{"doi":"10.1002/agm2.12103","title":"Influenza immunization among Chinese seniors: Urgent calling for improving vaccination coverage, education, and research","abstract":"It is with great pleasure that we provide this commentary with a focus on influenza vaccination for an expert consensus entitled “Recommendations for influenza and Streptococcus pneumoniae vaccination in elderly people in China” to be published in this issue of Aging Medicine.1 Influenza is a major global public health burden with pandemic threat. Seasonal influenza infection is responsible for 3-5 million severe illness cases and 290 000-650 000 respiratory deaths annually worldwide.2, 3 According to the Centers for Disease Control and Prevention (CDC), influenza affects 5%-20% of the population each year in the United States.4 It is estimated that influenza causes 226 000 excess hospitalizations, 25 000-69 000 deaths, and US $87 billion excess health-care cost with over 600 000 life-years lost annually.5, 6 Among all infectious diseases, influenza is foremost in its age-related increase in serious complications, leading to hospitalization, catastrophic disability, and death in older adults.7, 8 Moreover, influenza frequently causes exacerbation of many chronic conditions that are common in older adults, including cardiovascular diseases,9, 10 further indirectly impacting senior health and mortality. In fact, over 90% of influenza-related mortality occurs in persons aged over 65 years.11 In the United States, influenza and its secondary pneumonia are the fourth leading cause of death in this population.12 Therefore, prevention and treatment of influenza in older adults have become a major public health priority. Like many preventable infectious diseases, immunization is the main strategy for influenza prevention in addition to the universal contact- and airborne-precaution measures. In the United States, annual influenza vaccination is recommended for all adults aged 50 years and older. The annual vaccination is overall efficacious, with estimated risk reduction of 50%-70% for influenza infection in young adults and less robust risk reduction in older adults.13, 14 This reduced efficacy in older adults is thought to be due to immunosenescence and common health conditions, such as frailty.15 In recent years, a new generation of influenza vaccines, including high-dose (HD) and adjuvanted ones, have been approved by the US Food and Drug Administration (FDA) for older adults in the United States and elsewhere, in addition to the standard dose trivalent inactivated influenza vaccine (IIV3). As Chen et al1 point out in the expert consensus paper, influenza vaccination coverage for older adults in China is extremely low. This is in the context of the largest and fastest growing older adult population,16 leaving the majority of Chinese seniors unprotected by vaccination against influenza. Historically, China has classified vaccines into two categories. The first-category vaccines are mostly for childhood immunization, such as measles, mumps, and rubella; diphtheria, tetanus, and pertussis; varicella; and Bacillus Calmette-Guerin. The Chinese authorities have mandated that these first-category vaccines be given to every child born in China, free of charge. The second-category vaccines, influenza vaccine included, are mostly for adult immunization. Immunization with the second-category vaccines is not mandated and immunization cost is not covered by government-sponsored health insurance. As such, childhood immunization is nearly universal in China as it should be. For example, two recent studies report Bacillus Calmette-Guerin vaccination coverage in children in China's Zhejiang Province to be from 88.3% to 98.7%.17, 18 Influenza vaccination coverage for Chinese seniors, however, is a far cry from optimal and anything but acceptable. There are a number of other reasons for extremely low influenza immunization coverage for seniors in China, though. In the United States, most older adults recognize the importance of influenza vaccination and proactively get vaccinated each influenza season when the vaccine is available. Their health-care","journal":"Aging Medicine","year":2020,"id":107933,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":5,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9627,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":106961,"name":"Sean X. Leng","orcid":"0000-0002-2690-8055","position":1,"is_corresponding":false},{"id":328555,"name":"Xin Li","orcid":"0000-0002-2977-5075","position":0,"is_corresponding":true}],"reference_count":26,"raw_metadata":null,"created_at":"2026-07-18T23:12:39.385256Z","pmid":"32232187","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}