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      Influenza Vaccination Hesitancy among Healthcare Workers in South Al Batinah Governorate in Oman: A Cross-Sectional Study

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          Abstract

          Background: Seasonal influenza infections are a major cause of morbidity and mortality worldwide. Healthcare workers (HCWs) are an important target group for vaccination against influenza due to their increased risk of infection and their potential to transmit the infection to their patients, families and communities. The aim of this study was to assess the potential hesitancy and its associated factors towards influenza vaccination amongst HCWs in the South Al Batinah governorate in Oman. Methods: A cross-sectional survey of 390 HCWs with direct or indirect patient contact was conducted in May and June 2019 using a self-administered questionnaire. Associations between HCW characteristics and vaccination status were examined using bivariate and multivariate analyses to identify the likelihood of vaccination against seasonal influenza among HCWs. Results: Overall, 60% of HCWs were vaccinated in the 2018/2019 season; vaccine uptake among nurses was 52% and uptake was higher among women. Self-protection and protection of the community were the most cited reasons for vaccine acceptance, with side effects being the main reason for hesitancy. Vaccinated respondents had a higher mean knowledge score (7.18; standard deviation SD: 2.14) than unvaccinated respondents (6.30; SD: 2.2). Odds of vaccination were highest among respondents who believed influenza vaccine should be mandatory for HCWs (Odds ratio (OR): 2.04 [1.30–3.18]), those working in the general medicine, emergency medicine, or intensive care units (OR: 1.92 [1.20–3.10]), nurses and doctors (OR: 1.75 [1.09–2.79]) and those who believe that HCWs should receive an influenza vaccine (OR: 1.35 [1.07–2.77]). Conclusions: The study provides valuable insights into the enablers and barriers of influenza vaccination practices among HCWs and may inform interventions to increase acceptance of vaccination.

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          Estimates of global seasonal influenza-associated respiratory mortality: a modelling study

          Estimates of influenza-associated mortality are important for national and international decision making on public health priorities. Previous estimates of 250 000-500 000 annual influenza deaths are outdated. We updated the estimated number of global annual influenza-associated respiratory deaths using country-specific influenza-associated excess respiratory mortality estimates from 1999-2015.
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            Vaccine hesitancy and healthcare providers.

            While most people vaccinate according to the recommended schedule, this success is challenged by individuals and groups who delay or refuse vaccines. The aim of this article is to review studies on vaccine hesitancy among healthcare providers (HCPs), and the influences of their own vaccine confidence and vaccination behaviour on their vaccination recommendations to others. The search strategy was developed in Medline and then adapted across several multidisciplinary mainstream databases including Embase Classic & Embase, and PschInfo. All foreign language articles were included if the abstract was available in English. A total of 185 articles were included in the literature review. 66% studied the vaccine hesitancy among HCPs, 17% analysed concerns, attitudes and/or behaviour of HCPs towards vaccinating others, and 9% were about evaluating intervention(s). Overall, knowledge about particular vaccines, their efficacy and safety, helped to build HCPs own confidence in vaccines and their willingness to recommend vaccines to others. The importance of societal endorsement and support from colleagues was also reported. In the face of emerging vaccine hesitancy, HCPs still remain the most trusted advisor and influencer of vaccination decisions. The capacity and confidence of HCPs, though, are stretched as they are faced with time constraints, increased workload and limited resources, and often have inadequate information or training support to address parents' questions. Overall, HCPs need more support to manage the quickly evolving vaccine environment as well as changing public, especially those who are reluctant or refuse vaccination. Some recommended strategies included strengthening trust between HCPs, health authorities and policymakers, through more shared involvement in the establishment of vaccine recommendations.
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              Factors associated with uptake of vaccination against pandemic influenza: A systematic review

              In June 2009 a global influenza pandemic was declared by the World Health Organisation. A vaccination programme against H1N1 influenza was introduced in many countries from September 2009, but there was low uptake in both the general population and health professionals in many, though not all, countries. To examine the psychological and demographic factors associated with uptake of vaccination during the 2009 pandemic. A systematic literature review searching Web of Science and PubMed databases up to 24 January 2011. 37 articles met the study inclusion criteria. Using the framework of Protection Motivation Theory the review found that both the degree of threat experienced in the 2009 pandemic influenza outbreak and perceptions of vaccination as an effective coping strategy were associated with stronger intentions and higher uptake of vaccination. Appraisal of threat resulted from both believing oneself to be at risk from developing H1N1 influenza and concern and worry about the disease. Appraisal of coping resulted from concerns about the safety of the vaccine and its side effects. There was evidence of an influence of social pressure in that people who thought that others wanted them to be vaccinated were more likely to do so and people getting their information about vaccination from official health sources being more likely to be vaccinated than those relying on unofficial sources. There was also a strong influence of past behaviour, with those having been vaccinated in the past against seasonal influenza being more likely to be vaccinated against pandemic influenza. Demographic factors associated with higher intentions and uptake of vaccination were: older age, male gender, being from an ethnic minority and, for health professionals, being a doctor. Interventions designed to increase vaccination rates could be developed and implemented in advance of a pandemic. Strategies to improve uptake of vaccination include interventions which highlight the risk posed by pandemic influenza while simultaneously offering tactics to ameliorate this risk (e.g. vaccination). Perceived concerns about vaccination can be tackled by reducing the omission bias (a perception that harm caused by action is worse than harm caused by inaction). In addition, interventions to increase seasonal influenza vaccination in advance of a future pandemic may be an effective strategy. Copyright © 2011 Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                Vaccines (Basel)
                Vaccines (Basel)
                vaccines
                Vaccines
                MDPI
                2076-393X
                06 November 2020
                December 2020
                : 8
                : 4
                : 661
                Affiliations
                [1 ]Office of Health Affairs, Ministry of Health, P.O. Box 393, PC 100 Muscat, Oman
                [2 ]Directorate of Health Services, South Batinah Governorate, Ministry of Health, Oman, P.O. Box 543, PC 329 Rustaq, Oman; almayahi96@ 123456hotmail.com
                [3 ]Faculty of Medicine, Center for Infectious Diseases Research, American University of Beirut, 1107 2020 Beirut, Lebanon; malakkaddoura94@ 123456gmail.com
                [4 ]Department of Experimental Pathology, Faculty of Medicine, Immunology & Microbiology, American University of Beirut, 1107 2020 Beirut, Lebanon
                [5 ]Department of Public Health Medicine, University of KwaZulu Natal, Durban PC 4051, South Africa; ozayr411@ 123456gmail.com
                [6 ]Faculty of Public Health, Lebanese University, Fanar, P.O. Box 6573/14 Badaro, Lebanon; nathalie.lahoud@ 123456hotmail.com
                [7 ]World Health Organization Regional Office for the Eastern Mediterranean, Cairo 11371, Egypt; abubakara@ 123456who.int
                Author notes
                [* ]Correspondence: salah.awaidy@ 123456gmail.com (S.T.A.A.); hz34@ 123456aub.edu.lb (H.Z.); Tel.: +968-99315063 (S.T.A.A.); +961-350000 (H.Z.)
                Author information
                https://orcid.org/0000-0002-4456-3177
                https://orcid.org/0000-0001-8076-0453
                https://orcid.org/0000-0002-5131-5518
                https://orcid.org/0000-0003-3807-6409
                Article
                vaccines-08-00661
                10.3390/vaccines8040661
                7712351
                33172064
                50bf9484-cd8f-4e7a-91dd-e2987ad0c4ef
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 06 October 2020
                : 29 October 2020
                Categories
                Article

                hesitancy,influenza,vaccination,uptake,healthcare workers,oman
                hesitancy, influenza, vaccination, uptake, healthcare workers, oman

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