{
  "abstract": "Background and ObjectivesInfluenza vaccination has a strong safety record and is effective in reducing pediatric influenza-associated morbidity and mortality. However, pediatric vaccination coverage (VC) has declined since the 2019/20 influenza season in the United States. We estimated the impact of increased vaccine protection (through increased VC and/or vaccine effectiveness [VE]) on pediatric influenza-associated burden during the 2022/23-2024/25 seasons.\n\nMethodsWe used a compartmental model and laboratory-confirmed influenza-associated hospitalization, VC, and VE data among children 6 months-17 years to estimate influenza burden from 2022/23-2024/25 (the baseline scenario) and the impact of vaccination. We simulated scenarios that (1) increased VC by five percentage points; (2) increased VE by five percentage points; (3) increased VC and VE by five percentage points; and (4) increased VC to levels achieved in 2019/20 (the season with the highest pediatric VC to date). We estimated the difference in hospitalizations and deaths between each scenario and the baseline scenario.\n\nResultsAmong children 6 months-17 years, an estimated 120,000 influenza-associated hospitalizations and 1,650 deaths occurred across all seasons at baseline. Increasing VC to 2019/20 levels had the greatest estimated impact, reducing hospitalizations by 8,670 (7.2%) and deaths by 130 (7.9%). Increasing both VC and VE by five percentage points reduced hospitalizations by 6.6% and deaths by 6.7%, whereas increasing VC or VE by five percentage points reduced hospitalizations by 3.1% and deaths by 3.2%.\n\nConclusionsIncreasing pediatric influenza vaccination coverage back to 2019/20 levels was estimated to significantly reduce pediatric influenza-associated morbidity and mortality.\n\nWhats known on this subjectPediatric influenza vaccination coverage has declined in the United States since the 2019/20 influenza season despite its effectiveness and strong safety record. The impact of this decline on influenza-associated morbidity and mortality has not been quantified.\n\nWhat this study addsWe estimated pediatric influenza-associated outcomes in the 2022/23-2024/25 influenza seasons under different scenarios that increased vaccination coverage and/or effectiveness. We estimated the greatest reductions in influenza-associated hospitalizations and deaths (7.2% and 7.9%, respectively) if coverage remained at 2019/20 levels.",
  "abstract_shown": true,
  "affiliations": [
    "Centers for Disease Control and Prevention"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 16,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "S. E. Morris"
    },
    {
      "name": "S. M. Mathis"
    },
    {
      "name": "J. R. Chung"
    },
    {
      "name": "J. DeCuir"
    },
    {
      "name": "S. M. Olson"
    },
    {
      "name": "S. Ellington"
    },
    {
      "name": "A. O'Halloran"
    },
    {
      "name": "D. Ujamaa"
    },
    {
      "name": "C. H. Bozio"
    },
    {
      "name": "A. Jain"
    },
    {
      "name": "A. Srivastav"
    },
    {
      "name": "P.-j. Lu"
    },
    {
      "name": "L. A. Grohskopf"
    },
    {
      "name": "C. Reed"
    },
    {
      "name": "A. D. Iuliano"
    },
    {
      "name": "M. Biggerstaff"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/dfebedc6feaz4.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.09.25.26363797",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.09.25.26363797v1.full",
  "id": "dfebedc6feaz4",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.09.25.26363797v1",
  "language": null,
  "licence": "CC0-1.0",
  "licence_label": "CC0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/publicdomain/zero/1.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "epidemiology"
    ],
    [
      "openalex",
      "2713|Influenza Virus Research Studies"
    ]
  ],
  "openalex": "W7215076760",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.09.25.26363797v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-25",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/dfebedc6feaz4.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:49Z",
      "native_id": "10.64898/2026.09.25.26363797",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.09.25.26363797v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:epidemiology",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Potential impact of changes in influenza vaccination coverage and effectiveness on pediatric influenza burden in the United States, 2022/23-2024/25",
  "title_text": "Potential impact of changes in influenza vaccination coverage and effectiveness on pediatric influenza burden in the United States, 2022/23-2024/25",
  "type": "preprint",
  "updated_at": "2026-10-30T12:19:49Z",
  "url": "https://research.draconitic.com/paper/dfebedc6feaz4",
  "venue": "medRxiv",
  "versions": []
}