Impact of COVID-19 pandemic on flu vaccine uptake in healthcare workers in Europe: a systematic review and meta-analysis

ABSTRACT

Introduction

Influenza immunization policies in Europe primarily target at-risk and vulnerable subjects. Healthcare workers (HCWs) are a key focus of vaccination campaigns. Our systematic review and meta-analysis aim to evaluate the role of the COVID-19 pandemic on influenza vaccine uptake among HCWs since the 2020/21 influenza season.

Areas covered

Fourteen studies were included in the meta-analysis and systematic review, selected from scientific articles available in MEDLINE/PubMed, ISI Web of Knowledge, and Scopus databases between 1 January 2021 and 15 January 2023 The analysis revealed a significant relationship between influenza vaccine uptake and COVID-19 related determinants, such as willingness to receive COVID-19 vaccination, fear of COVID-19, and differentiating between influenza and COVID-19 symptoms (OR = 5.70; 95%CI = 2.08–15.60). Several studies reported higher vaccination coverages in the 2020/21 season compared to previous seasons, with VC values ranging from + 17% to + 38% compared to the 2019/20 season. The included studies identified a shift in HCWs’ attitudes toward influenza vaccination, attributed to increased awareness due to the COVID-19 pandemic.

Expert opinion

Vaccine hesitancy is common among HCWs in Europe, necessitating mutual strategies across all European countries. So far, mandatory vaccination policies have shown the most potential in achieving high and sustainable influenza vaccination rates among HCWs.

KEYWORDS:

• Healthcare workers
• vaccine compliance
• influenza
• nosocomial infection
• mandatory vaccination
• SARS-CoV-2

Article highlights

• HCWs are among the at-risk categories for whom influenza vaccination is strongly recommended

• vaccination protects HCWs from occupational infectious diseases and patients from the risk of infection

• Since the 2020/21 season, influenza seasons have been characterized by the co-circulation with SARS-CoV-2

• Our study evaluates the role of COVID-19 pandemic on influenza vaccine attitude.

• A significant relationship was evidenced between flu vaccine uptake and the COVID-19 related determinants [uptake or willingness to receive COVID-19 vaccination, fear of COVID-19, and differential diagnosis between influenza and COVID-19 symptoms].

• The scenario of management strategies for hesitant individuals is very difficult

• VCs reached in the 2020/21 season were higher than in previous seasons.

• None of the reported experiences proved to meet an optimal target

• Mandatory strategy seems to be necessary to deal with low uptake

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or material discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or mending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

FPB and ST conceived the study. NS and DR did the literature research. FPB did the meta analysis. EC and AD participated in the design of the meta analysis. GM supervisioned the meta analysis. FPB and ST codrafted the first version of the article.

Additional information

Funding

The study was funded by Puglia Region.