Influenza-Associated Hospitalizations in Unvaccinated Children Across Six Consecutive Seasons: Clinical Burden and Regional Vaccination Coverage Trends in Galați County, Romania.

Background

Influenza vaccination coverage among children remains critically low in Romania, yet regional data contextualizing the clinical burden relative to local vaccine uptake are scarce.

Methods

A retrospective descriptive study was conducted at "Sf. Ioan" Clinical Emergency Pediatric Hospital in Galați, Romania, including all patients aged 0-14 years with Reverse Transcriptase Polymerase Chain Reaction (RT-PCR)-confirmed influenza over six consecutive seasons (October 2019-April 2025). Regional influenza vaccination coverage data for children aged 0-14 years and pregnant women were obtained from county public health authority records and contextualized against Romanian National Institute of Statistics population data.

Results

A total of 525 unvaccinated children were included. The median age was 2 years (IQR 1-5); 50.5% were aged 2 years or younger. Multisystem clinical involvement was documented in 97.52% of patients, with respiratory involvement predominating (86.66%). The median length of hospital stay was 5 days (IQR 4-7). Regional vaccination coverage never exceeded 2.0% of the eligible pediatric population in any study year, falling to 0.3% in 2023 and 0.1% in 2025. Infants aged 0-2 years were consistently the least vaccinated group (0-5 months not eligible for vaccination). Maternal vaccination was effectively absent in most seasons.

Conclusions

These findings document a critical and persistent influenza vaccination gap among children and pregnant women in Galați County. Targeted public health interventions to improve vaccine uptake-particularly for infants, young children, and pregnant women-are urgently needed in this and similar low-coverage Eastern European settings.