Knowledge, Attitude, and Practice towards Influenza Vaccination among Older Adults in Southern China during the COVID-19 Pandemic

The 2nd China Vaccinology Integrated Innovation & Teaching Development Conference: Promoting the construction of vaccinology discipline system

The 2nd China Vaccinology Integrated Innovation & Teaching Development Conference was held in Sun Yat-sen University, Shenzhen, 18-19, November 2023. Over 200 participants in the field of Vaccinology gathered together to address challenges and issues relevant to vaccine education and training courses, research, and public health programs in China. The conference themed "Promoting the Integrated and Innovative Development of Vaccinology through Collective Efforts." The conference was organized by the China Association of Vaccine (CAV) and hosted by Vaccinology Education Professional Committee of CAV, and School of Public Health (Shenzhen), Sun Yat-sen University. Other partners included the Medical Virology Branch of the Chinese Medical Association, the editorial committee of the Chinese Journal of Preventive Medicine, Human Vaccines & Immunotherapeutics, and the People's Medical Publishing House. The 1st conference was held in Hangzhou, in October 2020.

The impact of the COVID-19 pandemic and the free vaccination policy on seasonal influenza vaccination uptake among older adults in Ningbo, Eastern China

In 2020-21, during the COVID-19 pandemic, a free influenza vaccination program was initiated among the elderly residents in Ningbo, China. The impact of the COVID-19 pandemic and free vaccination policy on influenza vaccine uptake needs to be evaluated. The influenza vaccine uptake among individuals born before 31 December, 1962 from 2017-18 to 2022-23 season in Ningbo was analyzed. Multivariate logistic regressions were used to estimate the impact of the COVID-19 pandemic and free vaccination policy. Our analysis included an average of 1,856,565 individuals each year. Influenza vaccination coverage increased from 1.14% in 2017-18 to 33.41% in 2022-23. The vaccination coverage among the free policy target population was 50.03% in 2022-23. Multivariate analysis showed that free vaccination policy increased influenza vaccine uptake most (OR = 11.99, 95%CI: 11.87-12.11). The initial phase of the pandemic was associated with a positive effect on influenza vaccination (OR = 2.09, 95%CI: 2.07-2.12), but followed by a negative effect in the subsequent two seasons(2021-22: OR = 0.75, 95%CI: 0.73-0.76; 2022-23: OR = 0.40, 95%CI: 0.39-0.40). COVID-19 vaccination in the current season was a positive predictor of influenza vaccine uptake while not completing booster COVID-19 vaccination before was negative predictor in 2022-23. Having influenza vaccine history and having ILI medical history during the last season were also positive predictors of influenza vaccine uptake. Free vaccination policies have enhanced influenza vaccination coverage among elderly population. The COVID-19 pandemic plays different roles in different seasons. Our study highlights the need for how to implement free vaccination policies targeting vulnerable groups with low vaccination coverage.

Impact of propensity to COVID-19 vaccination/vaccine on influenza vaccination from willingness to behavior among older adults in rural China

To explore impact of the propensity to coronavirus disease 2019 (COVID-19) vaccine/vaccination on influenza vaccination from willingness to behavior after COVID-19 pandemic among older adults in rural China. A combined study involving a cross-sectional survey for the willingness of influenza vaccination, a health education momentary intervention and a community intervention program were conducted from September 11th to 16th, 2023 among rural older adults in China. Totally 3138 individuals were investigated in this study with 1923 (61.3%) willing to receive influenza vaccination. After the momentary intervention, 47.8% (582/1215) individuals changed to be willing to receive influenza vaccination. There were 1440 (78.8%) vaccinated. The influenza vaccination willingness rate was significantly higher in the participants willing to receive COVID-19 vaccine booster dose vaccination than the participants unwilling to (69.4% vs. 37.7%, adjusted OR [aOR] = 2.671, 95% CI 2.211-3.227, p < .001), as well as for the influenza vaccination willingness change rate (52.2% vs. 41.7%, aOR = 1.303, 95% CI 1.022-1.662, p < .05) and the influenza vaccination behavior rate (79.7% vs. 74.9%, aOR = 1.337, 95% CI 1.002-1.784, p < .05). The influenza vaccination behavior rate was significantly higher in those positive toward COVID-19 vaccine effectiveness or safety overall (80.0% vs. 74.9%, aOR = 1.394, 95% CI 1.065-1.823; 80.6% vs. 70.9%, aOR = 1.850, 95% CI 1.395-2.454; both p < .05). There was a positive impact of COVID-19 vaccine/vaccination on influenza vaccination from willingness to behavior among the older adults in rural China after COVID-19 pandemic, suggesting that integrating health education of related pathogens and vaccines might promote influenza vaccination.

Evaluation and analysis of respiratory infectious disease prevention behaviors in older adults

Background

Respiratory infectious diseases (RIDs) are a global public health problem, characterized by strong infectivity, high transmissibility, and a high incidence in the population. This study aimed to explore RID prevention behaviors among older adults and analyze their influencing factors.

Methods

A cross-sectional study was conducted to examine RID prevention behaviors among 2219 Chinese older adults. Analysis of variance and the Kruskal-Wallis test were used to compare behaviors among subjects with different characteristics. Pearson's correlation analysis was used to assess the relationships between knowledge, skills, and behavior, and a generalized linear model was used for multi-factor analysis.

Results

The participants in this questionnaire survey were predominantly older adults individuals aged 65-70 years (45.65%), with no more than a primary school educational level (86.70%). Univariate analysis revealed statistically significant associations between age, education, place of residence, living condition, marital status, annual income in the past year, type of medical insurance, health status, smoking status, drinking status, weekly exercise durations, and sleep status in older adults and their RID prevention behavior. Pearson's correlation analysis indicated a moderate correlation between knowledge, skills, and behavioral scores. Multivariate analysis identified place of residence, annual income, smoking habits, alcohol consumption, exercise frequency, knowledge level, and skill level as influential factors for behaviors related to the prevention and control of RID in older adults.

Conclusion

Our results confirm the importance of a healthy lifestyle in RID prevention among older adults, especially in terms of smoking, alcohol consumption, and regular exercise, and provide empirical evidence for the development of health promotion programs for older adults people, particularly in rural areas.

The relationship between influenza vaccine hesitancy and vaccine literacy among youth and adults in China

Objectives

The present study aimed to assess influenza vaccine hesitancy and vaccine literacy levels among youth and adults in China, as well as the association between them.

Methods

An online cross-sectional survey was conducted in Mainland China. Participants' total vaccine literacy and three sub-dimension vaccine literacy (knowledge literacy, competence literacy, and decision-making literacy) were assessed by a validated vaccine literacy scale. Having received influenza vaccination in the past three years or intending to accept it in next influenza season indicates less influenza vaccine hesitancy.

Results

Among 997 participants, a sub-optimal vaccine literacy was observed, with a mean score of 66.83 ± 10.27. Regression models 1-4 revealed that participants with middle (aOR: 1.431, P=0.039, 95% CI: 1.018~2.010) or high (aOR: 1.651, P=0.006, 95% CI: 1.157~2.354) total vaccine literacy, as well as those with high competence literacy (aOR: 1.533, P=0.017, 95% CI: 1.079~2.180), or high decision-making literacy (aOR: 1.822, P=0.001, 95% CI: 1.261~2.632) were more likely to have been vaccinated against influenza at least once in past three years. However, those with a high knowledge literacy were associated with a lower influenza vaccine rate (aOR: 0.676, P=0.046, 95% CI: 0.460~0.994). Regression models 5-8 revealed that participants with middle (aOR: 1.661, P=0.008, 95% CI: 1.142~2.414) or high total vaccine literacy (aOR: 2.645, P=0.000, 95% CI: 1.774~3.942), as well as those with middle (aOR: 1.703, P=0.005, 95% CI: 1.177~2.464) or high competence literacy (aOR: 2.346, P=0.000, 95% CI: 1.159~3.461), or high decision-making literacy (aOR: 2.294, P=0.000, 95% CI: 1.531~3.436) were more likely to express the willingness to receive the influenza vaccine in the next influenza season.

Conclusion

The participants' influenza vaccine hesitancy was negatively associated with their total vaccine literacy levels and two of the three sub-dimensions: competence literacy and decision-making literacy. Knowledge literacy suggested a positive or no relationship with influenza vaccine hesitancy.

Parental knowledge, attitudes, and practices toward vaccinating their children against influenza: a cross-sectional study from China

Aims

Influenza infection is a health burden in children, and the influenza vaccine is an important prevention strategy for flu illness. Parents play a crucial role in children's influenza vaccination. The study aimed to assess parental knowledge, attitudes, and practices (KAP) related to influenza illness for their children and explore factors that may impact their decisions.

Methods

This cross-sectional study was conducted in a tertiary hospital in Guangzhou from November 2022 to April 2023. Answers to KAP questions regarding influenza illness and vaccination were summed, with a total KAP score of 20. Univariate and multivariate logistic regression models and linear regression models were conducted to explore the factors associated with influenza vaccination. The results were presented as odds ratios (ORs), β, and 95% confidence intervals (CIs).

Results

Overall, 530 parents were respondents, of whom 162 (30.56%) had vaccinated their children during the past year. The mean KAP score (standard deviation) was 13.40 (3.57). Compared to parents who reported non-vaccinated for their children in the past year, the parents who reported an influenza vaccination have higher knowledge scores, attitude scores, practice scores, and total scores. Child body mass index, parental education level (under college), parental work (part-time), and more than two family members over 60 years old were negatively correlated with knowledge score. Child health condition and knowledge score were positively correlated with attitude score. Parental age was negatively associated with attitude score.

Conclusion

Though high awareness about influenza illness and vaccination for parents, the coverage rate of influenza vaccination in children was lower in Guangzhou. Implementing public health policies is necessary to spread knowledge about influenza illness and vaccination and to promote the practice of receiving the influenza vaccine in children. Education campaigns would help change the attitudes of parents toward vaccinating their children against the flu.

Evaluating Influenza Vaccination Practices among COPD Patients

Chronic Obstructive Pulmonary Disease (COPD) stands as a global health concern linked to considerable morbidity and mortality. In Jordan, the prevalence of COPD is substantial, but research in this area is limited. Exacerbations of COPD can lead to severe outcomes, including hospitalization and increased cardiovascular risk. Influenza is a significant trigger of exacerbations in COPD patients, and vaccination is recommended. However, studies have shown negative attitudes towards the influenza vaccine. This cross-sectional study aimed to investigate the knowledge, attitudes, practices, and intentions of COPD patients in Jordan regarding influenza vaccination. Data were collected through a custom-designed questionnaire from 300 COPD patients. The study revealed low influenza vaccination rates, with forgetfulness and lack of knowledge about vaccine effectiveness being the main barriers. Higher knowledge and positive attitudes were associated with greater intention to vaccinate. To tackle these challenges, it is recommended to implement customized health education campaigns, foster collaborations with healthcare providers, and engage in community-focused initiatives to enhance acceptance of the influenza vaccine among COPD patients in Jordan. These findings underscore the importance of addressing knowledge gaps and negative attitudes to enhance vaccine uptake and improve health outcomes for COPD patients.

Examining Influenza Vaccination Patterns and Barriers: Insights into Knowledge, Attitudes, and Practices among Diabetic Adults (A Cross-Sectional Survey)

Diabetes mellitus is a prevalent global chronic condition affecting individuals of all ages. People with diabetes face an elevated risk of lower respiratory tract infections such as pulmonary tuberculosis, influenza, and pneumonia. Additionally, the influenza virus increases the likelihood of deep venous thrombosis and pulmonary embolism. This study examined the knowledge, attitudes, and practices of diabetic patients regarding the influenza vaccine. This study involved 418 diabetic patients (53.3% female) at Jordanian outpatient respiratory clinics, with an average age of 49 (±14) years. The results showed that 70.6% had never received the influenza vaccine, and only 23.7% intended to do so in the current year. A positive attitude toward the influenza vaccine significantly reduced hesitancy to get vaccinated (OR = 0.505, 95% CI 0.424-0.601, p < 0.001). The duration of diabetes exhibited a positive association with vaccine hesitancy (OR = 1.053, 95% CI 1.006-1.102, p = 0.028). The primary reason for not getting vaccinated was a lack of awareness of its benefits (42.6%). Future health education programs should emphasize the importance of the influenza vaccine for diabetic patients and address their concerns.