Seasonal Influenza Immunization Research Articles

SARS-CoV-2 and influenza vaccine hesitancy during the COVID-19 pandemic in a dynamic perspective

ABSTRACT To investigate the dynamic evolution of vaccine hesitancy toward both COVID-19 and influenza in a context characterized by the compresence of SARS-CoV-2 pandemic and seasonal flu epidemics, a two times repeated cross-sectional exploratory design was performed at Udine Hospital (Italy) following a cohort of 479 adult patients with a previous history of SARS-CoV-2 infection in 2020. Vaccine attitude was assessed through standardized telephone interviews performed at 12 and 18 months after the acute illness. The first interview reported the success of the 2020/21 seasonal influenza immunization with 46.8% (224/479) of the participants showing a positive attitude, especially the elderly and people with comorbidities (p < .001), but the investigation conducted at 18 months showed a drastic drop in flu shot acceptance (30/166, 18.1%). On the other hand, a great increase in vaccinations against SARS-CoV-2 occurred after the introduction of Green Pass (26.7% vs 72.9%). The major drivers of flu vaccine skepticism were represented by the feeling of protection regardless of prevention and by concerns regarding vaccines safety and efficacy; conversely compulsory strategies seemed to play a secondary role, since only a minority of the participants identified in the restrictions induced by the certification the major incentive to get immunized against SARS-CoV-2. The focus on this peculiar historical period helps to take a step forward in the comprehension of the complexity and dynamicity of the vaccine hesitancy phenomenon. Future vaccination campaigns will need to consider the role of personal opinions and emotions, interpreted according to the social and political context.

Cell-Mediated Proteomics, and Serological and Mucosal Humoral Immune Responses after Seasonal Influenza Immunization: Characterization of Serological Responders and Non-Responders.

Immunization against influenza through vaccination is the most effective method with which to prevent infection. To assess protection after immunization, analysing humoral response with a hemagglutinin inhibition assay is the gold standard, but cell-mediated immune response has been shown to better correlate with protection in the elderly. Our aim was to explore the influenza-specific cell-mediated and mucosal humoral responses in serologically defined responders and non-responders. We analysed sera for total immunoglobulins (Ig) A, G, and M and nasal swab samples for influenza-specific IgA. Peripheral blood mononuclear cells were stimulated with trivalent influenza vaccine VaxiGripTetra, and supernatants were analysed for influenza-specific responses with the Olink Immune-Oncology panel using a proximity extension assay. We included 73 individuals, of which 69 completed the study with follow-up sampling at one and six months post-vaccination. Of the 73, 51 (70%) were found to be serological responders and 22 (30%) were non-responders. We did not find any significant differences in sex or mucosal humoral response between responders and non-responders; however, a higher IFNγ/IL-10 ratio in individuals ≤65 years of age indicates an enhanced cell-mediated immune response in this age group. Characteristics of the non-responders were found to be higher levels of IgM, Granzyme B and Interleukin 12, and lower levels of C-X-C motif chemokine 13 compared with those of the responders. In conclusion, our results did not show any correlation between serological response and age. Furthermore, the majority of influenza-specific cell-mediated immune markers did not differ between responders and non-responders; the immune marker profile of the non-responders and its contribution to protection is of interest but needs to be further explored.

Cardiologists' knowledge and perceptions of the seasonal influenza immunisation

BackgroundSeasonal influenza immunisation reduces cardiovascular events in high-risk patients, but 50% do not receive routine immunisation. The perceptions and current role of cardiologists in recommending and prescribing influenza immunisation has not been well described. MethodsWe used an exploratory sequential mixed methods design. Semi-structured interviews of 10 cardiologists were performed to identify themes for quantitative evaluation. 63 cardiologists undertook quantitative evaluation in an online survey. The interviews and surveys addressed (a) attitudes and behaviours regarding influenza immunisation and (b) preventative care in cardiology. ResultsOne quarter (25.4%, n = 16) of cardiologists recommended influenza immunisation to all patients. Less than half (49.2%, n = 31) recommended influenza immunisation to secondary prevention patients. Almost 1/3 of respondents (31.7%, n = 20) were uncertain or unaware of the guidelines regarding influenza immunisation and patients with cardiac disease. Most cardiologists believed that general practitioners were responsible for ensuring patients received influenza immunisation (76.2%, n = 48). ConclusionsDespite reducing cardiovascular events in high-risk patients, influenza immunisation is not widely recommended by cardiologists. Further clinician education is needed to address the knowledge gaps which prevent recommendation and uptake of this guideline directed treatment.

Understanding of seasonal influenza immunisation and its cardiovascular benefits among cardiology patients

Abstract Background Seasonal influenza immunisation reduces the risk of cardiovascular events. Patients with established cardiovascular disease (CVD) derive a greater benefit than those without yet up to 50% globally do not take up the immunisation. Purpose To describe the understanding and perceptions of seasonal influenza immuni2ation among patients CVD. Methods A cross sectional, voluntary and anonymous survey was administered to cardiology inpatients and outpatients attending a large health system in Australia during the 2022 influenza season, May 1st 2022 to August 31st 2022. Demographics, educational and employment status and prior immunisation behaviours were collected. Questions on perceptions and beliefs around seasonal influenza immunisation and influenza-related illness were presented with 5-point Likert scale (strongly disagree through to strongly agree). Results A total of 181 surveys were completed; median age was 64 (50.5% &amp;lt;65 years), 65.0% (115/177) of the population were inpatients, 82.2% (143/174) had completed high school or more; 35.0% (63/180) were female and 24.2% (43/178) spoke a language other than English at home. Over one third of respondents did not receive the seasonal influenza immunisation in the prior year (63/181, 34.5%). Only half (97/179, 54.2%) of patients agreed that their heart condition placed them at higher risk of complications and serious illness if they contracted influenza. While 73.3% (132/180) agreed that immunisation would help prevent risk of serious illness, only 26.8% (48/179) agreed that it would help to prevent myocardial infarction. Nearly a quarter of patients (24.0%, 43/179) were concerned about side effects while 1 in 10 (12.8%, 23/179) patients raised cost as a barrier despite being free-of-charge to all patients with CVD in Australia. If asked to receive the seasonal influenza immunisation, 86% (154/179) patients would agree if their cardiologist recommended it. Conclusions Despite guideline recommendations, most cardiology patients are uninformed of the cardiovascular benefits of seasonal influenza immunisation with many unaware they are at higher risk of influenza-related, preventable illness. The vast majority of patients would accept the immunisation if recommended by their cardiologist highlighting their important role in improving uptake among this high-risk group.

The role of seasonal influenza immunisation in cardiovascular care: a survey of cardiologists

Abstract Background Seasonal influenza immunisation reduces cardiovascular events by 30% in those with atherosclerotic cardiovascular disease (ASCVD) and up to 50% in those with recent acute coronary syndrome. However, uptake in high-risk patients remains poor. Clinician recommendation has been shown to increase adoption of influenza immunisation in the general population; thus, cardiologists are well-placed to promote uptake in patients with cardiovascular disease. Purpose To describe the attitudes and behaviours of Australian cardiologists regarding seasonal influenza immunisation. Methods We used an exploratory sequential mixed methods design. Semi-structured interviews of 10 cardiologists were performed to identify themes for quantitative evaluation in an online survey. Multiple choice and Likert scale questions explored (a) attitudes and behaviours regarding influenza immunisation, (b) engagement with colleagues and professional bodies and (c) preventative care in cardiology. The survey was administered to 63 cardiologists between November 2020 and January 2021 and respondents received an honorarium for their time. Results The majority of respondents were general cardiologists (50/63) – compared with subspecialist cardiologists, and had spent an average of 21 years in practice. Less than half of the cardiologists surveyed asked patients about their vaccination status always or most of the time (46%, 29/63). Only one quarter (25.4%, 16/63) of cardiologists recommended influenza immunisation to all of their patients while higher proportions recommended it among patients with ASCVD (49.2%, 31/63), heart failure (69.8%, 44/63) and those over the age of 65 years (68.3%, 44/63). Just over half of the cardiologists (57.1%, 36/63) agreed that influenza immunisation was important/very important for prevention of cardiac events, however this was of lower priority compared with other components of preventive care including smoking cessation (100% agreed important, 63/63), anti-hypertensives (96.8%, 61/63), statins (94.3%, 60/63), exercise (80.9%, 51/63), anticoagulants (74.6%, 47/63), SGLT2 inhibitors (69.8%, 44/63) and diet (68.2%, 43/63). Three quarters of cardiologists (76.2%, 48/63) believed that the clinician predominantly responsible for ensuring that patients received the immunisation was the general practitioner, with only a minority (12.7%, 8/63) reporting that it was the role of the cardiologist. Conclusions Despite a relative risk reduction exceeding that of statins and antihypertensives for patients with CVD, influenza immunisation is not prioritized or recommended by many cardiologists. Efforts at increasing awareness and advocacy among cardiologists may assist in broadening uptake among high-risk patients with cardiovascular disease.

Attitudes and Beliefs of Australian Cardiologists on the Role of Seasonal Influenza Immunisation in Cardiovascular Care

Attitudes and Beliefs of Australian Cardiologists on the Role of Seasonal Influenza Immunisation in Cardiovascular Care

Awareness of the Seasonal Influenza Immunisation and its Cardiovascular Benefits: A Survey of Australian Patients With Cardiovascular Disease

Awareness of the Seasonal Influenza Immunisation and its Cardiovascular Benefits: A Survey of Australian Patients With Cardiovascular Disease

Impact of the COVID-19 pandemic on the quality of diabetes care: Insights from longitudinal data in Switzerland

In this population-based cohort study on diabetes care, self-reported quality indicators measured just before (2019) and during (2021) the COVID-19 pandemic were comparable, apart from a modest increase in seasonal influenza immunization and a small decline in patient-centeredness of care in 2021.

Increased adverse events following third dose of BNT162b2/Pfizer vaccine in those with previous COVID-19, but not with concurrent influenza vaccine.

Prior studies suggest that adverse events (AEs) following doses one and two of BNT162b2/Pfizer vaccine are worse in those with a prior history of COVID-19. To establish whether this outcome applies to a third/booster dose, we conducted a survey with 534 healthcare workers (HCW) in Northeast England, who reported AEs following all three doses of BNT162b2/Pfizer vaccine. We also explored AEs associated with concurrent seasonal influenza immunisation, in a subset of 492 HCWs. For all doses of BNT162b2/Pfizer vaccine there was a cluster of systemic AEs that were consistently worse in HCWs with a prior history of COVID-19. AEs were no worse in HCWs who received their third/booster dose within 7 days of the influenza jab, rather than further apart. Gender and the presence of ongoing COVID-19 symptoms (OCS) had no effect on AEs associated with COVID-19 or influenza vaccination, though younger HCWs experienced more AEs overall. Our findings have implications for vaccine hesitancy and immunisation protocols.

Awareness, Knowledge, Attitude and Practice among Taif City Residents about Seasonal Influenza and Influenza Vaccine Immunization

Awareness, Knowledge, Attitude and Practice among Taif City Residents about Seasonal Influenza and Influenza Vaccine Immunization

Knowledge, attitude, and practice of seasonal influenza and influenza vaccine immunization among people visiting primary healthcare centers in Riyadh, Saudi Arabia.

Influenza infection continues to be a hazard to the Saudi population, resulting in high death rates and illness prevalence; it also places a substantial financial burden on the government. The government takes several strategies and approaches through the Ministry of Health has shown great success in curbing the disease. Vaccination is considered the most appropriate control measure; unfortunately, most Saudi residents, particularly in the city of Riyadh, do not consider vaccination a safe health practice. As a result, many have not participated in the influenza vaccine immunisation programme. Therefore, this study aimed to assess the knowledge, attitudes, and practices (KAPs) of seasonal influenza and influenza vaccine immunisation among clients visiting primary healthcare centers in Riyadh, Saudi Arabia. Furthermore, the study investigated the relationship between participants' demographics and their KAPs regarding influenza vaccination. A cross-sectional, descriptive, correlational study was conducted among 611 individuals who visited four of Riyadh's primary healthcare centers: Alsylimania, Alwady, Alyasmin, and Alsahafah. A self-reported questionnaire was used to assess the KAPs of participants, with questions regarding seasonal influenza and influenza vaccine immunisation. The scores of participants' knowledge showed that the majority had good knowledge regarding seasonal flu (64.5%) and the flu vaccine (73.3%). Furthermore, only 52% of participants had a positive attitude score towards the seasonal influenza vaccination. Despite that, significant knowledge gaps and mistaken beliefs regarding certain aspects of influenza were noted in participants, resulting in negative attitudes and perceptions as well as a reduced likelihood of being vaccinated. In this study, 43.7% of participants (267 out of 611) had ever received a flu vaccine. Participants with a history of previous vaccination had a significantly higher level of knowledge and more positive attitudes, which resulted in increased vaccination coverage. Therefore, educational strategies to improve knowledge regarding influenza in Riyadh are recommended.

Costs of seasonal influenza vaccination in South Africa.

BackgroundInfluenza accounts for a substantial number of deaths and hospitalisations annually in South Africa. To address this disease burden, the South African National Department of Health introduced a trivalent inactivated influenza vaccination programme in 2010.MethodsWe adapted and populated the WHO Seasonal Influenza Immunization Costing Tool (WHO SIICT) with country‐specific data to estimate the cost of the influenza vaccination programme in South Africa. Data were obtained through key‐informant interviews at different levels of the health system and through a review of existing secondary data sources. Costs were estimated from a public provider perspective and expressed in 2018 prices. We conducted scenario analyses to assess the impact of different levels of programme expansion and the use of quadrivalent vaccines on total programme costs.ResultsTotal financial and economic costs were estimated at approximately USD 2.93 million and USD 7.91 million, respectively, while financial and economic cost per person immunised was estimated at USD 3.29 and USD 8.88, respectively. Expanding the programme by 5% and 10% increased economic cost per person immunised to USD 9.36 and USD 9.52 in the two scenarios, respectively. Finally, replacing trivalent inactivated influenza vaccine (TIV) with quadrivalent vaccine increased financial and economic costs to USD 4.89 and USD 10.48 per person immunised, respectively.ConclusionWe adapted the WHO SIICT and provide estimates of the total costs of the seasonal influenza vaccination programme in South Africa. These estimates provide a basis for planning future programme expansion and may serve as inputs for cost‐effectiveness analyses of seasonal influenza vaccination programmes.

Medical factors associated with caregiver intention to vaccinate their children against COVID-19

ObjectiveTo describe medical factors that are associated with caregiver intention to vaccinate their children against COVID-19. MethodsWe conducted a cross-sectional study of families receiving primary care in a mid-Atlantic pediatric healthcare system, linking caregiver-reported data from a survey completed March 19 to April 16, 2021 to comprehensive data from the child’s EHR. Results513 families were included (28% Black, 16% Hispanic, 44% public insurance, 21% rural, child age range 0–21 years). 44% of caregivers intended to vaccinate their children against COVID-19, while 41% were not sure and 15% would not. After adjusting for socio-demographics, the only medical factors that were associated with caregiver COVID-19 vaccine hesitancy were caregiver COVID-19 vaccination status at the time of the survey (aOR 3.0 if the caregiver did not receive the vaccine compared to those who did, 95% CI 1.7–5.3) and child seasonal influenza immunization history (aOR 3.3 if the child had not received the influenza vaccine in the 2020–2021 season compared to those who did, 95% CI 2.0–5.4). Other medical factors, including family medical experiences with COVID-19, other child immunization history, child health conditions like obesity and asthma, and family engagement with the healthcare system were not associated with caregiver intention to vaccinate their children against COVID-19. ConclusionsThis study highlights important factors, such as general attitudes towards vaccines and understanding of COVID-19 morbidity risk factors, that healthcare providers should address when having conversations with families about the COVID-19 vaccine.

Developing and piloting a context-specified ethics framework for health technology assessment: the South African Values and Ethics for Universal Health Coverage approach.

While ethics has been identified as a core component of health technology assessment (HTA), there are few examples of practical, systematic inclusion of ethics analysis in HTA. Some attribute the scarcity of ethics analysis in HTA to debates about appropriate methodology and the need for ethics frameworks that are relevant to local social values. The "South African Values and Ethics for Universal Health Coverage" (SAVE-UHC) project models an approach that countries can use to develop HTA ethics frameworks that are specific to their national contexts. The SAVE-UHC approach consisted of two phases. In Phase I, the research team convened and facilitated a national multistakeholder working group to develop a provisional ethics framework through a collaborative, engagement-driven process. In Phase II, the research team refined the model framework by piloting it through three simulated HTA appraisal committee meetings. Each simulated committee reviewed two case studies of sample health interventions: opioid substitution therapy and either a novel contraceptive implant or seasonal influenza immunization for children under five. The methodology was fit-for-purpose, resulting in a context-specified ethics framework and producing relevant findings to inform application of the framework for the given HTA context. The SAVE-UHC approach provides a model for developing, piloting, and refining an ethics framework for health priority-setting that is responsive to national social values. This approach also helps identify key facilitators and challenges for integrating ethics analysis into HTA processes.

Type 1 Diabetes Patients' Practice, Knowledge and Attitudes towards Influenza Immunization.

Diabetic patients are at higher risk of developing infectious diseases and severe complications, compared to the general population. Almost no data is available in the literature on influenza immunization in people with type 1 diabetes mellitus (T1DM). As part of a broader project on immunization in diabetic patients, we conducted a cross-sectional study to: (i) report on seasonal influenza coverage rates in T1DM patients, (ii) explore knowledge, attitudes, and practices (KAPs) towards seasonal influenza in this population, and (iii) identify factors associated with vaccine uptake, including the role of family doctors and diabetologists. A survey was administered to 251 T1DM patients attending the Diabetes Clinic at San Raffaele Research Hospital in Milan, Italy and individual-level coverage data were retrieved from immunization registries. Self-reported seasonal influenza immunization coverage was 36%, which decreased to 21.7% when considering regional immunization registries, far below coverage target of 75%. More than a third (36.2%) of T1DM patients were classified as pro-vaccine, 30.7% as hesitant, 17.9% as uninformed, and 15.1% as anti-vaccine. Diabetologists resulted to be the most trusted source of information on vaccines’ benefits and risks (85.3%) and should be more actively involved in preventive interventions. Our study highlights the importance of developing tailored vaccination campaigns for people with diabetes, including hospital-based programs involving diabetes specialists.

Faktori povezani sa imunizacijom protiv sezonskog gripa među osobama sa hroničnim bolestima

Annually, at a global level, 3 to 5 million people present severe clinical forms of seasonal influenza and up to 650 000 people die of influenza-related complications. People with chronic diseases, such as cardiovascular, pulmonary, renal, hepatic, neurologic, hematologic and metabolic diseases or those reciveing immunosuppressive therapy, constitute a high-risk population group for the development of influenza-related complications, more severe clinical course and poorer health-related outcomes. Due to all of the above, people with chronic diseases are of high priority to receive the influenza vaccine. Immunization represents the key strategy to prevent influenza both in terms of effectiveness and health care costs. Based on the World Health Organization (WHO) recommendations, adequate seasonal influenza immunization coverage among people with chronic diseases is set at 75%. However, few countries achieve this threshold. Understanding predictive factors of vaccination, at different levels of health care delivery (such as individuals, service providers, health policy), is essential to secure acceptance of influenza immunization and achieve the recommended level of vaccination coverage. In this mini review, all the available evidence regarding seasonal influenza vaccination coverage is summarized, alongside factors associated with vaccine uptake in people with chronic diseases as a whole, as well as according to specific diseases such as: cardiovascular and pulmonary disorders, diabetes and cancer. Based on the reviewed empirical evidence, a wide spectrum of factors associated with immunization against influneza was found in people who have chronic diseases. Although diverse, these factors can be systematized into 4 distinctive groups: socio-demographic characteristics, individual attitudes and beliefs, health promoting behaviors and factors related to the health care system. Further efforts are needed to improve the seasonal influenza vaccination coverage. The immunization strategy needs to include the health care system and the community to support people with chronic diseases to continously accept the influenza vaccine.

The Effects of Imprinting and Repeated Seasonal Influenza Vaccination on Adaptive Immunity after Influenza Vaccination.

(1) Background: The influenza virus continues to cause significant annual morbidity and mortality. The overall efficacy of seasonal influenza vaccination is suboptimal, which is partly due to host immune factors. The effects of imprinting and repeated seasonal influenza vaccination were investigated to assess for immune factors and mechanisms that impact influenza vaccine responses. (2) Methods: Twenty participants were enrolled into a prospective pilot study based on birth cohort and seasonal influenza immunization history. Immunologic parameters were assessed over a six-month period after the seasonal influenza vaccine was administered. (3) Results: There was no significant imprinting effect, as measured by hemagglutination inhibition (HAI) fold change, HAI geometric mean titer (GMT) for Day 29 or Day 180 post-vaccination and antigen- specific antibody-secreting cells (ASC) for Day 8 post-vaccination. Individuals who had minimal prior seasonal influenza vaccination had a higher magnitude ASC response and a higher HAI fold change post-vaccination than individuals who were repeatedly vaccinated. (4) Conclusions: Repeated seasonal influenza vaccination resulted in a decreased fold change of the immune response, although individuals in this cohort tended to have high HAI titers at baseline that persisted after vaccination. Imprinting effects were not observed in this cohort. These host immune factors should be considered in the development of universal influenza vaccines. ClinicalTrials.gov Identifier: NCT03686514.

A Campaign to Improve Seasonal Influenza Immunization Compliance in a University Nursing Health and Wellness Clinic: A Case Study

Seasonal influenza can result in enormous physical and economic burdens. Healthy People 2020 report that substantially fewer than the recommended 70% in most age groups actually receive the immunization (Bekkat-Berkani &amp; Romano-Massotti, 2018). The purpose of this study was to ascertain whether the WTAMU Nursing Health and Wellness Clinic seasonal flu campaign was considered effective and advantageous to those who received it on campus. A brief survey was developed for distribution to those who received the influenza immunization during the 2018-2019 flu seasons. Making the flu vaccine convenient and inexpensive/free has been an effective mechanism to improve immunization acceptance in our community. Response rate for the survey was 61% or 106 individuals with 44%, reporting that they would not have sought out the seasonal flu immunization had it not been made available on the university campus. More importantly, when the 106 participants were asked where on campus they received their immunization, only 41% physically came to the nursing clinic, while 59% were provided the vaccine in their office or departmental workplace. Of those individuals receiving immunization in their office or workplace, 38% reported that had it not been provided in this setting, they would not have gone to the nursing clinic or elsewhere to be immunized. Of those responding to the survey, 61% reported having received an influenza immunization during the 2017-2018 seasons. The remaining 39% of respondents either could not recall or denied receiving the vaccine. However, when asked about their intentions to be immunized in the 2019-2020 season, 90% of the participants related positive intention to receive the seasonal flu immunization.

Influenza vaccination and absenteeism among healthy working adults: a cost-benefit analysis.

Seasonal influenza is a highly contagious infection that might lead to serious clinical complications and incurs a conspicuous socio-economic impact. Influenza vaccination is currently recommended only for specific groups of healthy adults (such as healthcare workers) even though it was demonstrated to be effective in reducing absenteeism and decreased workers' productivity during flu epidemic period. The main purpose of this study is to analyse the extent of absences due to illness following a voluntary flu immunization program among the Komatsu Italia Manufacturing company's personnel during the flu season 2017-2018. Secondly, we aimed at performing a cost-benefit analysis of the vaccination campaign from the company's perspective. This is an observational cohort study conducted during the period between the 14th week of 2017 and the 13th week of 2018 (from 03/04/2017 to 01/04/2018). The study population was the personnel of Komatsu Italia Manufacturing S.p.A. on duty during the study period. For each subject the following data were collected: sex, date of birth, professional profile, seasonal influenza immunization status and sick-leave days. Sick-leave days were compared among the influenza epidemic period and the previous one between vaccinated and unvaccinated and any difference in days of absence was considered to be caused by seasonal influenza. Out of 408 employees, 60 (14.7%) accepted the voluntary influenza vaccination. In multivariate analysis (logistic model) an age ≥ 50 years was the only predictor for vaccination acceptance (ORM 3.11 p<0.001). During the flu period, the monthly mean of sick-leave days per employee was significantly lower among the vaccinated than the unvaccinated, respectively of 0.328 days/person vs 0.752 days/person (p = 0.022). Unvaccinated employees reported a higher average of sick-leave days during the flu period compared to the previous non-influenza period (0.752 days/month/person vs 0.337 days/month/person p <0.001). The monthly mean cost for sickness absences per employee was significantly higher for an unvaccinated subject compared to one vaccinated, respectively € 129.00 and € 54.00 (p = 0.028). The overall net saving estimated was € 314.00 per person vaccinated. Influenza vaccination proved to be an extraordinary preventive tool and a cost-effective intervention. However, influenza immunization seems to be unappealing among healthy adults and higher flu vaccination coverages could be achieved through educational interventions possibly addressing young employees who showed little interest in vaccination. Finally, among health promotion interventions, companies should point out the importance of flu vaccination both for the individual wellbeing and the company environment.

Patients’ attitudes toward seasonal influenza immunization

Introduction. Immunization is an important measure in the prevention of diseases that can seriously endanger health of the population. The aim of the study was to determine the attitudes of the adult population toward seasonal influenza immunization. Material and Methods. This cross-sectional prospective study including 160 adult subjects of both sexes was conducted from November 15, 2019 to December 15, 2019 at the General Medicine Department of the ?Liman? Health Center, Novi Sad, Serbia. The respondents filled out a questionnaire, specifically designed for this purpose. The collected data were used to analyze the influence of gender, age and employment status on personal attitudes toward seasonal influenza immunization. Results. The study included 160 examinees, 74 (46.2%) men and 86 (53.8%) women, average age of 63 years. There were 88 (55%) employed and 72 (45%) unemployed participants. Of 160 participants, 113 (72.4%) had a positive attitude toward vaccination, 20 (12.8%) had a negative attitude, while 23 (14.7%) respondents were undecided. No statistically significant difference was established between the sexes in attitudes toward immunization. Vaccination coverage was higher in unemployed compared to employed subjects (75% vs. 59.1%; p &lt; .05). Unemployed respondents were more regularly vaccinated than the employed examinees (66.1% vs. 46.7%; p &lt; .05). Conclusion. Higher vaccination coverage rates for planned immunizations against seasonal influenza can be achieved through better promotion strategies and health education of the population.