Background: Influenza poses a serious threat to the health of older adults, and vaccination is a key strategy for prevention. As an economically developed city, Suzhou has a rapidly aging population, yet the influenza vaccination rate among older adults remains substantially lower than that in developed countries. There is an urgent need to understand the current vaccination status and its associated factors to inform future strategies for improving vaccination coverage. Objectives: To compare influenza- and vaccine-related knowledge, attitudes, practices, and information access channels between vaccinated and unvaccinated older adults (≥60 years) in Suzhou, and to identify factors associated with vaccination behavior in economically developed areas. Methods: A comparative cross-sectional survey was conducted from April to August 2024 across six districts or county-level cities randomly selected from Suzhou’s ten county-level administrative divisions. Participants were divided into vaccinated and unvaccinated groups based on their influenza vaccination status during the 2023–2024 influenza season. A two-stage sampling method was employed: the six districts were selected as primary sampling units; within each district, eligible older adults (aged ≥60 years) were randomly selected from two independent sampling frames—the vaccination information system for the vaccinated group and the basic public health service system for the unvaccinated group. Face-to-face structured interviews were conducted using a questionnaire consisting of four sections; data were entered using EpiData 13.1 and analyzed using SPSS 27.0. The χ² test, t-test, and multivariable logistic regression were used for statistical analysis. Results: Among 4622 valid older adults (vaccinated: n = 2007; unvaccinated: n = 2615), the vaccinated group scored significantly higher on influenza-related knowledge (4.06 ± 2.21 vs. 3.16 ± 2.33, p < 0.001), vaccine-related knowledge (2.10 ± 1.18 vs. 0.67 ± 1.07, p < 0.001), and perceived influenza risk scores (2.72 ± 1.42 vs. 2.26 ± 1.64, p < 0.001). Vaccine safety and efficacy endorsement were also markedly higher among the vaccinated group (70.3% vs. 22.0%; 49.7% vs. 9.3%). Regarding information sources, the vaccinated group relied more on healthcare institutions (54.56% vs. 46.92%), whereas the unvaccinated group relied more on television (60.34% vs. 51.17%). Multivariable logistic regression revealed that awareness of the influenza vaccine (aOR = 9.151, 95%CI: 6.32–13.25), having a planned vaccination site (aOR = 2.66, 95%CI: 2.01–3.54), and perceiving the vaccine as safe (aOR = 1.81, 95%CI: 1.31–2.49) were positively associated with vaccination, while rural household registration (aOR = 0.76, 95%CI: 0.63–0.93), full-time employment (aOR = 0.41, 95%CI: 0.28–0.60), and hypertension (aOR = 0.79, 95%CI: 0.65–0.94) were inversely associated. Conclusions: Compared with the unvaccinated group, the vaccinated group demonstrated significantly better influenza- and vaccine-related knowledge, risk perception, and recognition of vaccine safety and efficacy, and relied more on healthcare institutions for information. Multivariable regression analysis identified awareness of the influenza vaccine as the strongest associated factor. These findings suggest that vaccination coverage could be improved by strengthening vaccine knowledge promotion through healthcare professionals and increasing awareness of vaccination policies that integrate medical insurance reimbursement.

Background/Objectives: This prospective cohort study assessed the impact of seasonal influenza during pregnancy on fetal and infant health outcomes. Methods: Pregnant women with laboratory-confirmed influenza were matched (1:4) by age and pregnancy loss history with women without influenza from annual cohorts in Suzhou, China, during 2015–2018. Participants underwent twice-weekly follow-up for influenza illness, and medical records were linked to ascertain outcomes. Multivariable regression models were used to estimate associations. Results: We included 441 pregnant women with influenza and 1764 without it. Four (0.9%) in the influenza group had late pregnancy loss, whereas one (0.1%) in the non-influenza group did. Influenza was associated with late pregnancy loss (adjusted hazard ratio [aHR] 31.1, 95% Confidence Interval [CI]: 1.3–756.8, p = 0.035). Four (0.9%) in the influenza group experienced early pregnancy loss, while five (0.3%) in the non-influenza group did. Influenza was not significantly associated with early pregnancy loss (aHR 2.1, 95% CI: 0.4–10.4, p = 0.374). By 8 months of age, infants born to 198 of the 441 mothers (44.9%) in the influenza group met the criteria for the program-defined child health monitoring indicator, compared with infants born to 650 of the 1764 mothers (36.8%) in the non-influenza group. Overweight/obesity was the largest contributor: 142 (32.2%) versus 470 (26.6%). Maternal influenza was associated with higher odds of meeting program-defined child health monitoring indicator in offspring (adjusted odds ratio [aOR] 1.4, 95% CI: 1.1–1.8, p = 0.006), with a significant contribution from overweight/obesity (aOR 1.3, 95% CI: 1.0–1.7, p = 0.045). Conclusions: In this cohort, influenza during pregnancy was associated with an increased risk of late pregnancy loss and program-defined child health monitoring indicator in offspring, particularly overweight/obesity. Because the observed association with pregnancy loss was based on a small number of events and had a wide confidence interval, it should be interpreted cautiously and confirmed in larger studies. These findings are consistent with current recommendations supporting influenza vaccination during pregnancy to protect maternal and infant health.