Seroprevalence of Anti-SARS-CoV-2 IgG Antibodies in Healthcare Personnel in El Salvador Prior to Vaccination Campaigns.

COVID-19, caused by the SARS-CoV-2 virus, is a highly pathogenic emerging infectious disease. Healthcare personnel (HCP) are presumably at higher risk of acquiring emerging infections because of occupational exposure. The prevalence of COVID-19 in HCP is unknown, particularly in low- to middle-income countries like El Salvador. The goal of this study was to determine the seroprevalence of anti-SARS-CoV-2 antibodies among HCP in El Salvador just prior to vaccine rollout in March 2021. We evaluated 2176 participants from a nationally representative sample of national healthcare institutions. We found 40.4% (n = 880) of the study participants were seropositive for anti-spike protein antibodies. Significant factors associated with infection included younger age; living within the central, more populated zone of the country; living in a larger household (≥7 members); household members with COVID-19 or compatible symptoms; and those who worked in auxiliary services (i.e., housekeeping and food services). These findings provide insight into opportunities to mitigate SARS-CoV-2 risk and other emerging respiratory pathogens in HCP in El Salvador.

Role of acemannan and pectic polysaccharides in saline-water stress tolerance of Aloe vera (Aloe barbadensis Miller) plant.

This study investigates the impact of water and salinity stress on Aloe vera, focusing on the role of Aloe vera polysaccharides in mitigating these stresses. Pectins and acemannan were the most affected polymers. Low soil moisture and high salinity (NaCl 80 mM) increased pectic substances, altering rhamnogalacturonan type I in Aloe vera gel. Aloe vera pectins maintained a consistent 60 % methyl-esterification regardless of conditions. Interestingly, acemannan content rose with salinity, particularly under low moisture, accompanied by 90 to 150 % acetylation increase. These changes improved the functionality of Aloe vera polysaccharides: pectins increased cell wall reinforcement and interactions, while highly acetylated acemannan retained water for sustained plant functions. This study highlights the crucial role of Aloe vera polysaccharides in enhancing plant resilience to water and salinity stress, leading to improved functional properties.

Novel species of Triatoma (Hemiptera: Reduviidae) identified in a case of vectorial transmission of Chagas disease in northern Belize.

Chagas disease is a leading cause of non-ischemic cardiomyopathy in endemic regions of Central and South America. In Belize, Triatoma dimidiata sensu lato has been identified as the predominate taxon but vectorial transmission of Chagas disease is considered to be rare in the country. We recently identified an acute case of vector-borne Chagas disease in the northern region of Belize. Here we present a subsequent investigation of triatomines collected around the case-patient's home. We identified yet undescribed species, closely related to Triatoma huehuetenanguensis vector by molecular systematics methods occurring in the peridomestic environment. The identification of a T. cruzi-positive, novel species of Triatoma in Belize indicates an increased risk of transmission to humans in the region and warrants expanded surveillance and further investigation.

An open natural language processing (NLP) framework for EHR-based clinical research: a case demonstration using the National COVID Cohort Collaborative (N3C).

Despite recent methodology advancements in clinical natural language processing (NLP), the adoption of clinical NLP models within the translational research community remains hindered by process heterogeneity and human factor variations. Concurrently, these factors also dramatically increase the difficulty in developing NLP models in multi-site settings, which is necessary for algorithm robustness and generalizability. Here, we reported on our experience developing an NLP solution for Coronavirus Disease 2019 (COVID-19) signs and symptom extraction in an open NLP framework from a subset of sites participating in the National COVID Cohort (N3C). We then empirically highlight the benefits of multi-site data for both symbolic and statistical methods, as well as highlight the need for federated annotation and evaluation to resolve several pitfalls encountered in the course of these efforts.

Evaluation of Acemannan in Different Commercial Beverages Containing Aloe Vera (Aloe barbadensis Miller) Gel.

Aloe vera (Aloe barbadensis Miller) gel is a frequently used ingredient in many food pro-ducts, particularly beverages, due to its reported health benefits. Studies have identified acemannan, a polysaccharide rich in mannose units which are partially or fully acetylated, as the primary bioactive compound in Aloe vera gel. The acemannan content and its degree of acetylation (DA) were measured in 15 different commercial beverages containing Aloe vera at varying concentrations (from 30% to 99.8%) as listed on the label. Other biopolymers such as pectins, hemicelluloses, and cellulose were also evaluated. Flavoured beverages (seven samples labelled as containing from 30% to 77% Aloe vera) presented low levels of acemannan (<30 mg/100 g of fresh sample) and were fully deacetylated in most cases. These samples had high levels of other polymers such as pectins, hemicelluloses, and cellulose, likely due to the addition of fruit juices for flavour. Unflavoured beverages (eight samples, with Aloe vera concentrations above 99% according to their labels) had variable levels of acemannan, with only three containing more than 160 mg/100 g of fresh sample. In fact, four samples had less than 35 mg acemannan/100 g of fresh sample. DA levels in all but one sample were lower than 35%, possibly due to processing techniques such as pasteurization causing degradation and deacetylation of the acemannan polymer. Legislation regarding Aloe vera products is limited, and manufacturers are not required to disclose the presence or quality of bioactive compounds in their products, leaving consumers uncertain about the true properties of the products they purchase.

An approach to the effects of longevity, sexual maturity, and reproduction on telomere length and oxidative stress in different Psittacidae species.

Introduction: Aging is a multifactorial process that includes molecular changes such as telomere shortening. Telomeres shorten progressively with age in vertebrates, and their shortening rate has a significant role in determining the lifespan of a species. However, DNA loss can be enhanced by oxidative stress. The need for novel animal models has recently emerged as a tool to gather more information about the human aging process. Birds live longer than other mammals of the same size, and Psittacidae species are the most persevering of them, due to special key traits. Methods: We aimed to determine telomere length by qPCR, and oxidative stress status using colorimetric and fluorescence methods in different species of the order Psittaciformes with different lifespans. Results: We found that telomeres shorten with age for both long- and short-lived birds (p < 0.001 and p = 0.004, respectively), with long-lived birds presenting longer telomeres than short-lived ones (p = 0.001). In addition, short-lived birds accumulated more oxidative stress products than long-lived birds (p = 0.013), who showed a better antioxidant capacity (p < 0.001). Breeding was found related to telomere shortening in all species (p < 0.001 and p = 0.003 for long- and short-lived birds). Short-lived birds, especially breeding females, increased their oxidative stress products when breeding (p = 0.021), whereas long-lived birds showed greater resistance and even increased their antioxidant capacity (p = 0.002). Conclusion: In conclusion, the relationship between age and telomere length in Psittacidae was verified. The influence of breeding increased cumulative oxidative damage in short-lived species, while long-lived species may counteract this damage.

A New Functional Food Ingredient Obtained from Aloe ferox by Spray Drying.

Aloe mucilages of Aloe ferox (A. ferox) and Aloe vera (A. vera) were spray-dried (SD) at 150, 160 and 170 °C. Polysaccharide composition, total phenolic compounds (TPC), antioxidant capacity and functional properties (FP) were determined. A. ferox polysaccharides were comprised mainly of mannose, accounting for >70% of SD aloe mucilages; similar results were observed for A. vera. Further, an acetylated mannan with a degree of acetylation >90% was detected in A. ferox by 1H NMR and FTIR. SD increased the TPC as well as the antioxidant capacity of A. ferox measured by both ABTS and DPPH methods, in particular by ~30%, ~28% and ~35%, respectively, whereas in A. vera, the antioxidant capacity measured by ABTS was reduced (>20%) as a consequence of SD. Further, FP, such as swelling, increased around 25% when A. ferox was spray-dried at 160 °C, while water retention and fat adsorption capacities exhibited lower values when the drying temperature increased. The occurrence of an acetylated mannan with a high degree of acetylation, together with the enhanced antioxidant capacity, suggests that SD A. ferox could be a valuable alternative raw material for the development of new functional food ingredients based on Aloe plants.

Management of high-risk and post-operative non-metastatic prostate cancer in Catalonia: an expert Delphi consensus.

BACKGROUND: To reach a consensus on recommendations for the management of high-risk and post-operative non-metastatic prostate cancer by a group of Radiation Oncologists in Catalonia dedicated to prostate cancer. METHODS: A modified Delphi approach was employed to reach consensus on controversial topics in Radiation Oncology on high-risk non-metastatic (eight questions) and post-operative (eight questions) prostate cancer. An agreement of at least 75% was considered as consensus. The survey was electronically sent 6 weeks before an expert meeting where topics were reviewed and discussed. A second-round survey for the controversial questions only was sent and answered by participants after the meeting. RESULTS: After the first round of the survey, 19 experienced Radiation Oncologists attended the meeting and 74% fulfilled the second-round online questionnaire. An agreement of 9 of the 16 questions was accounted for the first round. After the meeting, an additional agreement was reached in 3 questions leading to a final consensus on 12 of the 16 questions. There are still controversial topics like the use of PET for staging of high-risk and post-operative non-metastatic prostate cancer and the optimal dose to the prostate bed in the salvage setting. CONCLUSION: This consensus contributes to establish recommendations and a framework to help in prostate cancer radiation therapy and pharmacological management in daily clinical practice of high-risk and post-operative non-metastatic prostate cancer.

Diagnosis of Acute Chagas Disease in a Belizean Child with Evidence of a Multiclonal Trypanosoma cruzi Infection.

In January 2020, we instituted acute febrile illness surveillance in 11 hospitals and clinics across Belize. Within 3 months, we diagnosed an acute case of Chagas disease by polymerase chain reaction in a 7-year-old child in the northern part of the country. Phylogenetic analyses of the parasite from the acute blood specimen revealed a multiclonal Trypanosoma cruzi infection, including parasites from the TcII (25.0% of haplotypes), TcIV (2.5% of haplotypes), and TcV (72.5% of haplotypes) discrete typing units. The family reported no history of travel, and three Triatoma species vectors were found within the home. The child's mother was seronegative for antibodies to T. cruzi, ruling out congenital transmission. Convalescent blood samples documented seroconversion and confirmed acute infection. The child was successfully treated with nifurtimox. This is the first known diagnosed case of acute Chagas infection in Belize, highlighting the need for further investigation and public health prevention measures.

Estimated projection of oral cavity and oropharyngeal cancer deaths in Spain to 2044.

BACKGROUND: Oral cavity cancer (OCC) and oropharyngeal cancer (OPC) are two common malignancies whose mortality is worryingly increasing worldwide. However, few studies have estimated the mortality trends for these cancers in the coming years. This study analysed the mortality rates for OCC and OPC observed between 1980 and 2019 to generate a predictive model for the next 25 years in Spain. METHODS: Mid-year population data and death certificates for the period 1980-2019 were obtained from the Spanish National Institute of Statistics. The Nordpred program (Norwegian Cancer Registry, Oslo, Norway) was used to calculate adjusted mortality rates as well as estimated mortality projections with an age-period-cohort model for the period 2020-2044. RESULTS: The specific mortality rate per 100,000 inhabitants for OCC decreased from 2.36 (1980-1984) to 2.17 (2015-2019) and is expected to decline to 1.68 (2040-2044), particularly in males. For OPC, mortality rates rose from 0.67 (1980-1984) to 1.23 (2015-2019) and are projected to drop to 0.71 (2040-2044). In the group of females > 65 years predictions showed rising mortality rates for both OCC and OPC. The predictive model projects more deaths in females than in males for OCC in the period 2040-2044, while deaths for OPC will decrease in males and gradually increase in females. CONCLUSIONS: Although OCC mortality rates have been found to decrease in males in the last observed decades, there is still room to improve them in females > 65 years in the future by promoting campaigns against smoking and alcohol consumption. OPC mortality will become a growing health problem. Vaccination campaigns for the prevention of human papillomavirus-associated cancers may have a long-term impact on the mortality of these cancers, which should be evaluated in upcoming studies. CLINICAL RELEVANCE: Our findings highlighted the importance of closely monitoring OCC and OPC mortality rates in the coming years by age group and sex, and the need to continue preventive measures against the main known risk factors, such as tobacco, alcohol, and human papillomavirus infection.

Knowledge, attitudes, and practices regarding seasonal influenza vaccination during pregnancy in Costa Rica: A mixed-methods study.

BACKGROUND: Influenza increases stillbirth risk, morbidity and mortality in pregnant women. Vaccination protects pregnant women against severe disease and indirectly protects their infants, but coverage among pregnant women remains low worldwide. We aimed to describe knowledge, attitudes, and practices (KAP) regarding seasonal influenza vaccination among postpartum women and prenatal care physicians in Costa Rica. METHODS: We conducted cross-sectional KAP surveys to women one to three days after childbirth at Costa Rican Social Security Fund maternity hospitals, and obstetricians and general practitioners who provided prenatal care in 2017. Principal components analysis, multiple imputation, and logistic regression were used to examine associations between influenza vaccination and demographics, prenatal care, and sources of information-separately for postpartum women and physicians. We also held two focus groups of six healthcare workers each to further describe vaccination KAP. RESULTS: We surveyed 642 postpartum women and 146 physicians in maternity hospitals in five Costa Rican provinces of whom 85.5 % (95 % CI: 82.6 %-88.0 %) and 57.9 % (95 % CI: 49.6 %-65.7 %) were vaccinated for influenza, respectively. Factors associated with influenza vaccination for postpartum women included tetanus vaccination (aOR: 3.62, 95 % CI: 1.89-6.92); received vaccination recommendations from clinicians during prenatal check-ups (aOR: 3.39, 95 % CI: 2.06-5.59); had other children in household vaccinated for influenza (aOR: 2.25, 95 % CI: 1.08-4.68); and secondary/university education (aOR: 0.15-0.31) with no formal education as reference. For postpartum women, reasons for vaccination were perceived benefits for mother and infant, whereas not being offered vaccines was most cited for non-vaccination. Most prenatal care physicians recommended influenza vaccines during prenatal check-ups but believed vaccination causes flu-like symptoms. CONCLUSION: Vaccination campaigns and provisions of free vaccines effectively increased knowledge and coverage among women in Costa Rica. To improve access, women should be offered vaccines during prenatal care appointments. Educating healthcare workers about vaccine benefits for themselves and patients is needed to mitigate safety concerns.

High-Intensity Ultrasound Processing Enhances the Bioactive Compounds, Antioxidant Capacity and Microbiological Quality of Melon (Cucumis melo) Juice.

The bioactive compounds, antioxidant capacity and microbiological quality of melon juice processed by high-intensity ultrasound (HIUS) were studied. Melon juice was processed at two ultrasound intensities (27 and 52 W/cm2) for two different processing times (10 and 30 min) using two duty cycles (30 and 75%). Unprocessed juice was taken as a control. Total carotenoids and total phenolic compounds (TPC) were the bioactive compounds analyzed while the antioxidant capacity was determined by DPPH, ABTS and FRAP assays. The microbiological quality was tested by counting the aerobic and coliforms count as well as molds and yeasts. Total carotenoids increased by up to 42% while TPC decreased by 33% as a consequence of HIUS processing regarding control juice (carotenoids: 23 µg/g, TPC: 1.1 mg GAE/g), gallic acid and syringic acid being the only phenolic compounds identified. The antioxidant capacity of melon juice was enhanced by HIUS, achieving values of 45% and 20% of DPPH and ABTS inhibition, respectively, while >120 mg TE/100 g was determined by FRAP assay. Further, the microbial load of melon juice was significantly reduced by HIUS processing, coliforms and molds being the most sensitive. Thus, the HIUS could be an excellent alternative supportive the deep-processing of melon products.

The lung ultrasound "Rule of 7" in the prognosis of COVID-19 patients: Results from a prospective multicentric study.

Purpose: There is growing evidence regarding the imaging findings of coronavirus disease 2019 (COVID-19) in lung ultrasound (LUS), however the use of a combined prognostic and triage tool has yet to be explored.To determine the impact of the LUS in the prediction of the mortality of patients with highly suspected or confirmed COVID-19.The secondary outcome was to calculate a score with LUS findings with other variables to predict hospital admission and emergency department (ED) discharge. Material and methods: Prospective study performed in the ED of three academic hospitals. Patients with highly suspected or confirmed COVID-19 underwent a LUS examination and laboratory tests. Results: A total of 228 patients were enrolled between March and September 2020. The mean age was 61.9 years (Standard Deviation - SD 21.1). The most common findings in LUS was a right posteroinferior isolated irregular pleural line (53.9%, 123 patients). A logistic regression model was calculated, including age over 70 years, C-reactive protein (CRP) over 70 mg/L and a lung score over 7 to predict mortality, hospital admission and discharge from the ED. We obtained a predictive model with a sensitivity of 56.8% and a specificity of 87.6%, with an AUC of 0.813 [p < 0.001]. Conclusions: The combination of LUS, clinical and laboratory findings in this easy to apply "rule of 7" showed excellent performance to predict hospital admission and mortality.

Objetivo: Existe una evidencia creciente con respecto a los hallazgos de imagen de la enfermedad por coronavirus 2019 (COVID-19) en la ecografía pulmonar (LUS), sin embargo, aún no se ha explorado el uso de una herramienta combinada de pronóstico y triaje.El objetivo principal de este estudio fue determinar el impacto de la LUS en la predicción de la mortalidad de los pacientes con sospecha de afectación pulmonar por COVID-19. El objetivo secundario fue calcular una puntuación con los hallazgos del LUS con otras variables para predecir el ingreso hospitalario y el alta del servicio de urgencias (SU). Material y métodos: Estudio prospectivo realizado en urgencias de tres hospitales académicos, en pacientes con sospecha de COVID-19 o confirmación de esta, a los que se sometió a un examen de LUS y pruebas de laboratorio. Resultados: Se inscribieron un total de 228 pacientes entre marzo y septiembre de 2020. La edad media fue de 61,9 años (DE 21,1). El hallazgo más común en la LUS fue la irregularidad pleural posteroinferior derecha (53,9%, 123 pacientes). Se calculó un modelo de regresión logística, que incluyó la edad mayor de 70 años, proteína C reactiva (PCR) mayor de 70 mg/L y puntuación de afectación pulmonar mediante LUS score superior a 7 para predecir la mortalidad, el ingreso hospitalario y el alta del SU. Se obtuvo una sensibilidad del 56,8% y una especificidad del 87,6%, con un AUC de 0,813 [p < 0,001] para dicho modelo predictivo, en materia de mortalidad. Conclusiones: La combinación de LUS, hallazgos clínicos y de laboratorio en esta «regla de 7¼ de fácil aplicación se mostró de utilidad para predecir el ingreso hospitalario y la mortalidad.

Epidemiological and Clinical Characteristics of Acute Dengue Virus Infections Detected through Acute Febrile Illness Surveillance, Belize 2020.

The Acute Febrile Illness (AFI) Surveillance Network in Belize is a country-wide active surveillance program aimed at diagnosing vector-borne, respiratory, and enteric pathogens among patients presenting to 11 participating hospitals and clinics with new onset fever. This study describes the epidemiology of dengue virus (DENV) infections in Belize diagnosed through AFI surveillance in 2020. Of the 894 patients enrolled and PCR-tested for DENV in this period, 44 DENV-positive cases (5%) were identified. All four DENV serotypes were detected, with two cases testing positive for DENV serotype 4, which is the first report of this serotype in Belize since 2004. The majority of DENV cases (66%) were diagnosed in the Belize District, which contains the largest urban center in the country (Belize City). Positive cases were detected between January 2020 and September 2020, with the majority (89%) diagnosed during the dry season between January and April, unlike years prior when cases were more often diagnosed during the wet season. Clinical signs and symptoms varied slightly between DENV serotypes. Active surveillance of DENV among AFI cases provides insight into the epidemiologic and clinical characteristics of DENV in Belize. This information is important for informing public health interventions to mitigate DENV transmission.

The lung ultrasound "Rule of 7" in the prognosis of COVID-19 patients: Results from a prospective multicentric study.

PURPOSE: There is growing evidence regarding the imaging findings of coronavirus disease 2019 (COVID-19) in lung ultrasound (LUS), however the use of a combined prognostic and triage tool has yet to be explored. To determine the impact of the LUS in the prediction of the mortality of patients with highly suspected or confirmed COVID-19.The secondary outcome was to calculate a score with LUS findings with other variables to predict hospital admission and emergency department (ED) discharge. MATERIAL AND METHODS: Prospective study performed in the ED of three academic hospitals. Patients with highly suspected or confirmed COVID-19 underwent a LUS examination and laboratory tests. RESULTS: A total of 228 patients were enrolled between March and September 2020. The mean age was 61.9 years (Standard Deviation - SD 21.1). The most common findings in LUS was a right posteroinferior isolated irregular pleural line (53.9%, 123 patients). A logistic regression model was calculated, including age over 70 years, C-reactive protein (CRP) over 70mg/L and a lung score over 7 to predict mortality, hospital admission and discharge from the ED. We obtained a predictive model with a sensitivity of 56.8% and a specificity of 87.6%, with an AUC of 0.813 [p<0.001]. CONCLUSIONS: The combination of LUS, clinical and laboratory findings in this easy to apply "rule of 7" showed excellent performance to predict hospital admission and mortality.

La integración de cuidados de enfermería en el anciano en estado de necesidad desde la perspectiva comunitaria / Integration of Nursing Care in the Elderly in Need from the Community Perspective

Introducción: El cuidado en enfermería se aborda desde una perspectiva holística que permita cubrir las necesidades reales de los pacientes en su entorno, que tienen entre sus funciones la de ayudar al anciano enfermo o sano a realizar las actividades que contribuyen a su salud, recuperación o una muerte tranquila en la comunidad. Objetivo: Exponer algunas consideraciones sobre la integración de los cuidados de enfermería en el anciano en estado de necesidad desde la perspectiva comunitaria. Métodos: Se realizó una revisión bibliográfica sistemática para desarrollar un análisis crítico reflexivo sobre la integración cuidados de enfermería en el anciano en estado de necesidad desde la perspectiva comunitaria, en documentos, artículos originales y de revisión disponible en Google Académico y Medline en el período de marzo a junio de 2018, las palabras clave utilizadas fueron Cuidado de enfermería; cuidados comunitarios; Enfermería; integración de cuidados de enfermería, identificadas a través del DECs o de MeSH. Se utilizaron los métodos de análisis, síntesis y sistematización, que posibilitaron la interpretación y la organización de los conocimientos. Tras la identificación de los estudios preseleccionados se llevó a cabo la lectura de los títulos, resumen y palabras clave, y se comprobó la pertinencia con el estudio. Conclusiones: La integración de los cuidados de enfermería permitió contextualizar este fenómeno desde la perspectiva de la comunidad, mediante el aporte de elementos puntuales en el manejo, seguimiento y control de los ancianos en estado de necesidad(AU)

Introduction: Nursing care is approached from a holistic perspective that allows meeting the real needs of patients in their settings, whose functions include helping the sick or healthy elderlies carry out activities that contribute to their health, recovery or having a quiet death in the community. Objective: To present some considerations about the integration of nursing care in the elderly in need from the community perspective. Methods: A systematic bibliographic review was carried out to develop a critical-reflective analysis about the integration of nursing care in the elderly in need from the community perspective, using documents, original articles and review available in Google Scholar and Medline, in the period from March to June 2018. The keywords used were Cuidado de enfermería [Nursing care], cuidados comunitarios [community care], Enfermería [Nursing] and integración de cuidados de enfermería [integration of nursing care], identified through DECs or MeSH. Analysis, synthesis and systematization methods were used, which made the interpretation and organization of knowledge possible. After the identification of the preselected studies, the titles, abstract and keywords were read, and the relevance to the study was checked. Conclusions: The integration of nursing care allowed contextualizing this phenomenon from the community perspective, through the contribution of specific elements to the management, follow-up and control of the elderly in need(AU)

Knowledge, attitudes, and practices for the use of seasonal influenza vaccination, healthcare workers, Costa Rica.

INTRODUCTION: Annual seasonal influenza vaccination in healthcare workers prevents nosocomial transmission to patients, coworkers, and visitors, and reduces absenteeism. This study aimed to describe knowledge, attitudes, and practices (KAP) of seasonal influenza vaccine among public healthcare workers attending patients in Costa Rica. METHODOLOGY: We conducted a cross-sectional survey of healthcare personnel attending patients in public hospitals in 2017-2018. Frequency distributions of demographics, vaccination KAP, sources of information, clinical manifestations and reasons for non-vaccination were reported. Logistic regression was used to analyze associations between exposures of interest (demographics, sources of information, knowledge, attitudes towards vaccination) and self-reported influenza vaccination. RESULTS: We surveyed 747 healthcare workers in 2017-2018. Of 706 participants who knew their vaccination status, 55.7% were vaccinated for seasonal influenza. Only 20.7% of participants knew the influenza vaccine was an inactivated virus, and 94.6% believed the vaccine causes flu-like symptoms. Factors associated with current influenza vaccination were vaccination in previous year (aOR: 8.13; 95% CI: 5.65-11.71) and believed influenza vaccination may be harmful (aOR: 0.62; 95% CI: 0.44-0.89). Reasons for non-vaccination included fear of adverse effects and access limitations. CONCLUSIONS: Suboptimal influenza vaccination among healthcare workers may be attributed to misconceptions about the vaccine and limited engagement strategies focusing on healthcare workers. Appropriate interventions are needed to increase healthcare worker vaccination rates and improve their knowledge and beneficence, which would improve patient safety in hospitals.