Acceptability, cost-effectiveness, and capacity of a facility-based seasonal influenza vaccination among high-risk groups: a study protocol in selected tertiary care hospitals of Bangladesh.

BACKGROUND: In Bangladesh, seasonal influenza imposes considerable disease and economic burden, especially for those at high-risk of severe disease. The most successful approach for influenza prevention is the administration of a vaccine. Many poor and middle-income nations, including Bangladesh, do not have a national strategy or program in place for seasonal influenza vaccines, despite the World Health Organization's (WHO) advice to prioritize high-risk populations. Additionally, there is a scarcity of substantial data on the cost-effectiveness of seasonal influenza vaccination in these countries. The aim of our study is to determine acceptability, health beliefs, barriers, and intention of receiving influenza vaccine among high-risk populations, assess the cost-effectiveness of implementing a facility-based seasonal influenza vaccination programme, and investigate the required capacity for a potential seasonal influenza vaccination programme. METHODS: We will undertake this study following STROBE guidelines. We will conduct the study in inpatient and outpatient departments of three selected tertiary-level hospitals leveraging the ongoing hospital-based influenza surveillance (HBIS) platform. The study population will include the WHO-defined four high-risk groups excluding healthcare workers: children six months to eight years, pregnant women, elderly ≥ 60 years, and adults with chronic diseases. We will collect quantitative data on participants' acceptability, health beliefs, barriers, and vaccination intentions using the health belief model (HBM) from patients meeting the criteria for high-risk populations attending two public tertiary-level hospitals. In one of the two public tertiary-level hospitals, we will arrange an influenza vaccination campaign before the influenza season, where the vaccine will be offered free of cost to high-risk patients, and in the second hospital, vaccination will not be offered. Both the vaccinated and unvaccinated participants will then be followed-up once a month for one year to record any influenza-like illness, hospitalization, and death. Additional data for objective two will be collected from patients with symptoms of influenza-like illness (ILI) and severe acute respiratory infection (SARI) at one public and one private hospital to determine both direct and indirect costs associated with influenza illness. We will estimate the required number of influenza vaccines, safe injections, and total storage volume utilizing secondary data. We will use a deterministic Markov decision-analytic model to estimate the cost-effectiveness of facility-based influenza vaccination in Bangladesh. DISCUSSION: The results of this study will enable the National Immunization Technical Advisory Group and the Ministry of Health & Family Welfare of Bangladesh to decide what steps to take to develop and implement an influenza vaccination strategy targeting high-risk populations. TRIAL REGISTRATION: The Clinicaltrials.gov registration number is NCT05996549. The registration for the protocol version 2.0 took place in August 2023, with the initial participant being enrolled in March 2022.

Mandatory vaccination for seasonal influenza: what are nurses' views?

BACKGROUND: Preventing seasonal influenza is a public health priority but, although the benefits of vaccinating healthcare workers (HCWs) are emphasised, seasonal influenza vaccine uptake rates remain low. Voluntary vaccination policies have been less successful in achieving high vaccine uptake when compared to mandatory policies and the persistently low vaccine uptake among HCWs has fuelled debate on whether mandatory vaccination programmes should be implemented in the interest of patient safety. AIM: This study explored nurses' views on mandatory vaccination policy for seasonal influenza. METHODS: A self-selected sample (n=35) of qualified nurses working in two large hospital sites in Ireland participated in five focus groups. Data were analysed using Braun and Clarke's framework. FINDINGS: Two themes were identified: (1) mixed views on mandatory vaccination and (2) leave nurses to make their own choice on vaccination. CONCLUSION: This study provides an understanding of nurses' views regarding mandatory vaccination policy for seasonal influenza and highlights that individual choice and autonomy are crucial for vaccine acceptance.

Antibody response to seasonal influenza vaccination in patients with multiple sclerosis receiving immunomodulatory therapy.

BACKGROUND AND PURPOSE: We have previously shown that patients with multiple sclerosis receiving immunomodulatory treatment have reduced seroprotection rates after influenza immunization. The aim of this study was to further investigate the influence of immunomodulatory therapies on the antibody response and seroprotection rates in patients immunized with seasonal influenza vaccine in 2012/2013 compared with healthy controls. METHODS: Ninety patients receiving fingolimod, glatiramer acetate, interferon beta-1a/1b, natalizumab or no therapy were compared with 62 healthy controls. All subjects received the inactivated split virus vaccine in 2012 and serum samples were collected pre-vaccination and 3, 6 and 12 months post-vaccination. The vaccine responses were evaluated by the hemagglutination inhibition assay and adjusted for age and gender. RESULTS: No significant differences in rates of protection against H1N1 for interferon beta-1a/1b and glatiramer acetate were observed as compared with controls at 3, 6 and 12 months. Fingolimod provided reduced protection at all time points post-vaccination, whereas natalizumab displayed reduced protection at 3 and 6 months. Patients without immunomodulation did not display protection rates that were significantly different from the controls at 3 and 12 months. CONCLUSION: These findings suggest that patients with multiple sclerosis receiving fingolimod or natalizumab should be considered for a second dose of the vaccine in cases of insufficient protection. Our results further indicate that new immunomodulatory treatment regimens should be systematically evaluated for their influence on influenza-specific vaccine responses.

Maternal antibodies protect offspring from severe influenza infection and do not lead to detectable interference with subsequent offspring immunization.

BACKGROUND: Various studies have shown that infants under the age of 6 months are especially vulnerable for complications due to influenza. Currently there are no vaccines licensed for use in this age group. Vaccination of pregnant women during the last trimester, recommended by the WHO as protective measure for this vulnerable female population, may provide protection of newborns at this early age. Although it has been observed that maternal vaccination can passively transfer protection, maternal antibodies could possibly also interfere with subsequent active vaccination of the offspring. METHODS: Using a mouse model, we evaluated in depth the ability of maternal influenza vaccination to protect offspring and the effect of maternal immunization on the subsequent influenza vaccination of the offspring. By varying the regimen of maternal immunization we explored the impact of different levels of maternal antibodies on the longevity of these antibodies in their progeny. We subsequently assessed to what extent maternal antibodies can mediate direct protection against influenza in their offspring, and whether these antibodies interfere with protection induced by active vaccination of the offspring. RESULTS: The number of immunizations of pregnant mice correlates to the level and longevity of maternal antibodies in the offspring. When these antibodies are present at time of influenza challenge they protect offspring against lethal influenza challenge, even in the absence of detectable HAI titers. Moreover, no detectable interference of passively-transferred maternal antibodies on the subsequent vaccination of the offspring was observed. CONCLUSION: In the absence of a licensed influenza vaccine for young children, vaccination of pregnant women is a promising measure to provide protection of young infants against severe influenza infection.

Socialization, Indifference, and Convenience: Exploring the Uptake of Influenza Vaccine Among Medical Students and Early Career Doctors.

The Chief Medical Officer recommends that all health care workers receive an influenza vaccination annually. High vaccination coverage is believed to be the best protection against the spread of influenza within a hospital, although uptake by health care workers remains low. We conducted semistructured interviews with seven medical students and nine early career doctors, to explore the factors informing their influenza vaccination decision making. Data collection and analysis took place iteratively, until theoretical saturation was achieved, and a thematic analysis was performed. Socialization was important although its effects were attenuated by participants' previous experiences and a lack of clarity around the risks and benefits of vaccination. Many participants did not have strong intentions regarding vaccination. There was considerable disparity between an individual's opinion of the vaccine, their intentions, and their vaccination status. The indifference demonstrated here suggests few are strongly opposed to the vaccination-there is potential to increase vaccination coverage.

Factors Influencing Seasonal Influenza Vaccination Uptake in Emergency Medical Services Workers: A Concept Mapping Approach.

Seasonal influenza has serious impacts on morbidity and mortality and has a significant economic toll through lost workforce time and strains on the health system. Health workers, particularly emergency medical services (EMS) workers have the potential to transmit influenza to those in their care, yet little is known of the factors that influence EMS workers' decisions regarding seasonal influenza vaccination (SIV) uptake, a key factor in reducing potential for transmitting disease. This study utilizes a modified Theory of Planned Behavior (TPB) model as a guiding framework to explore the factors that influence SIV uptake in EMS workers. Concept mapping, which consists of six-stages (preparation, generation, structuring, representation, interpretation, and utilization) that use quantitative and qualitative approaches, was used to identify participants' perspectives towards SIV. This study identified nine EMS-conceptualized factors that influence EMS workers' vaccination intent and behavior. The EMS-conceptualized factors align with the modified TPB model and suggest the need to consider community-wide approaches that were not initially conceptualized in the model. Additionally, the expansion of non-pharmaceutical measures went above and beyond original conceptualization. Overall, this study demonstrates the need to develop customized interventions such as messages highlighting the importance of EMS workers receiving SIV as the optimum solution. EMS workers who do not intend to receive the SIV should be provided with accurate information on the SIV to dispel misconceptions. Finally, EMS workers should also receive interventions which promote voluntary vaccination, encouraging them to be proactive in the health decisions they make for themselves.

HIV infection Worsens Age-Associated Defects in Antibody Responses to Influenza Vaccine.

BACKGROUND: Antibody responses to seasonal influenza vaccines are defective during older age and human immunodeficiency virus (HIV) infection. The effect of HIV on immune function in aging is relatively unknown. METHODS: HIV-infected and HIV-uninfected young women (age, 19-54 years) and older women (age, >55 years) were evaluated for B-cell and T-cell responses before and 4 weeks after influenza vaccination. RESULTS: Frequencies of seroprotection pre-vaccination and vaccine responsiveness (≥4-fold increase in antibody titer) were lower in HIV-infected participants than in age-matched HIV-uninfected participants. A subgroup of vaccine nonresponders were compared to responders and found to have reduced frequencies of memory B cells and antigen-specific antibody-secreting cells after vaccination. Frequencies of peripheral T-follicular helper (pTfh) cells correlated with memory B-cell function and influenza A(H1N1) antibody titers. Serologic and immunologic deficits were most frequent in older HIV-infected participants. Underlying CD4(+) T-cell immune activation and inflammation correlated negatively with antibody titers and B-cell function, which was not enhanced by exogenous interleukin 21 supplementation in HIV-infected, older vaccine nonresponders. CONCLUSIONS: Immune activation associated with HIV infection and impaired pTfh function heighten deficiencies in antibody responses to influenza vaccine in older individuals. Strategies to reduce immune activation or augment pTfh function may enhance antibody responses in the aging HIV-infected population.

Exploring Perceptions and Barriers: A Health Belief Model-Based Analysis of Seasonal Influenza Vaccination among High-Risk Healthcare Workers in China.

The annual seasonal influenza vaccination rate among high-risk healthcare workers (HCWs) has fallen below expectations, underscoring the importance of exploring the impact of perception on vaccination behavior. An online survey, grounded in the Health Belief Model (HBM), was administered to high-risk healthcare workers at West China Hospital. The data analysis encompassed descriptive statistics, logistic regression for univariate analysis, and path regression for multivariate analysis. A total of 1845 healthcare workers completed the survey, with an acceptance rate of 83.90% (95% CI, 82.20-85.60%). Path analysis revealed significant correlations between vaccination acceptance and perceived susceptibility (ß = 0.142), perceived benefits (ß = 0.129), perceived barriers (ß = 0.075), exposure to vaccination advertisements (ß = 0.115), and knowledge about seasonal influenza (ß = 0.051). Vaccination education efforts should prioritize elucidating the risks associated with the disease and emphasizing the benefits of vaccination. Furthermore, leveraging advertising proves to be an effective strategy for promotion.

The effectiveness of interventions to improve the seasonal influenza vaccination uptake among nurses: A systematic review.

Background: Seasonal influenza is a significant cause of mortality and morbidity worldwide. Despite annual recommendations, influenza vaccination uptake rates are disproportionately lower among nurses compared to other health care professionals, especially when compared to physicians. Nurses have an additional risk of exposure to influenza infection due to the nature of their work. Aim: To determine the effectiveness of interventions in increasing seasonal influenza vaccination uptake among nurses. Methods: Evidence on the effectiveness of interventions to improve seasonal influenza vaccination uptake among nurses was systematically reviewed. A comprehensive search of six electronic databases and grey literature was undertaken. A minimum of two reviewers completed study selection, data extraction and risk of bias assessment independently. Results: One hundred and thirty-four studies were identified of which one cluster randomised trial met the inclusion criteria. The results of the included study found the implementation of an intervention with multiple components increased nurses' seasonal influenza vaccination rates during a single influenza season in geriatric healthcare settings in France. As the evidence in this review was very limited, it was not possible to make recommendations regarding which interventions were effective at increasing the seasonal influenza vaccination rate for nurses. Conclusion: This systematic review highlights a lack of high-quality studies that assessed interventions to improve the seasonal influenza vaccination of nurses. In view of the likelihood of influenza and the coronavirus (COVID-19) pandemic occurring together, it is imperative to have evidence on effective interventions for the nursing workforce and for policy decision makers.

Parental Acceptance, Parental Hesitancy, and Uptake of Seasonal Influenza Vaccination among Children Aged 6-59 Months: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis summarises the literature on parental acceptance, parental hesitancy, uptake, and the associated factors of seasonal influenza vaccination (SIV) among children aged 6-59 months. Studies were sourced from the following platforms: PubMed, Web of Science, MEDLINE, and EMBASE databases. A random-effects model was used to evaluate the prevalence and 95% confidence intervals (CI) of parental acceptance, parental hesitancy, and SIV uptake in the last flu season and lifetime among children. A total of 36 studies were included for analysis. The overall prevalence was 64% for parental acceptance (95% CI: 51-75%), 34% for parental hesitancy (95% CI: 22-48%), 41% for SIV uptake in the last flu season (95% CI: 33-50%), and 46% for SIV uptake in a lifetime (95% CI: 20-74%). Associated factors of parental acceptance/hesitancy and uptake included the age of the children or parents, parental education level, household income level, ethnicity, and other modifiable factors, including perceived benefits, perceived barriers, perceived severity, perceived susceptibility, and cues to action related to SIV. Meta-regression analyses revealed regional differences in parental acceptance (Americas: 79% vs. Asia: 60%). The results provided implications informing us of the development of intervention programs targeting parents to improve SIV coverage among young children.

Nationwide Survey on Seasonal Influenza Vaccination among Health Care Workers during the COVID-19 Pandemic in Greece: Determinants, Barriers and Peculiarities.

BACKGROUND: Seasonal influenza vaccination (SIV) of health care workers (HCWs) is critical in protecting patients' and HCWs' health. Our objective was to examine HCW SIV coverage and related determinants. METHODS AND MATERIALS: A nationwide cross-sectional questionnaire survey was conducted among HCWs during the first half of 2021. The questionnaire (online or paper-based) included knowledge, attitude and practice questions regarding SIV, COVID-19 vaccines and vaccination. RESULTS: Out of 6500 questionnaires administered, 2592 were completed (response rate: 39.9%). SIV coverage reached 69.4% (95% CI: 67.6-71.2%) based on self-reported vaccine uptake. Nurses and administrative staff were found to be more skeptical and have lower vaccine acceptance in comparison with physicians (aOR = 0.66 and aQR = 0.59, respectively). Other SIV hesitancy risk factors included working in secondary health care (aOR = 0.59) and working in northern Greece (aQR = 0.66). Determinants for SIV acceptance included being or living with high-risk people due to medical history (aOR = 1.84 and aOR = 1.46, respectively), positive attitudes towards routine vaccinations (aOR: 1.86), knowledge about COVID-19 vaccines (aOR = 1.53) and COVID-19 vaccine uptake (aOR = 3.45). The primary reason for SIV refusal was low risk perception (58.7%). CONCLUSIONS: SIV coverage (2020/2021) was relatively high, but remained far from formal recommendations. Specific occupational groups were skeptical and low-risk perception was the main reason for vaccine refusal. Targeted policies should be developed and enforced.

Pharmacists' attitudes toward influenza vaccination: does the COVID-19 pandemic make a difference?

Background: Influenza vaccine uptake in most European countries remains low, despite the World Health Organization's target of 75%. Community pharmacists play a vital role in promoting vaccination; however, they have been reported to be vaccine-hesitant. This study aimed to investigate changes in pharmacists' attitudes toward influenza vaccination since the onset of the COVID-19 pandemic, as well as their COVID-19 vaccination intentions. Methods: In December 2020, all members of the Swiss Association of Pharmacists were invited to participate in an online, cross-sectional survey. This study assessed pharmacists' attitudes toward influenza vaccination by surveying influenza vaccine uptake during the 2019-20 influenza season and possible reasons for their decision(s), in addition to their intention to receive COVID-19 and seasonal influenza vaccination(s) during the 2020-21 influenza season. Descriptive analysis and multinomial logistic regression were used to assess predictors of vaccine uptake and intention. Results: Of 5900 Swiss pharmacists, 569 (9.6%) completed the survey. The self-reported influenza vaccination coverage among pharmacists during the 2019-20 season was 48.0%. The primary reason for vaccine uptake was the belief that all healthcare workers should be vaccinated, whereas the main reason for refusal was a lack of concern about contracting influenza. The proportions of participants who intend to accept influenza and COVID-19 vaccinations in the 2020-2021 season, when available, were 63.3% and 66.5%, respectively. The most important predictor of high willingness to be vaccinated against influenza in 2020-21 was vaccination history (OR = 3.73; 95% CI = 1.47-9.50), while the most critical predictor of willingness to be vaccinated against COVID-19 was the intention to be vaccinated against influenza (OR = 3.45; 95% CI = 1.74-6.84). Conclusions: Findings indicated that although pharmacists' readiness to accept seasonal influenza vaccination significantly increased during the COVID-19 pandemic, influenza vaccine uptake among them remains suboptimal. This is consistent with what has been reported in the literature.

Identification of groups at high risk for under-coverage of seasonal influenza vaccination: A national study to inform vaccination priorities during the COVID-19 pandemic.

PURPOSE: Seasonal influenza vaccination is an important public health strategy to reduce preventable illness, hospitalization, and death. Because of overlapping risk factors for severe illness from seasonal influenza and COVID-19, uptake of the seasonal influenza vaccination has heightened importance during the COVID-19 pandemic. We analyzed receipt of seasonal influenza vaccination among COVID-19 priority groups and further examined socio-demographic and behavioral factors associated with receiving the seasonal influenza vaccine among US adults. METHODS: Using the 2018 National Health Interview Survey, we classified 24,772 adults into four COVID-19 priority groups: healthcare workers, medically vulnerable, non-healthcare essential workers, and the general population. We performed multiple logistic regression to compare the relative odds of receiving the influenza vaccine by COVID-19 priority group, socio-demographics, and health-related factors. RESULTS: Healthcare workers, medically vulnerable adults, essential workers, and the general population comprised 8.9%, 58.4%, 6.6%, and 26.1 % of the US population, respectively. Compared with healthcare workers, the adjusted odds ratio (aOR) of receiving influenza vaccine were significantly lower in medically vulnerable adults (aOR=0.43, 95% CI=0.37, 0.48), essential workers (aOR=0.28, 95% CI=0.23, 0.34), and the general population (aOR=0.32, 95% CI=0.28, 0.37). Being young, male, Black, and having no health insurance were associated with lower relative odds of receiving the flu vaccine. CONCLUSIONS: Patterns of influenza vaccine cause concern for under-coverage of populations at high risk for both seasonal influenza and COVID-19. Achieving optimal protection against vaccine-preventable respiratory illness in US adults will require emphasis on those employed outside of the healthcare sector, younger age groups, and adults with lower socioeconomic resources.

Parental Willingness and Associated Factors of Pediatric Vaccination in the Era of COVID-19 Pandemic: A Systematic Review and Meta-Analysis.

A significant decline in pediatric vaccination uptake due to the COVID-19 pandemic has been documented. Little is known about the parental willingness and associated factors of pediatric vaccination during the COVID-19 pandemic. An extensive literature search in the databases of PubMed, Scopus, Web of Science, and EBSCOhost were conducted. A total of 20 eligible studies published from 2020-2022 were included for systematic summary by a thematic analysis, among which 12 studies were included in a meta-analysis conducted with R-4.2.1. The prevalence of parental willingness to childhood/routine vaccination and seasonal influenza vaccination was 58.6% (95%CI 2.8-98.6%) and 47.3% (95%CI 25.3-70.5%). Moreover, there is no sufficient evidence of significant change in parental willingness to childhood/routine vaccination, human papillomavirus vaccination, or pneumococcal conjugate vaccination during the pandemic. However, a significant increase in parental willingness to vaccinate their children against seasonal influenza was found. In addition to the factors of parental vaccination willingness/hesitancy that are well-studied in literature, children/parents' history of COVID-19 and children's perceived vulnerability to COVID-19 were associated with parental willingness. Developing synergetic strategies to promote COVID-19 vaccination together with other pediatric vaccination is warranted during the pandemic. This may help to improve and/or catch up the vaccine uptake of children during and/or after the COVID-19 pandemic.

Increasing Seasonal Influenza Vaccination among University Students: A Systematic Review of Programs Using a Social Marketing Perspective.

The health and economic consequences of seasonal influenza present great costs to communities. Promoting voluntary uptake of the seasonal influenza vaccine among university students, particularly during the COVID-19 pandemic, can deliver protective effects for both individuals and the wider community. Vaccine uptake will be greatest when more of the social marketing benchmarks are applied. This systematic review summarizes evidence from programs aiming to increase seasonal influenza vaccination among university students. Six major electronic databases for health promotion studies (PubMed, EBSCO, ProQuest, Ovid, Web of Science, and ScienceDirect) were searched in November 2021 to capture peer-reviewed studies reporting field trials that have sought to increase seasonal influenza vaccination in university student populations, without any restrictions regarding the publication period. Following PRISMA guidelines, this paper identified 12 peer-reviewed studies that were conducted in the field in the United States, Australia, and Spain. Three studies were targeted at healthcare students and the rest focused on wider university student populations. Studies were narratively summarized, evidence of social marketing principles were identified, and quantitative outcomes were meta-analyzed. The findings indicate that none of the field studies, even a self-classified social marketing study, had adopted all eight of the social marketing benchmarks in program design and implementation. The two studies that only used promotion, but not other marketing-mix and social marketing principles, reported increases in students' intention to be vaccinated but not actual behavior. Given that change is more likely when more social benchmarks are applied, this paper identifies activities that can be included in flu vaccine programs to improve flu vaccine uptake rates. The analysis highlights a lack of field studies focusing on increasing rates of vaccination behavior as research outcomes in countries beyond the United States.

The Application and Outcome Evaluation of a Social Marketing Intervention to Increase Seasonal Influenza Vaccination among University Students.

Seasonal flu vaccination rates among university students are exceedingly low and research focused on voluntarily influencing vaccination uptake is limited. This study outlines the development, implementation, and evaluation of a theory-driven social marketing vaccination intervention following the co-create-build-engage (CBE) framework. This study drew upon a pre-intervention segmentation study and co-created interventions targeted at receptive segments. The intervention delivered a significant 343% increase in vaccination rates using a difference-in-difference analysis. Online communication channels effectively engaged students to register for and receive their flu vaccine Almost 90% of students who received vaccinations signed up in the first two weeks of the intervention program indicating that those who can be motivated will act early in the flu season. Financial incentives, as found in previous studies, were confirmed as highly effective in increasing awareness and influencing vaccination uptake behaviours. Friend referral incentives were also found to be influential in motivating vaccination uptake. Suggestions are provided for future research and practical implementation of interventions on university campuses to motivate flu vaccination and other health behaviours.

Demand and motivation for influenza vaccination among healthcare workers before and during the COVID-19 era: a cross-sectional survey.

Protection of healthcare workers (HCWs) against influenza is essential for patient health and a functional health system. The study aimed to analyze the demand for seasonal influenza vaccination (SIV) among various groups of HCWs in a tertiary care hospital before and during the COVID-19 pandemic and to identify their motives for this season's SIV. Before this influenza season (2020/21), the hospital management offered free SIV to all HCWs and promoted it on the internal network. Out of 4,167 HCWs, 630 HCWs expressed interest in SIV and were vaccinated in the hospital. They filled in a total of 603 self-administered pen-and-paper questionnaires. The mean age of the respondents (374 females and 229 males) was 45 ± 12 years. Physicians accounted for 48% of the vaccinated persons but for only 24% (p < .001) of all HCWs to whom SIV was offered. Only 16% of respondents vaccinated this year also received SIV before the last season (2019/20), with the proportion of physicians (19%) being statistically significantly higher than that of non-physicians (13%, p = .045) and the proportion of chronically ill HCWs (22%) being higher than that of healthy individuals (13%, p = .004). Most frequently, respondents' motivation to get vaccinated this year was self-protection (61%), that is concerns about contracting influenza together with COVID-19 or alone, followed by family protection (58%) and patient protection (53%). In conclusion, COVID-19 contributed to an increased demand for SIV among HCWs and the threat of contracting it together with influenza was the most frequent motive.

Motivating Seasonal Influenza Vaccination and Cross-Promoting COVID-19 Vaccination: An Audience Segmentation Study among University Students.

In the response to the coronavirus pandemic, much attention has been invested in promoting COVID-19 vaccination. However, the impact of seasonal influenza should not be neglected, particularly during the winter influenza surge. Currently, most influenza vaccination campaigns target at healthcare workers or high-risk population groups, while COVID-19 vaccination programmes are targeting the whole population as a single homogeneous group. There is limited research on the promotion of influenza vaccination for university students who study, live, and socialise in close contact with a large variety of people on campus, resulting in a low vaccination rate among this underserved group. Thus, a vaccination programme tailored for university students should be developed to increase protection against influenza-like illnesses and complications, and to help achieve herd immunity across populations who spread viruses. WHO has advocated the potential value of social marketing in vaccination campaigns and highlighted the need for audience segmentation as a major prerequisite component of intervention design. This study aims to identify distinct and homogeneous groups of university students based on sociodemographic, psychographic, and behavioural attributes to inform interventions. Two-step cluster analysis was applied in a sample size of 530 university students and revealed four segments that demonstrate statistically significant differences in their attitudes, behaviours, intentions, and responses to promotion messages about seasonal influenza and COVID-19 vaccination. The findings provide a detailed understanding of segment characteristics among university students that can be applied to develop an effective social marketing campaign that can motivate influenza vaccination and cross-promote uptake of the COVID-19 vaccine.

A cost-effectiveness analysis of South Africa's seasonal influenza vaccination programme.

BACKGROUND: Seasonal influenza imposes a significant health and economic burden in South Africa, particularly in populations vulnerable to severe consequences of influenza. This study assesses the cost-effectiveness of South Africa's seasonal influenza vaccination strategy, which involves vaccinating vulnerable populations with trivalent inactivated influenza vaccine (TIV) during routine facility visits. Vulnerable populations included in our analysis are persons aged ≥ 65 years; pregnant women; persons living with HIV/AIDS (PLWHA), persons of any age with underlying medical conditions (UMC) and children aged 6-59 months. METHOD: We employed the World Health Organisation's (WHO) Cost Effectiveness Tool for Seasonal Influenza Vaccination (CETSIV), a decision tree model, to evaluate the 2018 seasonal influenza vaccination campaign from a public healthcare provider and societal perspective. CETSIV was populated with existing country-specific demographic, epidemiologic and coverage data to estimate incremental cost-effectiveness ratios (ICERs) by comparing costs and benefits of the influenza vaccination programme to no vaccination. RESULTS: The highest number of clinical events (influenza cases, outpatient visits, hospitalisation and deaths) were averted in PLWHA and persons with other UMCs. Using a cost-effectiveness threshold of US$ 3400 per quality-adjusted life year (QALY), our findings suggest that the vaccination programme is cost-effective for all vulnerable populations except for children aged 6-59 months. ICERs ranged from ~US$ 1 750 /QALY in PLWHA to ~US$ 7500/QALY in children. In probabilistic sensitivity analyses, the vaccination programme was cost-effective in pregnant women, PLWHA, persons with UMCs and persons aged ≥65 years in >80% of simulations. These findings were robust to changes in many model inputs but were most sensitive to uncertainty in estimates of influenza-associated illness burden. CONCLUSION: South Africa's seasonal influenza vaccination strategy of opportunistically targeting vulnerable populations during routine visits is cost-effective. A budget impact analysis will be useful for supporting future expansions of the programme.

Seasonal influenza vaccination among primary health care workers in Southwestern Saudi Arabia.

Background: Vaccination of primary healthcare workers (PHCWs) help to prevent the spread of influenza among at-risk patients.Objectives: To assesses seasonal influenza vaccination (SIV) coverage and the factors affecting SIV's utilization among PHCWs in Abha city, southwestern Saudi Arabia.Methods: A cross-sectional survey was carried out between June 2018 and August 2018 in all primary healthcare centers in Abha city. It targeted physicians, nurses, technicians, and pharmacists. A self-administered questionnaire was used to collect data regarding SIV status during the 2017-2018 season, obtain knowledge regarding SIV and influenza disease, and identify potential motivators for and barriers to SIV.Results: Of 312 PHCWs, the SIV coverage rate was 45.5% in the 2017-2018 vaccination season. A multivariable logistic regression model showed that the risk groups for non-vaccination were PHCWs less than 40 years old (adjusted Odds Ratio (aOR) = 4.07, 95% CI: 1.50-11.03), technicians (aOR = 3.73, 95% CI: 1.20-11.54), single PHCWs (aOR = 2.36, 95% CI:1.20-4.62), and PHCWs lacking adequate influenza vaccine knowledge (aOR = 4.22, 95% CI: 2.13-8.35). Approximately 23% and 32% of PHCWs were found to have inadequate knowledge about SIV and influenza disease, respectively. PHCWs' awareness about their risk of infection and their need for protection was found to be the most common motivator (77.5%), and a fear of side effects was found to be the most frequent barrier (40%).Conclusion: SIV coverage rate is suboptimal. Knowledge gaps and misconceptions about the influenza vaccine are the main barriers to an adequate coverage.