Comparisons between vaccinated and unvaccinated older adults in Suzhou suggest that vaccination coverage could be improved by strengthening vaccine knowledge promotion through healthcare professionals and increasing awareness of vaccination policies that integrate medical insurance reimbursement.
Abstract
Background: Influenza poses a serious threat to the health of older adults, and vaccination is a key strategy for prevention. As an economically developed city, Suzhou has a rapidly aging population, yet the influenza vaccination rate among older adults remains substantially lower than that in developed countries. There is an urgent need to understand the current vaccination status and its associated factors to inform future strategies for improving vaccination coverage. Objectives: To compare influenza- and vaccine-related knowledge, attitudes, practices, and information access channels between vaccinated and unvaccinated older adults (≥60 years) in Suzhou, and to identify factors associated with vaccination behavior in economically developed areas. Methods: A comparative cross-sectional survey was conducted from April to August 2024 across six districts or county-level cities randomly selected from Suzhou’s ten county-level administrative divisions. Participants were divided into vaccinated and unvaccinated groups based on their influenza vaccination status during the 2023–2024 influenza season. A two-stage sampling method was employed: the six districts were selected as primary sampling units; within each district, eligible older adults (aged ≥60 years) were randomly selected from two independent sampling frames—the vaccination information system for the vaccinated group and the basic public health service system for the unvaccinated group. Face-to-face structured interviews were conducted using a questionnaire consisting of four sections; data were entered using EpiData 13.1 and analyzed using SPSS 27.0. The χ2 test, t-test, and multivariable logistic regression were used for statistical analysis. Results: Among 4622 valid older adults (vaccinated: n = 2007; unvaccinated: n = 2615), the vaccinated group scored significantly higher on influenza-related knowledge (4.06 ± 2.21 vs. 3.16 ± 2.33, p < 0.001), vaccine-related knowledge (2.10 ± 1.18 vs. 0.67 ± 1.07, p < 0.001), and perceived influenza risk scores (2.72 ± 1.42 vs. 2.26 ± 1.64, p < 0.001). Vaccine safety and efficacy endorsement were also markedly higher among the vaccinated group (70.3% vs. 22.0%; 49.7% vs. 9.3%). Regarding information sources, the vaccinated group relied more on healthcare institutions (54.56% vs. 46.92%), whereas the unvaccinated group relied more on television (60.34% vs. 51.17%). Multivariable logistic regression revealed that awareness of the influenza vaccine (aOR = 9.151, 95%CI: 6.32–13.25), having a planned vaccination site (aOR = 2.66, 95%CI: 2.01–3.54), and perceiving the vaccine as safe (aOR = 1.81, 95%CI: 1.31–2.49) were positively associated with vaccination, while rural household registration (aOR = 0.76, 95%CI: 0.63–0.93), full-time employment (aOR = 0.41, 95%CI: 0.28–0.60), and hypertension (aOR = 0.79, 95%CI: 0.65–0.94) were inversely associated. Conclusions: Compared with the unvaccinated group, the vaccinated group demonstrated significantly better influenza- and vaccine-related knowledge, risk perception, and recognition of vaccine safety and efficacy, and relied more on healthcare institutions for information. Multivariable regression analysis identified awareness of the influenza vaccine as the strongest associated factor. These findings suggest that vaccination coverage could be improved by strengthening vaccine knowledge promotion through healthcare professionals and increasing awareness of vaccination policies that integrate medical insurance reimbursement.
Seasonal Influenza and COVID-19 vaccination programmes are critical for reducing morbidity and mortality in older adults, yet uptake remains uneven across populations. We aimed to profile vaccination attitudes and examine predictors of COVID-19/influenza vaccination uptake among a UK participatory surveillance system - FluSurvey. We analysed FluSurvey data from participants aged [≥]65 years who were eligible for both vaccines in the 2023-2024 and 2024-2025 Autumn - Winter seasonal campaigns. Descriptive analyses examined self-reported attitudes to influenza vaccination. Logistic regression examined factors (age, sex, socioeconomic status, education, employment, transport, smoking and chronic conditions) associated with influenza and COVID-19 vaccination uptake in each season, adjusting for confounders. Belonging to a risk group and reducing risk of influenza were frequently reported motivations for influenza vaccination, while building natural immunity and concerns around safety and adverse effects were frequently reported barriers. Individuals vaccinated against COVID-19 were more likely to receive an influenza vaccination (aOR2023-2024=13.90 [9.28-21.17]; aOR2024-2025=8.54 [5.82-12.60]), and vice-versa (aOR2023-2024=13.91 [9.30-21.19]; aOR2024-2025=8.52 [5.81-12.58]). Lower educational attainment was associated with lower odds of COVID-19 vaccination (aOR2023-2024=0.59 [0.45-0.78], aOR2024-2025: 0.56 [0.39-0.79]). Other results were weaker or demonstrated variation by season. Our findings highlight recent attitudes and barriers to influenza and COVID-19 vaccination among the FluSurvey cohort, which may inform approaches to improve vaccination coverage in the population.
L. Adams, C. Watson, R. E. Green et al.· medRxiv· 0 citations
Strengthening obstetricians’ guidance, promoting non-injectable influenza vaccines, and delivering targeted health education are important strategies to improve vaccination uptake in this population of women to inform evidence-based policy interventions.
Peipei Liu, Yanfang Min, Chunmei Cai et al.· Human Vaccines & Immunothera...· 0 citations
Evaluating current influenza vaccination coverage and identifying factors that may influence whether adults choose to be vaccinated suggests that efforts to advance equity may benefit from addressing structural barriers, such as expanding insurance coverage, workplace vaccination programs, and targeted outreach to underserved populations.
Christian Smolen, Joseph P. Fava, Paul E. Kilgore· Infectious Disease and Thera...· 0 citations
Background/Objectives: Healthcare personnel (HP) are a priority group for seasonal influenza vaccination due to their increased occupational exposure and potential to transmit influenza in healthcare settings. This study examined patterns and factors associated with in-season influenza vaccination uptake among HP in Kuwait. Methods: A nationwide observational study was conducted using Ministry of Health (MOH) administrative records covering the 2022/2023 through 2024/2025 influenza seasons. A person–season dataset was constructed, comprising one observation per HP for each of the three seasons. The primary outcome was in-season influenza vaccination, defined as receipt of an influenza vaccine between September and March of a given study season. Independent variables included age, sex, nationality, governorate of residence, profession, managerial position, previous-year influenza vaccination status, and pre-season sickness absence duration (days). Generalized estimating equations (GEE) logistic regression model with an exchangeable correlation structure was used to estimate factors associated with vaccination uptake. Results: The final analytic dataset included 48,886 HP contributing 146,658 person–season observations across three influenza seasons. Overall, in-season vaccination uptake was 8.7%, and repeated vaccination across seasons was uncommon. Older age, male sex, non-Kuwaiti nationality, and being a physician were independently associated with higher odds of in-season influenza vaccination. Previous-year influenza vaccination was the strongest predictor of current-season vaccination uptake (aOR 2.01, 95% CI 1.87–2.16; p < 0.001). Compared with HP with no pre-season sickness absence, those with 1–3 pre-season sickness absence days had slightly higher adjusted odds of vaccination (aOR 1.08, 95% CI 1.03–1.14), whereas those with ≥8 days had lower adjusted odds (aOR 0.91, 95% CI 0.85–0.97). Conclusions: In-season influenza vaccination uptake among HP in Kuwait was low across three consecutive influenza seasons, with limited continuity of annual vaccination. Previous-year vaccination was the strongest predictor of current-season vaccination uptake, while the association between pre-season sickness absence and vaccination varied by absence duration. These findings support continued efforts to improve and sustain in-season influenza vaccination uptake among HP, while further research is needed to clarify the factors underlying vaccination decisions.
ABSTRACT The pneumococcal conjugate vaccine (PCV), Haemophilus influenzae type b (Hib) vaccine, rotavirus vaccine (RV), and varicella vaccine (VarV) have been recommended by WHO for inclusion in National Immunization Program (NIP). However, their vaccination rate is low in China as self-funded vaccines. This study aimed to investigate the coverage of these four vaccines and to identify their influencing factors. Selected via multi-stage stratified sampling, 4,182 guardians participated in a February–March 2025 study. Guardians completed an online questionnaire capturing sociodemographic characteristics, attitudes toward vaccination, and indicators of immunization service accessibility. Individual-level vaccination histories for children were extracted from the Beijing Immunization Information System and linked to survey responses. The vaccination coverage of PCV, Hib vaccine, RV and VarV were 48.5%, 47.4%, 43.5% and 89.3%, respectively. Older age, residence outside urban areas (suburban, outer suburban), and greater number of children in the household were associated with lower coverage of PCV, Hib vaccine, and RV, with adjusted ORs ranging from 0.160 to 0.929 (all p values < .05). Conversely, higher household income (200,000–499,999 CNY and ≥500,000 CNY), guardians’ perceived vaccination necessity, and receipt of vaccination notifications were associated with higher coverage of PCV, Hib vaccine, and RV, with adjusted ORs ranging from 1.018 to 6.521 (all p values < .05). The results indicated the vaccination coverage of PCV, Hib vaccine, and RV remains suboptimal in Beijing, with evident regional disparities. Free vaccination policies for PCV, Hib vaccine, RV, and VarV, together with strengthened reminder systems and targeted health education interventions, may help improve vaccine coverage among children.
Qianli Yuan, Wei Zhang, Huai Wang et al.· Human Vaccines & Immunothera...· 0 citations
Background Seasonal influenza poses a substantial health threat to children under 5 years of age. Despite recommendations for annual seasonal influenza vaccination (SIV), coverage among preschool-aged children in China remains low. Vaccine hesitancy is an important barrier to vaccine uptake. This study assessed parental knowledge, vaccine hesitancy, and practices regarding SIV for preschool-aged children in Shenzhen, China, and identified factors associated with hesitancy. Methods A cross-sectional online survey was conducted from September to December 2025 using a multistage sampling strategy across six administrative districts of Shenzhen. Parents of children aged 0–5 years were recruited from community health service centers and kindergartens/childcare institutions. An adapted Chinese version of the Parental Attitudes toward Childhood Vaccines (PACV) scale was used to assess hesitancy toward SIV. Parents’ knowledge regarding influenza and SIV, as well as SIV practices, were assessed and scored. Independent factors associated with hesitancy scores were identified using multivariable linear regression, and factors associated with binary hesitancy outcomes were conducted using multivariable logistic regression. Sensitivity analyses excluding the behavioral PACV items were also performed. Results A total of 17,955 parents were included in the final analysis, and 19.16% reported that their child had received SIV in the past year. The mean PACV hesitancy score was 32.26 ± 18.50, and 19.42% of parents (3,487/17,955) were classified as vaccine hesitant. The highest proportions of hesitant responses were related to concerns about serious adverse reactions (69.47%), the safety of repeated annual vaccination (55.61%), and doubts regarding vaccine effectiveness (52.68%). Higher knowledge and vaccination practice scores were independently associated with lower levels of vaccine hesitancy in both multivariable linear and logistic regression analyses (both P < 0.001). Additionally, older parental age, Shenzhen household registration, employment in enterprises/public institutions, middle-level household income, kindergarten attendance, obtaining vaccine information from kindergartens and relatives/friends were negatively associated with vaccine hesitancy in multivariable logistic regression analyses (all P < 0.05). Sensitivity analyses yielded generally consistent findings. Conclusion Parental hesitancy toward SIV among preschool-aged children in Shenzhen was low-to-moderate and was associated with knowledge, prior vaccination behaviors, and sociodemographic characteristics. Concerns about vaccine safety and effectiveness were the most frequently cited reasons for hesitancy. Targeted communication strategies delivered through multiple channels, together with consideration of free SIV for preschool-aged children may help improve vaccine uptake in this high-burden population.
