---
title: "Factors Associated with Influenza Vaccine Uptake Among Georgian Healthcare Workers, 2021–2024"
id: "plos-one-23-factors-associated-with-influenza-vaccine-uptake-among-healthcare-workers-in"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-23-factors-associated-with-influenza-vaccine-uptake-among-healthcare-workers-in"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356495"
published_at: "2026-08-25T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Factors Associated with Influenza Vaccine Uptake Among Georgian Healthcare Workers, 2021–2024
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-23-factors-associated-with-influenza-vaccine-uptake-among-healthcare-workers-in
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356495)
- **Published At:** 2026-08-25T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This prospective cohort secondary analysis used self-reported influenza vaccination and attitude data collected from healthcare workers (HCWs) enrolled at six urban secondary-level hospitals in Georgia between early 2021 and early 2023, covering three influenza seasons (2021–2022, 2022–2023, 2023–2024). - The analytic sample comprised 403 HCWs who completed all three years of follow-up and the Year 3 attitudes questionnaire; median age was 46 years (IQR 36–54) and 90% were female. - Participant roles included nurses or midwives (42%), support staff (21%), doctors (19%), and other staff (19%). - Overall, 289 (72%) reported receiving influenza vaccine in at least one of the three seasons; 114 (28%) reported no vaccination in any season. - In multivariable logistic regression, age ≥30 years was associated with higher odds of uptake; HCWs aged 40–49 had the highest odds (adjusted odds ratio [aOR] 2.67, 95% CI 1.09–6.59) compared with the reference younger group. - Beliefs about vaccine safety and effectiveness were strongly associated with uptake: HCWs who did not believe the vaccine was safe had lower odds of vaccination (aOR 0.27, 95% CI 0.11–0.68), and those who doubted effectiveness had lower odds (aOR 0.36, 95% CI 0.14–0.89). - One hospital (Hospital B) showed substantially lower uptake (aOR 0.06, 95% CI 0.02–0.23) compared with the reference hospital, indicating institutional variation in coverage. - No statistically significant differences in uptake were observed by sex or by occupation in adjusted analyses. - The authors conclude that vaccine confidence—specifically perceived **safety** and **effectiveness**—and institutional factors explain lower uptake, while older HCWs were likelier to be vaccinated; they recommend campaigns that address safety and effectiveness concerns and target demographic and facility-level disparities. - Data limitations include reliance on self-reported vaccination status, restriction to HCWs with complete three-year follow-up and attitudinal data, and modest sample size that precluded season-specific multivariable modelling; these details were reported in the source.
## Clinical Analysis & Structured Key Points
Factors associated with influenza vaccine uptake among healthcare workers in Georgia, 2021–2024 | PLOS One Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click here . Article Authors Metrics Comments Media Coverage Reader Comments Figures Figures Abstract Background Healthcare workers (HCWs) are prioritised to receive influenza vaccine annually in Georgia. We aimed to identify factors associated with influenza vaccine uptake among Georgian HCWs. Methods We used self-reported influenza vaccination data for three influenza seasons (2021–2024) and 2023 survey data on attitudes towards influenza from a prospective cohort of HCWs in six hospitals in Georgia. HCWs who received influenza vaccine in at least one season were compared with those who were not vaccinated in any season. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated using multivariable logistic regression to identify factors associated with vaccination uptake. Findings Of 403 participants, the median age was 46 (IQR 36–54), 364 (90%) were female, 168 (42%) were nurses or midwives, 85 (21%) were support staff, 75 (19%) were doctors, and 75 (19%) were other staff. Overall, 289 (72%) received influenza vaccine in at least one season, while 114 (28%) did not receive it in any season. Multivariable analysis showed no differences in vaccine uptake by sex or occupation. HCWs ≥ 30 years were more likely to be vaccinated, with those aged 40–49 having the highest odds (aOR 2.67, 95% CI 1.09–6.59). HCWs who did not believe the vaccine was safe (aOR 0.27, 95% CI 0.11–0.68), those who doubted its effectiveness (aOR 0.36, 95% CI 0.14–0.89), and HCWs at Hospital B (aOR 0.06, 95% CI 0.02–0.23) were less likely to be vaccinated. Conclusions Georgian HCWs who questioned influenza vaccine safety and effectiveness, and those at one hospital, had lower odds of vaccination over three years, whereas older HCWs were more likely to be vaccinated. Future campaigns to promote influenza vaccination among HCWs should address safety and effectiveness concerns and target demographic disparities. Citation: Artemchuk O, Chakhunashvili G, Finci I, Rojas M, Kissling E, Zakhashvili K, et al. (2026) Factors associated with influenza vaccine uptake among healthcare workers in Georgia, 2021–2024. PLoS One 21(8): e0356495. https://doi.org/10.1371/journal.pone.0356495 Editor: Harapan Harapan, Universitas Syiah Kuala, INDONESIA Received: November 17, 2025; Accepted: August 4, 2026; Published: August 25, 2026 Copyright: © 2026 Artemchuk et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: All relevant data are within the paper and its Supporting information files. Funding: The data analysed in this study were collected as part of a vaccine effectiveness study among healthcare workers in Georgia, supported by the World Health Organization Regional Office for Europe, the US Centers for Disease Control and Prevention (Cooperative Agreement No. NU2GGH002093), and the Public Health Institute. No specific funding was received for the present secondary analysis. The funders had no role in the design of this secondary analysis, data interpretation, or the decision to submit the work for publication. The authors affiliated with the World Health Organization (WHO) are alone responsible for the views expressed in this publication, and they do not necessarily represent the decisions or the policies of the WHO. Competing interests: The authors have declared that no competing interests exist. Introduction Healthcare workers (HCWs) are at increased risk for influenza infection. Influenza vaccination remains the best intervention to prevent influenza infection. The World Health Organization (WHO) considers HCWs to be a priority group for annual influenza vaccination [ 1 ]. Influenza vaccination provides direct protection to HCWs by reducing the risk of symptomatic illness and severe complications [ 2 , 3 ]. Vaccinated HCWs are also less likely to transmit influenza to patients, thereby lowering the risk of nosocomial infections, particularly among vulnerable populations such as the elderly or immunocompromised [ 4 , 5 ]. Furthermore, higher vaccination coverage among HCWs has been associated with reduced absenteeism during influenza seasons, supporting continuity of care and mitigating strain on healthcare services [ 6 , 7 ]. However, annual influenza vaccine uptake among HCWs varies widely across countries and regions. A recent meta-analysis reported an overall global influenza vaccination rate of 41.7% among HCWs. Regional coverage ranged from 67.1% in the Americas (USA, Canada, Peru and Costa Rica) to 6.5% in Africa (Morocco, Egypt and Sierra Leone) [ 8 ]. HCWs’ attitudes, perceptions, and confidence in vaccines influence vaccination decisions [ 9 ]. Understanding factors associated with influenza vaccination uptake among HCWs, including attitudes and perceptions about influenza vaccine, may help inform targeted efforts to promote vaccine uptake among HCWs. In recent years, variability in vaccination uptake has increasingly been examined through the concept of vaccine hesitancy, defined as delay in acceptance or refusal of vaccines despite availability of vaccination services [ 10 ]. Vaccine hesitancy is a complex and context-specific phenomenon influenced by factors such as confidence in vaccine safety and effectiveness, perceived risk of disease, and access to vaccination services [ 10 , 11 ]. Studies conducted during the COVID-19 pandemic demonstrated that vaccine hesitancy also occurs among HCWs and is associated with sociodemographic characteristics, profession, trust in health authorities, and previous vaccination behaviour, including influenza vaccination history [ 12 – 14 ]. More recent reviews continue to highlight the importance of vaccine confidence, perceived safety, and institutional trust as key determinants of vaccination behaviour among HCWs [ 15 – 17 ]. Georgia is an upper-middle income country in the South Caucasus region with a population of 3.7 million people. The Georgia Ministry of Health recommends influenza vaccination for HCWs [ 18 ]. In 2019, influenza coverage among HCWs in Georgia reported annually through the WHO/UNICEF Joint Reporting Form on Immunization was 64% [ 19 ]. From 2021–2024, the National Center for Disease Control and Public Health, Georgia (NCDC) together with WHO Regional Office for Europe conducted a prospective cohort study among HCWs in six Georgian hospitals to measure COVID-19 and influenza vaccine effectiveness (VE) [ 20 ]. We used data from this VE study with the aim of evaluating sociodemographic factors and attitudes about influenza vaccine associated with influenza vaccine uptake in at least one of the three seasons (2021–2022, 2022–2023, and 2023–2024) among Georgian HCWs. Methods Study design and study population Methods related to the COVID-19 and influenza vaccine effectiveness study in Georgian HCWs have been previously described [ 21 ]. Briefly, in early 2021, we invited all HCWs at six hospitals in Georgia to enrol in a longitudinal prospective cohort study to evaluate COVID-19 and influenza vaccine effectiveness. Of the total of 3849 HCWs across the six participating hospitals, 1606 (42%) were enrolled in the study. The six participating hospitals are secondary level facilities located in urban areas of Georgia and include clinical and referral hospitals providing inpatient medical care. Data collection We administered questionnaires about attitudes towards influenza infection and vaccination at study enrolment (early 2021), and again one and two years later, during re-enrolment for Year 2 and Year 3 (early 2022 and early 2023). Influenza vaccination status in the 2021–2022, 2022–2023 and 2023–2024 influenza epidemic season was self-reported by participants. We defined the influenza epidemic season as epidemiological week 40 of one calendar year through week 20 of the following year [ 22 ]. For our analysis, we used a dataset that only included data from HCWs who participated in all 3 years of the study. We further restricted our dataset to only include participants who had completed the sociodemographic questionnaire in the first year of the study, the influenza vaccination status questions in all three study seasons, and the questions about attitudes towards influenza and influenza vaccine in the Year 3 (2023) re-enrolment questionnaire. We restricted the analysis to participants who completed all three years of follow-up because the outcome variable required information on influenza vaccination status across the three influenza seasons (2021–2022, 2022–2023, and 2023–2024), and key attitudinal variables were collected in the Year 3 questionnaire. Including only participants with complete vaccination history and attitudinal data allowed us to classify vaccination uptake across the entire three-year study period and evaluate associations with attitudes measured at the end of follow-up. In addition, given the modest sample size of participants with complete three-year follow-up data, modelling vaccination uptake separately by season would have substantially reduced statistical power and limited multivariable analyses. Therefore, we focused on overall uptake across the study period. The Year 3 re-enrolment survey included 4 questions about attitudes towards influenza and influenza vaccine where participants were asked to provide answers on a Likert scale, a common measurement method used in research to evaluate attitudes, opinions and perceptions. The Year 3 re-enrolment survey also included questions about reasons for receiving or not receiving the influenza vaccine in the 2022–2023 influenza epidemic season. For the purposes of the analysis, we grouped possible responses into the following binary variables: Strongly agree/Mildly agree and Neutral/Mildly disagree/Strongly disagree; Extremely effective/Very effective/Somewhat effective and Not too effective/Not at all effective; Extremely worried/Very worried/Moderately worried and A little worried/Not at all worried. Study data were uploaded and stored in the REDCap system (Research Electronic Data Capture, Vanderbilt University, Nashville, Tennessee, USA). The data for analysis were accessed on 25 March 2023. Authors had no access to information that could identify individual participants during or after data collection. Statistical analysis We described the study population overall and by socio-demographic, clinical and work-related characteristics. We also described the population by their influenza vaccination status, in two groups: 1) not vaccinated in any of the three study seasons and 2) vaccinated in at least one of the three study seasons. We conducted univariable and multivariable logistic regression analyses to identify independent factors associated with receipt of influenza vaccine in at least one of the three study seasons. Our primary exposures of interest were age, sex, hospital of work, chronic medical conditions, occupation, smoking status, household size, providing hands-on medical care to patients, having regular contact with patients, performing aerosol-generating procedures, self-rated health status, department of work, attitudes towards influenza vaccination. We first conducted univariable and partially adjusted logistic regression analyses to examine associations between influenza vaccination status and potential covariates. In these partially adjusted models, each covariate was assessed while adjusting for age, sex, occupation, and hospital. Variables with a p-value 0.05). Variables were removed sequentially, beginning with the least significant (i.e., those with the smallest effect sizes), until only statistically significant variables remained. After each removal, a likelihood ratio test was performed to assess the significance of the change in model fit. Only variables that significantly contributed to the model (p < 0.05) were retained in the final model. A priori variables (age, sex, occupation, and hospital) were retained in all models regardless of statistical significance, to adjust for potential confounding and ensure robust estimation of the exposure effect. We presented adjusted odds ratios (aORs) and corresponding 95% confidence intervals (CIs) from the final model. Sensitivity analysis As a sensitivity analysis, we restricted the outcome to influenza vaccination uptake during the 2023–2024 influenza epidemic season, when attitudinal variables were measured. We included all participants with available Year 3 data and applied the same univariable and multivariable logistic regression approach as in the primary analysis. All analyses were conducted using Stata version 16.0 (StataCorp LLC, College Station, TX, USA). Ethics The study was approved by the Georgia NCDC Institutional Review board (IRB # 021-014) and the Ethical Review Boards of WHO (reference number CERC.0097B). All participants provided written informed consent. Results Characteristics of participants Overall, of the 1606 HCWs who were enrolled in Year 1, 403 (25%) participants had complete data, were still enrolled in Year 3, and were included in our analysis. The median age was 46 (IQR = 36–54), 364 (90%) were female, 168 (42%) were nurses or midwives, 85 (21%) were support or janitorial staff, 75 (19%) were doctors and 75 (19%) were other unspecified staff. A third of HCWs [134 (33%)] reported having at least one underlying condition, 131 (33%) reported smoking currently or in the past, and 289 (72%) reported their self-rated health status as “excellent,” “very good,” or “good” ( Table 1 ). Download: PNG larger image TIFF original image Table 1. Sociodemographic characteristics of HCWs (N = 403) overall and by influenza vaccination status, Georgia, 2021–2024. https://doi.org/10.1371/journal.pone.0356495.t001 Most participants reported having regular contact with patients [319 (79%)] and providing hands-on medical care to patients [210 (52%)]. Less than half of participants reported performing aerosol-generating procedures [157 (39%)]. Most participants worked in inpatient or outpatient units/services [322 (80%)], and most participants [320 (79%)] reported living with family members. Overall, 289 (72%) participants received influenza vaccine in at least one of the 3 seasons, while 114 (28%) participants were never vaccinated against influenza in any season. Of the 289 participants who reported having received influenza vaccine in at least one of the 3 seasons, 81/289 (28%) had received vaccine in all 3 seasons, 110/289 (38%) received vaccine in two seasons and 98/289 (34%) received vaccine in only one season. Attitudes towards influenza vaccination Most participants [351 (87%)] said they thought that influenza vaccine was “extremely effective” or “very effective” or “somewhat effective” in preventing influenza, and most participants [357 (89%)] “strongly” or “mildly” agreed that influenza vaccination was safe. More than three-quarters of participants [320 (79%)] were not worried about becoming ill with influenza during the next 12 months. The large majority [373 (93%)] of HCWs strongly or mildly agreed with the statement, “If I am fully vaccinated against influenza, I will be less likely to miss work because of becoming ill with influenza” ( Table 2 ). Download: PNG larger image TIFF original image Table 2. Attitudes towards influenza vaccination overall and by influenza vaccination status, Georgia, 2021–2024. https://doi.org/10.1371/journal.pone.0356495.t002 In the univariable analysis we evaluated 14 sociodemographic, occupational, and attitudinal variables. Of these, 7 variables met criteria to be included in the multivariable analysis, of which 4 remained significant in the multivariable analysis ( Table 3 ). Download: PNG larger image TIFF original image Table 3. Univariable and partially adjusted analysis of factors associated with uptake of influenza vaccine in at least one of the three study seasons among health care workers, Georgia, 2021–2024. https://doi.org/10.1371/journal.pone.0356495.t003 Compared to HCWs aged 18–29 years, HCWs in the age group 40–49 years were more likely to get vaccinated (adjusted odds ratio (aOR): 2.67, 95% CI 1.09–6.59). While older HCWs in other age group categories were also more likely to have received influenza vaccine, the aORs were not statistically significant ( Table 4 ). Download: PNG larger image TIFF original image Table 4. Multivariable analysis of factors associated with uptake of influenza vaccine in at least one of the three study seasons among health care workers, Georgia, 2021–2024. https://doi.org/10.1371/journal.pone.0356495.t004 HCWs who did not believe influenza vaccine was safe (aOR: 0.27, 95% CI 0.11–0.68), HCWs who thought that influenza vaccine was not effective (aOR: 0.36, 95% CI 0.14–0.89), and HCWs who worked in Hospital B (aOR: 0.06, 95% CI 0.02–0.23) were less likely to get vaccinated. In a sensitivity analysis restricted to influenza vaccination uptake during the 2023–2024 season (the year in which attitudes were measured), perceived vaccine safety and perceived effectiveness in preventing missed work remained strongly associated with vaccination uptake. Institutional differences were also observed. Results were consistent with the primary analysis ( S1 Table ). Reasons for getting and not getting influenza vaccine in 2022–2023 season HCWs who did not get vaccinated in the 2022–2023 season, cited as the main reason for not getting vaccinated “even if I get the flu, it won’t be severe, so I don’t need vaccination” [97 (66%)] followed by “I do not trust the official recommendations” [84 (58%)] ( Table 5 ). Among HCWs who did get vaccinated, the main reason reported was “to protect my health” [211 (99%)] ( Table 6 ). Download: PNG larger image TIFF original image Table 5. Reasons for not getting influenza vaccine, Georgia, 2022–2023. https://doi.org/10.1371/journal.pone.0356495.t005 Download: PNG larger image TIFF original image Table 6. Reasons for getting influenza vaccine, Georgia, 2022–2023. https://doi.org/10.1371/journal.pone.0356495.t006 Discussion In our study of factors associated with influenza vaccine uptake among Georgian HCWs over a three-year period, we found that older HCWs were more likely to be vaccinated, while doubts about influenza vaccine safety and effectiveness were associated with lower vaccination uptake. These findings highlight not only the patterns of vaccination behaviour but also the underlying beliefs that may shape HCW decision-making. These findings, which combine three seasons of influenza vaccination history among HCWs in six Georgian hospitals, can be used to tailor messaging to emphasize influenza vaccine safety and effectiveness. In addition, the findings highlight the need to increase vaccine promotion among younger HCWs in Georgia. Our finding that doubts about influenza vaccine safety were associated with lower vaccine uptake among HCWs has been reported in other studies conducted mostly in high-income countries. For example, in a global meta-analysis Kong et al. (2022) found that safety concerns were a common barrier to influenza vaccination among HCWs across multiple studies [ 23 ]. Likewise, a study among Lebanese physicians by Farah et al. (2025) identified vaccine safety perceptions as a k
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