Flu is estimated to affect between 5% and 20% of the general population each year. It is estimated that approximately 25% of respiratory febrile processes can be caused by influenza. [1]
Influenza is a public health problem that directly affects health care workers due to the increase in consultations resulting from the infection and its complications, leading to an increase in healthcare pressure and hospitalisations. [1, 2, 3] In addition, professionals who work in healthcare areas are at higher risk of catching the flu than those who work in non-healthcare areas, and the fact that they get the flu can affect the healthcare system due to their possible leaves. [4]
Influenza vaccination (VAG) is an effective primary prevention measure to prevent the onset of influenza and its complications [1, 5]. Its administration is recommended to risk groups and people who may be vectors of transmission, such as health professionals [1, 6]. Health workers can also infect people in their family environment and can be a key factor in the spread of epidemic outbreaks in health centres. [7] Sometimes the flu can turn up asymptomatically or mildly, and even if the spread of the virus in these forms is not clearly known, unvaccinated professionals continue to work and can act as a source of infection for the people they care for.. Although it is not clear what the vaccination coverage threshold for professionals should be considered, vaccination of health workers in nursing homes, health centres and hospitalisation plants could improve safety and reduce the morbidity and mortality associated with this infection [8]. In fact, vaccination of professionals has been shown to have some protective effects in elderly patients, with respect to mortality from pneumonia or mortality from other causes [4].
Overall, VAG coverage in health professionals achieved through vaccination campaigns is usually low. These coverages are far from the 75% target proposed by the World Health Organisation (WHO) and the European Centre for Disease Prevention and Control (ECDC) for the 2020-21 campaign. [9, 10]. Data collected in the European Union during the seasons 2015-16, 2016-17, 2017-18 show that vaccine coverage ranges from 15.6–63.2% [11]. In the 2019-20 campaign, coverage in Spain was 39.4%, and 30.2% in Catalonia [12].
The acceptance of vaccination by professionals can be influenced by different factors: 1) personal factors, linked to knowledge, beliefs, perceptions and factors that have to do with motivation; 2) social/community factors, linked to personal experiences and relationships and 3) professional factors that support behaviour; and 4) environmental factors, such as policy or environment that, despite not being adjustable, influence the individual by offering him/her the opportunity to be vaccinated. [4] According to Herzog [13], increased knowledge about vaccines, beliefs aligned with scientific evidence, and favourable attitudes towards them are associated with higher vaccination intentions. The social benefit provided by vaccination (protection to patients and the professional environment) is also a justification in favour of VAG in professionals [14]. In contrast, several studies have identified fear of adverse events and doubts about the effectiveness of the vaccine as the main reasons for non-vaccination by health care providers [14, 15]. However, a survey carried out in 2012 on 336 health workers in our country indicated as the main reasons for rejecting the VAG the fact that they do not consider themselves at risk, the lack of concern, or the lack of time. [16]
The role of professionals is crucial in order to increase the coverage of the population’s flu vaccine, both in terms of informing patients and making health recommendations. Vaccine coverage for healthcare professionals, along with their opinion and attitude towards the effectiveness of the vaccine, influences the vaccination rates of their patients. [17]
The consensus document on influenza vaccination in health personnel, published in 2012 by 19 Spanish scientific societies, makes recommendations based on three basic pillars: necessity, ethics and exemplariness. As to necessity, self-protection is pointed out as the main reason for vaccination, because health professionals are more exposed to circulating viruses and this fact increases the likelihood of leaves. As to ethics (primum non nocere), it should be borne in mind that unvaccinated professionals could be transmitters of the virus to people at risk, who could be more severely affected by the disease, as well as their professional and family environment. As to exemplariness, the fact that professionals are vaccinated, aware and convinced of the usefulness and safety of the flu vaccine leads to more confidence in the general population and also among the professionals themselves, and influences the improvement of vaccine coverage. [18]
In the context of the current SARS-CoV-2 pandemic, the VAG 2020-21 campaign was considered to be influenced by ignorance of influenza virus behaviour and the risk of coinfection by both viruses. For this reason, health authorities promoted an increase in VAG coverage to reduce the incidence and the impact on healthcare pressure that takes place each year [9, 10].
In the 2020-21 influenza vaccination campaign, Catalonia and Spain set the goal to reach or exceed 75% of vaccination in people over 65 and in health personnel, and 60% in pregnant women and people with high risk of complications [9, 10].
In the context of the SARS-CoV-2 pandemic, it is important to know the intention to receive the VAG by health professionals, as intention is a key factor for action [14, 19] and therefore can help focus actions that improve vaccine coverage. It is also interesting to explore the pandemic-related reasons that may lead them to decide on the VAG.
The aim of the study is to determine the intention to vaccinate against seasonal flu of health professionals in the 2020-21 campaign, in the context of the SARS-CoV-2 pandemic. The specific objectives are: 1) Assess the perception of risk of seasonal flu in the context of the SARS-CoV-2 pandemic. 2) Determine whether the contextual factors related to the physical and hygienic protection measures disseminated and implemented during the pandemic influence the intention of getting vaccinated against the flu.