Of the 1500 distributed questionaiers, 993 HCWs completed and returned the questionnaire with a total response rate of 66.2% in the three Middle East countries with the highest response rate from Kuwait; where 300 questionairre were distributed and 232 (77.3%) completed the questionairre. In Oman, 600 questionairre were distributed and 360 (60%) completed the survey. In UAE, 691 questionairre were distributed and 401(58%) had completed and returned the survey. Approximately, seventy percent of the respondents were in the age range of 25- 45 years with the majority of the respondents being female (65.4%). The majority of the participants (66.5%)were professional staff. Data on the demographic information of participants are summarized in Table .
Characteristics of respondent to the influenza vaccine survey of health care workers (**: Significance level < 0.005)
The study results showed that a total of 42.5% of all the respondents self reported influenza vaccination in the three countries. There was a statistically significant difference in the rate of vaccination among participants in the three countries (p-value <0.0001) with the highest vaccination rate in Kuwait (67.2%) compared to 46.4% in Oman and only 24.7% in UAE.
A small proportion of the respondents reported that they got influenza like symptoms on regular basis (11.6%) and the majority of the participants reported that they got it rarely (53.0%). When the respondents were asked about their awaeness of the CDC recomendations for influenza vaccination, around fifty one percent of the respondents reported that they are aware of the CDC recommendations regarding immunization against seasonal influenza. Data are summarized in table .
The association between the respondents' charactarestics and the vaccination status were tested to identify the different variables associated with the likelihood of vaccination aganist influenza among HCWs. The data are summarized in table . There was no significant association between HCWs age and the vaccination status in both UAE and Kuwait with a p-value > 0.05 (χ2test) with highest vaccination rate being within the age range of > 45 years (32.2%)in UAE and within the age range of 36-45 years of age (69.5%) in Kuwait.In Oman, there was a significant difference in the vaccination rate among the different age groups (P = 0.005) with the age range of 36-45 years of age (56.3%) having the highest vaccination rate. The lowest vaccination rate was within the age range below 25 years of age(25.5%).
Bivariate analysis of association between vaccination status and respondent characteristics and multivariate analysis of likelihood of vaccination.
Results also showed that gender does not have any statistically significant effect on the vaccination rate of the participants with a p-value = 0.05 (χ2 test) in the three participated countries.
The attitude of HCWs' were also analyzed to see if their decision to take influenza vaccination were in any way influenced by their previous history of infliction with influenza like symptoms. Results from UAE and Kuwait showed that there is no association between respondents' previous history of influenza illness and their vaccination status (p-value > 0.05, χ2 test) in fact in Oman, the highest vaccination rate (66.4%) was obtained for individuals who never got influenza like symptoms. Multivariate analysis of the results showed that having history of influenza illness was less likely to occur in the vaccinated group in Oman (OR=0.662). Data are shown in table .
On the other hand, the study showed that influenza vaccinated healthcare workers often continue to work while getting sick with influenza illness compared to none vaccinated individuals. In UAE, there was a significant difference (p-value =0.05) observed between the vaccination status of the respondents who continue to work despite their infection with influenza (70.1%).
Participants' awareness of the CDC recommendations of vaccination against seasonal influenza were assessed which revealed that almost half of the participants (48.5%) were aware of these recommendations. Despite this fact, the vaccination rate was low in all the three countries; in UAE, only 26.7% of the vaccinated workers were aware of the CDC recommendations. In Oman, the majority of the vaccinated individuals (56.5%) were aware of the CDC recommendations and those HCWs were 2.2 times more likely to have been vaccinated than others. Data are summarized in table .
The different motivating factors that influenced the health care workers to take the vaccine was assessed and found that the most common factor that influenced their decision to take the vaccine was for their self protection (59%). 46.9% took the vaccine based on the recommendations set by their institutions and 45.5% of HCWs took the vaccine to protect their patients and other HCWs from getting infected with influenza virus. The motivating factors that influenced HCWs' decision to take influenza vaccine were similar in all the three countries. The only factor that showed statistically significant difference among the three countries was accessibility of the concerned vaccine where 38.3% and 42.9% of the respondents in Oman and Kuwait respectively reported that they took the vaccine because it was easily accessible compared to (12.1%) in UAE (p-value= 0.049, χ2 test). Data are summarized in Table .
Reasons for up-taking vaccine among health care workers in three countries.
On the other hand, self reported reasons among HCWs on refusal to take influenza vaccine were assessed and showed that the most common reason that discouraged HCWs to take the vaccine was “lack of time” as reported by 31.8% of the respondents. Other reasons for not taking the vaccine were unawareness of vaccine availability (29.4%), unavailability of vaccine (25.4%), doubts about vaccine efficacy (24.9%), lack of information about importance (20.1%) and concerns about its side effects (17.3%). Data is shown in table .
Reasons for not-taking vaccine among health care workers in three countries.
The most common reason for not taking the vaccine in UAE & Oman was the unawareness of vaccine availability (21.5% and 31.6%, respectively) while in Kuwait “lack of time” was the main reason for not being vaccinated (90.9%) among HCWs.
The most common reasons among HCWs for not taking the vaccine were similar in the three countries but there were statistically significant differences for some factors among the three countries. HCWs' apprehensions of experiencing side effects was more in UAE (19.5%) compared to 13.2% and 15.5% in Kuwait and Oman, respectively. Lack of time was extremely important factor as reported by the majority of respondents from Kuwait (90.9%) to be the main reason for not taking the vaccine compared to 14.6% and 19.7% in UAE and Oman, respectively. Another factor was HCWs doubts regarding vaccine efficacy as reported in Kuwait by 56.6% of the respondents with a significant p-value < 0.05, χ2 test compared to 20.9% and 18.7% in UAE and Oman, respectively. All other factors were of non-significant difference among the respondents from the three participated countries.