The Discrepancy Between Influenza Vaccine Recommendation and Uptake Among Healthcare Workers in China: A Multicenter Cross-Sectional Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for your submission, it was an interesting study. I have a few comments for your consideration:

• Material and methods:
  • 1 settings and participants: You selected various geographical locations, please explain why two eastern provinces were selected but no northern province was selected.
  • 2 please define CDC. Is this the Chinese Centers for Disease Control and Prevention? It is not defined.
• Results:
  • Page 4 line 174. Please define what “allied clinical technicians” includes (are they technicians that work in a physician’s office that is a non-degree health-care worker?)
  • Page 11 line 218- define ILI
  • Page 12 line 245, 246, 249. 254. A confidence interval of zero and not a range is not typically seen, the only way to have an interval with no width would be to sample the entire population, which is not the case for a calculated odds ratio.
  • Page 12 line 256, since there was only one person in your sample that was widowed do you need to show an OR of zero, with a CI of zero?
• Table 2
  • Fix the formatting of the Hubei column it looks like it needs to be a little wider to fix the data on one line
  • The p-value data does not line up correctly with the rows, it is difficult to read which p-value goes to which data point
• Table 3
  • Please consider having the provinces match with those on Table 2. For example, Table 2 has: Shanghai, Shandon, Hubei, Chongqing.  Table 3 has Shanghai, Chongqing, Shandon, Hubei.  Please consider having them match so they are consistent.
  • There are a few formatting issues with the columns.
  • What does the data 56 (98.25) 1 (1.75) on the first row go to? There is no heading for that column and no other data points in that column.
• Discussion
  • Thank you for adding the limitations stated in your manuscript. You identified possible ways to reduce barriers of receiving the influenza vaccine.
• References
  • Consider adding the DOI numbers if you have them available

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Excellent manuscript.  I am very pleased overall.  I just have a couple sections of the methods regarding the selection process drilling down [noted in the attached pdf] that could use a little clarification.

Comments for author File: Comments.pdf

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Your sampling procedure is sound and well thought out.  It aligns with your intention to get a national sample to improve the external validity of your findings.  The descriptive statistics provide the most interesting findings of the study.  The finding that 94% of the surveyed health care workers recommend the vaccine is not surprising, but it IS important.  By the same token, however, this means that the multivariate analyses that you do on this dependent variable are rather trivial as there is so little variation to explain. My recommendation is to drop this portion of the analysis.  

You discover a lot of useful information on knowledge gaps that can inform future professional programs.  I would recommend adding a couple of sentences in the discussion section highlighting these specifics.  

 

The findings on health care worker vaccinations was surprising.  The primary reason was that they just forgot.  This raises the question of whether they intended but just procrastinated or it is just low priority or that they are so busy that their own health practices come last.  A qualitative study to tease out health workers to their own health practices might be informative.

There is one thing you must fix before publication. There are multiple errors in the reported percentages in some the charts, especially the sample characteristics (e.g. professional roles, marital status, health status educational status and monthly income).  The frequencies are consistent throughout, but the percentages do not align with the frequencies in several places.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 3 Report

Comments and Suggestions for Authors

You have addressed all my concerns and suggestions. I am recommending publication as is. Very informative cover letter.  Best wishes in this and future endeavors.