Understanding Gaps in Annual Influenza Vaccination in Children Aged 2–5 Years in India: A Medical Insight Survey

Background: In India, influenza contributes significantly to pediatric morbidity, hospitalizations, and mortality in children under 5 years. National guidelines recommend yearly influenza vaccination for all children up to 5 years of age; however, vaccine uptake declines after completion of the routine early childhood immunization schedule. Acute illness–driven healthcare visits in children may lead to missed opportunities for revaccination, highlighting the need to understand current pediatric practices and barriers to revaccination. Aim: This study aimed to explore current clinical practices and pediatricians’ perspectives regarding the decline in annual influenza vaccination uptake among children aged 2–5 years across India, and to identify potential strategies and reminder-recall approaches to improve revaccination coverage. Methods: A questionnaire-based survey was conducted among 104 practicing Indian paediatricians. Responses were collected based on their clinical experience and routine practice, which were analyzed on a question-by-question basis. Results: Among 104 paediatricians surveyed, 65% responded that children aged 2–5 years constituted more than half of their clinical practice. Acute illnesses (fever and respiratory infections) were the most common reason for visits after 2 years (97%). Parental lack of awareness or forgetfulness (76%) was the most frequently reported barriers. Most paediatricians observed significant benefits of annual influenza vaccination, including reduced severity and faster recovery (83%), lower hospitalization rates (79%), and reduced school absenteeism (88%) among vaccinated children. The survey highlights a significant gap in reminder practices, nearly one in five paediatricians (18%) responded not using any reminder system at all for influenza revaccination. Conclusion: Survey highlights in children aged 2–5 years clinical visits are driven by acute illnesses, presenting missed opportunities for influenza vaccination. Reinforcing caregiver counselling and implementing structured recall and reminder approaches—particularly digital reminders such as WhatsApp or SMS—may help improve annual influenza vaccination coverage in this age group.