Influenza Vaccine Hesitancy and Its Determinants Among Rheumatology Patients

Abstract

Objective Patients with rheumatic disease (RD) have an increased risk of influenza and its complications. Despite inactivated influenza vaccine (IIV) recommendations, IIV uptake in patients with RD is suboptimal, a problem of increasing importance in the COVID‐19 era. We estimated the frequency of IIV hesitancy and associated factors among Canadian patients with RD. Methods A cross‐sectional vaccine hesitancy survey was completed by rheumatology clinic patients (November 2019 to January 2020). Patients rated their likelihood of receiving the influenza vaccine (scale of 0‐10). We categorized these as follows: likely to refuse (scale of 0‐2), uncertain (scale of 3‐7), or likely to accept (scale of 8‐10). Multivariate logistical regression was used to evaluate factors associated with vaccine hesitancy. Results A total of 282 patients (63.5% of those approached) completed the survey, with 165 (58.5%) being likely to accept, 67 (23.8%) being likely to refuse, and 50 (17.7%) uncertain. Uncertain patients were younger and more likely to be employed than those in the other two groups. No previous influenza vaccination (odds ratio [OR] 36.6, 95% confidence interval [CI] 5.3‐252.9), belief that vaccination should not be mandatory (OR 0.1, 95% CI 0.0‐0.7), unwillingness to take time off work to be vaccinated (OR 6.8, 95% CI 1.5‐30.6), and distrust in pharmaceutical companies (OR 41.0, 95% CI 5.6‐301.5) predicted likeliness to refuse. Reluctance to pay for vaccination (OR 2.8, 95% CI 1.1‐7.5) and no previous influenza vaccination (OR 18.9, 95% CI 3.3‐109.7) predicted uncertainty. Conclusion More than 40% of rheumatology patients are either likely to refuse or uncertain about receiving IIV. This contributes to suboptimal vaccine coverage in this population. Interventions addressing these concerns are needed, particularly in the COVID‐19 era.

Understanding the Barriers and Attitudes toward Influenza Vaccine Uptake in the Adult General Population: A Rapid Review

“…Sixty-one studies reported perceived barriers to receiving an influenza vaccination in the total population ( Table 4 ) [ 16 , 17 , 19 , 21 , 22 , 23 , 24 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 40 , 41 , 43 , 45 , 46 , 47 , 48 , 49 , 50 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , …”

“…Barrier types were further assessed to determine the key factors (determined by agreement rate) across the general and unvaccinated population for not receiving an influenza vaccine. The top-five barriers to influenza vaccination, as reported by the total population compared to the unvaccinated population, are illustrated in Figure 3 [ 16 , 17 , 19 , 21 , 22 , 23 , 24 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 40 , 41 , 43 , 45 , 46 , 47 , 48 , 49 , 50 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , ...…”

“…Of the 80 publications included in this review, 64 suggested strategies to overcome barriers and increase uptake of the influenza vaccine [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 38 , 39 , 40 , 41 , 42 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 58 , 59 , 60 , 61 , 62 , 64 , 65 , 67 , 68 , 69 , 70 , 72 , 73 , 75 , 76 , 78 ,…”

“…Despite recommendations, vaccinating this population has a substantial impact on preventing the spread of influenza to older adults (>65 years) and pediatric populations and should be taken into consideration [ 106 , 107 ]. From a wide geographical perspective, it was noted that healthcare systems should aim to overcome this attitude towards vaccination by encouraging the promotion of influenza vaccination by healthcare professionals, increasing the volume of education programs, and improving public knowledge of vaccination safety and efficacy [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 38 , 39 , 40 , 41 , 42 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 58 , 59 , 60 , 61 , 62 , 64 , 65 , 67 , 68 , 69 , 70 ...…”

The 2022 ACR vaccination guideline: a call-to-action

“…In addition to the recent vaccination guidelines, understanding the barriers to vaccine uptake from the perspective of individuals with RMDs, and implementing specific strategies to address them is crucial 8 , 9 . Vaccine-hesitancy, vaccine-avoidance and vaccine-refusal have increased since the COVID-19 pandemic and are amplified by misinformation promoted by social media platforms 10 .…”