Economic Burden of Pediatric Influenza in Europe: Urgent Need for Vaccination Policies


Vaccination can minimize health care costs associated with influenza.

A recent systematic review published in the journal Influenza and Other Respiratory Viruses confirmed that vaccination can reduce health care costs and societal burdens in Europe.

Leonardo Villani, of the section of hygiene in the university department of life sciences and public health at the Università Cattolica del Sacro Cuore in Rome, Italy, and colleagues conducted the research. The study authors examined the direct and indirect costs associated with pediatric influenza. “Knowing health and social costs of childhood influenza is essential to support value-based health decisions to implement effective immunization strategies,” the authors wrote.

Researchers said that Europe sees 4 to 5 million flu cases per year, 150,000 hospitalizations, and between 15,000 and 70,000 deaths. Children ≤5 years of age are at particular risk for severe illness or death, which affects their parents and siblings.1 Pediatric flu rates range from 20% to 30% annually, Villani and colleagues said. Children have limited pre-existing immunity, making them more susceptible to the virus. Study authors noted that young children also play a crucial role in spreading flu to their families and the wider community.

Globally, influenza-related hospitalizations for children ≤5 years exceed 870,000 annually, with an estimated 28,000 to 111,500 deaths in this age group attributed to influenza-related causes.1 These deaths are mostly seen in developing countries, researchers reported. Outpatient visits for influenza in children aged 0-5 months, 6-23 months, and 24-59 months are estimated to be 10, 100, and 250 times higher than hospitalization rates.1

Villani and colleagues searched PubMed, Web of Science, and Scopus databases for all relevant articles published through September 3, 2021. Only studies reporting the economic burden of influenza in pediatric and youth populations across European countries that were written in English were included.

Researchers screened a total of 2225 records and identified 9 articles that met the inclusion criteria. The findings revealed that cost estimates varied significantly between countries and among different age groups.

Researchers found that expenses directly associated with individual influenza cases can vary significantly across Europe. They said these costs were mainly influenced by pediatric hospitalizations and outpatient visits. For example, in Italy, the direct costs were estimated at approximately €74, while in Germany, they soared to €252.1 These expenses varied depending on the child’s age, with younger age groups often requiring twice the resources compared to older ages, as seen in Italy, France, and Germany.1

The study authors said indirect costs, such as workdays lost by parents, also contributed significantly to the economic burden of pediatric flu. The impact was prominent for children under 2 and those 2-5 years old, surpassing the costs incurred for children older than 5.1 Germany witnessed the highest economic impact, with parents losing an average of €251 per week due to influenza-related absences from work.1

Villani and colleagues noted that there “is the scarcity of evidence on the costs associated with influenza among children in Europe as well as the lack of standardized methods for their evaluation and, therefore, the difficulty of analyzing and comparing them comprehensively.”1

The evidence reveals the need to address the economic impact of pediatric flu in European countries. Researchers said the data shows that implementing influenza vaccination policies for children should be a priority. Vaccination can reduce the direct costs associated with hospitalizations and outpatient visits. Indirect costs, such as workdays lost by parents, can be mitigated, providing relief to families and the economy as a whole, Villani and colleagues said.

The study findings emphasize the importance of considering both direct and indirect costs when evaluating the economic burden of pediatric flu. With this knowledge, policymakers can make value-based healthcare decisions and prioritize effective immunization strategies, Villani and colleagues concluded.

1. Villani L, D'Ambrosio F, Ricciardi R, de Waure C, Calabrò GE. Seasonal influenza in children: Costs for the health system and society in Europe. Influenza Other Respir Viruses. 2022;16(5):820-831. doi:10.1111/irv.12991
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