Healthcare Workers' Willingness to Receive Influenza Vaccination in the Context of the COVID-19 Pandemic: A Survey in Southern Italy

Real-life experience on COVID-19 and seasonal influenza vaccines co-administration in the vaccination hub of the University Hospital of Palermo, Italy

With the pandemic, there has been a global reduction in influenza virus circulation, with WHO reporting, during 2021/22 season, laboratory testing positivity rate for influenza of less than 3%. Influenza surveillance systems anticipated a peak of influenza cases in the Northern Hemisphere during 2022/2023 season and the Italian Ministry of Health recommended the routinary co-administration of influenza with bivalent COVID-19 vaccines for the 2022/2023 season. At the Vaccination Hub of the University Hospital (UH) of Palermo, more than 700 subjects received influenza and COVID-19 booster doses in co-administration, during the 2021/2022 season. A cross-sectional study analyzing attitudes and factors associated with adherence to influenza and COVID-19 seasonal vaccines co-administration was conducted at the Vaccination Hub of the UH of Palermo, from October to December 2022. Among the 1,263 respondents, 74.7% (n = 944) received the co-administration of seasonal influenza and COVID-19 vaccines. The main reason reported for accepting it was confidence in the recommendations of the Health Ministry (41.3%). At the multivariable analysis, subjects aged ≤ 59 y old (AdjOR: 2.48; CIs95%: 1.89-3.65), male (AdjOR: 1.51; CIs95%: 1.27-1.75), Health-care professionals (HCPs) (AdjOR: 1.66; CIs95%: 1.08-2.57) and those who received co-administration during 2021/2022 (AdjOR: 41.6; CIs95%: 25.5-67.9) were significantly more prone to receive co-administration during 2022/23 season. From data obtained, the role of HCPs in accepting and then promoting co-administration of COVID-19 and influenza vaccines is crucial, as well as receiving co-administration in the previous season that represented the main drive for accepting it in the following seasons, supporting safety and effectiveness of this procedure.

Impact of COVID-19 on vaccine confidence and uptake: A systematic literature review

During the coronavirus disease 2019 (COVID-19) pandemic, scheduled vaccinations were postponed, mass vaccination programmes were suspended and opportunities for healthcare workers to administer vaccines ad hoc decreased. The aims of this systematic literature review were to determine the impact of the COVID-19 pandemic on vaccine confidence, intent and uptake in preexisting routine childhood or adult vaccination programmes, and to identify factors associated with changes in acceptance, intent and uptake of preexisting vaccines. Medline and Embase were searched for studies in Australia, Brazil, Canada, China, Japan, the USA, and European countries, published between 1 January 2021 and 4 August 2022. A complementary gray literature search was conducted between 11 and 13 October 2022, and supplemented with additional gray research in October 2023. In total, 54 citations were included in the review. Study design and geography were heterogeneous. The number of adults who received or intended to receive an influenza or pneumococcal vaccine was higher during the pandemic than in previous seasons (n = 28 studies). In addition, increased acceptance of adult vaccinations was observed during 2020-21 compared with 2019-20 (n = 12 studies). The rates of childhood vaccinations decreased during the COVID-19 pandemic across several countries (n = 11 studies). Factors associated with changes in intention to receive a vaccination, or uptake of influenza vaccine, included previous vaccination, older age, higher perceived risk of contracting COVID-19, anxiety regarding the pandemic and fear of contracting COVID-19. Acceptance and uptake of influenza and pneumococcal vaccines generally increased after onset of the COVID-19 pandemic.

Knowledge and attitudes of healthcare workers about influenza vaccination

BACKGROUND

Influenza infection is a highly contagious viral disease. It may cause several nosocomial outbreaks. This study aimed to evaluate the knowledge and attitudes of healthcare workers (HCWs) about influenza vaccination and to identify factors associated with the uptake of influenza vaccination.

METHODS

We conducted a cross-sectional study over 5 months between November 2021 and March 2022. Data was collected using an anonymous self-administered questionnaire. We included all HCWs at Taher Sfar University Hospital who were willing to participate in the study.

RESULTS

A total of 395 HCWs were included. They were mainly women (78.7%) with an average age of 27 years. The medical personnel was the largest group (67.8%). Most respondents considered the vaccination to be optional and knew that it should be renewed every year, but 97.5% of them judged the efficacy of the vaccine to be low. The influenza vaccination uptake was only 20.2%. The main reasons for accepting vaccination were to protect patients and families. However, misconceptions about the severity and the risk of influenza and the belief that barrier measures were sufficient to prevent infection were the main causes of avoiding vaccination. The factors associated with adherence to vaccination were being a medical professional, old age, longer professional experience, and considering vaccination to be mandatory for HCWs.

CONCLUSION

Our study showed a low adherence to influenza vaccination with misconceptions about vaccine efficacy and safety. More efforts are needed to improve the knowledge of HCW about the vaccine and boost the adherence rates.

A comparative analysis of knowledge, attitude, and practice (KAP) towards influenza and influenza vaccination among healthcare workers in Kyrgyzstan prior to and during the COVID-19 pandemic

INTRODUCTION

Influenza, a globally significant respiratory illness with pandemic potential, affects around 1 billion individuals annually, leading to increased risk for severe illness and mortality. Despite recommendations from the WHO Strategic Advisory Group of Experts on Immunization (SAGE) and MoH prioritization, influenza vaccination coverage rate among HCWs in Kyrgyzstan remains low, ranging between 16 % and 46 % over the past five years. Understanding the Knowledge, Attitudes, and Practices (KAP) dynamics of HCWs regarding influenza vaccinations, both before and during the COVID-19 pandemic is crucial for refining national strategies and institutional approaches to enhance vaccination coverage rates in this important risk group.

METHOD

This study employed cross sectional investigations aimed at assessing KAPs among HCWs regarding influenza disease and vaccination. Conducted prior to and during the initial phase of the COVID-19 pandemic, the project involved 2400 participants from diverse medical disciplines. EPI Info was utilized to run biostatistical analyses, with descriptive and logistic regression models, to elucidate the dynamics of KAP over time.

RESULTS

The findings indicate that HCWs with over 5 years of experience were more likely to get vaccinated or recommend it to patients (p = 0.000). Low confidence in vaccine effectiveness influenced on recommendations of influenza vaccination in pre-pandemic time, where insufficient (95 %CI 0.08-0.6; p = 0.003) or uncertain assurance in vaccine effectiveness (95 %CI 0.007-0.18; p = 0.000) was a barrier for vaccine promotion during the pandemic. The study underscores to consider mandatory influenza vaccination for HCWs which may impact on likelihood of flu vaccination (p = 0.001). Priority groups for influenza vaccination shifted during the COVID-19 period, emphasizing older adults, individuals with existing conditions, and HCWs, compared to the pre-pandemic focus on HCWs, children, and patients with pre-existing conditions.

CONCLUSION

Our investigation provides valuable insights into HCWs KAP concerning influenza vaccination in Kyrgyzstan, highlighting the need for targeted interventions addressing factors influencing vaccine acceptance. The study suggests policy implications, advocating for the revision of national strategies to strengthen capacity building for medical staff.

Acceptance of Seasonal Influenza Vaccine Following COVID-19 Vaccination: A Survey among Israel Defense Forces Soldiers

Data regarding the contribution of COVID-19 vaccine rollouts to real-world uptake of influenza vaccination remains unclear. This cross-sectional survey-based study among Israel Defense Forces (IDF) soldiers aimed to assess the impact of the COVID-19 pandemic and specifically, previous COVID-19 vaccines uptake, on the intention to vaccinate for influenza during 2021-2022 season. Participants engaged in an online survey addressing vaccination history and current vaccine-related preferences. The survey was delivered prior to the initiation of the IDF's annual influenza immunization campaign. A multinomial logistic regression model was applied to analyze factors correlated with unwillingness to receive influenza vaccine. Overall, 825 invitations to participate in the survey were distributed and the overall response rate was 78.5%. Among the 648 participants who replied (61.6% males, median age of 20 years), 51.9% were willing to receive the upcoming influenza vaccine. Factors associated with vaccine reluctance included being female, not receiving the previous season's influenza vaccine, not having a previous diagnosis of COVID-19, and having decreased uptake of COVID-19 vaccines. Among participants not intending to receive an influenza vaccine, 50.3% stated that they are healthy and have no need for the vaccine and 36.2% stated they received too many vaccines over the previous year. The results of this study may suggest that influenza vaccination rates in the post-COVID-19 vaccine era may be reduced due to a perceived "vaccine saturation" phenomenon, owing to the density of COVID-19 vaccine administration. Future interventions such as campaigns related to maximizing influenza vaccination coverage should address repeated doses of COVID-19 vaccine administration.

Attitudes toward influenza vaccination in healthcare workers in Italy: A systematic review and meta-analysis

Healthcare workers (HCWs) are among the at-risk groups for whom influenza vaccination is strongly recommended. To assess the proportion of Italian HCWs with positive attitudes toward influenza vaccination, we conducted a systematic review of relevant literature and a meta-analysis. Our focus was on the influenza seasons from 2017/18 to 2021/22. The prevalence of favorable attitudes toward vaccination varied, ranging from 12% during the 2017/18 influenza season to 59% in the 2020/21 season. The significant increase in the 2020/21 season can be attributed to adaptations necessitated by the COVID-19 pandemic. During the 2021/22 influenza season, there was a decline in vaccination coverage (37%), likely due to the absence of a robust preventive culture. Various strategies have been employed to enhance HCWs' attitudes to achieve higher vaccination rates, but none of them have demonstrated satisfactory results. Policymakers should consider implementing a policy of mandatory vaccination to ensure elevated vaccination coverage among HCWs.

Flu vaccination coverage in Italy in the COVID-19 era: A fuzzy functional k-means (FFKM) approach

BACKGROUND

In Europe, flu vaccination coverage has decreased, and there are complex barriers to overcome to vaccinate against flu. Many studies have been conducted to estimate vaccination coverage. The COVID-19 pandemic threatens to disrupt immunization programs in many countries, including Italy, where vaccination against the flu is recommended but not mandatory. This paper aims to understand changes in flu vaccine uptake in Italian regions.

METHODS

Using functional data analysis and fuzzy functional k-means clustering, we investigated changes in flu vaccine coverage in Italian regions before (2010-2019) and after (2020-2022) the COVID-19 vaccination period.

RESULTS

The period of COVID-19 pandemic brought an increase in vaccine coverage globally. Elbow's method determined that the optimal number of clusters in vaccination uptake is 2. Apulia, Basilicata, Emilia Romagna, Liguria, Molise, Tuscany, and Umbria in 2019 belong less to the group with low flu vaccination uptake (G1) but increase their tendency to belong to this group over time: they decrease their propensity to be vaccinated for flu. For others, it seems that COVID-19 served as a push to increase flu vaccination coverage rates. Sicily appears to be the region that has responded best to the pandemic, changing its membership value from 2019 to 2022.

CONCLUSION

The present study highlights that the COVID-19 era has resulted in a higher flu vaccination coverage rate. Moreover, the regional level's improvement or worsening in flu vaccination coverage rate is not affected by the historical gap and socio-cultural and economic differences prevailing among Italian regions.

COVID‐19 booster dose vaccination of healthcare workers in Qatar: A web‐based cross‐sectional survey

Background

Vaccines are an important public health measure and effective strategy to protect the population from COVID‐19. Front‐line healthcare personnel should receive priority in vaccination programs. However, the reported hesitancy among healthcare workers (HCWs) toward the COVID‐19 vaccines cannot be ignored. It widely influences the level of vaccine hesitancy in the general population. Hesitancy, fear, and anxiety were documented in first and second rounds of COVID‐19 vaccination. This study assessed the acceptance of COVID‐19 booster doses among the HCWs in Qatar.

Methods

A web‐based cross‐sectional online survey was conducted using the 7C Vaccine Readiness Scale to evaluate the preparedness of the HCWs to receive COVID‐19 vaccines. Descriptive and inferential statistics were used to identify factors associated with preparedness for vaccination.

Results

A total of 382 participants completed the survey. Allied health professionals scored the least on the readiness score (−7.0 ± 9.9) compared to the physicians (3.1 ± 7.2) and nurses (3.0 ± 7.8). Physicians scored higher on confidence (58.8%), calculation (64.7%), and complacency (60.8%). Nurses scored higher on constraints (51.6%), collective responsibility (62.7%), and compliance (39.1%), and allied health professionals scored higher on (67.9%) conspiracy. There was a significant association between readiness score and not being infected with COVID‐19, post‐vaccine symptom experience, and hesitancy for the initial two doses.

Conclusion

This study reports higher complacency and constraints with the perception of lower risks and the lack of interest in taking collective responsibility among the HCWs. Addressing vaccine hesitancy among them is critical to ensure successful vaccination campaigns and promote community safety during future pandemics.

Knowledge, attitudes, concern, behaviors, and barriers associated with the readiness to receive seasonal influenza vaccine among healthcare workers in oncology setting during the COVID-19 pandemic

This study examines the knowledge, attitudes, concerns, behaviors, and barriers related to seasonal influenza vaccination among healthcare workers (HCWs) in the oncology setting during the COVID-19 pandemic. The objective is to assess the readiness of HCWs to receive the influenza vaccine. A cross-sectional study was conducted at the King Hussein Cancer Center (KHCC) in Amman, Jordan. HCWs were surveyed using a self-administered web-based questionnaire between October 2021 and November 2021. Among 223 participants, the coverage rates for seasonal influenza vaccination ranged from 65% to 81% during the autumns of 2019 and 2020, respectively. These vaccination rates showed a significant increase despite the challenges posed by the COVID-19 pandemic. Furthermore, 89.1% of the participants expressed their intention to receive the vaccine in the autumn of 2021. The analysis revealed a significant association between receiving the influenza vaccine in 2020 and the participants' work experience (P < .001, respectively). Additionally, receiving the influenza vaccination was significantly associated with higher knowledge levels (P = .036, 0.015). Although knowledge about the influenza vaccine was generally high, concerns and barriers were identified. This study demonstrates a high rate of influenza vaccination among HCWs during the COVID-19 pandemic. The participants also expressed a strong willingness to receive the vaccine in the post-pandemic season and exhibited good knowledge about it. However, concerns and barriers related to vaccination remain. These findings emphasize the importance of addressing these concerns and barriers to further enhance influenza vaccination rates among HCWs.

Determinants of Acceptance of COVID-19 Vaccination in Healthcare and Public Health Professionals: A Review

Vaccinations of healthcare workers (HCWs) aim to directly protect them from occupational diseases, and indirectly protect their patients and communities. However, studies increasingly highlight that HCWs can be vaccine hesitant. This review aims to analyze HCWs' and public health professionals' sentiments toward COVID-19 (Coronavirus Disease 2019) vaccination and determinants across different countries. A search strategy was conducted in PubMed using keywords such as "COVID-19", "sentiment/acceptance", "healthcare workers", "vaccine hesitancy", and "influenza". A total of 56 articles were selected for in-depth analyses. The highest COVID-19 vaccination uptake was found in an Italian study (98.9%), and the lowest in Cyprus (30%). Older age, male gender, the medical profession, higher education level, presence of comorbidities, and previous influenza vaccination were associated with vaccine acceptance. Factors for low acceptance were perceived side effects of the vaccine, perceived lack of effectiveness and efficacy, and lack of information and knowledge. Factors for acceptance were knowledge, confidence in the vaccine, government, and health authorities, and increased perception of fear and susceptibility. All studies focused on healthcare providers; no studies focusing on public health professionals' sentiments could be found, indicating a gap in research that needs to be addressed. Interventions must be implemented with vaccination campaigns to improve COVID-19 vaccine acceptance.

Impact of COVID-19 pandemic on flu vaccine uptake in healthcare workers in Europe: a systematic review and meta-analysis

INTRODUCTION

Influenza immunization policies in Europe primarily target at-risk and vulnerable subjects. Healthcare workers (HCWs) are a key focus of vaccination campaigns. Our systematic review and meta-analysis aim to evaluate the role of the COVID-19 pandemic on influenza vaccine uptake among HCWs since the 2020/21 influenza season.

AREAS COVERED

Fourteen studies were included in the meta-analysis and systematic review, selected from scientific articles available in MEDLINE/PubMed, ISI Web of Knowledge, and Scopus databases between 1 January 2021 and 15 January 2023 The analysis revealed a significant relationship between influenza vaccine uptake and COVID-19 related determinants, such as willingness to receive COVID-19 vaccination, fear of COVID-19, and differentiating between influenza and COVID-19 symptoms (OR = 5.70; 95%CI = 2.08-15.60). Several studies reported higher vaccination coverages in the 2020/21 season compared to previous seasons, with VC values ranging from + 17% to + 38% compared to the 2019/20 season. The included studies identified a shift in HCWs' attitudes toward influenza vaccination, attributed to increased awareness due to the COVID-19 pandemic.

EXPERT OPINION

Vaccine hesitancy is common among HCWs in Europe, necessitating mutual strategies across all European countries. So far, mandatory vaccination policies have shown the most potential in achieving high and sustainable influenza vaccination rates among HCWs.

A qualitative study exploring healthcare providers’ and trainees’ barriers to COVID-19 and influenza vaccine uptake

Background

Vaccines are effective biological interventions which reduce health burdens and protect healthcare providers from vaccine-preventable diseases. However, there are concerns about varying levels of vaccination coverage of influenza and COVID-19 vaccines among those working in healthcare. The aim of this study was to identify barriers and facilitators to COVID-19 and influenza vaccinations among healthcare providers and trainees using the Theoretical Domains Framework (TDF).

Methods

Semi-structured interviews (n = 18) were carried out with healthcare providers and trainees in Canada. A thematic analysis approach was used to code interview transcripts and match findings to TDF domains and broader categories.

Results

Three overarching themes were generated from six TDF domains and three inductively generated categories: (1) making informed health decisions with an added responsibility to protect oneself and patients; (2) a pro-vaccine social network, widespread accessibility, and pursuing a sense of normalcy; and (3) seeking a more nuanced, respectful, and calculated approach to vaccine communication and policy implementation.

Conclusion

These findings help to identify factors associated with influenza and COVID-19 vaccine uptake among individuals in the healthcare field. Addressing these factors may improve healthcare provider sentiments surrounding vaccines, lead to better patient education, and increased uptake of vaccinations with the potential for seasonal booster doses.

Preventive Measures for SARS-CoV-2 in the Workplace and Vaccine Acceptance: Assessment of Knowledge, Attitudes and Behaviors of Workers in Southern Italy

(1) Background: this study investigated the preventive measures implemented in the workplace and evaluated knowledge, attitudes and adherence behaviors regarding SARS-CoV-2 routes of transmission and preventive measures in a group of workers. (2) Methods: this cross-sectional study was conducted from May to July 2021 among 501 workers in the Campania region, in Southern Italy. (3) Results: 80.5% of respondents declared that their company had implemented the main COVID-19 preventive measures, and 54.7% of respondents knew SARS-CoV-2 routes of transmission along with the main preventive measures. Moreover, 34.2% were highly concerned about contracting SARS-CoV-2 in the workplace and transmitting it to family. Adherence to all preventive measures in the workplace involved 42.5% of respondents. The results of the multivariate logistic regression model revealed that significant determinants of adherence to all preventive measures in the workplace were being female, working not as a manager or office employee, cohabiting with someone that received a diagnosis of SARS-CoV-2 infection, knowing SARS-CoV-2 routes of transmission and the related main preventive measures, being highly concerned of contracting SARS-CoV-2 in the workplace and transmitting it to family and believing that COVID-19 vaccine offers high protection against disease. At the time of the survey, 47.5% of respondents had already received COVID-19 vaccine. Among unvaccinated respondents, 11.8% expressed unwillingness to get vaccinated for COVID-19. (4) Conclusions: These findings highlighted a good awareness about COVID-19 prevention and underlined a good propensity to get vaccinated among workers. Therefore, there is the need that preventive measures should be prioritized in the working context.

Schoolteachers and Vaccinations: A Cross-Sectional Study in the Campania Region

Background: This cross-sectional survey aimed to determine the knowledge, attitudes, and behaviors regarding vaccinations among schoolteachers in Italy. Methods: Data were collected through an online questionnaire from September 2020 to May 2021 from a sample of schoolteachers in the Campania region of southern Italy. Results: Only 27% of the participants had good knowledge about the vaccinations recommended for schoolteachers. Females who had children, who were unsatisfied by their health status, and not needing additional information about vaccinations were more likely to have good knowledge. Moreover, 61.5% perceived that vaccinations are useful in preventing infectious diseases, and 44.5% agreed or strongly agreed that vaccinations should be mandatory for schoolteachers. The results of multivariate logistic regression showed that schoolteachers who perceived that vaccinations are useful in preventing infectious diseases, who considered the recommended vaccinations to be useful to protecting their own and their students’ health, who believed that information received about vaccination was useful, and who needed additional information about vaccinations recommended for schoolteachers, were significantly more likely to agree or strongly agree that vaccinations should be mandatory for schoolteachers. Conclusions: These findings suggest the need for education strategies to ensure that schoolteachers are better informed about vaccinations recommended for their profession.

Vaccinations Status against Vaccine-Preventable Diseases and Willingness to Be Vaccinated in an Italian Sample of Frail Subjects

BACKGROUND

Study aim was to investigate the vaccination status against vaccine-preventable diseases (VPD) of frail adults during the SARS-CoV-2 pandemic and, for those subjects eligible for at least one vaccine, with respect to the recommended vaccination in line with the Italian National Vaccination Prevention Plane (NPVP), to explore the willingness to be vaccinated.

METHODS

A cross-sectional study was carried out among adults aged ≥ 60, immunocompromised or subjects affected by chronic conditions.

RESULTS

Among the 427 participants, a vaccination coverage rate lower than the targets for all the vaccines considered was found. Of those, 72.6% of subjects stated their willingness to receive recommended vaccinations, and 75.2% of the respondents stated that the advice to undergo vaccinations was received by the General Practitioner (GP). In a multivariable logistic regression model, higher odds of recommended VPD vaccination uptake (defined as having two or more of the recommended vaccinations) were associated with the willingness towards recommended VPD vaccination (Odds Ratio = 3.55, 95% Confidence Interval: 1.39 to 9.07), university education (OR = 2.03, 95% CI: 1.03 to 3.97), but having another person in the household (OR = 0.52, 95% CI: 0.28 to 0.97), and history of oncological disease (OR = 0.39, 95% CI: 0.18 to 0.87) were predictive of lower odds of vaccination uptake. In another multivariable model, higher odds of willingness to receive vaccines were associated with kidney disease (OR = 3.3, 95% CI: 1.01 to 10.5), perceived risk of VPD (OR = 1.9, 95% CI: 1.02 to 3.3), previous influenza vaccination (OR = 3.4, 95% CI: 1.8 to 6.5), and previous pneumococcal vaccination (OR = 3.1, 95% CI: 1.3 to 7.7), but increasing age (OR = 0.93 per year, 95% CI: 0.91 to 0.97), working (OR = 0.40, 95% CI: 0.20 to 0.78), and fear of vaccine side effects (OR = 0.38, 95% CI: 0.21 to 0.68) were predictive of lower odds of willingness to receive vaccines.

CONCLUSIONS

Despite specific recommendations, vaccination coverage rates are far below international targets for frail subjects. Reducing missed opportunities for vaccination could be a useful strategy to increase vaccination coverage in frail patients during the routine checks performed by GPs and specialists.

Surveying Parents’ Awareness and Adherence to Influenza Vaccination Recommendations in Children in Southern Italy

Background: This study explored awareness and adhesion of parents to the recommendations for influenza vaccination for their children. Methods: This cross-sectional study was conducted from March to June 2022 among parents of 6 months–6 years-old children in Southern Italy. Results: Only 22.1% of parents were aware that influenza vaccination was recommended for healthy children, and 31.8% reported at least one influenza vaccination in the four influenza seasons from 2018/2019 to 2021/2022. Adherence was higher among parents who had received influenza vaccination at least once, who knew the main childhood vaccinations, who knew that influenza can be prevented, that influenza vaccination is recommended for healthy children, who believe that it is useful, and who have been informed about it by physicians. Willingness to vaccinate their children in the upcoming season was 48.6% and was higher among parents who had vaccinated their children at least once, believed that influenza vaccination protects against severe complications, believed that it is useful, and that it is not better for children to acquire immunization through illness than through vaccination. Conclusions: These findings suggest that efforts should be devoted to educating parents on the risks associated with the disease and the benefits of the vaccine.

Influenza incidence overlapped with COVID-19 or under COVID-19 control measures

INTRODUCTION

COVID-19 pandemic caused infection when influenza was still prevalent. This study was conducted to examine influenza incidence overlapped with COVID-19 and the effect of the COVID-19 measures on influenza incidence as a proxy.

METHODS

The routine sentinel surveillance data on COVID-19 and influenza was obtained from the national integrated care electronic health record system. Data were collected in 28 points from 11 months before the outbreak (from March 2019 to January 2020) and 17 months after the outbreak (February 2020 to June 2021).

RESULTS

In Iran, the incidence rate of influenza was 51.1 cases per 100,000 populations in November 2019, while it was only 0.1 in November 2020. The average number of influenza cases specifically for the Kurdistan province during the seasonal flu peak in 2019-2020 was 2.5 cases per 100,000 populations, while the average of influenza cases in the preceding 4 years was 0.4 cases per 100,000 populations. In other words, the seasonal peak of influenza in Iran was significantly higher than that of previous and after years.

CONCLUSION

It seems that some of the nonpharmaceutical interventions (NPIs) used to control COVID-19 are effective against influenza epidemics and the results indicated a marked decline in the number of influenza cases may cause after the implementation of public health measures for COVID-19. The results showed the seasonal peak of influenza in Iran was significantly higher than that of previous years, so it seems that the influenza winter peak season (November 2019) overlapped with SARS-CoV-2 causing observed undetected infection during influenza winter peak.

COVID-19 vaccination hesitancy in Italian healthcare workers: a systematic review and meta-analysis

INTRODUCTION

As for other vaccines, vaccination hesitancy may be a determining factor in the success (or otherwise) of the COVID-19 immunization campaign in healthcare workers (HCWs).

AREAS COVERED

To estimate the proportion of HCWs in Italy who expressed COVID-19 vaccine hesitancy, we conducted a systematic review of the relevant literature and a meta-analysis. Determinants of vaccine compliance and options suggested by these studies to address vaccine hesitancy among HCWs were also analyzed. Seventeen studies were included in the meta-analysis and systematic review, selected from scientific articles available in the MEDLINE/PubMed, Google Scholar and Scopus databases between January 1, 2020 and January 25, 2022. The vaccine hesitancy rate among HCWs was 13.1% (95%CI: 6.9-20.9%). The vaccine hesitancy rate among HCWs investigated before and during the vaccination campaign was 18.2% (95%CI=12.8-24.2%) and 8.9% (95%CI=3.4-16.6%), respectively. That main reasons for vaccine hesitation were lack of information about vaccination, opinion that the vaccine is unsafe, and fear of adverse events.

EXPERT OPINION

Despite strategies to achieve a greater willingness to immunize in this category, mandatory vaccination appears to be one of the most important measures that can guarantee the protection of HCWs and the patients they care for.

Attitudes of Healthcare Workers toward Influenza Vaccination in the COVID-19 Era

Healthcare workers (HCWs) are reluctant to participate in the influenza vaccination program, despite their high risk to contract and diffuse influenza due to professional exposure. The onset of the COVID-19 pandemic could raise HCW flu vaccination adherence. The aim of this study was to assess HCW attitudes toward influenza vaccination in the COVID-19 era. A multicenter observational study was carried out in three Italian hospitals (two in Pesaro and one in Fano, Marche region, Italy). Data about HCW influenza vaccination between 2013 and 2021 were extracted from the vaccination registers. An online questionnaire was sent to HCWs from July to October 2020 to assess their opinion about influenza vaccination in terms of knowledge, attitude, and practice during the COVID-19 pandemic. The number of flu-vaccinated HCWs increased from 3.7% in the 2013−2014 flu season to 53.6% in the 2020−2021 flu season (p < 0.001). About 15% (n = 324) of HCWs responded to the online questionnaire, and 30.5% of them declared that they had changed their minds on flu vaccination after the COVID-19 pandemic, deciding to get vaccinated. The COVID-19 pandemic significantly increased HCWs’ attitudes toward flu vaccination. However, flu vaccination adherence remained low and should be improved.

COVID-19 and Influenza Vaccination Campaign in a Research and University Hospital in Milan, Italy

Background: Healthcare workers (HCWs) are a historical key target of influenza vaccination programs. For the 2021–2022 season, WHO considered the coadministration of a flu and a COVID-19 vaccine as acceptable and recommended it to allow for higher uptake of both vaccines. The aim of this study was to investigate demographic and occupational features of vaccinated HCWs, reasons behind flu vaccine acceptance and a possible effect of the coadministration of a COVID-19 vaccine, in order to potentially draw general conclusions on HCWs’ attitude towards flu vaccination and inform further strategies for consistent improvement of vaccine acceptance. Methods: a promotional and educational campaign, a gaming strategy, and vaccination delivery through both a large central hub and on-site ambulatories, were the implemented strategies. In the central hub, the flu/COVID-19 vaccine coadministration was offered. Statistical descriptive analysis, multiple correspondence analysis (MCA) and logistic regression models were performed. Results: 2381 HCWs received the flu vaccine, prompting a vaccination coverage rate (VCR) of 52.0% versus 43.1% in the 2020–2021 campaign. Furthermore, 50.6% vaccinated HCWs belonged to the 18–39 years-old age group. The most expressed reasons for vaccine uptake were “Vaccination is the most effective strategy of prevention” (n = 1928, 81.0%), “As HCW it’s my duty to get vaccinated to protect my patients” (n = 766, 32.2%), and the group of COVID-19-related reasons (n = 586, 24.6%). In addition, 23.3% HCWs received the flu vaccine in the current campaign but not in the previous one (newly vaccinated) and the flu/COVID-19 vaccine coadministration was more frequent in this group. A total of 51.0% HCWs were hesitant towards the coadministration, while residents and nurses showed the highest propensity to receive it. Conclusions: in the second year of the COVID-19 pandemic, the Fondazione’s influenza VCR continued to increase, with the greatest participation among HCWs aged 18–39 years. A potential propelling role of the COVID-19 vaccine coadministration was highlighted.

COVID-19 Vaccination Uptake and Related Determinants in Detained Subjects in Italy

Background: This study explored the extent of COVID-19 vaccination coverage and investigated drivers and barriers to COVID-19 vaccine uptake among people in prison. Methods: This cross-sectional study was conducted from July to October 2021 among 517 detained people in the Campania region of South Italy. Results: In total, 47.1% of participants expressed a high concern about contracting COVID-19 after vaccination, whereas 60.6% and 53.8% of respondents reported a positive attitude towards usefulness and safety of COVID-19 vaccines, respectively. Adherence to the active offer of COVID-19 vaccination involved 89.7% of detained subjects. COVID-19 vaccination uptake was significantly higher in females, and in those who reported influenza vaccination uptake, had received information about COVID-19 vaccination from media and newspapers, did not express need of additional information about COVID-19 vaccine, believed that COVID-19 vaccine is safe, were involved in working activities in the prison, and had a high school or university degree. Conclusions: These findings showed a high self-reported COVID-19 vaccination coverage in detained subjects, supporting the effectiveness of the strategy aimed at giving priority to COVID-19 vaccinations in prisons. Further efforts are needed to contrast the hesitancy of those who refused vaccination to increase their confidence about usefulness and safety of COVID-19 vaccines.

Effect of COVID-19 Pandemic on Influenza Vaccination Intention: A Meta-Analysis and Systematic Review

Poorer outcomes have been reported with COVID-19 and influenza coinfections. As the COVID-19 pandemic rages on, protection against influenza by vaccination is becoming increasingly important. This study examines how COVID-19 has influenced influenza vaccination intentions from a global perspective. A literature search was conducted on Embase, PubMed, and CNKI from 1 January 2019 to 31 December 2021 for articles reporting rates of influenza vaccination pre-COVID-19 (19/20 season), and intention and/or uptake of influenza vaccination post-COVID-19 (20/21 season). The changes in vaccination intention and reasons for changes were reported. Subgroup analyses were performed by region, gender, age, and occupation. Newcastle Ottawa Scale was used for quality assessment of the articles. Twenty-seven studies with 39,193 participants were included. Among 22 studies reporting intention to vaccinate in 20/21, there was increased intention to vaccinate (RR 1.50, 95% CI 1.32−1.69, p < 0.001) regardless of age, gender, and occupation. The remaining five studies reporting vaccination intention and uptake in 20/21 showed a similar increase (RR 1.68, 95%CI 1.20−2.36). Important determinants include historical vaccine acceptance, and perception of influenza severity and vaccine safety. The COVID-19 pandemic has increased intention to vaccinate against influenza internationally. The pandemic could be a window of opportunity to promote influenza vaccination and decrease vaccine hesitancy.

Parents' Willingness to Vaccinate Their Children With COVID-19 Vaccine: Results of a Survey in Italy

PURPOSE

This cross-sectional study was conducted to assess the parents' willingness to vaccinate their children with the COVID-19 vaccine and related determinants with specific attention to willingness for adolescents as compared to younger children.

METHODS

Data were collected through a confidential online questionnaire.

RESULTS

A total of 607 parents agreed to participate. More than two-thirds of the parents had good knowledge about the modes of transmission of COVID-19, knew that subjects of any age may be susceptible to SARS-CoV-2 infection, and 85.5% correctly indicated the main behavioral preventive measures against COVID-19. With regard to attitudes, 78.7% agreed that COVID-19 is a serious disease, whereas only 42.3% agreed that it is preventable. Overall, 68.5% were willing to vaccinate their children with the COVID-19 vaccine, specifically 74.5% of parents of adolescents and 65.5% of those of younger children, and the results of the multivariate analysis showed that parents of adolescents aged 12-15 years or 16-18 years compared to those of children aged 11 years or less, those who had more than two children, those who reported that their children had been visited by the primary care pediatrician/physician in the previous 12 months, those who agreed that COVID-19 is a serious disease, considered very useful the COVID-19 vaccine, had been vaccinated against influenza in the previous season, and had received at least one shot of COVID-19 vaccine were more likely to be willing to vaccinate their children.

CONCLUSION

In conclusion, a relevant proportion of parents are willing to vaccinate their children, with the parents of adolescents showing a higher willingness compared to those of younger children. However, there is still room for reducing hesitancy and refusal of the COVID-19 vaccine in this strategic population group by promoting communication to mitigate concerns toward the COVID-19 vaccine.

Attitude of Health Care Workers and Medical Students towards Vaccination against COVID-19

The role of medical personnel in promoting vaccination and pro-health attitudes seems to be of key importance for protection against COVID-19. The aim of the study was to assess the attitudes of health care workers and students of medical faculties towards preventive vaccinations against COVID-19. A cross-sectional online self-administered survey was conducted among 497 people. The questions concerned attitudes towards vaccination as well as concerns about the side effects of the vaccine and contracting COVID-19. A positive attitude to vaccination was observed in 82% of the respondents. More than 54% respondents were concerned about side effects after COVID-19 vaccination. Medical students under 26 years had a more positive attitude towards COVID-19 vaccination, twice as high as among health care workers OR (95%Cl): 2.20 (1.03–4.66) vs. 4.06 (2.54–6.48), respectively. Students were more concerned than nurses about adverse effects of COVID-19 vaccine 3.8 (3.2–4.1) vs. 3.0 (2.7–3.5) and contracting the virus (1.7 (1.2–2.5) vs. 1.2 (1.0–2.0). Medical students had a more positive attitude toward vaccination than nursing students 4.2 (3.9–4.3) vs. 3.7 (3.3–4.3). In conclusion, predictors of positive attitudes toward vaccination were medical student status and young age.

The impact of COVID-19 on hospital-based workers influenza vaccination uptake: A two-year retrospective cohort study

OBJECTIVES

This study aimed at exploring 2020/2021 and 2019/2020 seasonal influenza vaccine uptake among healthcare and non-healthcare workers, hereafter hospital-based workers (HBWs); examining attitudes and motivations for uptake in the 2020/2021 season; and exploring the amount, types, and sources of information used by HBWs.

METHODS

A retrospective cohort study. Socio-demographics, working profile, working area, and vaccination status data were collected. Motivations for vaccination uptake in the 2020/2021 season were also explored. Descriptive and inferential statistics were used.

RESULTS

Overall, uptake increased from 14.8% in 2019/2020 to 31.7% in 2020/2021. Male workers show greater vaccination uptake than their female counterparts (20.4% vs. 12.6% in 2019/2020, and 36.5% vs. 29.8% in 2020/2021). Uptake increased for healthcare assistants (+8.9%), administrative/managerial staff (+17%), nurses/midwives (+17.1%), non-medical graduate staff (+22.8%), and physicians (+33.2%), while it decreased slightly for resident physicians despite still being one of the most vaccinated categories (-4.6%). Main reasons for vaccination were the desire to protect patients (33.0%) and relatives (51.1%). Lastly, 60.8% of HBWs relied on institutional sources of information; the remainder relied on non-institutional sources including social media and chatting with colleagues.

CONCLUSIONS

Vaccination uptake increased in the 2020/21 season. Tailored educational interventions are required on the impact of influenza in care settings, vaccine efficacy, and vaccination safety. Investments in improving HBWs' reliance on institutional sources, and their ability to find them, are also needed.

Trends, Uptake, and Predictors of Influenza Vaccination Among Healthcare Practitioners During the COVID-19 Pandemic Flu Season (2020) and the Following Season (2021) in Saudi Arabia

Background

Healthcare practitioners (HCPs) are at high risk of influenza. Seasonal influenza vaccines can reduce influenza-associated morbidity in healthcare settings, but despite mandatory influenza vaccination in the Kingdom of Saudi Arabia, the vaccination uptake rate among HCPs is below expectations. This study investigated vaccination trends from 2017 to 2020 to identify factors affecting vaccination among HCPs during the COVID-19 pandemic flu and subsequent seasons.

Methods

Cross-sectional study among HCPs was conducted in January 2021. A structured questionnaire was shared via social media. Vaccine uptake predictors were identified using descriptive statistics and logistic regression models (p-value 0.05).

Results

A total of 424 HCPs (118 physicians and 306 nurses) completed the questionnaire. Vaccine uptake increased from 2017 to 2019 (45% to 52% to 62%) but fell (to 59%) during the 2020 COVID-19 pandemic flu season. Multivariable analysis indicated participants >40 years old (AOR 3.09, 95% CI 1.64–5.83), female (AOR 1.74, 95% CI 1.13–2.67), non-Saudi (AOR 2.62, 95% CI 1.72–4.01), nurses (AOR 2.70, 95% CI 1.75–4.17), and who possessed accurate knowledge of the flu vaccine efficacy duration (AOR 3.04, 95% CI 1.87–4.94) were more likely to have received the vaccine. However, 79% of HCPs declared their intention to be vaccinated in the 2021 flu season, with participants >40 years old, female (AOR 2.25, 95% CI 1.38–3.68), non-Saudi (AOR 3.79, 95% CI 2.34–6.16), or nurses (AOR 2.94, 95% CI 1.82–4.76) more likely to do so.

Conclusion

Influenza vaccination uptake declined among HCPs during the 2020 flu season compared with the previous season but is expected to increase in the upcoming 2021 season. Nevertheless, the findings are encouraging and indicate increased willingness of HCPs to become vaccinated in the upcoming 2021 season, but coverage could be further increased by policymakers via a comprehensive plan focusing particularly on younger HCPs, Saudis, males, and physicians.

Perception of Heath Care Providers About COVID-19 and Its Vaccination in Saudi Arabia: Cross-Sectional Study

Purpose

The aim of this study was to assess the perception of health care providers about the COVID-19 and its vaccine in Saudi Arabia.

Patients and Methods

In this study, we used a quantitative, cross-sectional and descriptive design. We recruited healthcare providers (HCPs) from social media platforms such as WhatsApp, Facebook, Twitter and emails that was distributed from March 15, 2021, to April 14, 2021. Chi-square tests were used to compare categorized data between health care workers.

Results

A total of 390 health care providers from different regions of the country began the online survey. A total of 298 respondents (77.8%) accepted the COVID-19 vaccine, whereas 85 (22.2%) HCP disapproved. There was a significant difference in the degree of acceptance of COVID-19 immunization among health care providers (P<0.001). Moreover, the results showed 200 females (52.63%) were more likely to accept the COVID-19 immunization; 97 (25.5%) males were planning on getting one as soon as possible.

Conclusion

As shown in the results, 77.8% of health care providers agreed to receive the vaccine. Since COVID-19 is still ongoing, we must increase the number of HCPs who get vaccinated. In addition, a comprehensive immunization campaign is necessary to achieve maximum acceptance by the general public.

Influenza Vaccination Strategies in Healthcare Workers: A Cohort Study (2018-2021) in an Italian University Hospital

Vaccinating healthcare workers (HCWs) is the most effective intervention for preventing nosocomial influenza infection. However, influenza vaccination coverage (VC%) among HCWs remains low. The aim of the study was to analyse the trend of VC% among healthcare workers in an Italian hospital through a three-year vaccination project covering three influenza seasons (2018-2019, 2019-2020, and 2020-2021). A gap analysis was performed at the case base (2018-2019), on-site vaccination was trialled in the 2019-2020 season, and an integrated vaccination offer (on-site vaccination and the classic offer at a vaccination clinic) was implemented for the 2020-2021 season. For each unit of vaccinated HCWs, the following variables were recorded: main demographic details, area of affiliation (medical/surgical/services), and professional category. Logistic regression analyses were performed to assess the relationship between outcome (undergoing vaccination in 2020-2021) and other variables related to the healthcare workers' characteristics. In the three seasons, VC% values of 13.2%. 27.7%, and 58.9% were recorded, respectively (p < 0.005). The highest VC% was recorded among physicians (94.93%), in the medical area (63.27%), and males (62.59%) and in general among the youngest HCWs. Comparison of the coverage values recorded in the three seasons showed that in the last season considered (2020-2021) about 80% of health workers preferred to be vaccinated in the workplace instead of using the standard vaccination delivery method (invitation to attend the vaccination clinic). Our study suggests that the integrated vaccination offer may lead to an increase in VC% among HCWs compared to the classical offer modalities.

Determinants of Influenza Vaccination Coverage among Greek Health Care Workers amid COVID-19 Pandemic

In the context of the evolving current COVID-19 pandemic, influenza vaccination among the public and health care workers is of particular importance. There are sparse data on the influenza vaccination coverage among health care workers amid COVID-19 pandemic. We aimed to study possible factors associated with influenza vaccination coverage among Greek physicians, dentists, and pharmacists during the flu season 2020–2021. We formulated the hypothesis that COVID-19 pandemic exerted a positive impact on the influenza vaccination coverage of health care workers. An online survey was conducted among the members of the Larissa, (Thessaly, Central Greece) Medical, Dentists, and Pharmacists Associations. The influenza vaccination coverage was 74% (251/340). Acceptance of COVID-19 vaccination coverage was the only factor independently associated with the likelihood of influenza vaccination coverage. In conclusion, we report here a considerable improvement of the influenza vaccination coverage among HCWs and especially among physicians. Acceptance of COVID-19 vaccination was the only predictor of influenza vaccination coverage. This finding provides public health workers and policymakers with useful policy-relevant evidence in order to maintain and even further improve the gains of increased vaccination coverage achieved during the flu season 2020–2021.