The double-edged impacts of COVID-19 epidemic on influenza vaccination uptake in nurses in Hong Kong

Abstract

Background

Worldwide, the COVID-19 pandemic has disrupted influenza seasonality and impacted influenza vaccination behaviours. This study examines the patterns of influenza vaccination uptake in nurses during the pre-pandemic seasons and amidst the pandemic in 2020/21 in subtropical Hong Kong.

Methods

In April 2021, a cross-sectional survey was conducted in practising and student nurses. Six patterns were differentiated by their influenza vaccination status in 2020/21 and preceding five seasons: (a) resistance throughout, (b) negative change, (c) decreased tendency, (d) increased tendency (e) positive change, and (f) adherence throughout. Participants’ characteristics and reasons for vaccination/non-vaccination and their associations with each vaccination pattern were explored using multivariable multinomial regression.

Results

Among 1323 nurses (88% female with a median age of 39 years), no substantial change in vaccination uptake was noted from 2019/20 (41%) to 2020/21 (42%). Some 4% were positive-changers who were older at age of ≥50 years (aOR 4.77) and more likely to anticipate a reduced risk of severe disease with COVID-19/influenza co-infection following vaccination (aOR 8.76). Negative-changers made up 3% and were more inclined to perceive an unlikelihood of widespread influenza outbreaks amidst the pandemic (aOR 3.67). Some 26 and 43% remained adherent and resistant to influenza vaccination throughout respectively notwithstanding the COVID-19 outbreak.

Conclusions

In contrast to the increased uptake elsewhere, the stable influenza vaccination coverage among nurses in Hong Kong could be explained by the ubiquity of strict physical distancing regulations, which have deterred vaccination in some nurses that offsets the new uptakes induced by the mild COVID-19 outbreaks.

Keywords:

• Influenza
• COVID-19
• vaccination
• epidemic
• nurse

Acknowledgement

The authors thank Ms. Mandy Li for her assistance in data collection. We appreciated the logistic support provided by the staff of The Association of Hong Kong Nursing Staff, while their members are also thanked for their participation in this study. Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong is acknowledged for rendering technical support throughout the study. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author contributions

Conceptualisation: CP Chan, NS Wong; Data acquisition and curation: CP Chan; Formal analysis: CP Chan; Writing – original draft: CP Chan; Writing – review & editing: NS Wong, SS Lee; Resources: SS Lee; Supervision: SS Lee; All authors have approved the final article.

Disclosure statement

No potential conflict of interest was reported by the author(s).