Fig. 5

a-c Simulation results of pediatric QLAIV vaccination in Germany. Each bar represents the results for 10 years (2017–26): dark grey: indirectly prevented cases among adults, light grey: indirectly prevented cases among children, white: directly prevented cases among children, black: remaining cases which are not prevented. Numbers above the bars give the ratios “all indirectly prevented cases” / “all directly prevented cases”. Simulations are initialized from 2000 to 2016 using TIV with the baseline vaccination coverage. In the 10-year period starting with 2017, vaccinations are switched to QIV (reference scenario) and the effect of additional QLAIV vaccination of 2–17 years old children is evaluated. In the QLAIV scenario, children below 2 and adults receive QIV as in the reference scenario; in the first evaluation year the QLAIV coverage of 2–17 year old children is identical to the baseline coverage (around 5%), then it is increased stepwise for 3 years to reach a final coverage of 20 to 60%. a Symptomatic cases; b cases with acute otitis media (AOM; percentages of symptomatic cases in the “no risk” group: 0–1 year: 39.7%, 2–6: 19.6%, 7–12: 4.4%, 13–17: 4%, 18+: 1%; in the risk group: 1% [32,33,34,35]), (c) deaths due to influenza (percentages of symptomatic cases in the “no risk” group: 0–1 year: 0.062%, 2–6: 0.027%, 7–12. 0.011%, 13–17: 0.005%, 18+: 0.0132%; in the risk group: 0.13%, guided by [36, 37]). For numerical results, see Additional file 1: Table S3