Importance of vaccination habit and vaccine choice on influenza vaccination among healthy working adults

Impact of the COVID-19 pandemic on self-paid vaccination intentions for children: a cross-sectional study in China

OBJECTIVES

While it is widely accepted that COVID-19 has disrupted routine vaccination globally, the long-term impact of COVID-19 on parental vaccination intentions is uncertain. This study aims to estimate whether COVID-19 impacted parental intentions for self-paid vaccines, and provides suggestions for local vaccination policy and intervention strategies accordingly.

METHODS

A questionnaire-based cross-sectional survey was conducted among 2212 caregivers in Zhejiang province between 22 March and 30 June 2023. The following information was collected: sociodemographic characteristics, self-paid vaccination related intentions and behaviours, and vaccine hesitancy measured by the Vaccine Hesitancy Scale. Multiple multinomial logistic regression models were used to analyse the factors influencing the change in vaccination intentions.

RESULTS

In total, 19.32% (n=390) of respondents increased their intention to immunise their children with self-paid vaccines after the COVID-19 epidemic, 9.16% (n=185) decreased their intention, and 71.52% (n=1444) of respondents indicated that the COVID-19 epidemic did not affect their intention. The major reason for increased intentions was 'Vaccines are effective in preventing diseases' (83.89%) and for decreased intentions was 'Worried about the side effects of vaccines' (65.95%). A higher hesitancy degree (OR=2.208, p=0.0001), reduced trust in vaccines after COVID-19 (OR=16.650, p<0.0001), doctors' recommendation of Expanded Programme on Immunization vaccines (OR=2.180, p=0.0076), and non-perfect satisfaction with vaccine information (all OR>1, all p<0.05) were considered to be drivers of decreased intention.

CONCLUSION

Although the intentions of self-paid vaccinations were not largely influenced, nearly 30% of caregivers' vaccination intentions changed after the COVID-19 pandemic and most of them increased their intentions. In addition, vaccination history of self-paid vaccines, vaccine information, vaccine trust and doctors' recommendations were the active factors for self-paid vaccination. Therefore, education on the knowledge of self-paid vaccines for caregivers should be implemented to increase their vaccination intentions and decrease the threat of infectious diseases to children's health.

Vaccine Hesitancy in Israel: Exploring the Relationships with Vaccination History, Knowledge, and Attitudes towards Influenza Vaccines

Influenza vaccination is a highly effective strategy for mitigating all the repercussions of influenza infections. Despite the potential severity of influenza and the accessibility of secure vaccinations, worldwide rates of influenza vaccination continue to be low, particularly among students. This study examines the correlative relationships between influenza vaccine history, knowledge, attitudes toward influenza vaccines, and vaccine hesitancy among college students. To that end, we used an online questionnaire to conduct a cross-sectional study encompassing 610 students. A significant majority of participants reported having experienced influenza (82%), with slightly more than half having received influenza vaccinations in the past (57%). With respect to the current research year, health sciences students exhibited a higher likelihood of either having been vaccinated or intending to receive the vaccine than did their counterparts. Among students who had been vaccinated previously, approximately one-fifth opted for vaccination in the present year (21%). Similarly, 22% of the students whose parents were vaccinated chose to get vaccinated this year. Notable disparities in knowledge about influenza vaccines were observed across various departments, with health sciences students demonstrating the highest levels of awareness. Moreover, a negative relationship was found between knowledge, attitudes, and vaccine hesitancy. These results suggest that targeted lectures by professionals emphasizing vaccine safety and university-hosted events addressing this subject in collaboration with the Ministry of Health, incorporating influenza vaccination stations, could be instrumental in bolstering the vaccination rate.

Assessing the Knowledge, Attitudes, and Vaccination Practices Towards COVID-19 Vaccination Among Mainland Chinese Nursing Students and Interns: A Multicenter Cross-Sectional Study

Objective

This study investigated factors influencing the knowledge, attitudes, practice profiles, and vaccination intentions among Chinese nursing students and nursing interns toward the coronavirus disease (COVID-19) vaccination.

Materials and Methods

The multicenter cross-sectional study was based on a self-reported questionnaire collecting information among nursing students and nursing interns from three major geographic regions of China, and the sample was selected by consecutive sampling. The questionnaire was developed by knowledge, attitudes, and practice (KAP) theory. Univariate and multivariate logistic regression were used for statistical analysis.

Results

A total of 3180 nursing students and interns (effective rate: 99.8%) from six Chinese provinces were polled. The vaccine hesitation rate was 9.65% (307/3180), 2230 participants (70.1%) had gotten at least one dose of the vaccine, and 643 participants (67.7%) had indicated a readiness to be vaccinated. The results showed that older age, higher academic background, perfect vaccine management, others' recommendations, influenza vaccination history, epidemic under control, knowledge of vaccines or intervals, and vaccine knowledge training were associated with higher vaccination rates. Conversely, vaccine hesitancy was caused by a perceived lack of physical need, uncertainty about vaccination requirements, and fear of vaccination.

Conclusion

This study provided population-based estimates of COVID-19 vaccine uptake intention among mainland Chinese nursing students and interns. Factors such as age, education, vaccine knowledge, and attitudes influence COVID-19 vaccine behaviour. Relevant authorities should understand the barriers to COVID-19 vaccination from knowledge, attitude and practice, which is significant for formulating effective response strategies in future global public health crises.

Waiting for the COVID-19 vaccine: vaccine intention, trust in authorities and information needs in an Italian sample

The COVID-19 vaccine development timelines offered a unique opportunity to explore the public's vaccine intention in an unusual situation characterised by great uncertainty about the vaccine's features and the disease it intended to prevent. To advance our knowledge of vaccine intention mechanisms under these unusual circumstances, to plan effective vaccination strategies, and to better direct communication efforts in similar scenarios, this study explored i) COVID19-related information needs, information-seeking behaviours, and perceived trustworthiness of news media; ii) COVID-19 vaccination intention and its determinants, during the first wave of COVID-19 pandemic in Italy. In particular, it was investigated whether and to what extent the perception of severity and susceptibility to the infection, trust in authorities, and demographics shaped people's vaccine intention. Between April and May 2020 in a cross-sectional study, 1373 Italian participants completed an online survey measuring demographic features, perception of the disease severity, disease risk perception, COVID19-related worry, disease-related information needs and behaviours, vaccination intention, and level of trust in authorities and news media. The leading information needs were the COVID-19 incubation period and transmission modalities, with the majority of people actively looking for information from one to three times a day. Despite uncertainty around the details of a COVID-19 vaccination, 68% of participants reported intending to be vaccinated for COVID-19. Greater COVID-19 vaccination intention was associated with having a regular history of seasonal flu vaccine, a greater COVID19-related worry, a higher perception of disease severity, and a higher trust in the Government. These findings further our understanding of vaccine intention in a pandemic scenario where a vaccine is still hypothetical and provide valuable information on the public's representation of the infection and future acceptance of a vaccine to inform the development of communication interventions aiming to maximise adherence to vaccination programmes and to modify disease-related dysfunctional representations.

Healthcare workers' (HCWs) attitudes and related factors towards COVID-19 vaccination: a rapid systematic review

Herd immunity through vaccination is a key measure to control COVID-19 pandemic. However, vaccine hesitancy remains a public health threat, which is still common among healthcare workers (HCWs). This systematic review aimed to synthesise evidence on HCWs' attitudes towards COVID-19 vaccination and analyse associated factors to provide information for vaccine policy development and practice. We searched PubMed, Embase, ScienceDirect, Web of Science and three Chinese databases for literature published on 12 February 2021. Two researchers screened the literature independently, and 13 studies were included in the systematic review. Vaccine acceptance varied widely and ranged from 27.7% to 77.3%. HCWs had positive attitudes towards future COVID-19 vaccines, while vaccine hesitancy was still common. Demographic variables such as men, older age and physicians were positive predictive factors. Women and nurses had more vaccine hesitancy. Previous influenza vaccination and self-perceived risk were facilitators. Concerns for safety, efficacy and effectiveness and distrust of the government were barriers. Influences of direct (COVID-19) patient care towards vaccination intention were less conclusive. Tailored communication strategies were needed to increase the uptake rate of COVID-19 vaccines among HCWs. More importantly, more data and information on the safety and efficacy of vaccines should be provided with transparency.

A novel high throughput plate-based method for 2-PE quantification in novel multidose vaccines (R21 malaria, Covishield and Covovax) and combination vaccines (Hexavalent)

Multidose presentation of vaccines is the most preferred choice, for mass immunization particularly during pandemics. WHO also recommends multidose containers of fill finished vaccines for programmatic suitability and global immunizations programmes. However, multidose vaccine presentations requires inclusion of preservatives to prevent contaminations. 2-Phenoxy ethanol (2-PE) is one such preservative which is being used in numerous cosmetics and many vaccines recently. Estimation of 2-PE content in multidose vials is a crucial quality control parameter to ensure in use stability of the vaccines. Presently available conventional methods, have their own limitation in terms of being time consuming, requiring sample extraction, large sample volume requirement etc. Therefore, a robust, simple, high-throughput method with a low turnaround time was required, which can quantitate 2-PE content in the conventional combination vaccines as well as new generation complex VLP based vaccines. In order to address this issue, a novel absorbance-based method has been developed. This novel method specifically detects 2-PE content in Matrix M1 adjuvanted R21 malaria vaccine, nano particle and viral vector based covid vaccines and combination vaccines like Hexavalent vaccine. The method has been validated for parameters such as linearity, accuracy and precision. Importantly, this method works even in presence of high amounts of proteins and residual DNA. Considering the advantages associated with method under study, this method can be used as an important in process or release quality parameter to estimate the 2-PE content in various vaccines containing 2-PE in multidose presentations.

Barriers and facilitators of vaccine hesitancy for COVID-19, influenza, and pertussis during pregnancy and in mothers of infants under two years: An umbrella review

BACKGROUND

Vaccination during pregnancy has been repeatedly demonstrated to be safe and effective in protecting against infection and associated harms for the mother, developing baby, and subsequent infant. However, maternal vaccination uptake remains low compared to the general population.

OBJECTIVES

An umbrella review to explore the barriers and facilitators to Influenza, Pertussis and COVID-19 vaccination during pregnancy and within 2 years after childbirth, and to inform interventions to encourage uptake (PROSPERO registration number: CRD42022327624).

METHODS

Ten databases were searched for systematic reviews published between 2009 and April 2022 exploring the predictors of vaccination or effectiveness of interventions to improve vaccination for Pertussis, Influenza, or COVD-19. Both pregnant women and mothers of infants under two years were included. Barriers and facilitators were organised using the WHO model of determinants of vaccine hesitancy through narrative synthesis, the Joanna Briggs Institute checklist assessed review quality, and the degree of overlap of primary studies was calculated.

RESULTS

19 reviews were included. Considerable overlap was found especially for intervention reviews, and the quality of the included reviews and their primary studies varied. Sociodemographic factors were specifically researched in the context of COVID-19, exerting a small but consistent effect on vaccination. Concerns around the safety of vaccination particularly for the developing baby were a main barrier. While key facilitators included recommendation from a healthcare professional, previous vaccination, knowledge around vaccination, and communication with and support from social groups. Intervention reviews indicated multi-component interventions involving human interaction to be most effective.

CONCLUSION

The main barriers and facilitators for Influenza, Pertussis and COVID-19 vaccination have been identified and constitute the foundation for policy development at the international level. Ethnicity, socioeconomic status, concerns about vaccine safety and side effects, and lack of healthcare professionals' recommendations, are the most relevant factors of vaccine hesitancy. Adapting educational interventions to specific populations, person-to-person interaction, healthcare professionals' involvement, and interpersonal support are important strategies to improve uptake.

Factors Associated With Airline Cabin Crews' Influenza Vaccination Intention in the Workplace-based Setting

BACKGROUND

Yearly influenza vaccination is the best way to prevent influenza. Workplace vaccination program for airline cabin crews is an important countermeasure in the management of infectious diseases. Understanding the influenza vaccination behavior of cabin crews is essential to establishing strategies to promote vaccine uptake. This study aimed to examine factors associated with airline cabin crews' influenza vaccination intention in a workplace-based setting. We applied the theory of planned behavior (TPB) to explain the vaccination behavior of employees.

METHODS

A cross-sectional study was performed in April 2021. Participants self-reported the structured questionnaires that consisted of TPB variables, and reasons for influenza vaccination/nonvaccination in 2020. A total of 253 crew members participated, and 242 were included in the analysis.

FINDINGS

The influenza vaccination rate was 70.7% in 2020, and vaccination intention was 5.92 of 7 points in 2021. Multiple linear regression showed that influenza vaccination intention was associated with subjective norms (β = .394, p < .001), positive attitude (β = .145, p = .007), perceived behavioral control (β = .170, p = .004), actual behavioral control (β = .145, p = .010), and the previous year's vaccination (β = .163, p < .001). The model accounted for 57% of the variance in influenza vaccination intention (F = 40.959, p < .001).

CONCLUSIONS/APPLICATION TO PRACTICE

Our findings indicate that TPB is useful in explaining employees' influenza vaccination intention and influencing factors. Focusing on positive messages that emphasize the social effects of vaccination and providing free vaccination on specific dates are potential strategies to increase intention. It can be applied to help design on-site workplace vaccination programs for essential frontline workers.

Attitude towards Intranasal Vaccines and Psychological Determinants: Effects on the General Population in Northern Italy

Little is known about the use of intranasal vaccines, but some studies have shown that this innovative way of administration is preferred over needle injection as it is considered both less painful and intrusive to the body, equally effective, and associated with fewer side effects. This study aimed to investigate specific psychological determinants (intolerance of uncertainty, persecutory ideation, perceived control, vaccine hesitancy) of attitude toward nasal vaccine delivery. A convenience sample including 700 Italian participants took part in this cross-sectional study and completed an online questionnaire. A structural equation model with a latent variable was performed to study the relationship between psychological variables, vaccine hesitancy, and attitude toward nasal vaccine delivery. The results indicate that both a hesitant attitude toward vaccination (β = 0.20, p = 0.000) and low perceived control (β = -0.20, p = 0.005) may directly increase preference for nasal administration; furthermore, high levels of persecutory ideation may indirectly influence the propensity for intranasal vaccine. These findings suggest that pharmaceutical companies could implement nasal vaccines and provide detailed information on these vaccines through informational campaigns. Hesitant individuals with low levels of perceived control could more easily comply with these types of vaccines.

Factors affecting children's HPV vaccination in Austria: Evidence from a parent survey

Human papillomavirus (HPV) is a sexually transmitted infection that causes cervical cancer, head and neck cancer, other urogenital cancers, and genital warts. In Austria, where HPV vaccination is free for children, the vaccination rate nevertheless remains insufficient for herd immunity against HPV. Using a cross-sectional survey of parents (N = 334) in the state of Tyrol, Austria, we examined parents' reasons for rejecting children's HPV vaccination and key predictors of vaccination intention for their children, including knowledge about HPV, attitude toward vaccination, sources of information about the HPV vaccine, socioeconomic factors, and HPV vaccination intention. Data analyzed using descriptive statistics and logistic regression modeling revealed an overall 81.9% acceptance rate of HPV vaccination. The most common reasons for vaccine hesitancy were a fear of side effects, a perceived lack of information, and the perception that children are too young to be vaccinated. A high level of knowledge about HPV was significantly associated with vaccine acceptance for female but not male children. Negative attitude toward vaccination was significantly related to lower vaccine acceptance, and parents who reported informing themselves about HPV vaccination from online sources were less likely to accept vaccination. Such results call for more educational measures to reduce misinformation about HPV vaccination and thereby reduce the fear of its side effects and promote early vaccination. More information is also needed to improve parents' attitude toward and their knowledge about vaccination, the dissemination of which should focus on the benefits of vaccines for children of both sexes.

COVID-19 Vaccine Acceptance and Associated Factors among Women in Saudi Arabia: A Cross-Sectional Study

Although women have been substantially affected by the pandemic, they tend to have a lower likelihood of COVID-19 vaccine acceptance. Research on factors associated with COVID-19 vaccine acceptance among this key population is imperative. Thus, this study aimed to assess COVID-19 vaccine acceptance and associated factors among women in Saudi Arabia. This study was part of a larger study conducted on the acceptance of the COVID-19 vaccine in Saudi Arabia, carried out between the 8th and 14th of December 2020. The study sample included 910 women aged 18 years and older. Bivariate and multivariable regression analyses was utilized to analyze the data. Overall, 41% of the participants were willing to receive the vaccine. Participants were more willing to accept vaccination if they were 40–49 years old (OR = 2.209, 95% CI: 1.49–2.02), if they had a moderate (OR = 2.570, 95% CI 1.562–4.228) or high to very high (OR = 1.925, 95% CI 1.093–3.390) perceived likelihood of being infected with COVID-19, or if they were in favor of mandatory COVID-19 vaccination for people in Saudi Arabia (OR = 64.916, 95% CI 35.911–117.351). However, participants with a high educational level (OR = 0.431, 95% CI 0.220–0.847) or who refused physician-recommended vaccines in the past (OR = 0.152, 95% CI 0.083–0.275) were less likely to accept COVID-19 vaccination. Given the low level of vaccine acceptance among women, relevant stakeholders should consider the needs and dynamics of this key population to increase vaccination uptake and to improve current and future outreach activities.

Trajectories and individual determinants of repeated seasonal flu vaccination use over the long term using data from the French E3N cohort

Despite the implementation of incentive policies to promote seasonal flu vaccination for more than 20 years in France, the coverage of high-risk individuals remains largely insufficient. While there is extensive literature on the determinants of vaccination in a given year, it rarely considers the specificity of flu vaccination, which must be repeated every autumn to remain effective. We aim to fill this gap by focusing on the flu vaccination behavior of high-risk individuals (65 years and older, chronic diseases) over a 15-year period. Based on data from 87,820 women in the French E3N cohort, we used sequence analysis methods (localized Optimal Matching) to identify typical seasonal flu vaccination profiles based on individual trajectories from 2004 to 2018. Then, using a multinomial model, we studied the individual determinants associated with the different patterns of vaccination use identified. Sequence analysis resulted in a partition of 8 clusters, which can be summarized into 4 typical behaviors: almost half of the women get vaccinated against flu each year (43%); conversely, another important share never get vaccinated against flu (32%); some do not get vaccinated for several years and then get vaccinated every year (20%); and finally, a minor share discontinued vaccination (5%). Thus, once women start getting vaccinated they generally continue every year. Nonetheless, this is a double-edged sword, as an important share of women considered at risk refrain from being vaccinated for more than a decade. Determinants associated with regular vaccination are being more at risk (age, weight, and chronic diseases), being in contact with physicians, being more educated, being in couple, having children, not smoking, and undergoing breast cancer screening.

Trends and Disparities in the Utilization of Influenza Vaccines Among Commercially Insured US Adults During the COVID-19 Pandemic

Objectives

Little is known about how the coronavirus disease 2019 (COVID-19) pandemic affected influenza vaccine utilization and disparities. We sought to estimate changes in the likelihood of receiving an influenza vaccine across different demographic subgroups during the COVID-19 pandemic.

Methods

In this cohort study, we analyzed influenza vaccine uptake from 2019 to 2020 using Optum commercial insurance claims data. Eligible individuals were aged 18 or above in 2018 and continuously enrolled from 08/01/2018 through 12/31/2020. Multivariable logistic regressions were fitted for the individual-level influenza vaccine uptake. Adjusting for demographic factors and medical histories, we estimated probabilities of receiving influenza vaccines before and after the COVID-19 pandemic across demographic subgroups.

Results

From August to December 2019, unadjusted influenza vaccination rate was 42.3%, while in the same period of 2020, the vaccination rate increased to 45.9%. Females had a higher vaccination rate in 2019 (OR: 1.16, 95% CI 1.15–1.16), but the increase was larger for males. Blacks and Hispanics had lower vaccination rates relative to whites in both flu seasons. Hispanics showed a greater increase in vaccination rate, increasing by 7.8 percentage points (p < .001) compared to 4.4 (p < .001) for whites. The vaccination rate for Blacks increased by 5.2 percentage points (p < .001). All income groups experienced vaccination improvements, but poorer individuals had lower vaccination rates in both seasons. The most profound disparities occurred when educational cohort were considered. The vaccination rate increased among college-educated enrollees by 8.8 percentage points (p < .001) during the pandemic compared to an increase of 2.8 percentage points (p < .001) for enrollees with less than a 12th grade education. Past influenza infections or vaccination increased the likelihood of vaccination (p < .001).

Conclusions

The COVID-19 pandemic was associated with increased influenza vaccine utilization. Disparities persisted but narrowed with respect to gender and race but worsened with respect to income and educational attainment.

Hesitation of the Tunisian population to COVID-19 vaccination, and its associated factors

BACKGROUND

Many people are reluctant to be vaccinated against COVID-19.

AIM

To determine the intention to accept COVID19 vaccine and its associated factors among Tunisians.

METHODS

We conducted a cross-sectional study among Tunisians from December 2020 to January 2021 using an online questionnaire. Factors associated with intention to accept coronavirus vaccine were analysed using multinomial logistic regression.

RESULTS

In total, 169 Tunisians participated in our study. The majority were female (85.2%). The mean age was 48.3 ± 11.8 years. Only 33.1% intended to accept to be vaccinated when COVID-19 vaccine will be available in Tunisia and 22.5% were still hesitant. In multinomial logistic regression, participants having high or very high perceived personal risk of COVID-19 infection (aOR: 3.257, 95% CI : 1.204 - 8.815) were more prone to hesitate to accept COVID-19 vaccine rather than those being willing to accept it. Respondents undergoing seasonal influenza vaccination (aOR: 0.091, 95% CI : 0.019 - 0.433) were less prone to refuse COVID-19 vaccine rather than those being willing to accept it. Young ones aged less than 40 years (aOR: 4.324, 95% CI: 1.180 - 15.843) were more prone to refuse COVID-19 vaccine rather than those being willing to accept it.

CONCLUSION

The acceptance rate of coronavirus vaccination was moderate. Therefore, a good communication and health education at a community level are needed.

Willingness to Receive COVID-19 Vaccination among Older Adults in Saudi Arabia: A Community-Based Survey

Identifying the factors driving vaccine hesitancy can improve vaccine attitudes and motivate individuals to have the recommended vaccinations. However, failure to address the issue directly, or worse, ignoring it, could deepen such concerns, resulting in lower vaccination rates, leading to elevated rates of illness and vaccine-preventable deaths among older adults. The aim of this study was to explore the rate of acceptance of the COVID-19 vaccine among older adults in Saudi Arabia, along with the associated predicting factors and reasons for hesitancy. This study extracted data from a cross-sectional online survey on the acceptability of COVID-19 vaccination in Saudi Arabia, which was conducted from 8 to 14 December 2020. The sample of the study included 488 older adults aged 50 and older. The major data analytic tools employed in the study were bivariate and multivariable regression analyses. Among the 488 participants, 214 (43.85%) reported willingness to accept the COVID-19 vaccine when available. Older men were more likely to be willing to be vaccinated (adjusted odds ratio (aOR): 2.277; 95% confidence interval (CI): 1.092-4.745) than older women. High levels of education were significantly associated with willingness to be vaccinated. Older adults who had previously refused any vaccine were less likely to take the COVID-19 vaccine (aOR: 0.358; 95% CI: 0.154-0.830). Those who expressed a high or very high level of concern related to becoming infected were more likely to accept the vaccine against COVID-19 (aOR: 4.437; 95% CI: 2.148-9.168). Adverse side effects (27.01%), and safety and efficacy concerns (22.63%) were the most commonly cited reasons for vaccine hesitancy. The vaccination acceptance rate among older adults in Saudi Arabia is low. Interventions designed specifically for older adults addressing worries and concerns related to the vaccine are of paramount importance. In particular, these interventions should be tailored to address gender-based and health literacy level differences.

Compulsory Vaccination for Healthcare Workers in Italy for the Prevention of SARS-CoV-2 Infection

The European Convention on Human Rights (ECHR) judgement no. 116(2021) of 8 April 2021 establishes the principle of mandatory vaccination, indicating the criteria that national legislation must comply with, following the principle of non-interference in the private life of the individual. Vaccination for the prevention of SARS-CoV-2 infection appears to be an essential requirement for providing healthcare assistance. The European experience with compulsory vaccinations, offers a composite panorama, as the strategy of some European countries is to make vaccinations compulsory, including financial penalties for non-compliance. As in other countries, there is a clear need for Italy to impose compulsory vaccination for healthcare workers, in response to a pressing social need to protect individual and public health, and above all as a defense for vulnerable subjects or patients, for whom health workers have a specific position of guarantee and trust. The Italian Republic provided for mandatory vaccinations for health professionals by Decree-Law of 1 April 2021 no. 44, to guarantee public health and adequate safety conditions. As stated by ECHR, the Italian State, despite having initially opted for recommendation as regards to SARS-CoV-2 vaccination, had to adopt the mandatory system to achieve the highest possible degree of vaccination coverage among health professionals to guarantee the safety of treatments and protection of patients' health. We present the Italian situation on vaccine hesitation in healthcare workers, with updated epidemiological data as well as the doctrinaire, social, and political debate that is raging in Italy and Europe.

Attitudes and Acceptance of COVID-19 Vaccination Among Nurses and Midwives in Cyprus: A Cross-Sectional Survey

Healthcare workers are at the frontline of the COVID-19 pandemic and have been identified as a priority target group for COVID-19 vaccines. This study aimed to determine the COVID-19 vaccination intention among nurses and midwives in Cyprus and reveal the influential factors that affected their decision. An Internet-based cross-sectional survey was conducted between December 8 and 28, 2020. Data collection was accomplished using a self-administered questionnaire with questions about socio-demographic characteristics, questions assessing general vaccination-related intentions and behaviors, and the intention to accept COVID-19 vaccination. A sample of 437 responders answered the survey, with 93% being nurses and 7% midwives. A small proportion of the participants would accept a vaccine against COVID-19, while 70% could be qualified as "vaccine hesitant." The main reasons for not receiving the COVID-19 vaccine were concerns about the vaccine's expedited development and fear of side effects. More females, individuals with a larger median age, and a higher number of years of working experience, intended to accept the COVID-19 vaccination, compared with those not intended to accept and undecided groups (p < 0.01). Having a seasonal flu vaccination in the last 5 years, receiving the vaccines recommended for health professionals, and working in the private sector were associated with a higher probability of COVID-19 vaccination acceptance. A considerable rate of nurses and midwives in Cyprus reported unwillingness to receive a COVID-19 vaccine due to vaccine-related concerns. Our findings highlight the need for forthcoming vaccination campaigns and programs to tackle coronavirus vaccine hesitancy barriers to achieve the desirable vaccination coverage.

Acceptability of Healthcare Professionals to Get Vaccinated against COVID-19 Two Weeks before Initiation of National Vaccination

Background and Objectives The greatest challenge vaccines face is that of acceptance from the general population. Healthcare professionals’ (HCPs) recommendations have significant influence on general public vaccination behavior. The aim of this study was to assess the willingness of HCPs to get vaccinated against COVID-19, two weeks before initiation of vaccinations. Materials and Methods: We conducted an anonymous online survey from 11–15 December 2020 among HCPs by emails delivered from the local medical and nursing stuff associations. Results: The 71.1% of 656 HCPs intended to accept vaccination, 5.9% did not and 23% were still undecided. The acceptance rate was higher in physicians (76.5%) and significantly lower in nurses (48.3%). Most of the responders who intended to accept vaccination were males (p = 0.01), physicians (p = 0.001), older (p = 0.02), married (p = 0.054) with children (p = 0.001), and had treated patients with COVID-19 (p < 0.001). In the multivariate logistic regression, the predictors of HCPs willingness to get vaccinated were parenthood (OR = 4.19, p = 0.003), being a physician (OR = 2.79, p = 0.04), and treating confirmed/suspected COVID-19 patients (OR = 2.87, p = 0.036). Conclusions: Low vaccination acceptance rate was found especially in nurses, and as this may have a negative impact in the vaccination compliance of the general public, interventional educational programs to enhance vaccination are crucial.

Understanding Behavioral Intentions Toward COVID-19 Vaccines: Theory-Based Content Analysis of Tweets

BACKGROUND

Acceptance rates of COVID-19 vaccines have still not reached the required threshold to achieve herd immunity. Understanding why some people are willing to be vaccinated and others are not is a critical step to develop efficient implementation strategies to promote COVID-19 vaccines.

OBJECTIVE

We conducted a theory-based content analysis based on the capability, opportunity, motivation-behavior (COM-B) model to characterize the factors influencing behavioral intentions toward COVID-19 vaccines mentioned on the Twitter platform.

METHODS

We collected tweets posted in English from November 1-22, 2020, using a combination of relevant keywords and hashtags. After excluding retweets, we randomly selected 5000 tweets for manual coding and content analysis. We performed a content analysis informed by the adapted COM-B model.

RESULTS

Of the 5000 COVID-19 vaccine-related tweets that were coded, 4796 (95.9%) were posted by unique users. A total of 97 tweets carried positive behavioral intent, while 182 tweets contained negative behavioral intent. Of these, 28 tweets were mapped to capability factors, 155 tweets were related to motivation, 23 tweets were related to opportunities, and 74 tweets did not contain any useful information about the reasons for their behavioral intentions (κ=0.73). Some tweets mentioned two or more constructs at the same time. Tweets that were mapped to capability (P<.001), motivation (P<.001), and opportunity (P=.03) factors were more likely to indicate negative behavioral intentions.

CONCLUSIONS

Most behavioral intentions regarding COVID-19 vaccines were related to the motivation construct. The themes identified in this study could be used to inform theory-based and evidence-based interventions to improve acceptance of COVID-19 vaccines.

Intention to Be Vaccinated for COVID-19 among Italian Nurses during the Pandemic

BACKGROUND

While the COVID-19 pandemic has spread globally, health systems are overwhelmed by both direct and indirect mortality from other treatable conditions. COVID-19 vaccination was crucial to preventing and eliminating the disease, so vaccine development for COVID-19 was fast-tracked worldwide. Despite the fact that vaccination is commonly recognized as the most effective approach, according to the World Health Organization (WHO), vaccine hesitancy is a global health issue.

METHODS

We conducted a cross-sectional online survey of nurses in four different regions in Italy between 20 and 28 December 2020 to obtain data on the acceptance of the upcoming COVID-19 vaccination in order to plan specific interventions to increase the rate of vaccine coverage.

RESULTS

A total of 531 out of the 5000 nurses invited completed the online questionnaire. Most of the nurses enrolled in the study (73.4%) were female. Among the nurses, 91.5% intended to accept vaccination, whereas 2.3% were opposed and 6.2% were undecided. Female sex and confidence in vaccine efficacy represent the main predictors of vaccine intention among the study population using a logistic regression model, while other factors including vaccine safety concerns (side effects) were non-significant.

CONCLUSIONS

Despite the availability of a safe and effective vaccine, intention to be vaccinated was suboptimal among nurses in our sample. We also found a significant number of people undecided as to whether to accept the vaccine. Contrary to expectations, concerns about the safety of the vaccine were not found to affect the acceptance rate; nurses' perception of vaccine efficacy and female sex were the main influencing factors on attitudes toward vaccination in our sample. Since the success of the COVID-19 immunization plan depends on the uptake rate, these findings are of great interest for public health policies. Interventions aimed at increasing employee awareness of vaccination efficacy should be promoted among nurses in order to increase the number of vaccinated people.

National Prevalence of Influenza Diagnoses and Vaccination Rates Among Patients Presenting to United States Physician Offices and Hospital Outpatient Departments, 2009 to 2016

Background

Influenza health resource utilization studies are important to inform future public health policies and prevent outbreaks. This study aimed to describe influenza prevalence, vaccination, and treatment among outpatients in the United States and to evaluate population-level characteristics associated with influenza health resource utilization.

Methods

Data were extracted from the National Ambulatory and National Hospital Ambulatory Medical Care Surveys (2009 to 2016). Prevalence rates were described as influenza visits (defined by International Classification of Diseases, Ninth Revision, Clinical Modification or International Classification of Diseases, Tenth Revision code) per 1000 total visits overall and by flu year, month, region, race, and age group. Influenza vaccination and antiviral treatments were identified by Multum code(s) and presented as vaccination visits per 1000 total visits and the percentage of patients diagnosed with influenza receiving antiviral treatment.

Results

In more than 19.2 million patient visits, an influenza diagnosis was made with rates ranging from 1.2 per 1000 during 2014–2015 to 3.7 per 1000 during 2009–2010. Rates were highest in the South (3.6 per 1000), in December (5.2), among black patients (2.8), and those less than 18 years (6.8). Vaccination rates were highest during 2014–2015 (29.3 per 1000) and lowest during 2011–2012 (15.5 per 1000), in the West (23.4), in October (69.2), among “other race” patients (26.2), and age less than 18 years (51.4). Overall, 39.4% of patients with an influenza diagnosis received an antiviral.

Conclusions

Overall, there were no major changes in influenza diagnosis or vaccination rates. Patient populations with lower vaccination rates had higher influenza diagnosis rates. Future campaigns should promote influenza vaccinations particularly in underserved populations.

Acceptability of a COVID-19 Vaccine Among Healthcare Workers in the Kingdom of Saudi Arabia

Objective: This study aims to determine the acceptability of a COVID-19 vaccine among healthcare workers in Saudi Arabia and the factors affecting their intention to accept the vaccine. Methods: The study used data from an online cross-sectional survey that was conducted in Saudi Arabia between 8 December 2020 and 14 December 2020. This study employed bivariate and multivariable regression analyses. The bivariate was used to describe and tabulate the frequency of all the variables, including the sociodemographic characteristics, the risk perception and the acceptance of the COVID-19 vaccination and a chi-squared test of independence was calculated. Multivariable logistic regression models were employed to examine and identify the factors associated with an intention to have the COVID-19 vaccination and the factors associated with its immediate acceptance. Results: Of the total of 736 healthcare workers who began the online questionnaire, 673 completed it (a 91.44% completion rate). Among the study participants, 50.52% were willing to have the COVID-19 vaccine, of which 49.71% intended to have the vaccine as soon as it becomes available in the country, while 50.29% would delay until the vaccine's safety is confirmed. Being a male healthcare worker, perceiving a high risk of infection, and believing that the COVID-19 vaccine should be compulsory for all citizens and residents in the country increased the probability of intention to vaccinate against COVID-19 and the probability of accepting the COVID-19 vaccination as soon as possible. Conclusion: This study calls for more health-related education among healthcare workers to alleviate any fears that might be associated with the COVID-19 vaccine.

Perceptions of Seasonal Influenza Vaccine Among U.S. Army Civilians and Dependents in the Kaiserslautern Military Community: A Mixed-Methods Survey

Introduction

Influenza is a globally occurring viral respiratory infection that can lead to hospitalizations and death. An influenza outbreak can interfere with combat readiness in a military setting, as the infection can incapacitate soldiers. Vaccination remains the most effective tool to prevent and mitigate seasonal influenza. Although influenza vaccinations for U.S. Army soldiers can be monitored through military health systems, those systems cannot capture DoD civilians and Army dependents who may not use military health services. This study aims to gauge flu vaccine uptake and perceptions in U.S. Army civilians and dependents.

Materials and Methods

An online survey was e-mailed to civilian and dependent enrollees of Landstuhl Regional Medical Center. The survey contained 24 questions pertaining to demographics, vaccine history, history of the flu, and beliefs toward vaccines. Chi-square tests, t-tests, and logistic regressions were performed to investigate the association between demographic, behavior, and belief factors with vaccine uptake. Free-text answers were coded and categorized by themes.

Results

Over 70% of respondents were vaccinated for the flu. There were differences between vaccinated and unvaccinated respondents regarding their perceptions of barriers to vaccination, benefits of the flu vaccine, severity of flu symptoms, and personal risk of getting ill with the flu. After controlling for confounders, flu vaccination in the previous season and healthcare worker status were associated with increased vaccine uptake, while perceived barriers to influenza vaccination were associated with decreased vaccine uptake.

Conclusions

Flu vaccine uptake may be increased by increasing access to vaccination, promoting vaccination and addressing concerns at the provider level, and engaging positively framed public messaging. Increasing flu vaccine uptake is of particular importance as the flu season approaches during the COVID-19 (Coronavirus disease 2019) pandemic.

Assessment of U.S. health care personnel (HCP) attitudes towards COVID-19 vaccination in a large university health care system

Background

As a priority group, healthcare personnel (HCP) will be key to success of COVID-19 vaccination programs. The purpose of this study was to assess HCP willingness to get vaccinated and identify specific concerns that would undermine vaccination efforts.

Methods

We conducted a cross-sectional survey of HCP, including clinical and non-clinical staff, researchers, and trainees between November 23 ^rd ,2020 and December 5 ^th ,2020. The survey evaluated attitudes, beliefs and willingness to get vaccinated.

Results

A total of 5287 respondents had a mean age of 42.5 years (SD=13.56), and were 72.8% female (n=3842). Overall 57.5 % of individuals expressed intent to receive COVID-19 vaccine. 80.4% were physicians and scientists representing the largest group. 33.6% of registered nurses, 31.6% of allied health professionals, and 32% of master’s level clinicians were unsure they would take the vaccine (p<.001). Respondents who were older, males, White, or Asian were more likely to get vaccinated compared to other groups. Vaccine safety, potential adverse events, efficacy and speed of vaccine development dominated concerns listed by participants. Fewer (54.0%) providers of direct care vs. non-care providers (62.4%), and 52.0% of those who had provided care for COVID-19 patients (vs. 60.6% of those who had not) indicated they would take the vaccine if offered (p<.001).

Conclusions

We observed that self-reported willingness to receive vaccination against COVID-19 differs by hospital roles, with physicians and research scientists showing the highest acceptance. These findings highlight important heterogeneity in personal attitudes among HCPs around COVID-19 vaccines and highlight a need for tailored communication strategies.

Intention of nurses to accept coronavirus disease 2019 vaccination and change of intention to accept seasonal influenza vaccination during the coronavirus disease 2019 pandemic: A cross-sectional survey

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Refusal rate of nurses to influenza vaccine reduced during the pandemic.

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A low acceptance level and high hesitancy level to COVID vaccination was observed.

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A strong association between COVID-19 and influenza vaccine acceptance was found.

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Major concern of nurses about the COVID-19 vaccine was its efficacy and safety.

Background

Maintaining health of healthcare workers with vaccination is a major component of pandemic preparedness and acceptance of vaccinations is essential to its success. This study aimed to examine impact of the coronavirus disease 2019 (COVID-19) pandemic on change of influenza vaccination acceptance and identify factors associated with acceptance of potential COVID-19 vaccination.

Method

A cross-sectional self-administered anonymous questionnaire survey was conducted among nurses in Hong Kong, China during 26 February and 31 March 2020. Their previous acceptance of influenza vaccination and intentions to accept influenza and COVID-19 vaccination were collected. Their relationship with work-related and other factors were examined using multiple multinomial logistic regressions.

Results

Responses from 806 participants were retrieved. More nurses changed from vaccination refusal to hesitancy or acceptance than those changed from acceptance to vaccination hesitancy or refusal (15.5% vs 6.8% among all participants, P < 0.001). 40.0% participants intended to accept COVID-19 vaccination, and those in private sector (OR: 1.67, 95%CI: 1.11–2.51), with chronic conditions (OR: 1.83, 95%CI: 1.22–2.77), encountering with suspected or confirmed COVID-19 patients (OR: 1.63, 95%CI: 1.14–2.33), accepted influenza vaccination in 2019 (OR: 2.03, 95%CI: 1.47–2.81) had higher intentions to accept it. Reasons for refusal and hesitation for COVID-19 vaccination included “suspicion on efficacy, effectiveness and safety”, “believing it unnecessary”, and “no time to take it”.

Conclusion

With a low level of COVID-19 acceptance intentions and high proportion of hesitation in both influenza and COVID-19 vaccination, evidence-based planning are needed to improve the uptake of both vaccinations in advance of their implementation. Future studies are needed to explore reasons of change of influenza vaccination acceptance, look for actual behaviour patterns of COVID-19 vaccination acceptance and examine effectiveness of promotion strategies.

Understanding vaccine acceptance and demand-and ways to increase them

Vaccination saves millions of lives, and the World Health Organization (WHO) European Region celebrated record high coverage in 2018. Still, national or sub-national coverage is insufficient to stop the spread of vaccine-preventable diseases. Health authorities are increasingly aware of the need to prioritize the “demand” side of vaccination. Achieving high and equitable vaccination uptake in all population groups is not a quick-fix; it requires long-term investment in multifaceted interventions, informed by research with the target groups. The WHO focuses on both individual and context determinants of vaccination behaviours. Individual determinants include risk perceptions, (dis)trust and perceived constraints; insights from psychology help us understand these. Context determinants include social norms, socioeconomic status and education level, and the way health systems are designed, operate and are financed. The WHO recommends using a proven theoretical model to understand vaccination behaviours and has adapted the “COM‑B model” for their Tailoring Immunization Programmes (TIP) approach. This adapted model is described in the article. Informed by insights into the factors affecting vaccination behaviours, interventions and policies can be planned to increase vaccination uptake. Some evidence exists on proven methods to do this. At the individual level, some interventions have been seen to increase vaccination uptake, and experimental studies have assessed how certain messages or actions affect vaccination perceptions. At the context level, there is more documentation for effective strategies, including those that focus on making vaccination the easy, convenient and default behaviour and that focus on the interaction between caregivers and health workers.

Factors associated with perceptions of influenza vaccine safety and effectiveness among adults, United States, 2017-2018

BACKGROUND

Annual vaccination against seasonal influenza is widely recognized as the primary intervention method in preventing morbidity and mortality from influenza, but coverage among adults is suboptimal in the United States. Safety and effectiveness perceptions regarding vaccines are consistently cited as factors that influence adults' decisions to accept or reject vaccination. Therefore, we conducted this analysis in order to understand sociodemographic, attitude, and knowledge factors associated with these perceptions for influenza vaccine among adults in three different age groups.

METHODS

Probability-based Internet panel surveys using nationally representative samples of adults aged ≥19 years in the United States were conducted during February-March of 2017 and 2018. We asked respondents if they believed the influenza vaccine was safe and effective. We calculated prevalence ratios using chi-square and pairwise t-tests to determine associations between safety and effectiveness beliefs and sociodemographic variables for adults aged 19-49, 50-64, and ≥65 years.

RESULTS

Survey completion rates were 58.2% (2017) and 57.2% (2018); we analyzed 4597 combined responses. Overall, most adults reported the influenza vaccine was safe (86.3%) and effective (73.0%). However, fewer younger adults reported positive perceptions compared with older age groups. Respondents who believed the vaccine was safe also reported it was effective.

CONCLUSIONS

Generally, adults perceived the influenza vaccine as safe and effective. Considering this, any improvements to these perceptions would likely be minor and have a limited effect on coverage. Future research to understand why, despite positive perceptions, adults are still choosing to forego the vaccine may be informative.

Forecasting influenza activity using self-adaptive AI model and multi-source data in Chongqing, China

Background

Early detection of influenza activity followed by timely response is a critical component of preparedness for seasonal influenza epidemic and influenza pandemic. However, most relevant studies were conducted at the regional or national level with regular seasonal influenza trends. There are few feasible strategies to forecast influenza activity at the local level with irregular trends.

Methods

Multi-source electronic data, including historical percentage of influenza-like illness (ILI%), weather data, Baidu search index and Sina Weibo data of Chongqing, China, were collected and integrated into an innovative Self-adaptive AI Model (SAAIM), which was constructed by integrating Seasonal Autoregressive Integrated Moving Average model and XGBoost model using a self-adaptive weight adjustment mechanism. SAAIM was applied to ILI% forecast in Chongqing from 2017 to 2018, of which the performance was compared with three previously available models on forecasting.

Findings

ILI% showed an irregular seasonal trend from 2012 to 2018 in Chongqing. Compared with three reference models, SAAIM achieved the best performance on forecasting ILI% of Chongqing with the mean absolute percentage error (MAPE) of 11·9%, 7·5%, and 11·9% during the periods of the year 2014–2016, 2017, and 2018 respectively. Among the three categories of source data, historical influenza activity contributed the most to the forecast accuracy by decreasing the MAPE by 19·6%, 43·1%, and 11·1%, followed by weather information (MAPE reduced by 3·3%, 17·1%, and 2·2%), and Internet-related public sentiment data (MAPE reduced by 1·1%, 0·9%, and 1·3%).

Interpretation

Accurate influenza forecast in areas with irregular seasonal influenza trends can be made by SAAIM with multi-source electronic data.

Parental acceptance of an intranasal vaccine: Example of influenza vaccine

BACKGROUND

Influenza vaccination coverage of children with chronic disease is insufficient in France, although a nasal live attenuated influenza vaccine (LAIV) has been approved.

OBJECTIVE

We aimed to evaluate the acceptance of nasally administered vaccines by parents of children with chronic illness, by comparing LAIV vs. injectable inactivated influenza vaccine (IIV) acceptance.

METHODS

We performed a retrospective, observational study (December 2014 to April 2015) including parents of all children vaccinated with the LAIV during the 2013-2014 influenza vaccination campaign at our university hospital. It was an opinion survey on the tolerance and acceptance of the LAIV.

RESULTS

A standardized evaluation form was completed by 67/79 parents of all children who received the LAIV (mean age: 113±56 months; 64% with a chronic respiratory disease). The parents responded that vaccines in general were important (99%) but only 58% of them accepted the injectable route of administration. Of the 48 parents of children who had received both LAIV and IIV in the past, global opinion (P<0.0001) and tolerance (P<0.0001) were better for LAIV. For the future, 81% of parents would prefer LAIV, mainly because of needle absence and/or less painful character, and 18% IIV, mainly because of easier administration or habit.

CONCLUSION

The better acceptance of a nasally administrated vaccine could increase vaccination coverage in the future for nasal vaccines.

Impact of an Onsite Clinic on Utilization of Preventive Services

OBJECTIVE

To assess impact of an onsite clinic on healthcare utilization of preventive services for employees of a public university and their dependents.

METHOD

Descriptive statistics, logistic regression and classification tree techniques were used to assess health claim data to identify changes in patterns of healthcare utilization and factors impacting usage of onsite clinic.

RESULT

Utilization of preventive services significantly increased for women and men employees by 9% and 14% one year after implementation of the onsite clinic. Hourly-paid employees, employees without diabetes, employees with spouse opt out or no coverage were more likely to go to the onsite clinic.

CONCLUSION

Adapted framework for assessing performance of onsite clinics based on usage of health informatics would help to identify health utilization patterns and interaction between onsite clinic and offsite health providers.

Skepticism toward Emerging Infectious Diseases and Influenza Vaccination Intentions in Nurses

Nurses generally show low compliance with vaccination recommendations. We assessed whether low vaccine acceptance is due to skeptical attitudes toward emerging infectious diseases (EIDs). Skepticism toward EIDs manifests as doubts about the real threat of emerging diseases and as distrust in the motives and the competence of institutions that fight these diseases. We performed a cross-sectional questionnaire study in 293 Swiss nurses using a newly developed scale to assess skepticism toward EIDs. Skepticism affected nurses' intentions to vaccinate themselves against seasonal influenza and against possible future pandemic influenza. The influence of skepticism persisted after controlling for other factors that are known to determine nurses' vaccination behavior, namely vaccination habits, feeling at risk of catching influenza, and perceiving vaccination as a professional duty. Skeptical attitudes toward EIDs seem to have a unique and hitherto ignored impact on vaccination intentions. Nurses' vaccine acceptance could be increased if vaccination campaigns specifically target skeptical attitudes toward EIDs. These campaigns should address nurses' doubts about the real threat of EIDs and should rebuild their trust in institutions which fight these diseases.

Barriers of Influenza Vaccination Intention and Behavior - A Systematic Review of Influenza Vaccine Hesitancy, 2005 - 2016

BACKGROUND

Influenza vaccine hesitancy is a significant threat to global efforts to reduce the burden of seasonal and pandemic influenza. Potential barriers of influenza vaccination need to be identified to inform interventions to raise awareness, influenza vaccine acceptance and uptake.

OBJECTIVE

This review aims to (1) identify relevant studies and extract individual barriers of seasonal and pandemic influenza vaccination for risk groups and the general public; and (2) map knowledge gaps in understanding influenza vaccine hesitancy to derive directions for further research and inform interventions in this area.

METHODS

Thirteen databases covering the areas of Medicine, Bioscience, Psychology, Sociology and Public Health were searched for peer-reviewed articles published between the years 2005 and 2016. Following the PRISMA approach, 470 articles were selected and analyzed for significant barriers to influenza vaccine uptake or intention. The barriers for different risk groups and flu types were clustered according to a conceptual framework based on the Theory of Planned Behavior and discussed using the 4C model of reasons for non-vaccination.

RESULTS

Most studies were conducted in the American and European region. Health care personnel (HCP) and the general public were the most studied populations, while parental decisions for children at high risk were under-represented. This study also identifies understudied concepts. A lack of confidence, inconvenience, calculation and complacency were identified to different extents as barriers to influenza vaccine uptake in risk groups.

CONCLUSION

Many different psychological, contextual, sociodemographic and physical barriers that are specific to certain risk groups were identified. While most sociodemographic and physical variables may be significantly related to influenza vaccine hesitancy, they cannot be used to explain its emergence or intensity. Psychological determinants were meaningfully related to uptake and should therefore be measured in a valid and comparable way. A compendium of measurements for future use is suggested as supporting information.

Using Behavioral Insights to Increase Vaccination Policy Effectiveness

Even though there are policies in place, and safe and effective vaccines available, almost every country struggles with vaccine hesitancy, that is, a delay in acceptance or refusal of vaccination. Consequently, it is important to understand the determinants of individual vaccination decisions to establish effective strategies to support the success of country-specific public health policies. Vaccine refusal can result from complacency, inconvenience, a lack of confidence, and a rational calculation of pros and cons. Interventions should, therefore, be carefully targeted to focus on the reason for non-vaccination. We suggest that there are several interventions that may be effective for complacent, convenient, and calculating individuals whereas interventions that might be effective for those who lack confidence are scarce. Thus, efforts should be concentrated on motivating the complacent, removing barriers for those for whom vaccination is inconvenient, and adding incentives and additional utility for the calculating. These strategies might be more promising, economic, and effective than convincing those who lack confidence in vaccination.

The relationship between influenza vaccination habits and location of vaccination

Although use of non-medical settings for vaccination such as retail pharmacies has grown in recent years, little is known about how various settings are used by individuals with different vaccination habits. We aimed to assess the relationship between repeated, annual influenza vaccination and location of vaccination. Study Design: We conducted a cross-sectional survey of 4,040 adults in 2010. Methods: We fielded a nationally representative survey using an online research panel operated by Knowledge Networks. The completion rate among sampled panelists was 73%. Results: 39% of adults reported that they have never received a seasonal influenza vaccination. Compared to those who were usually or always vaccinated from year to year, those who sometimes or rarely received influenza vaccinations were significantly more likely to be vaccinated in a medical setting in 2009–2010. Conclusions: Results indicate that while medical settings are the dominant location for vaccination overall, they play an especially critical role in serving adults who do not regularly receive vaccinations. By exploring vaccination habits, we can more appropriately choose among interventions designed to encourage the initiation vs. maintenance of desired behaviors.

Rural school employees' status, awareness, and perceptions of adult vaccinations

As key members of the school environment, it is important for school employees to be vaccinated. Employees are in direct contact with children in close quarters for long periods of time and such an environment can easily serve as an outbreak center for vaccine-preventable communicable diseases such as measles. Despite the fact that most school employees believe vaccines are safe and effective and many school employees report they are up-to-date with their vaccines, a closer examination reveals discrepancy between belief and behavior. This research study evaluates the vaccination status, awareness, and perceptions of school employees located in a large rural school district in Utah. As a vaccine advocate, the school nurse can be influential in providing adult vaccination education for school employees, thus increasing awareness of the importance of adult vaccines and knowing one's vaccination status. Additionally, school nurses might need to meet with school district policy makers to promote vaccine mandates for school employees and to assist in the creation of containment plans in the event of a measles outbreak at school.

The comparative value of various employer-sponsored influenza vaccination clinics

OBJECTIVE

Many US firms offer influenza vaccination clinics to prevent lost productivity due to influenza. Strategies to promote and offer vaccination differ, and the economic value of the strategies is unknown.

METHODS

Decision analytic modeling and Monte Carlo probabilistic sensitivity analyses estimated the one-season cost-consequences of three types of influenza clinics (trivalent inactivated influenza vaccine only, vaccine choice [trivalent inactivated influenza or intranasal {live attenuated influenza} vaccine], or vaccine choice plus incentive) in firms of 50 and 250 employees, from the employer's perspective.

RESULTS

On-site influenza vaccination was generally cost-saving over no vaccination. For the scenario of vaccine effectiveness of 70% and intermediate transmissibility, the incremental costs per employee for a firm of 50 employees were -$6.41 (ie, cost savings) for inactivated vaccine only versus no vaccination, -$1.48 for vaccine choice versus inactivated vaccine, and $1.84 for vaccine choice plus incentive versus vaccine choice. Clinics offering a choice of vaccines were slightly less costly under many scenarios. Generally, incremental costs were lower (1) in larger firms; (2) when influenza was assumed to be more contagious; and (3) when vaccine effectiveness was assumed to be higher.

CONCLUSION

Employer-sponsored influenza vaccination clinics are generally cost-saving.

Economic evaluation of the vaccination program against seasonal and pandemic A/H1N1 influenza among customs officers in Greece

INTRODUCTION

Health policies from many countries recommend influenza vaccination of "high-priority" professional groups, including customs officers. Our aim was to estimate the economic impact of the vaccination program against influenza among customs officers in Greece during the 2009/2010 period.

MATERIALS AND METHODS

We developed a decision analytical computational simulation model including dynamic transmission elements that estimated the economic impact of various scenarios with different attack rates, symptomatic percentages and vaccination participation among customs officers. We also assessed in real-time the economic impact of the national 2009/2010 campaign against seasonal and pandemic A/H1N1 influenza.

RESULTS

Implementing a seasonal and pandemic A/H1N1 influenza vaccination program among customs officers in Greece with a participation rate of 30%, influenza vaccination was not cost-saving in any of the studied influenza scenarios. When the participation rate reached 100%, the program was cost-saving, when the influenza attack rate was 30% and the symptomatic rate 65%. The real-time estimated mean net cost-benefit value in 2009/2010 period was -7.3 euros/custom officer.

CONCLUSIONS

With different clinical scenarios, providing a vaccination program against seasonal and pandemic A/H1N1 influenza can incur a substantial net benefit for customs offices. However, the size of the benefit strongly depends upon the attack rate of influenza, the symptomatic rate as well as the participation rate of the customs officers in the program.

Influenza vaccine-related information needs of US primary care physicians

OBJECTIVE

To explore influenza-related information needs of primary care providers, given expanded influenza vaccine recommendations and new influenza vaccine products.

METHODS

A cross-sectional, mailed survey of a national sample of primary care physicians (family physicians, general internists, pediatricians), conducted in July-October 2010. The overall response rate was 70%.

RESULTS

Among respondents who offer immunizations, almost all expected to provide injectable influenza vaccine for the 2010-11 influenza season, while only pediatricians planned wide use of intranasal vaccine. The information needs most frequently rated as high priority were subpopulations to prioritize if vaccine supply is limited and use of a higher dose formulation for the elderly. Most physicians who do not currently use intranasal vaccine rated that topic as a low priority.

CONCLUSION

Primary care providers have a number of high-priority information needs related to influenza vaccination. However, the limited interest of family physicians and internists in receiving more information about intranasal vaccine may impede efforts to expand its use among healthy adults.

The social ecological model as a framework for determinants of 2009 H1N1 influenza vaccine uptake in the United States

Research on influenza vaccine uptake has focused largely on intrapersonal determinants (perceived risk, past vaccine acceptance, perceived vaccine safety) and on physician recommendation. The authors used a social ecological framework to examine influenza vaccine uptake during the 2009 H1N1 pandemic. Surveying an adult population (n = 2,079) in January 2010 with significant oversamples of Blacks and Hispanics, this study found that 18.4% (95% confidence interval = 15.6-21.5) had gotten the 2009 H1N1 vaccine. Variables at each level of the social ecological model were significant predictors of uptake as well as of intent to get the vaccine. The intrapersonal level explained 53%, the interpersonal explained 47%, the institutional level explained 34%, and the policy and community levels each explained 8% of the variance associated with vaccine uptake. The levels together explained 65% of the variance, suggesting that interventions targeting multiple levels of the framework would be more effective than interventions aimed at a single level.