Changes of influenza vaccination rate and associated influencing factors after the COVID-19 pandemic in Shanghai, China

Hum Vaccin Immunother. 2024 Dec 31;20(1):2287294. doi: 10.1080/21645515.2023.2287294. Epub 2024 Feb 1.

Abstract

The vaccination rate for seasonal influenza remains low in most regions of China. It is essential to understand the factors that associated with the low influenza vaccination rate in various populations after the COVID-19 pandemic. A cross-sectional survey was conducted with residents in Pudong New Area, Shanghai, China. Respondents' vaccination condition during the 2021-2022 flu season and the reasons for receiving or not receiving influenza vaccine were investigated. Binary logistic regression was conducted to explore potential factors influencing vaccination uptake. 2,476 of 14,001 respondents received an influenza vaccine, with a total coverage of 17.68% (95% CI: 17.05%, 18.32%). Children had the highest vaccination coverage (35.68%; 95% CI: 34.02, 37.33), followed by adults (12.75%; 95% CI: 11.91%, 13.58%) and elderly individuals (11.70%, 95% CI: 10.78%, 12.62%). For children, lower household income was an significant promoting factor. For adults, factors significantly associated with vaccination were household income, sex, and education level. For elderly, factors significantly associated with vaccination were household income, education level, living state, and having underlying diseases. (P < .05)The main reason for vaccine hesitancy among children was worried about side effects (21.49%), for adults and elderly was self-rated good health (adults: 37.14%, elderly people: 30.66%). The overall influenza vaccination coverage rate in Shanghai, especially among elderly individuals, is lower than many developed countries. Appropriate strategies and programs targeting different populations need to be implemented to enhance influenza vaccine coverage.

Keywords: COVID-19; Influenza vaccination; children; coverage; elder people.

Plain language summary

The vaccination rate for seasonal influenza remains low in most regions of China. However, the COVID-19 pandemic has resulted in an increase in public awareness regarding the prevention and control of infectious diseases and changes in people's health behaviors thus may leading to changes in influenza vaccination rates and vaccination willingness. We conducted a survey on the medical service utilization behavior of community residents in Shanghai, the biggest city in eastern China. The vaccination status of respondents during the 2021–2022 flu season and the reasons for receiving or not receiving the vaccine were investigated among 14,001 local residents. The influenza vaccination rate in 2021–2022 season (17.68%) was higher than that in 2018–2019 season (11.8%) in the same area. And this trend was found in population of different age groups. However, the overall influenza vaccination coverage rate in Shanghai is still low, especially among elderly, it remains inadequate to establish an immune barrier and lags behind other developed regions. For children, lower household income was an independent promoting factor. For adults, factors significantly associated with vaccination were household income, sex, and education level. For elderly, factors significantly associated with vaccination were household income, education level, living state, and having underlying diseases. (P < .05) The main reason for vaccine hesitancy among children was worried about side effects (21.49%), for adults and elderly was self-rated good health (adults: 37.14%,elderly people: 30.66%).Efforts should be made to increase awareness of influenza vaccines according to the characteristics of different population.

MeSH terms

  • Adult
  • Aged
  • COVID-19* / epidemiology
  • COVID-19* / prevention & control
  • Child
  • China / epidemiology
  • Cross-Sectional Studies
  • Humans
  • Influenza Vaccines* / therapeutic use
  • Influenza, Human* / drug therapy
  • Influenza, Human* / epidemiology
  • Influenza, Human* / prevention & control
  • Pandemics / prevention & control
  • Vaccination

Substances

  • Influenza Vaccines

Grants and funding

This work was supported by the Shanghai Pudong New Area Public Health Peak Discipline “Infectious Disease” Project [PWYggf2021-01]. Chuchu Ye received funding from the Shanghai “Rising Stars of Medical Talents” Youth Medical Talents Public Health Leadership Program and Pudong New Area Health System Discipline Leader Training Program (PWRd2021-15).