The Vaccine Hesitancy Profiles and Determinants of Seasonal Influenza among Chinese Community Healthcare Workers: A Cross-Sectional Study

A cross-sectional study on the understanding and attitudes toward influenza and influenza vaccines among different occupational groups in China

This study aimed to assess the level of knowledge regarding influenza viruses and vaccines among different professional groups to investigate the reasons for vaccine hesitancy. We collected 2190 questionnaires regarding influenza vaccines in China in 2022. The respondents were categorized into the general population (GP), foreign affairs workforce population (FAWP), and veterinary workforce population (VWP) according to their job positions. Linear regression was used to assess the association between multiple factors and influenza vaccination rates. The association between work and influenza vaccination rates was also assessed by grouping different workforce populations. The vaccination rate of the GP was higher than that of the VWP (odds ratio: 1.342, 95% confidence interval: 1.025-1.853), surpassing the rates reported in previous studies. This may be attributed to heightened concerns about infectious diseases influenced by the ongoing coronavirus disease 2019 pandemic. Despite the VWP's more in-depth knowledge of the VWP on zoonotic diseases and their recognition of their importance, there was no significant difference in influenza knowledge among the three populations. This discrepancy contrasts with the observed differences in vaccination rates. Further investigation revealed that, compared with FAWP, the price of vaccines emerged as a primary influencing factor for vaccination rates (odds ratio:0.398, 95%CI; 0.280-0.564). General concerns regarding the protective effects and side effects of vaccines were also noted.

Influenza vaccine hesitancy among healthcare workers in a Northeastern province in Thailand: Findings of a cross-sectional survey

BACKGROUND

Healthcare workers (HCWs) are an important target group for influenza vaccination due to their increased risk of infection. However, their uptake remains a challenge. This study aimed to identify and measure influenza vaccine hesitancy among HCWs in Nakhon Phanom province, Thailand.

METHODS

A representative cross-sectional survey was conducted during August-September 2020, among 350 HCWs at six hospitals in the province selected by a two-stage cluster sampling using a self-administered questionnaire. HCWs who either delayed getting influenza vaccines, accepted the vaccines but were unsure, or refused the vaccine with doubts were categorized as hesitant. HCWs who accepted the influenza vaccine without any doubts were classified as non-hesitant. Determinants of vaccine hesitancy were identified by a multivariable logistic regression analysis.

RESULTS

A total of 338 participants (97%) filled the questionnaires. The mean age of the participants was 37.2 years. Most participants were female (280; 83%), nurses (136; 40%), working at district hospitals (238; 71%), with bachelor's degree (223; 66%), and without any pre-existing chronic medical conditions (264; 78%). Influenza vaccine hesitancy was evident among nearly 60% of the participants (197/338), who had varying patterns of hesitancy. Significant factors of influenza vaccine hesitancy were found to be age above 50 years (adjusted odds ratio [aOR] 3.2, 95% CI 1.3-8.5), fair knowledge of influenza and vaccination (aOR 0.4, 95% CI 0.2-0.8), and negative influence of other HCW (High level-aOR 2.3, 95% CI 1.1-4.8; Moderate level- aOR 2.1, 95% CI 1.1-4.4).

CONCLUSION

Influenza vaccine hesitancy was highly prevalent among the Thai HCWs in Nakhon Phanom province. Imparting updated information to the HCW, in combination with positive guidance from influential HCWs in the hospital, may help reduce hesitancy. These data may be useful to the National Immunization Program to design appropriate approaches to target hesitant HCWs in Thailand to improve influenza vaccine coverage.

Vaccine confidence mediates the association between a pro-social pay-it-forward intervention and improved influenza vaccine uptake in China: A mediation analysis

INTRODUCTION

A Chinese clinical trial has demonstrated that a prosocial pay-it-forward intervention that offered subsidized vaccination and postcard messages effectively increased influenza vaccine uptake and vaccine confidence. This secondary analysis explored the potential mediating role of vaccine confidence on the association between a pay-it-forward intervention and influenza vaccine uptake, and how this might vary by individual annual income levels.

METHODS

Data from 300 participants (150 standard-of-care and 150 pay-it-forward participants) were included in the analysis. We conducted descriptive analysis of demographic and vaccine confidence variables. Multivariable regression and mediation analysis on interventions, vaccine confidence and vaccine uptake were conducted. A sub-group analysis was conducted to further understand whether associations between these variables vary by income levels (<=$1860 or >$1860).

RESULTS

The pay-it-forward intervention was significantly associated with greater levels of perceived influenza vaccine importance (adjusted odds ratio (aOR) = 3.60, 95 %CI: 1.77-7.32), effectiveness (aOR = 3.37, 95 %CI: 1.75-6.52) and safety (aOR = 2.20, 95 %CI: 1.17-4.15). Greater perceived influenza vaccine importance was associated with increased vaccine uptake (aOR = 8.51, 95 %CI: 3.04-23.86). The indirect effect of the pay-it-forward intervention on vaccination was significant through improved perceived influenza vaccine importance (indirect effect1 = 0.07, 95 %CI: 0.02-0.11). This study further revealed that, irrespective of the individual income level, the pay-it-forward intervention was associated with increased vaccine uptake when compared to the standard-of-care approach.

CONCLUSIONS

Pay-it-forward intervention may be a promising strategy to improve influenza vaccine uptake. Perceived confidence in vaccine importance appears to be a potential mediator of the association between pay-it-forward and vaccine uptake.