity of influenza in all age groups. The objectives of this survey were to assess the level of influenza vaccination coverage in the 2002/2003 season compared with the 2003/2004 season in Germany, to understand the driving forces and barriers to vaccination, and to determine vaccination intentions for the following winter.

Methods: The authors conducted a random-sampling, telephone-based household survey among noninstitutionalized individuals representative of the population aged > or = 14. The surveys for 2002/2003 and 2003/2004 used the same questionnaire and were subsequently pooled. Four target groups were determined for analysis: (1) persons aged > or = 60; (2) people working in the medical field; (3) persons suffering from chronic illness; and (4) a group composed of persons aged > or = 60 or working in the medical field or suffering from a chronic illness.

Results: The overall sample consisted of 4,011 people. The influenza vaccination coverage rate in Germany increased from 22.3% in 2002/2003 to 25.1% in 2003/2004. This increase is not significant. The most frequent reasons for being vaccinated given by vaccinees were: influenza considered to be a serious illness, which people wanted to avoid (90.1%), having received advice from the family doctor or nurse to be vaccinated (71.3%), and not wanting to infect family and friends (70.4%). Reasons for not being vaccinated mentioned by people who have never been vaccinated were: thinking about it, however, not being vaccinated in the end (47.7%), not expecting to catch influenza (43.6%), and not having received a recommendation from the family doctor to be vaccinated (36.6%). Options encouraging influenza vaccination are: recommendation by the family doctor or nurse (66.6%), more available information on the vaccine regarding efficacy and tolerance (54.2%), and more information available about the disease (52.4%).

Conclusion: The vaccination coverage in the 2003/2004 season increased in comparison to the 2002/2003 season, although not significantly. The family doctor is the most important source of encouragement for people to be vaccinated against influenza. It seems that the public would be more likely to be vaccinated if they had more information on the efficacy and tolerance of the vaccine, as well as the disease. It is therefore suggested that family doctors be better informed on influenza vaccine and the disease itself, so that they can actively inform their patients on these topics.