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Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Background: Influenza during pregnancy may cause serious neonatal outcomes including stillbirth, fetal distress, preterm birth, congenital abnormalities, and stunted growth. Pregnant women are the highest priority group for seasonal influenza vaccination, but low coverage has been repeatedly reported in this population. Understanding reasons for and for not receiving the seasonal influenza vaccine is needed to design communication strategies to increase vaccination coverage. This study aimed to describe knowledge, attitudes, and practices (KAP) of seasonal influenza vaccination among women giving birth in public maternity hospitals in Honduras., Methods: From August 20-October 8, 2018, we conducted a cross-sectional KAP survey regarding seasonal influenza vaccinations to a sample of postpartum women who gave birth in maternity hospitals and clinics from the Ministry of Health of Honduras and Honduran Social Security Institute. We reported frequency distributions for demographics, KAP of influenza vaccine, and vaccination coverage. We used logistic regression to analyze unadjusted and adjusted associations between sociodemographic characteristics and influenza vaccination., Results: We surveyed 842 postpartum women in 17 healthcare facilities. Of 534 postpartum women with term pregnancy and verified vaccinations, 417 (78.1%; 95% CI: 74.6-81.6%) were vaccinated for influenza. Factors associated with verified influenza vaccination included receipt of vaccination recommendations by a healthcare worker during prenatal check-ups (aOR: 16.46; 95% CI: 9.73-27.85), concurrent chronic disease (aOR: 5.00; 95% CI: 1.25-20.07), and influenza vaccination of other children in the household (aOR: 2.28; 95% CI: 1.19-4.39). The most cited reasons for vaccination were perceived benefits for both mother and infant and easy access. Reasons for non-vaccination were: vaccine was not offered and fear of side effects, harm to the infant, and needles or pain caused by injection., Conclusion: Influenza vaccination was well received among postpartum women in Honduras. Increasing clinician recommendations for vaccination and assuring the vaccine is readily available to women during prenatal visits may increase vaccination rates., Competing Interests: The authors have declared that no competing interests exist.

Background: Older adults represent 70-90% of seasonal influenza-related deaths and 50-70% of influenza-related hospitalizations. Vaccination is the most efficient means of preventing influenza and reducing influenza-related illnesses. We aimed to describe knowledge, attitudes, and practices (KAP) of seasonal influenza vaccination among older adults in Honduras., Methods: From August 29-October 26, 2018, we conducted a cross-sectional KAP survey regarding seasonal influenza vaccinations to samples of older adults 1) admitted to nursing homes and 2) attending daycare centers. We used the Minimental State Examination (MMSE) psychometric tool to assess the cognitive status of older adults and included participants with scores of ≥23 points in the survey. We reported frequency distributions for demographics, KAP of influenza virus and vaccination, and vaccination coverage. We used logistic regression to analyze associations between demographics and verified influenza vaccination., Results: Of 511 MMSE participants, 341 completed the survey (95 adults in 12 nursing homes and 246 older adults in ten daycare centers). Almost all participants knew that influenza causes severe illness and may be transmitted from person to person, vaccination is safe and protects against disease, and older adults have greater risk of complications. Of 284 participants with verified vaccinations, 81.3% were vaccinated for influenza: 87.9% attending daycare centers and 61.4% in nursing homes. Among all participants, verified current influenza vaccination was associated with self-reported influenza vaccination in previous year (aOR: 14.05; 95% CI: 5.36-36.81); no formal education (aOR: 4.83; 95% CI: 1.63-14.37) or primary school education (aOR: 4.51; 95% CI: 1.79-11.37) having ≥secondary as reference; and indigenous (aOR: 4.55; 95% CI: 1.18-17.49) having Mestizo as reference. Reasons for vaccination were perceived self-benefits, protection against influenza complications, favorable vaccination hours, and healthcare provider recommendations., Conclusion: Four-fifths of older adults were vaccinated for seasonal influenza. Educational efforts provided in conjunction with vaccination campaigns resulted in high knowledge of influenza virus, transmission, and vaccination. Further outreach regarding disease risks and vaccine safety needs to be directed towards older adults in nursing homes who had lower knowledge and coverage than older adults in daycare centers., Competing Interests: The authors have declared that no competing interests exist.

Background: Seasonal influenza is a highly contagious vaccine-preventable disease that may cause high morbidity and mortality in susceptible populations. Healthcare workers are a priority group for seasonal influenza vaccination to protect them from contracting influenza and prevent nosocomial transmission to patients. This study aimed to evaluate knowledge, attitudes, and practices (KAP) of seasonal influenza vaccination among healthcare workers in Honduras., Method: From August 24 to October 21, 2018, we conducted a cross-sectional KAP survey regarding seasonal influenza vaccination to a random sample of healthcare workers who attended patients in hospitals of the Ministry of Health of Honduras (SESAL) and Honduran Social Security Institute (IHSS). We reported frequency distributions of demographics, vaccination KAP, sources of information, and reasons for non-vaccination. We used principal components factor analysis to create knowledge and attitude scores. We used linear regression to analyze associations between demographics and sources of information about the influenza vaccine, and knowledge and attitude scores. We used logistic regression to analyze associations between demographics, sources of information, knowledge scores, and attitude scores, and influenza vaccination., Result: We surveyed 947 healthcare workers who attended patients in 13 SESAL hospitals and two IHSS hospitals. Only 4.6% of participants knew the seasonal influenza vaccine was composed of inactivated viruses, 94.7% believed vaccination causes flu-like symptoms, and 52.0% were vaccinated for influenza in 2018. Knowledge scores were lower for nursing assistants and other healthcare professionals compared to doctors, and higher for healthcare workers who attended a healthcare facility training (P-values≤0.030). Attitude scores were higher for healthcare workers who attended ≥11 patients per day having ≤10 patients per day as reference, self-reported influenza vaccination in previous year, and cited trainings and informal information at the healthcare facility as sources of information for influenza vaccination (P-values≤0.030). Factors associated with self-reported vaccination were self-reported influenza vaccination in previous year (aOR: 7.61; 95% CI: 5.24-11.04), attitude score (aOR: 1.14; 95% CI: 1.07-1.21), and worked in a SESAL hospital (aOR: 1.73; 95% CI: 1.12-2.68) having IHSS as reference., Conclusion: Although influenza vaccination is required by law in Honduras and available for free in public health centers, coverage of healthcare workers in 2018 was half that reported in 2017. Lower coverage may be attributed to misconceptions of vaccination side effects., Competing Interests: The authors have declared that no competing interests exist.