Low influenza vaccination coverage among Chinese healthcare workers during the COVID-19 pandemic | Infectious diseases of poverty

Health care workers are the priority group for influenza vaccination in China and abroad; However, the local influenza vaccination rate has always been low. Participants in this study were users of the Breathing Circles platform, and most of them were respiratory physicians or nurses who were familiar with the risks of respiratory illness. However, the vaccination rate among them in the 2021/2022 influenza seasons was 35.4%, which is much lower than that of developed countries in Europe and the United States. [9]. This may be related to national policies – China has not included influenza vaccination in its immunization programme. Only 19.0% of the respondents reported that their workplace provides free vaccination. In addition, with the exception of mandatory vaccination, no single intervention showed a rapid and significant increase in vaccination uptake and maintenance. [10]. A study found that policy-based voluntary vaccination was rarely achieved and maintained an influenza vaccination rate of 40% in practice. [11]. In the United States, a large proportion of hospitals require healthcare workers to receive the influenza vaccine (61.4% in 2017) [12]. Virginia Mason Medical Center in Seattle, USA uses influenza vaccination as a condition of employment, and in 2005, implementation of a mandatory vaccination policy increased vaccination coverage among more than 5,000 health care workers in the four seasons following influenza by >98% [13].

Meanwhile, the vaccination rate among healthcare workers during the 2020/2021 and 2021/22 flu seasons in this study was lower than the vaccination rate in the 2019/2020 flu season (67%). [14]But it is even higher in the 2018/2019 flu season (11.6%). [15]. The reason for the higher rate compared to the 2018/2019 influenza season may be due to the official statement issued by the Chinese Health Commission in 2018/2019 that encouraged influenza vaccination. This was the first specific health care worker vaccination guideline to be introduced, requiring medical institutions at all levels to provide free influenza vaccination to health care workers and ensure that all health care workers in high-risk departments are vaccinated. The lower rate compared to the 2019/2020 influenza season may be because the COVID-19 pandemic has reduced access to vaccines. The COVID-19 vaccine has become a priority in all medical facilities, and the influenza vaccine cannot be given at the same time. The decrease in vaccine coverage among healthcare workers in the 2021/2022 influenza season compared to the 2020/2021 influenza season may be attributed to the vaccination campaign against the novel coronavirus in major populations in China, which began on December 15, 2020. [16]and expanded to the general population as of February 19, 2021 [17]. The use of routine immunization resources by COVID-19 has hampered influenza vaccination, since coadministration of the two vaccines is not permitted. In addition, the free influenza vaccination campaign was completed in most regions by the end of November in previous years, and the majority of people in other regions had been vaccinated by February. Our study, which completed the collection of questionnaire responses before the end of the influenza season, may have slightly reduced vaccine coverage. In addition, our research reported on the economic level of those living in the city, participation in vaccination work, frequent recommendation of vaccines for respiratory infectious diseases for appropriate vaccination kits, supportive attitude of all health care workers to be vaccinated against influenza, workplace requirements, vaccination policies Free in the workplace. Health care workers were more likely to be vaccinated if the vaccines were free. Meanwhile, in this study, the two main reasons for vaccinating health care workers in 2021/2022 were the WASH holding company’s concerns regarding infecting others and catching influenza themselves, which was consistent with previous studies elsewhere (Italy ). [18]Belgium [19]Slovenia [20]), Peru [21]Australia [22]and Singapore [23]).

Reluctance to receive the vaccine among health care workers is a public health challenge [24]. The main reasons for not vaccinating health care workers in this study during the 2021/2022 influenza season included inappropriate vaccination sites, which may be caused by the reduced number of free influenza vaccination facilities due to the impact of the COVID-19 pandemic since more vaccination facilities were converted to COVID-19 vaccine, and declining access to influenza vaccine.

However, the COVID-19 pandemic has not abated, and low influenza vaccination rates among health care workers may cause problems. The high incidence of influenza may cause health care workers to contract influenza and COVID-19, or other infectious respiratory diseasesAnd the Leading to an epidemic of multiple infectious respiratory diseases. In addition, the flu vaccine strengthens immunity and reduces the severity of COVID-19 [25]. WHO indicated in the Global Influenza Strategy 2019-2030 that influenza outbreaks may highlight the burden and severity of annual epidemics on the world’s population and countries’ health systems; Seasonal epidemics may highlight the economic burden of direct and indirect costs [26]. A recent study in the United States showed that mandatory influenza vaccination policies decreased absenteeism rates among health care workers while increasing influenza vaccination rates. [27]. Influenza vaccination also saves countries costs. A review of more than 140 studies showed that the per capita cost of seasonal influenza cases ranged from $30 to more than $60, and cost-effectiveness ratios for vaccination ranged from $10,000/outcome to more than $50,000/outcome. [28].

In short, effective measures must be taken to improve influenza vaccination coverage among health care workers. Our study found that health care workers who were required to be vaccinated by hospitals were more likely to be vaccinated; This is consistent with findings in the United States, where the influenza vaccination rate among healthcare workers was 92.3% during 2016-2017. [29]The highest vaccination rates were recorded among healthcare workers whose employer requested influenza vaccination (96.7%), compared to 45.8% in healthcare facilities where influenza vaccination was not required, promoted or provided on-site. Since free vaccination was likely the driving factor for promoting influenza vaccination among health care workers, hospitals could formulate free vaccination policies to encourage vaccination. In addition, access to influenza vaccination must also be improved through measures such as improving the public health function in hospitals and providing influenza vaccination points in hospitals. On-site vaccination is also an effective measure to improve vaccine coverage. An Italian study found that introducing an on-site strategy doubled influenza vaccine coverage in the 2017/18 flu season compared to the previous season. [30]. The Technical Guidelines for Influenza Vaccination in China (2021-2022) also recommend increasing the number of primary influenza vaccination points, starting vaccination earlier, extending the duration of vaccination, increasing daily service hours, and encouraging influenza vaccination campaigns for health care workers. [31]. In addition, since influenza and COVID-19 vaccines cannot be administered at the same time, the current technical guidelines for COVID-19 vaccination (first version) in China recommend that the interval between influenza and COVID-19 vaccinations be >14 days. However, current research has not found clear evidence of immunogenicity and safety for inactivated influenza vaccines and combination immunization. [32]. Future studies could focus on combining immunization regimens, which is important for prevention and control of the risks of overlapping epidemics in the future.

This study had several limitations. The HCWs in this study had a higher level of education than the HCWs in China in general. Therefore, our findings may not represent the state of health care worker vaccination nationwide. However, the low vaccination rates among these highly educated healthcare workers also reflect poor vaccination rates among the general population in China. Second, the vaccination status of HCWs in this study was self-reported rather than relying on actual vaccination records, which may be influenced by recall bias. Going forward, we will continue to track health care workers surveyed, expand the survey community, and focus on changes to the influenza vaccination order to provide a reference for influenza vaccination and prevention and control.

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