Influenza Immunization

Sex and Gender-based Analysis of this topic


The influenza immunization rate refers to the proportion of the Canadian population aged 12 and over who report having had their influenza immunization (flu shot) [1]. In 2005, the immunization rate (excluding territories) was 34%; including 36% for females and 31% for males [2]. Influenza infections are not typically problematic in healthy individuals, particularly adults and older children, but can lead to serious complications, such as pneumonia and death in young children, the elderly, and those with chronic conditions. Influenza complications can include: bronchitis, pneumonia, kidney failure, or heart failure and death [3].Influenza immunization uptake may be influenced by provincial eligibility criteria for funded vaccine.  All provinces and territories have eligibility criteria except for Ontario which has a universal program.

Sex Issues

In Canada, pregnant women, particularly those who deliver during the influenza season, are considered to be at high risk and immunization is recommended in their second or third trimester [2, 4]. Influenza immunization among pregnant women protects both the mother and infant from possible complications due to contact with the influenza virus [5]. Health care providers, caregivers, and senior women, especially those living in continuing care facilities, are also considered a high-priority group for immunization [6-8].

Gender Issues

In Canada, the majority of health care providers (77%) and informal care-givers are women [9,10]. Health care providers and care-givers are in close contact with individuals who are at high risk of complications from influenza, thus making these care providers a high-priority for influenza immunizations [6-8]. Senior women outnumber senior men in Canada [11] and constitute 70% of senior continuing care residents [12], indicating a higher need for immunization among senior women compared to men.

Women are more likely to have a flu shot than men (36% compared to 31%) [2] and may be due to a greater proportion of women both having a regular doctor or being seniors and having chronic conditions, both of which are predictors of immunization [2, 11,13,14].  However, the vast majority of health care workers and care providers are women and yet the influenza vaccine uptake rate is similar to the men. This may be due to a decrease in vaccine eligibity in women compared to men.


Mirroring Canadian influenza immunization trends in the overall population, immunization rates in women more than doubled from 16% in 1996/1997 to 36% in 2005 [2]. Immunization rates increase with age, with a rate of 78% among those aged 85 and older, compared to only 23% in those aged 12-49 [2].

Immunization rates range across the country, with Ontario (42%) and Nunuvut (41%) having the highest rates in the country [2,15]. The lowest immunization rates in the country are in Quebec and Newfoundland and Labrador with rates of 25% and 22% respectively.  The high rates of immunization in Ontario and Nunuvut may be attributed to the universal immunization programs established in the two provinces [15].  Immunization rates in Long Term Care facilities also vary: in British Columbia, 64% of Long Term Care Facilities staff were immunized compared to 91% of residents in the facilities [16].


The National Population Health Survey (NPHS) and Canadian Community Health Survey (CCHS) exclude important high risk populations such as children younger than 12 and the institutionalized elderly, which may  lead to an underestimation of rates [2]. Reliance on self-report data may also lead to an underestimation of immunization rates.  The cross-sectional nature of the survey also limits inferences about trends over time as data are not collected annually.

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