title: Influenza vaccination coverage rates among adults before and after the 2009 influenza pandemic and the reasons for non-vaccination in Beijing, China: a cross-sectional study.
abstract: BACKGROUND
  To optimize the vaccination coverage rates in the general population, the status of coverage rates and the reasons for non-vaccination need to be understood. Therefore, the objective of this study was to assess the changes in influenza vaccination coverage rates in the general population before and after the 2009 influenza pandemic (2008/2009, 2009/2010, and 2010/2011 seasons), and to determine the reasons for non-vaccination.
  
  
  METHODS
  In January 2011 we conducted a multi-stage sampling, retrospective, cross-sectional survey of individuals in Beijing who were ≥ 18 years of age using self-administered, anonymous questionnaires. The questionnaire consisted of three sections: demographics (gender, age, educational level, and residential district name); history of influenza vaccination in the 2008/2009, 2009/2010, and 2010/2011 seasons; and reasons for non-vaccination in all three seasons. The main outcome was the vaccination coverage rate and vaccination frequency. Differences among the subgroups were tested using a Pearson's chi-square test. Multivariate logistic regression was used to determine possible determinants of influenza vaccination uptake.
  
  
  RESULTS
  A total of 13002 respondents completed the questionnaires. The vaccination coverage rates were 16.9% in 2008/2009, 21.8% in 2009/2010, and 16.7% in 2010/2011. Compared to 2008/2009 and 2010/2011, the higher rate in 2009/2010 was statistically significant (χ2=138.96, p<0.001), and no significant difference existed between 2008/2009 and 2010/2011 (χ2=1.296, p=0.255). Overall, 9.4% of the respondents received vaccinations in all three seasons, whereas 70% of the respondents did not get a vaccination during the same period. Based on multivariate analysis, older age and higher level of education were independently associated with increased odds of reporting vaccination in 2009/2010 and 2010/2011. Among participants who reported no influenza vaccinations over the previous three seasons, the most commonly reported reason for non-vaccination was 'I don't think I am very likely to catch the flu' (49.3%).
  
  
  CONCLUSIONS
  Within the general population of Beijing the vaccination coverage rates were relatively low and did not change significantly after the influenza pandemic. The perception of not expecting to contract influenza was the predominant barrier to influenza vaccination. Further measures are needed to improve influenza vaccination coverage.
authors.affiliation: Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control, Beijing, China.
authors.forename: Shuangsheng
authors.initials: S
authors.lastname: Wu
authors.forename: Peng
authors.initials: P
authors.lastname: Yang
authors.forename: Haiyue
authors.initials: H
authors.lastname: Li
authors.forename: Chunna
authors.initials: C
authors.lastname: Ma
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhang
authors.forename: Quanyi
authors.initials: Q
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D058873:Pandemics / Q000706:statistics & numerical data*; D010349:Patient Compliance; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines