Associations between vaccine misinformation and influenza vaccine uptake: a population-based interrupted time-series study in China

Abstract Vaccine misinformation is linked to vaccine hesitancy, yet real-world evidence of its association with vaccine uptake remains limited. Most existing studies rely on self-reported intentions or experimental designs, offering little insight into population-level behavioural changes. Using influenza vaccination data from Zhejiang, China, we examined changes in vaccination trends coinciding with three misinformation events. Interrupted time-series and counterfactual analyses were applied to trace changes in weekly vaccination rates by vaccine type (government-funded vs. self-paid), age group, and region. Significant downward shifts in vaccination trends followed two safety-related misinformation events during the vaccination season. During the Sinovac Vaccine Rumours of Pulmonary Nodules (2022), weekly trends shifted from a 4.8% increase before the event to a 1.8% increase after the transition period. A similar reversal was observed following the Pasteur Influenza Vaccine Lot Recall (2024) (from +7.3% to −9.0% per week). Government-funded vaccination rates appeared more consistently affected. In contrast, the administrative event ( Disciplinary Case of Former Chief Engineer of Sinopharm , 2024) showed no significant change. This study provides real-world evidence of an association between vaccine misinformation and influenza vaccination rates. Thematic and temporal patterns of misinformation events are associated with behavioural responses, highlighting the need for timely and responsive vaccine communication strategies.