Only one in ten at-risk German children vaccinated against flu, data show

Only about 10 percent of children in Germany with health conditions that put them at higher risk from influenza have received a flu vaccination, according to an analysis published by the Robert Koch Institute. The figure is based on billing records from the regional associations of statutory health insurance physicians covering eleven flu seasons between 2014 and 2025.

The institute said that if the vaccination rate remains unchanged, an estimated 1.1 million children and adolescents with underlying medical conditions will enter the coming flu season without protection. That projection is based on scaling the current uptake rate to the full population of young people considered at elevated risk.

Germany's Standing Committee on Vaccination, known by its German acronym STIKO, has recommended that children and teenagers with certain chronic conditions receive an annual flu shot. Those conditions include chronic diseases of the respiratory organs, chronic cardiovascular disease, diabetes and obesity.

"These children and adolescents have an increased risk of becoming severely ill with influenza and, as a result of the illness, being hospitalized and treated in intensive care, or even dying," the committee said in a statement. It urged parents and guardians "urgently" to follow the vaccination recommendation and ensure children with risk factors are protected in time.

According to the recommendation, the vaccine should be given once a year, in autumn or winter, and can reduce the likelihood of a severe course of illness in children who do contract influenza.

Barbara Gärtner, a specialist in medical microbiology, virology and infectious disease epidemiology at Saarland University Hospital, said the low uptake likely stems from a widespread failure to see influenza as a serious threat. "Often the flu is not perceived as a threat, that is possibly a main reason," she said.

Gärtner added that practical obstacles also play a role. "In many situations, there is also simply forgetting the vaccination or the lack of a prompt from doctors," she said. She noted that concern about side effects, often cited as a reason for vaccine hesitancy in other contexts, appears to be a comparatively minor factor here, according to studies on the subject.

The Robert Koch Institute's analysis draws on more than a decade of insurance billing data, allowing researchers to track vaccination patterns among children with chronic illnesses across multiple flu seasons rather than relying on a single year's snapshot. The consistency of the roughly 10 percent figure across that period suggests the low uptake is not a one-off dip but a persistent pattern in pediatric care.

Health officials have periodically flagged flu vaccination among at-risk groups as an area of concern, pointing to the potential burden on hospitals during severe flu seasons when unvaccinated children with chronic conditions are more likely to require intensive treatment. The latest figures add specific national data to that concern, quantifying the scale of unprotected children ahead of the coming season.

The recommendation from the vaccination committee applies specifically to children and adolescents already living with chronic conditions rather than to the general pediatric population, reflecting the elevated risk this group faces if infected. Health authorities have not issued a broader vaccination mandate, and the flu shot for children with risk factors remains a recommendation to be discussed with treating physicians rather than a compulsory measure.

Gärtner's comments point to a gap in routine clinical practice, where opportunities to raise the topic with parents during regular appointments may be missed. She suggested that more consistent communication from physicians, rather than addressing misconceptions about vaccine safety, could be a more direct route to raising uptake among children who stand to benefit most.

No figures were given on regional variation in vaccination rates within Germany, nor on whether uptake differs by the specific underlying condition, such as diabetes compared with chronic respiratory illness. The Robert Koch Institute's dataset was drawn exclusively from claims submitted through the country's statutory insurance system, covering the large majority of the population but not including data from privately insured children.

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