Influenza Vaccination in Patients With Congenital Heart Disease in the Pre-COVID-19 Era: Coverage Rate, Patient Characteristics, and Outcomes

BELCODAC Consortium, Philip Moons, Steffen Fieuws, Corinne Vandermeulen, Fouke Ombelet, Ruben Willems, Eva Goossens, Liesbet Van Bulck, Michèle de Hosson, Lieven Annemans, Werner Budts, Julie De Backer, Stéphane Moniotte, Arianne Marelli, Katya De Groote

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Influenza vaccination is the most commonly recommended immune prevention strategy. However, data on influenza vaccination in patients with congenital heart disease (CHD) are scarce. In this study, our goals were to: (1) measure vaccination coverage rates (VCRs) for influenza in a large cohort of children, adolescents, and adults with CHD; (2) identify patient characteristics as predictors for vaccination; and (3) investigate the effect of influenza vaccination on hospitalization.

METHODS: A nationwide cohort study in Belgium included 16,778 patients, representing 134,782 vaccination years, from the Belgian Congenital Heart Disease Database Combining Administrative and Clinical Data (BELCODAC). Data over 9 vaccination years (2006-2015) were used, and patients were stratified into 5 age cohorts: 6 months to 4 years; 5-17 years; 18-49 years; 50-64 years; and 65 years and older.

RESULTS: In the respective age cohorts, the VCR was estimated to be 6.6%, 8.0%, 23.9%, 46.6%, and 72.8%. There was a steep increase in VCRs as of the age of 40 years. Multivariable logistic regression showed that higher anatomical complexity of CHD, older age, presence of genetic syndromes, and previous cardiac interventions were associated with significantly higher VCRs. Among adults, men had lower and pregnant women had higher VCRs. The association between influenza vaccination and all-cause hospitalization was not significant in this study.

CONCLUSIONS: The influenza VCR in people with CHD is low, especially in children and adolescents. Older patients, particularly those with complex CHD, are well covered. Our findings should inform vaccination promotion strategies in populations with CHD.

Original languageEnglish
Pages (from-to)1472-1479
Number of pages8
JournalCanadian Journal of Cardiology
Issue number9
Publication statusPublished - Sep 2021

Bibliographical note

Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.


  • Adolescent
  • Adult
  • Aged
  • Belgium/epidemiology
  • COVID-19
  • Child
  • Child, Preschool
  • Cohort Studies
  • Female
  • Heart Defects, Congenital/epidemiology
  • Hospitalization/statistics & numerical data
  • Humans
  • Infant
  • Influenza Vaccines/therapeutic use
  • Influenza, Human/epidemiology
  • Male
  • Middle Aged
  • Pandemics
  • SARS-CoV-2
  • Treatment Outcome
  • Vaccination Coverage/statistics & numerical data
  • Young Adult


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