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Vaccines
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Factors Affecting Influenza Vaccine Uptake
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Factors Affecting Influenza Vaccine Uptake

A special issue of Vaccines (ISSN 2076-393X). This special issue belongs to the section "Influenza Virus Vaccines".

Deadline for manuscript submissions: 31 October 2026 | Viewed by 5191

Special Issue Editor

Prof. Dr. Adriana Pistol

E-Mail Website
Guest Editor
Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
Interests: vaccination hesitancy; influenza epidemiology; other viral respiratory infections
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Influenza symptoms can range from mild to severe. Seasonal epidemics and sporadic pandemics typically characterize influenza. The influenza vaccine helps protect against influenza illness, which can be serious or life-threatening. Routine annual influenza vaccination is recommended for all persons aged ≥ 6 months who do not have contraindications. Frequently reported barriers to vaccination include concerns regarding vaccine safety or efficacy, vaccine hesitancy, lack of insurance, cost of vaccination, perceived lack of risk, and lack of guidelines or education.

Original research articles and reviews are welcome for this Special Issue. Research areas may include (but are not limited to) the following: factors affecting influenza vaccination rates in the general population and high-risk groups, methods to evaluate influenza vaccine uptake and reduce hesitancy, and hesitancy determinants.

I look forward to receiving your contributions.

Prof. Dr. Adriana Pistol
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Vaccines is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • influenza
  • vaccines
  • coverage
  • uptake
  • hesitancy
  • risk groups

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Published Papers (5 papers)

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Research

11 pages, 779 KB  
Article
The Effect of Aligning Childhood Influenza Vaccination with Specific Well-Visits in a Primary Care Institution in Singapore
by Ziying Goh, Yi Ling Eileen Koh, Wai Keong Aau, Ngiap Chuan Tan, Chirk Jenn Ng and Chung Wai Mark Ng
Vaccines 2026, 14(6), 469; https://doi.org/10.3390/vaccines14060469 - 25 May 2026
Viewed by 144
Abstract
Background/Objectives: Influenza vaccination in young children reduces the incidence of influenza-related complications. Compared to other vaccines in the Singapore National Childhood Immunization Schedule (NCIS), there is low influenza vaccine uptake rate among young children. Our retrospective database study aimed to evaluate the [...] Read more.
Background/Objectives: Influenza vaccination in young children reduces the incidence of influenza-related complications. Compared to other vaccines in the Singapore National Childhood Immunization Schedule (NCIS), there is low influenza vaccine uptake rate among young children. Our retrospective database study aimed to evaluate the effect of aligning childhood influenza vaccination to coincide with specific well-visits in the primary care setting. Methods: A retrospective interrupted time series study was conducted on two cohorts of children aged 6 to 12 months (n = 10,082 before, and n = 9234 after). The delivery schedule was aligned with routine touchpoints to administer Dose 1 of the influenza vaccine at the 6-month well-visit and Dose 2 at the 7-month visit. Results: Dose 1 influenza vaccination rates increased from 4.7% before the intervention to 73.7% after the intervention. The proportion of children who completed two doses of the influenza vaccines increased from 3.6% to 62%. Median age at Dose 1 influenza vaccine, and completion of two doses of influenza vaccine decreased from 8.7 to 7.6 months and 9.9 to 7.7 months, respectively. Conclusions: Aligning influenza vaccination with specific well-visits substantially improves uptake, completion rates, and timeliness of vaccination, demonstrating a scalable system-level strategy to enhance immunization coverage in primary care. Full article
(This article belongs to the Special Issue Factors Affecting Influenza Vaccine Uptake)
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19 pages, 1558 KB  
Article
Factors Associated with Seasonal Influenza Non-Vaccination Among Children with Chronic Health Conditions in Canada: A Cross-Sectional Study
by Arlanna Pugh, Sailly Dave, Marwa Ebrahim and Julie A. Laroche
Vaccines 2026, 14(5), 396; https://doi.org/10.3390/vaccines14050396 - 29 Apr 2026
Viewed by 361
Abstract
Background/Objectives: Seasonal influenza vaccination is pivotal for protecting high-risk populations, including those with chronic health conditions (CHCs), from severe complications and outcomes. This study aims to describe the sociodemographic characteristics of unvaccinated children (6 months–17 years old) with CHCs, the reasons why [...] Read more.
Background/Objectives: Seasonal influenza vaccination is pivotal for protecting high-risk populations, including those with chronic health conditions (CHCs), from severe complications and outcomes. This study aims to describe the sociodemographic characteristics of unvaccinated children (6 months–17 years old) with CHCs, the reasons why vaccine hesitant parents chose not to vaccinate their children, and the factors associated with seasonal influenza non-vaccination among these children. Methods: This cross-sectional analysis used a sub-sample from the 2023 Childhood COVID-19 Immunization Coverage Survey, which captured data between April and July 2023. Parent and child characteristics were explored, using frequencies and proportions. Weighted unadjusted, partially adjusted (with child age and sex at birth), and fully adjusted multivariable quasi-Poisson models were designed to identify socio-demographic factors associated with seasonal influenza non-vaccination. Results: A total of 649/1187 (55%) children with CHCs were unvaccinated against influenza during the 2022–2023 influenza season. Vaccine hesitant parents with unvaccinated children expressed concerns with vaccine effectiveness (39.1%) and safety (27.5%), as did parents who refused vaccination for their child (56.1% and 35.8%, respectively). Unvaccinated parents (RR: 4.549, 99% CI: 4.480, 4.619) and parents with low household income (RR: 1.428, 99% CI: 1.400, 1.456) were more likely to have unvaccinated children, whereas children who received an annual influenza vaccine (RR: 0.097, 99% CI: 0.094, 0.100) and did not have a disability (RR: 0.913, 99% CI: 0.904, 0.922) had a lower likelihood of non-vaccination. Conclusions: These findings highlight the need for renewed messaging and educational resources targeting vaccine hesitancy and misinformation prevalent among parents with vulnerable youth. Full article
(This article belongs to the Special Issue Factors Affecting Influenza Vaccine Uptake)
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14 pages, 700 KB  
Article
Influenza Vaccination Intention Among Caregivers in the Context of Highly Publicized Influenza Events: A Cross-Sectional Survey of Caregivers of Kindergarten and Primary School Children in Zhejiang, China
by Zhaokai He, Minchao Li, Yun Zeng, Rui Zhang, Jing Tao, Yumeng Wu, Jianwu Li, Guiwei Zhu, Qianhui Zheng, Junqi Yang, Liangliang Huo and Jing Wang
Vaccines 2026, 14(5), 377; https://doi.org/10.3390/vaccines14050377 - 23 Apr 2026
Viewed by 296
Abstract
Objective: This study assessed the influence of a highly publicized influenza-related death event on caregivers’ influenza vaccination intention for kindergarten and primary school children in Zhejiang, China, and identified associated factors. Methods: A cross-sectional survey was conducted from March to April [...] Read more.
Objective: This study assessed the influence of a highly publicized influenza-related death event on caregivers’ influenza vaccination intention for kindergarten and primary school children in Zhejiang, China, and identified associated factors. Methods: A cross-sectional survey was conducted from March to April 2025 using a multi-stage, stratified cluster sampling method across 10 districts/counties. Caregivers completed electronic questionnaires covering sociodemographics, event awareness, vaccination history, hesitancy, and cognitive attitudes. Factors associated with vaccination intention were analyzed using chi-square tests and logistic regression. Results: Among 2153 caregivers, overall vaccination intention for the 2025 season was 60.10%, markedly higher than the 2024 season’s actual rate (27.45%). Caregiver awareness of this event was 91.92%, primarily via social media (92.02%). In univariate analyses, event-related characteristics were significantly associated with vaccination intention: perceived “completely objective” coverage showed the highest willingness (79.68%, χ2 = 79.92, p < 0.001), whereas the “exaggerated risk” (52.44%) and “unaware” (51.15%) groups showed lower willingness. Exposure frequency also correlated positively: low exposure (0–2 times) had 53.39% willingness, moderate (3–5) 61.11%, and high (≥6) 66.10% (χ2 = 27.75, p < 0.001). However, stronger vaccination intention was independently associated with factors such as no prior vaccination refusal [aOR(95% CI) = 2.74(2.03,3.72)] or hesitancy history [1.47(1.13,1.92)], greater information need (aOR = 6.42–8.83), and disbelief in influenza’s spontaneous resolution [1.39(1.08,1.77)]. Weaker intention was associated with poorer child health status [0.19(0.04,0.74)], no influenza vaccination in 2024 [0.41(0.30,0.55)], no influenza illness in 2024 [0.73(0.56,0.95)], belief in vaccine protection [0.60(0.46,0.79)], and the perception that most parents have their children vaccinated [0.70(0.53,0.93)]. Conclusions: Following a highly publicized celebrity influenza death, vaccination intention was primarily driven by caregivers’ cognitive, psychological, and behavioral experience factors. Caregivers who perceived event coverage as completely objective showed higher vaccination intention, while prior vaccination behavior exhibited inertia. Targeted interventions should enhance information credibility and focus on previously unvaccinated and vaccine-hesitant groups to improve coverage. Full article
(This article belongs to the Special Issue Factors Affecting Influenza Vaccine Uptake)
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15 pages, 1271 KB  
Article
The Discrepancy Between Influenza Vaccine Recommendation and Uptake Among Healthcare Workers in China: A Multicenter Cross-Sectional Study
by Xingxing Zhang, Chenyan Jiang, Lin Sun, Yu Xiong, Qiangling Yin, Ju Wang, Xiao Yu, Qing Duan, Yinzi Chen, Xin You, Shuaixing Wang, Xiaoxu Zeng, Lei Yang and Dayan Wang
Vaccines 2026, 14(2), 166; https://doi.org/10.3390/vaccines14020166 - 11 Feb 2026
Viewed by 1096
Abstract
Background: Healthcare workers (HCWs) are pivotal in influenza containment, serving as both high-risk individuals and vaccine advocates. However, influenza vaccination coverage among Chinese HCWs remains suboptimal. Existing research is often constrained by limited geographic representativeness or non-robust designs. This study provides a robust, [...] Read more.
Background: Healthcare workers (HCWs) are pivotal in influenza containment, serving as both high-risk individuals and vaccine advocates. However, influenza vaccination coverage among Chinese HCWs remains suboptimal. Existing research is often constrained by limited geographic representativeness or non-robust designs. This study provides a robust, nationwide assessment of influenza vaccine uptake and recommendation behaviors among HCWs in China. Methods: A multicenter cross-sectional survey was conducted in late 2025 across four Chinese provinces (Shanghai, Shandong, Chongqing, and Hubei). A total of 390 frontline HCWs—only those defined as directly engaged in influenza management and prevention—from 48 hospitals (primary, secondary, and tertiary levels) completed validated electronic questionnaires. A multinomial logistic regression model was employed to identify determinants of personal vaccine uptake behavior among HCWs. Results: Overall influenza knowledge was moderate, with notable gaps in recognizing typical symptoms (29.23%), southern China’s peak season (31.03%), and optimal vaccination timing (55.38%). A striking “recommendation-uptake disparity” was observed: while 93.6% of HCWs recommended the vaccine to patients, only 22.3% received it annually themselves. A multinomial regression revealed that being a nurse (vs. doctor: OR = 3.11, 95% CI: 1.28–7.53) or female (vs. male: OR = 3.08, 95% CI: 1.28–7.44) was positively associated with annual vaccination, whereas clinical technicians (vs. doctors: OR = 0.18, 95% CI: 0.03–0.94) showed lower odds. Primary barriers to personal vaccination included inconvenience (49.5%), perceived high cost (16.2%), and efficacy concerns (19.5%). Conclusions: This study highlights a significant gap between high recommendation rates and low personal uptake among HCWs in China. The findings underscore the need for multifaceted interventions, including workplace-based reminder systems, free vaccination policies, and tailored education, to optimize coverage and strengthen the role of HCWs in national influenza prevention. Full article
(This article belongs to the Special Issue Factors Affecting Influenza Vaccine Uptake)
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14 pages, 1339 KB  
Article
Determinants of Accepting or Rejecting Influenza Vaccination—Results of a Survey Among Ligurian Pharmacy Visitors During the 2023/2024 Vaccination Campaign
by Daniela Amicizia, Silvia Allegretti, Federico Grammatico, Matteo Astengo, Francesca Marchini, Alberto Battaglini, Irene Schenone, Irene Schiavetti, Camilla Sticchi, Barbara Rebesco and Filippo Ansaldi
Vaccines 2025, 13(6), 580; https://doi.org/10.3390/vaccines13060580 - 29 May 2025
Cited by 3 | Viewed by 1411
Abstract
Background/Objectives: Seasonal influenza vaccination is crucial for reducing morbidity, mortality, and healthcare burdens. The 2023/2024 Ligurian vaccination campaign (Italy) utilized an inclusive model involving local health authorities, general practitioners, pediatricians, and pharmacies to enhance accessibility. Our study aimed at focusing on factors influencing [...] Read more.
Background/Objectives: Seasonal influenza vaccination is crucial for reducing morbidity, mortality, and healthcare burdens. The 2023/2024 Ligurian vaccination campaign (Italy) utilized an inclusive model involving local health authorities, general practitioners, pediatricians, and pharmacies to enhance accessibility. Our study aimed at focusing on factors influencing vaccine uptake, public attitudes and access to preventive healthcare services. Methods: A cross-sectional survey was conducted among adults (≥18 years) in Ligurian pharmacies visitors during the vaccination campaign. A self-administered structured questionnaire gathered data on demographics, vaccination history, healthcare access, and awareness. Results: The study included 30,499 participants, and the median age with P25–P75 (years) was 62.0 [47.0–74.0]; 54.6% were female. Considering determinants of accepting influenza vaccination, age was identified as a strong independent predictor. Each one-year increase in age was associated with a 3.8% increase in the odds of influenza vaccination (OR 1.03, 95% CI 1.03–1.04, p < 0.001). Compared to individuals who never visited their general practitioners, those who visited “sometimes”, “often”, or “very often” had significantly higher odds of influenza vaccination (OR 1.54, 1.97, and 1.98, respectively; p < 0.001 for all categories). The strongest predictor of influenza vaccination in the 2023/2024 season was having received the influenza vaccine in the previous season (2022/2023) (OR 71.73, 95% CI 65.38–78.78, p < 0.001). Consistent with increasing age predicting higher influenza vaccination uptake, older age was associated with lower odds of refusing the vaccine due to the belief that “getting or transmitting influenza does not matter” or due to “other or unspecified reasons”. In contrast, receipt of the COVID-19 vaccination significantly increased the odds of holding these opinions. Among individuals who cited reasons such as fear of side effects, concerns about vaccine safety, fear of injections, general opposition to vaccines, or doubts about vaccine effectiveness, having received the COVID-19 vaccine was associated with lower odds of citing these as barriers to influenza vaccination. Conclusions: Fear of side effects and perceived unnecessary vaccination are key barriers. Targeted education and the involvement of general practitioners could enhance vaccine acceptance, particularly among hesitant groups. Full article
(This article belongs to the Special Issue Factors Affecting Influenza Vaccine Uptake)
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