Exploring vaccination coverage and attitudes of health care workers towards influenza vaccine in Cyprus.

Seasonal influenza is a major public health problem. Nosocomial influenza is particularly concerning as it may affect patients at high risk for complications. Unvaccinated health care workers (HCWs) are an important source of nosocomial influenza and therefore a priority target group for vaccination. Despite the fact that some European countries have high coverage rates such as UK (76.8% in season 2020/21), others continue to have low coverage rates for influenza vaccines. This study aims to estimate vaccination coverage in HCWs in Cyprus, an island country located in the Eastern Mediterranean region and describe their attitudes towards influenza vaccination. This is a questionnaire based, nation-wide study assessing flu vaccination coverage in 2019-2020 and attitudes related to vaccination acceptance, of 962 HCWs in both public and private health care facilities. Multivariable logistic regression was used to investigate factors associated with flu vaccination status. Flu vaccination coverage was estimated as 31.8%. The top two reasons for getting vaccinated were to protect their family (81.4%) and themselves (77.4%). The top two reasons for not getting immunised, besides "no particular reason" (25.7%), included disbelief for vaccine effectiveness (21.5%) and safety (29.3%). The regression model showed that doctors compared to nurses had 10 times the odds of being vaccinated. Other factors positively associated with flu vaccination were encouragement by the supervisor, having sufficient knowledge on flu and flu vaccination and easy access to vaccination. A percentage of 54.8% of participants stated that COVID-19 pandemic strongly or somewhat influenced their decision to get vaccinated. Flu vaccination coverage in HCWs in Cyprus is rather low, similar to some other European countries. Barriers and facilitators in this study can be considered in strategies to increase flu vaccination uptake. Such questionnaire-based surveys should be repeated in order to evaluate effectiveness of targeted vaccination campaigns.

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Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.