Declining Influenza Vaccination Uptake, Attitudes, and Knowledge Among Healthcare Workers in Chengdu, China, in the Post-COVID-19 Era

Purpose: Despite the benefits of influenza vaccination, particularly for healthcare workers (HCWs) at higher risk, vaccination coverage among HCWs in China remains low. This study aims to provide updated insights into the knowledge, attitudes, practices, and barriers related to influenza vaccination among HCWs in China post-COVID-19 era, to inform strategies for improving vaccination rates and healthcare safety. Methods: A cross-sectional survey was conducted between December 2023 and January 2024 at two tertiary hospitals in Chengdu, China. Logistic regression analyses were used to identify factors associated with HCWs' influenza vaccination uptake for the 2023-2024 season. Results: Of the 602 HCWs who completed the questionnaire (response rate: 86.0%), influenza vaccination uptake for the 2023-2024 season was low at 14.1%, down from 31.2% in 2021-2022 and 18.4% in 2022-2023. Main reasons for vaccine hesitancy included mistrust of vaccines (56.0%), inconvenient access (52.0%), and concerns over time, cost, and information (57.6%). Although most HCWs acknowledged the protective benefits of vaccination, only one-third supported mandatory vaccination, with concerns about personal autonomy among opponents. Multivariable logistic regression analysis showed that HCWs were more likely to be vaccinated if they believed it was essential for their job [adjusted odds ratio (aOR): 2.21; 95% confidence interval (CI): 1.13, 4.30), recognized their higher risk (aOR: 2.37; 95% CI: 1.09, 5.15), and were aware of high-risk groups for influenza vaccination (aOR: 2.49; 95% CI: 1.41, 4.40) as well as the age group with a higher infection rate (aOR: 1.89; 95% CI: 1.01, 3.51). However, those favoring increased Conclusion: The persistently low influenza vaccination rates among HCWs in China post-COVID-19 highlight significant gaps in healthcare risk management. Targeted interventions, including enhanced education and better vaccine access, are needed, along with further discussion on mandatory vaccination as a potential solution.