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Abstract Background In Italy, since the 2020–2021 flu season, the flu vaccine recommendation was extended to all children aged 6 months to 6 years and quadrivalent Live-Attenuated Influenza Vaccine (qLAIV) was introduced. Since school-aged children are important carriers of annual influenza epidemics, a school-based influenza vaccination program may potentially increase vaccine uptake. Recent studies, conducted in the UK and the US, show that school-based vaccination can reach higher percentage of paediatric vaccination coverage compared to children vaccinated in other settings. Methods During 2022–2023 flu season in 9 preschools located in Milan healthcare personnel vaccinated children with qLAIV at the end of a school day. A Google Form questionnaire was administered to preschoolers’ parents of all preschools within the Municipality of Milan. Results In the preschools engaged in the vaccination program, 233 out of 1939 children were vaccinated (12%). Among these, 61 (26.2%) had never been vaccinated for influenza before. Vaccination coverage was 11.5% for Italian children and 14.3% for children coming from an immigrant background. We collected 3659 questionnaire responses, divided according to study participation status (371 from preschools that participated in the vaccination program and 3288 from other preschools in Milan). 57% of the families who answered to the questionnaire vaccinated their children for flu. qLAIV accounted for 85.6% of vaccinations. We observed a statistically significant difference in the percentage of vaccinated children between those attending a school participating in the project (67.9%) and children attending other schools (56%) (p

Background: In Italy, since the 2020–2021 flu season, the flu vaccine recommendation was extended to all children aged 6 months to 6 years and quadrivalent Live-Attenuated Influenza Vaccine (qLAIV) was introduced. Since school-aged children are important carriers of annual influenza epidemics, a school-based influenza vaccination program may potentially increase vaccine uptake. Recent studies, conducted in the UK and the US, show that school-based vaccination can reach higher percentage of paediatric vaccination coverage compared to children vaccinated in other settings. Methods: During 2022–2023 flu season in 9 preschools located in Milan healthcare personnel vaccinated children with qLAIV at the end of a school day. A Google Form questionnaire was administered to preschoolers' parents of all preschools within the Municipality of Milan. Results: In the preschools engaged in the vaccination program, 233 out of 1939 children were vaccinated (12%). Among these, 61 (26.2%) had never been vaccinated for influenza before. Vaccination coverage was 11.5% for Italian children and 14.3% for children coming from an immigrant background. We collected 3659 questionnaire responses, divided according to study participation status (371 from preschools that participated in the vaccination program and 3288 from other preschools in Milan). 57% of the families who answered to the questionnaire vaccinated their children for flu. qLAIV accounted for 85.6% of vaccinations. We observed a statistically significant difference in the percentage of vaccinated children between those attending a school participating in the project (67.9%) and children attending other schools (56%) (p < 0.001). Vaccination was administered by family pediatricians (48.9%), in vaccination centers (34.8%), in vaccine hubs (11.3%), in schools (2.6%), by private pediatricians (1.6%) and in other settings (0.7%). Focusing on the responses from families whose children attend schools participating in the vaccination program, 21.8% stated that the vaccination was provided in school. Conclusion: According to our experience, in Italy, at the moment, only the cooperation between health providers and alternative settings, including schools, may expand flu vaccination coverage. In particular, schools are to be considered a place to inform and reach out to families, useful to increase vaccination coverage. [ABSTRACT FROM AUTHOR]

Introduction. In the 2023-2024 cold season in Romania, there have been legislative changes regarding influenza immunization, with the aim of purchasing influenza vaccine by the patient on the basis of a doctor’s prescription. Objective. To track the impact of the change in legislative norms regarding the flu immunization rate through family doctors in Mureș County, Romania. Materials and method. In 29 March 2024, we made a questionnaire, with 11 questions, at which 30 family physicians from Mureş County answered. Results. In terms of influenza immunization of the surveyed doctors, 53% of the respondents were immunized and 47% of them did not opt for their own immunization. Regarding the rate of influenza vaccination, through legislative changes, 16.67% of doctors believe that the vaccination rate has increased, but 56.66% do not consider changes in the immunization rate, and at the opposite pole, 26.66% of the respondents were undecided. Conclusions. Legislative changes aimed at facilitating the population’s access to vaccination may influence the rate of flu immunization. Among the doctors interviewed, a reserved attitude towards flu immunization can be noted, which may impact the overall flu vaccination rate [ABSTRACT FROM AUTHOR]

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We examined the role of health literacy on preventive care among college students and assessed individual health literacy skills from a theory-based multidimensional perspective using both subjective and objective measures. Participants (n = 561) completed our online survey with valid responses. Data collection was conducted from April to June 2020. We assessed participants’ health literacy using different measures, including Health Insurance Literacy Measure (HILM), eHealth Literacy Scale (eHEALS), All Aspect of Health Literacy Scale (AAHLS), and the Newest Vital Sign (NVS). The first three were subjective measures. The last one was an objective test. Preventive care included annual flu vaccinations, annual routine physical examinations, blood pressure checks, blood tests for cholesterol level, and annual dental checks. We performed logistic and linear regressions to examine the relationships among individual’s preventive care use, health literacy, and other factors including age, education, gender, race/ethnicity, health insurance coverage, and self-rated health status. Age, education, gender, race/ethnicity, health insurance coverage (medical health insurance and dental insurance), and self-rated health status predicted 15.42% of the variance (model R2) in the number of preventive care services received. Higher HILM, eHEALS, and AAHLS scores were significantly associated with a greater number of preventive care services received. The HILM increased the model R2 by 2.42%. The eHEALS increased the model R2 by 1.20%. The AAHLS increased the model R2 by 1.73%. We identified health insurance status, health literacy, self-related health status, age, gender, and race/ethnicity as important predictors of preventive care use.

The anticipation of regret is known to be a primary motivator of receiving a vaccination. Aim of this study is to evaluate whether the use of messages that leverage the anticipated emotion of regret can increase the intention to get the flu vaccination. The participants (N = 110) randomly received a leaflet containing a standard prevention message (control condition) or message modified to induce the anticipation of regret over not being vaccinated (experimental condition), along with a questionnaire. The experimental condition’s participants reported significantly higher levels of regret and higher intention to vaccinate than the participants in the control condition. Anticipated regret resulted to be a significant mediator of the intention to get vaccinated. Manipulating the salience of regret appears to be a simple and inexpensive way of effectively promoting preventive behaviour. The implications of this result for reducing COVID-19 vaccine hesitation are discussed.

The anticipation of regret is known to be a primary motivator of receiving a vaccination. Aim of this study is to evaluate whether the use of messages that leverage the anticipated emotion of regret can increase the intention to get the flu vaccination. The participants (N = 110) randomly received a leaflet containing a standard prevention message (control condition) or message modified to induce the anticipation of regret over not being vaccinated (experimental condition), along with a questionnaire. The experimental condition's participants reported significantly higher levels of regret and higher intention to vaccinate than the participants in the control condition. Anticipated regret resulted to be a significant mediator of the intention to get vaccinated. Manipulating the salience of regret appears to be a simple and inexpensive way of effectively promoting preventive behaviour. The implications of this result for reducing COVID-19 vaccine hesitation are discussed. [ABSTRACT FROM AUTHOR]

Background Flu can have serious consequences for pregnant woman and unborn babies. Vaccination provides safe and effective protection, yet uptake among pregnant women is below national targets. Digital interventions are effective at increasing adherence to health interventions. Aims This review aimed to establish whether digital interventions are effective at increasing rates of flu vaccination among pregnant women, and to determine the overall effect size. Method Systematic searches identified digital intervention trials, aiming to increase rate of flu vaccination among pregnant women. Random-effects meta-analysis provided a combined effect size and examined which mode of digital interventions had the largest effects on flu vaccination. Results Ten studies were included in the review. The majority of digital interventions were more effective at increasing rates of flu vaccination (7–81.3% uptake) than usual care or non-digital interventions (7.3–47.1% uptake). When meta-analysed, digital interventions had a small, non-significant effect (odds ratio [OR] = 1.29, 95% confidence interval [CI]: 0.71, 2.31), P  = 0.40. Text messages (OR = 1.25, 95% CI: 0.58, 2.67), P  = 0.57 appeared less effective than other digital interventions (OR = 1.58, 95% CI: 1.02, 2.46), P  = 0.04. Conclusions Overall, there is a lack of high-quality studies reporting the effectiveness of digital interventions at increasing flu vaccination during pregnancy. Future interventions may benefit from using video or social media to communicate messages for maximum success in targeting an increase in rates of flu vaccination in pregnancy. [ABSTRACT FROM AUTHOR]

Our aim was to examine the association between religious affiliation and the likelihood of taking the flu vaccine. Cross-sectional data (year 2014 with n = 7172) were used from the nationally representative German Ageing Survey—covering community-dwelling individuals aged 40 years and over. Multiple logistic regressions showed that compared with individuals without a religious affiliation, individuals with certain religious affiliations had a lower likelihood of taking the flu vaccine. More precisely, the likelihood of taking a flu shot was significantly associated with belonging to the Roman Catholic Church (OR: 0.50, 95% CI: 0.44–0.57), the Protestant Church (OR: 0.68, 0.60–0.77), the Evangelic Free Church (OR: 0.54, 0.35–0.82) and other religious communities (OR: 0.25, 0.14–0.45). The results remained nearly the same when we restricted our analyses to individuals aged 60 years and over (according to existing recommendations for flu vaccination). The association between religious affiliation and the likelihood of taking the flu vaccine was moderated by thoughts about religion and deeds for religion. This knowledge could help to improve the immunization coverage by addressing individuals with certain religious affiliations. [ABSTRACT FROM AUTHOR]

Objective: This study examined the association between ikigai (a Japanese concept akin to purpose in life or a rationale for existence) and use of preventive healthcare services., Methods: Data were gathered in August and September of 2023 from a quota-based sample of 5000 individuals living in Germany (18 to 74 years). This sampling ensured representation across gender, age groups, and federal states to reflect the adult population of Germany. The recently validated German version of the Ikigai-9 scale (Ikigai-9-G) was used to assess ikigai. Outcomes were regular cancer screenings, flu vaccination, and routine health check-ups. Multiple logistic regressions were used., Results: Ikigai was associated with higher odds of regular use of preventive healthcare services (regular flu vaccinations: OR = 1.01, 95 % CI: 1.002 to 1.02; regular cancer screenings: OR = 1.01, 95 % CI: 1.004 to 1.02; routine health check-ups: OR = 1.02, 95 % CI: 1.01 to 1.03), adjusting for sociodemographic, lifestyle, and health-related factors. The association between ikigai and preventive healthcare was not moderated by gender, age, or education., Conclusion: Higher ikigai is associated with preventive health measures, independent of key covariates. These findings are consistent with the literature on ikigai and better health-related outcomes and subjective well-being. Ikigai may help point to new ways to counter the low use of preventive services in Germany., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Improving vaccination rates among marginalized populations is an important priority among public policy makers and healthcare providers in the United States of America (U.S.). Racial/ethnic minorities have a long history of reduced vaccination rates relative to white Americans (Khan, Hall, Tanner, & Marlow, 2018), while people with disabilities (PWD) have varied rates of vaccine use (Diab & Johnston, 2004; O’Neill, Newall, Antolovich, Lima, & Danchin, 2019). Yet, little is known about vaccine use among individuals who belong to both groups. This study examines the intersectional effects of race/ethnicity and disability on flu vaccine use. We used the 2015–2018 National Health Interview Survey to examine the odds of flu vaccine use by race/ethnicity, disability, and their interaction among adults aged 18+ in the U.S. non-institutionalized, civilian population stratified by age groups. For each unit increase in disability scores, we found a significant race-by-disability interaction for young black adults (18–39 years) who had higher odds of getting the flu vaccine compared to white adults in the same age group. A significant interaction occurred for middle-aged Hispanic vs. white adults (40–64 years) who had higher odds of getting the flu vaccine as their disability scores increased. Black vs. white adults were less likely to get the flu vaccine across all age groups irrespective of disability and other covariates, while results were more mixed among other racial/ethnic groups. Additionally, people with disabilities had higher odds of flu vaccination. Further, race/ethnicity had a moderating effect on the relationship between disability and flu vaccination and an interaction effect occurred between disability and certain racial/ethnic groups when stratified by age.

The seasonal flu vaccine is the most important way to prevent influenza epidemics, so it is useful to increase the awareness of health professionals. The aim of our study is to evaluate knowledge, attitudes, and behavior about flu vaccination among healthcare professionals in times of COVID-19. Methods: A cross sectional study was carried out between November 2020 and April 2021. Participants were recruited in teaching hospital 'Policlinico Umberto I' of Rome. A survey of 24 questions about flu vaccination was administered, evaluating their knowledge, attitude, and practice about this topic. Results: 872 healthcare professionals were involved in the study (36.9% men, 63.1% women). More than 90% of the HCWs, especially physicians, recognize the importance of getting influenza vaccination: The main reasons for not getting vaccinated were fear of vaccine side effects (20.3%) and fear of the needle (6.4%). Nevertheless, 40.7% of the healthcare providers consider mandatory vaccination as unethical, especially if they work in low-intensity wards. Conclusion: a high percentage of healthcare workers agree with the importance of influenza vaccination and only a small percentage is still opposed. It is therefore important to continue to promote the influenza vaccination through communication and health education programs. [ABSTRACT FROM AUTHOR]

Objective: Seasonal influenza is a preventable disease that may cause high morbidity and mortality. In the USA, the 2020 influenza season overlapped with the first wave of coronavirus disease 2019 (COVID-19) pandemic. There is a dearth of research on understanding influenza vaccination uptake and attitudes towards the vaccine among marginalised communities in the USA. The aim of this study was to examine general knowledge, misconceptions about, and barriers to influenza vaccination and determine if flu education delivered via trusted messengers improved knowledge among Asian Americans. Design: Quantitative prospective pre- and post-test design. Setting: Asian American communities in Metro Detroit area, Hamtramck, and Kent County in Michigan. Method: The study started with a training event in which 26 community leaders were trained to become trusted messengers to disseminate flu education. A total of 260 Asian American participants subsequently completed pre- and post-education surveys. Results: Asian Americans in the study reported low flu vaccination rate (48.5%). Reasons varied but included access-related issues (e.g. no access and no insurance) and health literacy (did not know they needed it). After education by trusted messengers, the paired t tests measuring improvement between pre- and post-survey scores showed a significant improvement (p <.05) for all of the knowledge items. Conclusion: Educational campaigns using targeted messages to address specific barriers and acknowledge individuals' concerns regarding misconceptions while providing equitable vaccine access can be key for the successful implementation of vaccination programmes. [ABSTRACT FROM AUTHOR]

Influenza represents a threat to global health and health care workers (HCWs) have an increased risk of contracting the influenza virus in the workplace. The COVID-19 pandemic has brought back the importance of influenza vaccination, as the influenza virus can circulate together with SARS-CoV-2. The aim of this report is to describe the actual flu vaccination coverage among healthcare workers of a research hospital and the trend changes, with respect to the past flu vaccination campaigns, in light of the present pandemic and COVID-19 vaccination. A Pearson's χ2 test was used to test the correlation of flu vaccination coverage, across all professional categories, between the last two years. A linear regression model was adopted to predict the total vaccination coverage of this year. A statistically significant decrease (p < 0.01) was observed in vaccination coverage among all the professional categories with a 50% reduction in vaccination trends between the last two years. Analyzing the data from the previous six flu vaccination campaigns, the expected value, according to the linear regression model, was estimated to be 38.5% while the observed value was 24%. The decrease in vaccination coverage may be due to the fear of the pandemic situation and especially to the uncertainty related to the consequences of a concurrent administration which may overload the immune system or may be more reactogenic. The COVID-19 pandemic represents an opportunity to promote and support large-scale influenza vaccination among HCWs through structured programs, adequate funding, and tailored communication strategies. [ABSTRACT FROM AUTHOR]

Stagnating COVID-19 vaccination rates and vaccine hesitancy remain a threat to public health. Improved strategies for real-time tracking and estimation of population-level behavior regarding vaccinations are needed. The aim of this study was to evaluate whether online search trends for COIVD-19 and influenza mirror vaccination rates. State-level weekly fraction of online searches for top vaccination-related search terms and CDC vaccination data were obtained from June 1, 2020, to May 31, 2021. Next, trends in online search and vaccination data for COVID-19 and influenza were analyzed for visual and quantitative correlation patterns using Spearman's rank correlation analysis. Online searches in the US for COVID-19 vaccinations increased 2.71-fold (95% CI: 1.98-3.45) in the 4 weeks after the FDA emergency authorization compared to the precedent 4 weeks. In March-April 2021, US online searches reached a plateau that was followed by a decline of 83.3% (95% CI: 31.2%-135.3%) until May 31, 2021. The timing of peaks in online searches varied across US states. Online searches were strongly correlated with vaccination rates (r=0.71, 95% CI: 0.45 - 0.87), preceding actual reported vaccination rates in 44 of 51 states. Online search trends preceded vaccination trends by a median of 3.0 weeks (95% CI: 2.0-4.0 weeks) across all states. For influenza vaccination searches, seasonal peaks in September-October between 2016-2020 were noted. Influenza search trends highly correlated with the timing of actual vaccinations for the 2019-2020 (r=0.82, 95% CI: 0.64 – 0.93) and 2020-2021 season (r=0.91, 95% CI: 0.78 – 0.97). Search trends and real-world vaccination rates are highly correlated. Temporal alignment and correlation levels were higher for influenza vaccinations; however, only online searches for COVID-19 vaccination preceded vaccination trends. These findings indicate that US online search data can potentially guide public health efforts, including policy changes and identifying geographical areas to expand vaccination campaigns. [ABSTRACT FROM AUTHOR]

Stagnating COVID-19 vaccination rates and vaccine hesitancy remain a threat to public health. Improved strategies for real-time tracking and estimation of population-level behavior regarding vaccinations are needed. The aim of this study was to evaluate whether online search trends for COIVD-19 and influenza mirror vaccination rates. State-level weekly fraction of online searches for top vaccination-related search terms and CDC vaccination data were obtained from June 1, 2020, to May 31, 2021. Next, trends in online search and vaccination data for COVID-19 and influenza were analyzed for visual and quantitative correlation patterns using Spearman’s rank correlation analysis. Online searches in the US for COVID-19 vaccinations increased 2.71-fold (95% CI: 1.98-3.45) in the 4 weeks after the FDA emergency authorization compared to the precedent 4 weeks. In March-April 2021, US online searches reached a plateau that was followed by a decline of 83.3% (95% CI: 31.2%-135.3%) until May 31, 2021. The timing of peaks in online searches varied across US states. Online searches were strongly correlated with vaccination rates (r=0.71, 95% CI: 0.45 - 0.87), preceding actual reported vaccination rates in 44 of 51 states. Online search trends preceded vaccination trends by a median of 3.0 weeks (95% CI: 2.0-4.0 weeks) across all states. For influenza vaccination searches, seasonal peaks in September-October between 2016-2020 were noted. Influenza search trends highly correlated with the timing of actual vaccinations for the 2019-2020 (r=0.82, 95% CI: 0.64 – 0.93) and 2020-2021 season (r=0.91, 95% CI: 0.78 – 0.97). Search trends and real-world vaccination rates are highly correlated. Temporal alignment and correlation levels were higher for influenza vaccinations; however, only online searches for COVID-19 vaccination preceded vaccination trends. These findings indicate that US online search data can potentially guide public health efforts, including policy changes and identifying geographical areas to expand vaccination campaigns.

Aim of the study: The impact of annual flu vaccination on the patients' clinical course with COVID‐19 and the outcome were tested. Methods: A total of 149 patients with COVID‐19‐positive admitted from March 20 to May 10, 2020, were retrospectively enrolled. Results: Ninety‐eight (65.8%) patients received at least a single annual flu shot in the last year, and fifty‐one (34.2%) were never vaccinated. On presentation, vaccinated patients were more likely to present with gastrointestinal symptoms (P <.05). There were no significant differences between study groups in laboratory findings or clinical outcomes. In multivariate analysis, receiving the annual shot did not influence risk of intensive care unit admission (OR = 1.17, 95%CI = 0.50‐2.72, P =.72), intubation (OR = 1.40, 95%CI = 0.60‐3.23, P =.43), complications (OR = 1.08, 95%CI = 0.52‐2.26, P =.83) or mortality (OR = 1.29, 95%CI = 0.31‐5.29, P =.73). Conclusion: Although the benefits of the influenza vaccine for preventing disease and reducing morbidity in influenza patients are well established, no differences in outcomes for hospitalised patients with COVID‐19 who received their annual influenza vaccination versus the non‐vaccinated cohort were evident. There is a need for future meta‐analyses, including randomised controlled studies in which the number of cases is increased to validate these findings. [ABSTRACT FROM AUTHOR]

Flu, while seemingly harmless, is actually much more dangerous. These include ubiquity, high contagiousness and the possibility of serious complications. The flu is associated with serious complications, especially in pregnancy. It includes increased rates of miscarriage, stillbirths, neonatal deaths, premature births, and decreased birth weight. The flu vaccine is an effective and safe preventive measure.According to WHO anti-flu vaccine is recommended to women in any trimester of the pregnancy. Research shows that vaccination during pregnancy is safe and does not cause foetal or maternal complications. Moreover, maternal antibodies cross the placenta and can protect infant against influenza up to 6 months. The most common reasons for refusing vaccines by pregnant women are hesitations and fear of adverse pregnancy outcome. Due to that it is important to increase the society’s awareness about flu complications during pregnancy as well for women and for children. Successful immunization of the society requires improving its vaccination behaviour and can benefit in reducing frequency of adverse pregnancy outcomes.

Abstract Background Pregnant women and their unborn babies are at increased risk of complications as a result of flu, yet uptake of the flu vaccination in the UK remains low. Digital interventions have proven effectiveness in changing health behaviour, but their effectiveness in increasing flu vaccination amongst pregnant women has not been examined. This protocol details the design and methodology of a systematic review and meta-analysis, examining the effectiveness of digital interventions in increasing flu vaccination amongst pregnant women. Methods Bibliographic databases will be searched using appropriate search terms related to vaccination, pregnancy and flu. Randomised, non-randomised, quasi randomised controlled trials and other quantitative study designs will be eligible for inclusion, and studies will present the rate of flu vaccination amongst pregnant women of digital interventions compared to non-digital interventions, or usual care. No date or study country restrictions will be put on included studies, but studies will be published in English. Discussion This is the first known systematic review to examine the effectiveness of digital interventions in increasing the rate of flu vaccination amongst pregnant women. This review has the potential to inform whether digital interventions are an appropriate and successful method of increasing flu vaccination amongst pregnant women, and to determine which mode of digital intervention is most effective. Trial registration This systematic review is registered on the international prospective register of systematic reviews (PROSPERO). Registration number pending.

Insurance-based marketing (IBM) is the marketing of products and services as being available for free or at a strongly reduced price due to coverage by clients' insurance plans. This paper introduces IBM, identifies its main characteristics and presents a theoretical model that can explain IBM's marketing function. A taxonomy with examples renders more insight into the different formats that IBM takes on in practice. Two studies into the prevalence of IBM for windshield repair and flu vaccination in different countries across the world provide evidence for the prevalence of IBM. Finally, a discussion of the ethical considerations highlights the benefits of IBM for clients' information provision, but also the risks of higher premiums through the encouragement of moral hazard. Diverse kinds of stakeholders can find value in thinking through their options to include IBM in their marketing mix. [ABSTRACT FROM AUTHOR]

Our aim was to examine the association between religious affiliation and the likelihood of taking the flu vaccine. Cross-sectional data (year 2014 with n = 7172) were used from the nationally representative German Ageing Survey—covering community-dwelling individuals aged 40 years and over. Multiple logistic regressions showed that compared with individuals without a religious affiliation, individuals with certain religious affiliations had a lower likelihood of taking the flu vaccine. More precisely, the likelihood of taking a flu shot was significantly associated with belonging to the Roman Catholic Church (OR: 0.50, 95% CI: 0.44–0.57), the Protestant Church (OR: 0.68, 0.60–0.77), the Evangelic Free Church (OR: 0.54, 0.35–0.82) and other religious communities (OR: 0.25, 0.14–0.45). The results remained nearly the same when we restricted our analyses to individuals aged 60 years and over (according to existing recommendations for flu vaccination). The association between religious affiliation and the likelihood of taking the flu vaccine was moderated by thoughts about religion and deeds for religion. This knowledge could help to improve the immunization coverage by addressing individuals with certain religious affiliations.

In order to reduce the burden on healthcare systems and to support differential diagnosis with COVID-19, influenza and pneumococcal vaccinations were strongly recommended during the COVID-19 pandemic, especially in vulnerable groups. However, no univocal and conclusive evidence on the relationship between influenza and pneumococcal vaccinations and COVID‐19 outcomes exists. We evaluated the association between such vaccinations, COVID-19 hospitalization, intensive care unit admissions and deaths in a cohort (N = 741) of COVID-19 patients who had access to the emergency room of a large Italian University hospital between March 1, 2020 and June 1, 2020. Results show that influenza and pneumococcal vaccinations did not affect hospitalization, intensive care unit admission and deaths in COVID-19 patients in the overall sample and in those ≥65 years. The same pattern of results was confirmed considering timing of influenza vaccine administration, vaccination type, and number of uptakes in the last five vaccination campaigns. In conclusion, our study does not support an impact of influenza and pneumococcal vaccinations on COVID-19 outcomes. [ABSTRACT FROM AUTHOR]

The seasonal flu vaccine is the most important way to prevent influenza epidemics, so it is useful to increase the awareness of health professionals. The aim of our study is to evaluate knowledge, attitudes, and behavior about flu vaccination among healthcare professionals in times of COVID-19. Methods: A cross sectional study was carried out between November 2020 and April 2021. Participants were recruited in teaching hospital ‘Policlinico Umberto I’ of Rome. A survey of 24 questions about flu vaccination was administered, evaluating their knowledge, attitude, and practice about this topic. Results: 872 healthcare professionals were involved in the study (36.9% men, 63.1% women). More than 90% of the HCWs, especially physicians, recognize the importance of getting influenza vaccination: The main reasons for not getting vaccinated were fear of vaccine side effects (20.3%) and fear of the needle (6.4%). Nevertheless, 40.7% of the healthcare providers consider mandatory vaccination as unethical, especially if they work in low-intensity wards. Conclusion: a high percentage of healthcare workers agree with the importance of influenza vaccination and only a small percentage is still opposed. It is therefore important to continue to promote the influenza vaccination through communication and health education programs.

Influenza represents a threat to global health and health care workers (HCWs) have an increased risk of contracting the influenza virus in the workplace. The COVID-19 pandemic has brought back the importance of influenza vaccination, as the influenza virus can circulate together with SARS-CoV-2. The aim of this report is to describe the actual flu vaccination coverage among healthcare workers of a research hospital and the trend changes, with respect to the past flu vaccination campaigns, in light of the present pandemic and COVID-19 vaccination. A Pearson’s χ2 test was used to test the correlation of flu vaccination coverage, across all professional categories, between the last two years. A linear regression model was adopted to predict the total vaccination coverage of this year. A statistically significant decrease (p < 0.01) was observed in vaccination coverage among all the professional categories with a 50% reduction in vaccination trends between the last two years. Analyzing the data from the previous six flu vaccination campaigns, the expected value, according to the linear regression model, was estimated to be 38.5% while the observed value was 24%. The decrease in vaccination coverage may be due to the fear of the pandemic situation and especially to the uncertainty related to the consequences of a concurrent administration which may overload the immune system or may be more reactogenic. The COVID-19 pandemic represents an opportunity to promote and support large-scale influenza vaccination among HCWs through structured programs, adequate funding, and tailored communication strategies.

INTRODUCTION Vaccination against the flu is the best method for the prevention of illness by influenza viruses. The objective of this study was to assess the impact of the COVID-19 pandemic on the seasonal influenza vaccination attitudes in Greece and to identify factors associated with a positive change in participants' choice to vaccinate against the flu. METHODS This is a sub-analysis of a cross-sectional nationwide survey (n=1004) that was conducted between 28 April and 3 May 2020 using a mixed methodology for data collection: computer assisted telephone interviewing (CATI) and computer assisted web interviewing (CAWI). Sampling followed a proportionate, stratified by region, systematic procedure to ensure a nationally representative sample of the urban/rural population. Data were collected using a structured questionnaire consisting of four parts: 1) demographics; 2) knowledge about COVID-19; 3) attitudes toward COVID-19; and 4) practices to control COVID-19 and vaccination against the flu. RESULTS Of the respondents, 66.3% (n=665) had not been vaccinated for seasonal influenza during the 2019-2020 season, the period prior to the COVID-19 pandemic. However, of those, 21.8% showed willingness to receive the vaccine (n=145) the upcoming flu season 2020-2021. Factors independently associated with increased intention to vaccinate in those that had not been vaccinated the previous flu season included: age ≥65 years; the belief that vaccination against the flu is considered preventive against the spread of the coronavirus; not believing that coronavirus was man-made in a laboratory; and not believing that the pandemic will end once a large percentage of the population is infected. CONCLUSIONS Factors that shift public opinion in favor of seasonal flu vaccination can be utilized to design effective strategies to increase vaccination uptake. [ABSTRACT FROM AUTHOR]

Physicians highlight that annual flu vaccination is the best strategy for preventing seasonal flu and flu-associated complications and it reduces the burden of infectious diseases. Path analyses were used to understand whether health beliefs (barriers, benefits, susceptibility, severity) influence flu vaccinations, in turn, enhance self-rated health of White, African American, Hispanic, and Asian adults in the U.S. (N = 446). Multiple-group analyses were performed to see whether given paths vary across the four groups. Regardless of race, perceived barriers and benefits significantly influenced flu vaccination. There was a group variance in the path-model of the perceived barriers, flu vaccination, and self-rated health. Although the direct effect of perceived barriers on flu vaccination was shown for all racial groups, the direct effect of perceived barriers on self-rated health was shown only for Asians. Social workers and healthcare providers should be educated to appropriately interpret different meanings of health beliefs of diverse racial groups. [ABSTRACT FROM AUTHOR]

To assess influenza vaccine uptake during the 2020/2021 flu season and compare it with that of the 2019/2020 flu season among respondents to the second phase of the web-based EPICOVID-19 survey, we performed an observational web-based nationwide online survey (January–February 2021) in which respondents to the first survey (April–June 2020) were contacted and asked to complete a second questionnaire. Factors associated with vaccine uptake in the 2020/2021 flu season were assessed by applying a multivariable multinomial logistic regression model. Out of the 198,822 respondents to the first survey, 41,473 (20.9%) agreed to fill out the follow-up questionnaire; of these, 8339 (20.1%) were vaccinated only during the 2020/2021 season, 8828 (21.3%) were vaccinated during both seasons and 22,710 (54.8%) were vaccinated in neither season. Educational level (medium (aOR 1.33 95%CI 1.13–1.56) and high (aOR 1.69 95%CI 1.44–1.97) vs. low) and socio-economic deprivation according to SES scoring (1 point aOR 0.83 (95%CI 0.78–0.89), 2 aOR 0.68 (95%CI 0.60–0.77) points or ≥3 points aOR 0.42 (95%CI 0.28–0.45) vs. 0 points) were found to be associated with flu vaccine uptake. Our study shows that social determinants seemed to affect flu vaccination uptake and identifies specific categories of the population to target during future influenza vaccination campaigns.

In January 2020, Chinese health authorities identified a novel coronavirus strain never before isolated in humans. It quickly spread across the world, and was eventually declared a pandemic, leading to about 310 million confirmed cases and to 5,497,113 deaths (data as of 11 January 2022). Influenza viruses affect millions of people during cold seasons, with high impacts, in terms of mortality and morbidity. Patients with comorbidities are at a higher risk of acquiring severe problems due to COVID-19 and the flu—infections that could impact their underlying clinical conditions. In the present study, knowledge, attitudes, and opinions of the general population regarding COVID-19 and influenza immunization were evaluated. A multicenter, web-based, cross-sectional study was conducted between 10 February and 12 July 2020, during the first wave of SARS-CoV-2 infections among the general population in Italy. A sample of 4116 questionnaires was collected at the end of the study period. Overall, 17.5% of respondents stated that it was unlikely that they would accept a future COVID-19 vaccine (n = 720). Reasons behind vaccine refusal/indecision were mainly a lack of trust in the vaccine (41.1%), the fear of side effects (23.4%), or a lack of perception of susceptibility to the disease (17.1%). More than 50% (53.8%; n = 2214) of the sample participants were willing to receive flu vaccinations in the forthcoming vaccination campaign, but only 28.2% of cases had received it at least once in the previous five seasons. A higher knowledge score about SARS-CoV-2/COVID-19 and at least one flu vaccination during previous influenza seasons were significantly associated with the intention to be vaccinated against COVID-19 and influenza. The continuous study of factors, determining vaccination acceptance and hesitancy, is fundamental in the current context, in regard to improve vaccination confidence and adherence rates against vaccine preventable diseases.

Background. Although the annual flu vaccination is the best way to prevent the flu, vaccination rates on college campuses across the United States (U.S.) remain remarkably low. Methods. Guided by the Health Belief Model, the purpose of this capstone pilot study was to identify the beliefs and barriers towards flu vaccination among undergraduate college students attending a HBCU. Results. Beliefs included: fear of contracting the flu, danger of getting the flu from the vaccination, and dangerous side effects associated with the vaccine. Moreover, the majority of the participants noted that they had not yet received the annual flu vaccine, nor did they have any intention of getting the vaccine. Conclusion. Findings underscore the importance of a culturally tailored campus-wide messaging and educational campaigns to debunk myths and misconceptions regarding the flu vaccine, especially in light of the current COVID- 19 pandemic and the race to develop and distribute a vaccine. [ABSTRACT FROM AUTHOR]

Background: Pregnant women and their unborn babies are at increased risk of complications as a result of flu, yet uptake of the flu vaccination in the UK remains low. Digital interventions have proven effectiveness in changing health behaviour, but their effectiveness in increasing flu vaccination amongst pregnant women has not been examined. This protocol details the design and methodology of a systematic review and meta-analysis, examining the effectiveness of digital interventions in increasing flu vaccination amongst pregnant women. Methods: Bibliographic databases will be searched using appropriate search terms related to vaccination, pregnancy and flu. Randomised, non-randomised, quasi randomised controlled trials and other quantitative study designs will be eligible for inclusion, and studies will present the rate of flu vaccination amongst pregnant women of digital interventions compared to non-digital interventions, or usual care. No date or study country restrictions will be put on included studies, but studies will be published in English. Discussion: This is the first known systematic review to examine the effectiveness of digital interventions in increasing the rate of flu vaccination amongst pregnant women. This review has the potential to inform whether digital interventions are an appropriate and successful method of increasing flu vaccination amongst pregnant women, and to determine which mode of digital intervention is most effective. Trial registration: This systematic review is registered on the international prospective register of systematic reviews (PROSPERO). Registration number pending. [ABSTRACT FROM AUTHOR]

Vaccinating healthcare workers (HCWs) is the most effective intervention for preventing nosocomial influenza infection. However, influenza vaccination coverage (VC%) among HCWs remains low. The aim of the study was to analyse the trend of VC% among healthcare workers in an Italian hospital through a three-year vaccination project covering three influenza seasons (2018–2019, 2019–2020, and 2020–2021). A gap analysis was performed at the case base (2018–2019), on-site vaccination was trialled in the 2019–2020 season, and an integrated vaccination offer (on-site vaccination and the classic offer at a vaccination clinic) was implemented for the 2020–2021 season. For each unit of vaccinated HCWs, the following variables were recorded: main demographic details, area of affiliation (medical/surgical/services), and professional category. Logistic regression analyses were performed to assess the relationship between outcome (undergoing vaccination in 2020–2021) and other variables related to the healthcare workers’ characteristics. In the three seasons, VC% values of 13.2%. 27.7%, and 58.9% were recorded, respectively (p < 0.005). The highest VC% was recorded among physicians (94.93%), in the medical area (63.27%), and males (62.59%) and in general among the youngest HCWs. Comparison of the coverage values recorded in the three seasons showed that in the last season considered (2020–2021) about 80% of health workers preferred to be vaccinated in the workplace instead of using the standard vaccination delivery method (invitation to attend the vaccination clinic). Our study suggests that the integrated vaccination offer may lead to an increase in VC% among HCWs compared to the classical offer modalities.

Background: Influenza vaccine rates in pregnant women remain suboptimal despite the recommendations from healthcare organizations. Though pharmacists can provide immunization services as a result of the standing order, few studies have examined the role of the pharmacist in providing immunization to pregnant women or explored their perspective on their role in providing influenza vaccines among pregnant women. Purpose: This study explored the perceptions and knowledge of Florida pharmacists in administering inactivated influenza vaccines (IIV) to pregnant women. Methods: Semi-structured in-depth interviews guided by the theory of planned behavior were conducted with 18 licensed Florida pharmacists, including clinical and retail pharmacists. A thematic analysis was conducted. Results: The majority of pharmacists (94%) were knowledgeable about the IIV in pregnant women. Participants expressed mixed attitudes, identified barriers and facilitators, and subjective norms influencing vaccine administration in pregnant women. Participants expressed the importance of trust and how that influenced vaccine uptake. Participants also expressed their position not to only provide immunization services but also to counsel and educate patients. Conclusion: There is a need to strengthen immunization services, provided by pharmacists to more individuals, including high-risk groups such as pregnant women.

Seasonal flu vaccination is one of the most important strategies for preventing influenza. The attitude towards flu vaccination in light of the COVID-19 pandemic has so far been studied in the literature mostly with the help of surveys and questionnaires. Whether a person chooses to be vaccinated or not during the COVID-19 pandemic, however, speaks louder than any declaration of intention. In our teaching hospital, we registered a statistically significant increase in flu vaccination coverage across all professional categories between the 2019/2020 and the 2020/2021 campaign (24.19% vs. 54.56%, p < 0.0001). A linear regression model, based on data from four previous campaigns, predicted for the 2020/2021 campaign a total flu vaccination coverage of 30.35%. A coverage of 54.46% was, instead, observed, with a statistically significant difference from the predicted value (p < 0.0001). The COVID-19 pandemic can, therefore, be considered as an incentive that significantly and dramatically increased adherence to flu vaccination among our healthcare workers.

Background: There is a high risk for morbidity and mortality in pregnant women associated with influenza virus illness. Vaccine uptake rates in pregnant women remain lower than the targeted Healthy People 2020 goals despite recommendations from the Centers for Disease Control (CDC). Few studies have examined the role of the pharmacist in providing immunization services to pregnant women, fewer still have directly examined the PharmD curricula and the perspectives of pharmacy students on how they perceive their role in providing influenza inactivated vaccine (IIV) to pregnant women. Objective: This study examined the PharmD curricula instruction with regard to immunizing pregnant women and how pharmacy students perceive it. Methods: Semi-structured, in-depth, in-person qualitative interviews were conducted with the six Academic Deans of the accredited schools of pharmacy in Florida, and three focus group sessions were held with third- and fourth-year pharmacy students (n = 18) in Florida. A thematic analysis was conducted. Results: Most academic deans reported providing instruction on immunization in schools with respect to vaccine administration in pregnant women and called for a need for all schools to make it compulsory to include pregnant-women-specific content. Pharmacy students reported a gap in knowledge of content related to administering the IIV in pregnant women, but feel that when presented with the opportunity, they will be willing to provide IIV to pregnant women. Conclusions: Pharmacists are in a good position to play a role in increasing IIV rates among pregnant women. Implications for practice include the need for incorporation of pregnancy-specific content to immunization curricula.

Background: Pregnant women are at increased risk of influenza complications. Influenza vaccine provides them a substantial protection. Objective: The aim of this study was to investigate determinants associated with non‐adherence to influenza vaccine recommendations in pregnant women in Italy. Methods: A cross‐sectional study has been carried out among pregnant women attending their follow‐up visit in some mother and child services in a Region of Italy from October 2016 to January 2017. The study protocol was approved by the local research Ethics. A self‐administered close‐ended questionnaire has been administered to the pregnant women. Differences in background, socio‐demographic characteristics, knowledge and attitudes towards flu vaccine were tested in vaccinated and unvaccinated women. Multivariate analysis was performed to control for confounding factors. Results: Three hundred and sixty‐six women answered the survey (97% response rate) and 96.1% (348) declared of being unvaccinated against influenza during the 2016‐2017 influenza season. Frequent reasons for refusing vaccination were drugs objection and concerns about vaccines' effects. According to the refusal attitude, influenza knowledge was low in the group. Moreover, analysis showed that low adherence to vaccination is associated to lacking promotion of vaccination to pregnant women carried out by healthcare workers (P < 0.005). Conclusions: Healthcare workers have a key role in assisting women during the gestational period, so their active involvement in vaccination promotion is essential. It is necessary to improve health care workers' knowledge about vaccine relevance in protecting pregnancy and their communication skills to properly inform pregnant women. [ABSTRACT FROM AUTHOR]

Flu vaccination for the general population, and specifically for vulnerable subgroups, brings the potential to reduce the impact of the COVID-19 pandemic in terms of mobility, mortality, and hospitalizations. In Italy, flu vaccination is recommended to all ≥6 months of age, even if it is only free of charge for specific categories. We investigated the intentions towards flu and COVID-19 vaccinations from a sample of 436 Italian university students. Results of a web-based survey show that 77.52% of them were willing to get the flu vaccine and 94.73% were willing to be vaccinated against COVID-19 when available. We identified positive predictive factors to undertake flu vaccination as being a medical student, having undertaken a previous vaccination against flu, and having a high level of concern and perceived vulnerability to the COVID-19 pandemic. Reinforced public health activities might consider engaging university students a as possible “positive influencer” towards flu and COVID-19 vaccination programs.

Influenza is an infectious disease with a high impact on the population in terms of morbidity and mortality, but despite International and European guidelines, vaccination coverage rates among healthcare workers (HCWs) remain very low. The aim of the present study was to evaluate influenza vaccination adherence in the three Sicilian University Hospitals of Catania, Messina, and Palermo and to understand the attitudes and perceptions of vaccinated healthcare workers and the main reasons for vaccination refusal. A cross-sectional survey through a self-administered questionnaire was conducted during the 2019/2020 influenza season. Overall, 2356 vaccinated healthcare workers answered the questionnaire. The main reason reported for influenza vaccination adherence during the 2019/2020 season was to protect patients. Higher self-perceived risk of contracting influenza and a positive attitude to recommending vaccination to patients were significantly associated with influenza vaccination adherence during the last five seasons via multivariable analysis. Fear of an adverse reaction was the main reason for influenza vaccine refusal. In accordance with these findings, Public Health institutions should develop and tailor formative and informative campaigns to reduce principal barriers to the immunization process and promote influenza vaccination adherence among HCWs.

Flu vaccination is recommended among healthcare workers (HCWs). The low vaccination coverage registered in our hospital among HCWs called for new engaging approaches to improve flu vaccination coverage. The aim of this study was to evaluate the efficacy of different strategies implemented during the last four years (2015−2019). A quasi-experimental study was conducted, involving almost 4000 HCWs each year. Starting from the 2015−2016 campaign, new evidence-based strategies were progressively implemented. At the end of each campaign, an evaluation of the vaccination coverage rate reached was performed. Moreover, during the last three campaigns, differences in coverage among job category, wards involved or not in on-site vaccination (OSV) intervention, age classes and gender were analyzed. An increasing flu vaccination coverage rate was registered, from 6% in 2015−2016 to almost 22% at the end of 2018−2019. The overall number of vaccinated HCWs increased, especially at younger ages. OSV strategy always leads to better results, and physicians always show a higher vaccination coverage than nurses and other HCWs. The implemented strategies were effective in achieving higher flu vaccination coverage among HCWs in our hospital and therefore can be considered valuable examples of good prevention practices in hospital settings.

Abstract Introduction The Flu vaccine is the most effective measure to prevent influenza. Yet, vaccination rates remain at sub-optimal levels, with 10%–29% coverage rates in the general population of the EU. As mistrust in vaccines has increased, effective strategies are needed and one is communication. The aim of this research is to identify vaccination recommendations of the health ministries in 5 European Member States and to investigate the communication strategies used. Methods Two methods were employed in this study. A review of flu vaccination recommendations in the European Union and five Members States (Austria, Germany, Malta, Ireland and United Kingdom). Next a content analysis was conducted of flu vaccination communication in those six contexts. Results and discussion All countries recommend flu vaccination as a primary protection tool, but they differed in their recommendations for various target audiences. Channels for communication included seven websites and 42 other materials. The main messages used were gained framed promoting protection , either for oneself, family or patients. Most communications provided basic information replying on providing facts and knowledge about the flu and the benefits of vaccination. No information on the development of the communication or its effects were found. Conclusion Communicating flu vaccination as a protective tool is common across countries and is consistent with the benefits of vaccination. Furthermore, the communications in the countries were not consistent with their recommendations. As the recommendations vary across and within countries, communication becomes a challenge. They should, at a minimum, be consistent with EU and country specific recommendations. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: More symmetric organisms are perceived as more attractive. Fluctuating asymmetry (FA) i.e. small, random deviations from perfect bilateral symmetry, is supposed to inform about developmental instability. According to the good genes hypothesis, a low level of FA is a putative cue to an organism's biological quality. An important aspect of this quality is the immune system functioning. The aim of this study was to evaluate the relationship between immune system functioning and body symmetry in healthy people. Materials and Methods: The composite body FA (cFA) was assessed on the basis of six bilateral traits (on hands and feet). The ISF was determined by many innate (total complement and lysozyme activity, neutrophils function) and adaptive immune parameters (T CD3 and B CD19 lymphocytes, total IgA and IgG and response to flu vaccine). A total of 98 men and 92 women were subjected to flu (among them 37 men and 30 women also to tetanus) vaccination. The blood samples were collected before and 4 weeks after the antigens exposure. Immunomodulatory factors: participant's age, body fat, and free testosterone level, were controlled. Results: Apart from the weak positive association between CD3 or CD19 and cFA in men, we found no association between the level of body symmetry and the rest of the analyzed immune parameters for both sexes. Discussion: Our results are the opposite of the good genes hypothesis prediction and suggest that in western, healthy populations, human mate preferences for more symmetric bodies are not related to immune competence. [ABSTRACT FROM AUTHOR]

The flu causes a significant number of largely vaccine-preventable hospitalizations and deaths each year. Previous studies show that efficacy beliefs about other flu prevention strategies may be barriers to flu vaccine uptake. The purpose of this study was to assess attitudes and behaviors regarding flu vaccination and other flu prevention strategies and to examine the decision to get a flu vaccine within a competitive context. Two independent surveys were administered in 2013 (general population, n = 1,158) and 2015 (millennial panel, n = 1,574) among adults in the United States, which generated propensity models to get flu vaccines. Compared to the vaccine, participants considered many strategies to be more effective at preventing seasonal flu, particularly behaviors related to maintaining a strong immune system. Propensity models demonstrate that perceived effectiveness of some alternative “healthy behaviors” in a competitive set were associated with a lower likelihood of vaccine uptake. Results suggest that adults’ engagement in alternative strategies may be at the expense of getting vaccinated. Social marketers should consider competition not just from unhealthy behaviors but from alternative healthy behaviors when designing programs and campaigns to ensure effectiveness of their messages. [ABSTRACT FROM AUTHOR]

Following the regulations of the German Equestrian Federation (FN) horses which take part in competitions have to be vaccinated against Equine Influenza. These vaccinations consist of the basic vaccinations (V1-V3) followed by revaccinations 6 month later and then in an interval of every 6 months (+3 weeks). The international rules are comparable. The World Organisation for Animal Health (O.I.E.) is responsible for recommending suitable vaccine strains for inclusions in commercial vaccines. This concerns only A2-equi-influenza (H3|N8) strains, A1-equi (H7|N7) is no longer recommended. The best protection against influenza should be protection against clinical manifestation and virus shedding. Serological tests as measurement for these kind of immunoprotection are based on the cross-protection between vaccine strain, test antigen and circulating virus strains. The O.I.E. prefers for such tests the single radial haemolysis (SRH) with protective values of ≥ 85mm2 for clinical protection and ≥150mm2 for both clinical and virological protection. Beside the SRH haemagglutination inhibition (HI), based on former WHO protective titers ≥1:40 (H3|N8) is an accepted serological test for the determination of an immunity level for horses. Both tests are based on antibodies against the haemagglutinin (HA) protein, a surface protein of the influenza viruses. These proteins undergo a continuous H3|N8-antigenic drift, which means that antibodies against one strain will not protect against HA of a different strain. This is also valid for the serological tests. Moreover, it's the question how p. vacc. serological titers depending on the used test antigen correlate to a protective immunity based on different forms of immunity p. inf. vs. p. vacc.. Different results from different laboratories, elaborated in their tests, may complicate the interpretation of individual antibody levels in correlation to immune protection. Sera from 636 vaccinated sport horses were collected and investigated in HI and SRH by two laboratories. Vaccination data of the horses were recorded in their Equine passports which were at our disposal. All of these sera were tested in HI- tests against H7|N7 and H3|N8-antigens, 73 sera of horses from the German championship competition 2013 additionally in the SRH and further 90 horses (2017) in both tests (stable K and stud farm M). The 2104 test results had been analysed under the following points of view: 1. Investigation of the different antibody titers (HI) and their percentage, comparing the results of the two labs. 2. On the same base the influence of the different test antigens used in HI and SRH. 3. These results showed partly significant titer differences in individual sera. The average titers of different vaccination groups equalized these differences more or less. 4. The timely difference between the last vaccinations and the bleeding of horses (3-9 months) had no remarkable influence on the persistence of antibodies and their titers. 5. The results of the two labs concerning their titers in HI and SRH and the different test antigens didn't correlate. 6. As a consequence to these different percentages of horses, tested against H3|N8 in HI vs. SRH,showed different values (percentages of protective titers). 7. More horses than vaccinated ones against H7|N7 showed antibody titers against this antigen in both tests. Even horses which had never been vaccinated with vaccines containing H7|N7 antigens. 8. 22 young horses (age classes 2011-2013) and also the used vaccines could be controlled beginning from their basic vaccinations (V1-V3) to V9. Despite of the application of vaccines without H7|N7 antigen 9 resp. 10 of them were positive in HI and/or SRH. The interpretation of the titers of these horses against H7|N7 and H3|N8 didn't show any evidence for an “immunological gap" between V2 and V3. The evaluation of the in toto analysed serological results under the described criteria comes to the conclusion of a non-existing objectivation of the individual antibody titers in relation to the immune protection of an individual horse. Too many variations are involved as the results, elaborated in two labs and their test conditions, show. This is discussed on the basis of immunity against influenza infection versus immunity post vaccination and the differences within the involved defense mechanisms and the existing possibility of their in vitro laboratory diagnostic. The consequences for acceptable tests to define “protective immunity" in horses for sport and trade are part of this. [ABSTRACT FROM AUTHOR]

Influenza vaccination is a cost-effective preventive service, but its utilization rate is below the recommended level. Many studies have explored possible predictors and causes for low vaccination rates. Despite a large volume of studies in this area, there is limited research on how local economic conditions can affect individual influenza vaccination. This study explores this topic by merging the 2008-2012 individual-level data from the Behavioral Risk Factor Surveillance System (BRFSS) with the Area Health Resources Files (AHRF), and the Bureau of Labor Statistics Local Area Unemployment Statistics (LAUS). Using county-level unemployment rates as a measurement of local economic conditions, we used multivariate probit models to examine its relationship with individual flu vaccination while controlling for individual socioeconomic and demographic factors and contextual characteristics. We found that county-level unemployment rates were significantly and negatively associated with individual influenza vaccination, especially for people who were employed or living in metropolitan counties. Our results support public health interventions to improve flu vaccination during economic recessions. [ABSTRACT FROM AUTHOR]