The Influence of COVID-19 Pandemic on Influenza Immunization in Saudi Arabia: Cross-Sectional Study

Abstract

Introduction Influenza vaccination is the primary control measure for severe complications caused by influenza viruses. Moreover, in the face of the COVID-19 pandemic, Saudi Arabia recommends vaccinating people at risk against influenza to minimise co-infection risk with SARS-CoV2. Therefore, this study aims to assess the Saudi population’s knowledge, attitude, and practice toward influenza vaccination during the COVID-19 pandemic. Moreover, we evaluate the impact of the COVID-19 pandemic on seasonal influenza vaccination. Methods This cross-sectional study was conducted using an online survey in Saudi Arabia between July to August 2021. Participants were invited to complete the questionnaire through a survey link sent to social media platforms. Results A total of 2410 participants were included in this study. Our data demonstrate a lack of practice, attitude, and knowledge, especially on the influenza virus’s symptoms, viral transmission, and vaccine efficacy. Moreover, this study showed that the COVID-19 pandemic significantly impacted seasonal influenza vaccination in the Saudi population by 1.5-times compared to the previous years. Conclusion COVID-19 pandemic has increased the hesitancy of Saudi participants in influenza vaccination due to the lack of knowledge. As the pandemic of COVID-19 is fading, awareness campaigns are needed to encourage the public about the importance of receiving the influenza vaccine, especially for those at high risk each year.

Low uptake of seasonal influenza vaccination in Al-Jouf region of Saudi Arabia

“…As such, the findings may not be representative of the general Saudi population. Nevertheless, the results presented here are consistent with vaccination rates reported in similar studies conducted in other parts of Saudi Arabia ( Alhazmi et al, 2019 , Aljamili, 2020 , Barry et al, 2020 , Fayed et al, 2021 , Sales et al, 2021 , Minshawi et al, 2022 ).…”

“…Seasonal influenza vaccinations are recommended for all persons aged 6 months and older in Saudi Arabia (unless contraindicated) ( Zeitouni et al, 2015 ). Nevertheless, the low rates of seasonal influenza vaccinations found in other similar studies of vaccination rates in Saudi Arabia, 12.7% and 37.2% ( Alhazmi et al, 2019 , Aljamili, 2020 , Barry et al, 2020 , Fayed et al, 2021 , Sales et al, 2021 , Minshawi et al, 2022 ), was confirmed by this study (27.4%). Influenza vaccination rates have been observed in various populations in other Arabian Gulf coast countries at a higher level than observed in this study for Saudi Arabia: 38.9% among health care professionals in United Arab Emirates ( Barqawi et al, 2021 ), 32.8% among patients with diabetes and kidney disease in Eastern Iran ( Ebrahimzadeh et al, 2022 ), and 52.3% of individuals with any one risk factor in Qatar ( Dsouza, 2022 ).…”

“…This study found that employed individuals, employees of the healthcare sector, and those with higher PHE knowledge Scores were significantly more likely to regularly get seasonal influenza vaccinations than their counterparts. Of the previous six studies that assessed seasonal influenza vaccination rates among Saudi citizens that had been published between October 19, 2017 and October 18, 2022, only one study conducted adjusted multivariate analyses to identify significant predictors of regular seasonal vaccinations ( Alhazmi et al, 2019 , Aljamili, 2020 , Barry et al, 2020 , Fayed et al, 2021 , Sales et al, 2021 , Minshawi et al, 2022 ). Specifically, Sales et al (2021) found positive views on the safety and efficacy of the seasonal influenza vaccine, that the vaccine should be taken at a specific time of the year, and the need to get the vaccine to minimize the risk of getting seasonal influenza were all significantly associated with regular seasonal vaccination rates.…”

“…Six studies conducted among Saudi citizens that had been published between October 19, 2017 and October 18, 2022 were identified in the literature. In general, seasonal influenza vaccination rates reported in these studies ranged from 12.7% to 55.0% ( Alhazmi et al, 2019 , Aljamili, 2020 , Barry et al, 2020 , Fayed et al, 2021 , Sales et al, 2021 , Minshawi et al, 2022 ). However, these studies inquired about seasonal influenza vaccination status in different ways.…”

“…Two other survey studies assessed past seasonal influenza vaccination status, finding 19.5% among a nationwide sample of adults ( Fayed et al, 2021 ), and 44.3% of a sample, residents from Riyadh province, had been vaccinated any time in the past ( Barry et al, 2020 ). Minshawi et al (2022) examine seasonal vaccination rates in relation to the COVID-19 pandemic, finding 40% of Saudi adults were vaccinated before the COVID-19 pandemic but only 25.7% were vaccinated during the pandemic. Surveillance data on vaccination rates among Hajj pilgrims found only 13.8% of pilgrims between 2007 and 2012 were vaccinated for both seasonal influenza and pneumonia ( Zafer et al, 2018 ).…”