Knowledge and Attitudes Regarding Seasonal Influenza and Influenza Vaccination among Patients and Their Companions in North Palestine Hospitals

Background. Seasonal influenza is a common highly infectious disease that can affect the upper and lower airway in children and adults mainly in wintertime which is caused by many different influenza viruses and, in some cases, may cause serious complications such as pneumonia. We conducted this study to assess the knowledge and attitudes among patients and their companions in North Palestine hospitals regarding seasonal influenza and influenza vaccination and factors influencing the uptake of this vaccine so that we can identify gaps in their knowledge and give feedback to health authorities for future quality improvement projects by increasing awareness of its effectiveness and safety. Methods. A cross-sectional 17-item survey included randomly selected samples of 327 North Palestinian patients and their companions at North Palestine hospitals. Result. A total of 327 completed questionnaires were received with a response rate of 92%. Of these, 129 participants (39.4%) believed that influenza is the same as common cold. The majority of participants (85.3%) had heard of the influenza vaccine before. Although nearly half of them (53.6%) believed that the influenza vaccine is safe, only 112 (34.7%) of the participants considered vaccination an effective means in preventing serious influenza-related complications and only 89 (27.2%) participants were previously vaccinated. The main reasons for not being vaccinated included that vaccination is not necessary because flu is not a serious disease (67%), concerns about vaccine efficacy and its side effects (25.6%), fear of needles and injection (25.2%), and 17.8% of the participants believed that this vaccine is expensive. Conclusion. The uptake and knowledge of the influenza vaccine among Palestinians are low. Vaccinated participants in our survey showed a higher level of knowledge compared to nonvaccinated participants. Half of the participants believed in the safety of the vaccine and one-third of them believed in its efficacy in preventing flu illness and its complications. Extensive and sustained efforts are needed by public health programs to promote the flu vaccine among the public by increasing awareness of its effectiveness and safety.

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Seasonal Influenza Vaccination among Saudi Children: Parental Barriers and Willingness to Vaccinate Their Children

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16214226 ◽

2019 ◽

Vol 16 (21) ◽

pp. 4226 ◽

Cited By ~ 1

Author(s):

Abdullah Alolayan ◽

Bdoor Almotairi ◽

Shouq Alshammari ◽

Malak Alhearri ◽

Mohammed Alsuhaibani

Keyword(s):

Influenza Vaccine ◽

Influenza Vaccination ◽

Seasonal Influenza ◽

Risk Groups ◽

Cross Sectional Survey ◽

Severe Condition ◽

Cross Sectional ◽

Seasonal Influenza Vaccine ◽

Awareness Campaigns ◽

Knowledge And Attitudes

Influenza is an acute respiratory infection. It is a contagious viral illness which can cause moderate to severe symptoms. However, high-risk groups, including children, can develop a severe condition requiring hospitalization that may, in severe cases, result in death. This study aimed to assess the knowledge and attitudes of Saudi parents toward the influenza vaccine and identify potential barriers to receiving the influenza vaccination. A cross-sectional survey was conducted using a questionnaire comprising 27 validated questions to assess parental awareness, knowledge, and attitudes toward the influenza vaccine. The overall attitude of the participants was positive (94.7%). However, their knowledge was generally poor (61.7%). Most participants were aware of the seasonal influenza vaccine (85.5%) and their children were up-to-date with the child national vaccination program vaccines (92.7%). Medical staff and awareness campaigns were the commonest sources of vaccine information. Significant predictors for knowledge about and attitudes toward the influenza vaccine included educational level, working in the medical field, monthly income, awareness of the seasonal influenza vaccine, having received the vaccine as parent, and having a child already vaccinated. Adherence to the influenza vaccination regimen for parents and their children was low. More educational campaigns are needed to increase knowledge about the vaccine.

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Characteristics of Healthcare Workers Vaccinated against Influenza in the Era of COVID-19

Vaccines ◽

10.3390/vaccines9070695 ◽

2021 ◽

Vol 9 (7) ◽

pp. 695

Author(s):

Giorgia Della Polla ◽

Francesca Licata ◽

Silvia Angelillo ◽

Concetta Paola Pelullo ◽

Aida Bianco ◽

...

Keyword(s):

Influenza Vaccine ◽

Influenza Vaccination ◽

Perceived Risk ◽

Healthcare Workers ◽

Seasonal Influenza ◽

High Risk Group ◽

High Coverage ◽

Cross Sectional ◽

Current Season ◽

Study Results

Understanding the potential impact of COVID-19 on receiving influenza vaccination among healthcare workers (HCWs) is of utmost importance. The purposes of the present cross-sectional study were to describe the characteristics and to explore the predictors of receiving influenza vaccination among a large cohort of Italian HCWs in hospital settings. Information was collected through an anonymous questionnaire from December 2020 through January 2021. General and practice characteristics, perceived risk of seasonal influenza, attitudes towards efficacy and safety of influenza vaccination, and reasons behind the decision to be vaccinated against influenza were explored. Fewer than half (46.2%) of HCWs agreed that influenza is a serious illness and perceived the risk of getting infected with influenza, and concerns about the safety of the vaccination were significant positive predictors. Fewer than half of the respondents were not concerned at all about the efficacy (48.6%) and safety (49.8%) of influenza vaccination, and 51.9% reported that they have not received a seasonal influenza vaccine during the previous season. The most mentioned reason for receiving the influenza vaccine in the current season was that influenza and COVID-19 share some similar symptoms. Study results will aid policymakers in developing vaccination education programs, promotion of trust to address negative misconceptions, and to achieve future high coverage among this high-risk group.

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Influenza Vaccination Hesitancy among Healthcare Workers in South Al Batinah Governorate in Oman: A Cross-Sectional Study

Vaccines ◽

10.3390/vaccines8040661 ◽

2020 ◽

Vol 8 (4) ◽

pp. 661

Author(s):

Salah T. Al Awaidy ◽

Zayid K. Al Mayahi ◽

Malak Kaddoura ◽

Ozayr Mahomed ◽

Nathalie Lahoud ◽

...

Keyword(s):

Influenza Vaccine ◽

Influenza Vaccination ◽

Healthcare Workers ◽

Seasonal Influenza ◽

General Medicine ◽

Knowledge Score ◽

Vaccine Uptake ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Increased Risk

Background: Seasonal influenza infections are a major cause of morbidity and mortality worldwide. Healthcare workers (HCWs) are an important target group for vaccination against influenza due to their increased risk of infection and their potential to transmit the infection to their patients, families and communities. The aim of this study was to assess the potential hesitancy and its associated factors towards influenza vaccination amongst HCWs in the South Al Batinah governorate in Oman. Methods: A cross-sectional survey of 390 HCWs with direct or indirect patient contact was conducted in May and June 2019 using a self-administered questionnaire. Associations between HCW characteristics and vaccination status were examined using bivariate and multivariate analyses to identify the likelihood of vaccination against seasonal influenza among HCWs. Results: Overall, 60% of HCWs were vaccinated in the 2018/2019 season; vaccine uptake among nurses was 52% and uptake was higher among women. Self-protection and protection of the community were the most cited reasons for vaccine acceptance, with side effects being the main reason for hesitancy. Vaccinated respondents had a higher mean knowledge score (7.18; standard deviation SD: 2.14) than unvaccinated respondents (6.30; SD: 2.2). Odds of vaccination were highest among respondents who believed influenza vaccine should be mandatory for HCWs (Odds ratio (OR): 2.04 [1.30–3.18]), those working in the general medicine, emergency medicine, or intensive care units (OR: 1.92 [1.20–3.10]), nurses and doctors (OR: 1.75 [1.09–2.79]) and those who believe that HCWs should receive an influenza vaccine (OR: 1.35 [1.07–2.77]). Conclusions: The study provides valuable insights into the enablers and barriers of influenza vaccination practices among HCWs and may inform interventions to increase acceptance of vaccination.

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Seasonal Influenza Vaccination and Recommendation: The Difference between General Practitioners and Public Health Workers in China

Vaccines ◽

10.3390/vaccines8020265 ◽

2020 ◽

Vol 8 (2) ◽

pp. 265 ◽

Cited By ~ 1

Author(s):

Hongguo Rong ◽

Xiaozhen Lai ◽

Xiaochen Ma ◽

Zhiyuan Hou ◽

Shunping Li ◽

...

Keyword(s):

Public Health ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

General Practitioners ◽

Seasonal Influenza ◽

Health Workers ◽

The Elderly ◽

Vaccine Uptake ◽

Knowledge And Attitudes ◽

Public Health Workers

Seasonal influenza vaccination for healthcare workers (HCWs) is critical to the protection of HCWs and their patients. This study examined whether the separation of public health workers and general practitioners could affect the influenza vaccine uptake and recommendation behaviors among HCWs in China. A survey was conducted from August to October 2019, and HCWs from 10 provinces in China were recruited. A self-administered and anonymous questionnaire was used to assess HCWs’ demographic information, knowledge, and attitudes toward influenza vaccination, as well as vaccine uptake and recommendation behaviors. The primary outcome was HCWs’ vaccination and recommendation status of seasonal influenza vaccine. Multivariate logistic regression models were used to identify the influence factors of influenza vaccine uptake and recommendation among HCWs. Of the 1159 HCWs in this study, 25.3% were vaccinated against influenza in the previous season. “No need to get vaccinated” was the primary reason for both unvaccinated public health workers and general practitioners. Multivariate logistic regression showed that public health workers were more likely to get vaccinated against influenza (OR = 2.20, 95% CI 1.59–3.05) and recommend influenza vaccination to children (OR = 2.10, 95% CI 1.57–2.80) and the elderly (OR = 1.69, 95% CI 1.26–2.25) than general practitioners. Besides, the knowledge and perceived risk of influenza can give rise to HCWs’ vaccination and recommendation behaviors, and HCWs who got vaccinated in the past year were more likely to recommend it to children and the elderly in their work. The influenza vaccine coverage and recommendation among HCWs are still relatively low in China, especially for general practitioners. Further efforts are needed to improve the knowledge and attitudes toward influenza and influenza vaccination among HCWs, and coherent training on immunization for both public health workers and general practitioners might be effective in the face of separated public health and clinical services in China.

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Knowledge, Attitude, and Barriers Influencing Seasonal Influenza Vaccination Uptake

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2020/7653745 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Mazin A. Barry ◽

Khalid I. Aljammaz ◽

Abdulaziz A. Alrashed

Keyword(s):

Saudi Arabia ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Seasonal Influenza ◽

Well Being ◽

Influenza Viruses ◽

Vaccine Uptake ◽

Severe Illness ◽

Seasonal Influenza Vaccination ◽

Vaccination Uptake

Background. Seasonal influenza is an acute respiratory infection caused by influenza viruses that are highly contagious and circulate in all parts of the world. It gives rise to an estimated 3 to 5 million cases of severe illness and about 250,000 to 500,000 deaths globally each year. Influenza tends to cause epidemics with serious illness and death among high-risk groups such as children aged 5 years and younger, pregnant women, elderly ≥65 years of age, and with chronic medical conditions. According to the Centers for Disease Prevention and Control (CDC), all people who are 6 months old and above are recommended to receive the seasonal influenza vaccine annually. Despite the fact that influenza vaccine is readily available, and the severity of the disease is known to adversely affect the individual’s quality of life and well-being, vaccination uptake rates are still low, contributing to the increased burden of the disease worldwide. Objectives. To measure the influenza vaccine uptake among residents of Riyadh Province, Saudi Arabia, that determines their attitude, knowledge, and beliefs regarding the vaccine. Methods. A cross-sectional study was conducted using a self-administered structured questionnaire distributed online targeting residents of Riyadh Province, Saudi Arabia, from 1st of August 2019 till 30th of September 2019. Participants were selected through volunteer sampling. The questionnaire included demographic data including age, gender, occupation, education level, marital status, and comorbidities. It also included questions regarding knowledge, attitude, and beliefs regarding influenza vaccine. After collection of data, statistical analyses were conducted by using Statistical Package for Social Sciences (SPSS) version 19.0. A P value of <0.05 was considered statistically significant. Results. Our study included 503 participants, with age ranging from 18 to 65 years old and 324 (64%) were females. 100 participants (19.9%) had comorbid conditions, and 223 (44.3%) have been vaccinated against influenza in the past. A large portion of participants (41.2%) were familiar with seasonal influenza vaccination from the media. The knowledge part of the questionnaire showed that 302 (60%) participants knew how often they should receive the vaccine and 313 (62.2%) participants knew that the vaccine is provided freely in all of Saudi Arabia. In terms of belief and attitude, 371 participants (73.8%) thought they were susceptible to the disease and 365 (73.8%) believed that influenza vaccine is beneficial, while 446 participants (88.7%) thought that the general public need more knowledge and awareness on the scientific facts of influenza vaccine. Regarding barriers, 295 participants (58.6%) wanted to avoid vaccines and 252 (50.1%) were concerned about the vaccine’s adverse effects. Participants with frequent health checkups and those who had previous knowledge on the availability of the vaccine for free were more likely to be vaccinated. Vaccinated participants (44.3%) were asked if they were willing to take the vaccine again when it is due, 158 (70.9%) answered yes. Those who elicited symptomatic reaction to the vaccine (26.0%) were less inclined to take it again P = 0.035 . Conclusion. We concluded that there is a low influenza vaccine uptake rate among our study population, considering that the barriers most commonly chosen by participants are solvable with health education and campaigns oriented towards delivering facts about the vaccine and dispelling misinformation; such measures are highly recommended and are postulated to carry a great benefit that should target common misconceptions identified in this study.

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Development of an interactive online tool for genome sequence-based influenza vaccine strain selection

10.32469/10355/85856 ◽

2021 ◽

Author(s):

◽

Sweta Pragyan Praharaj

Keyword(s):

Influenza Vaccine ◽

Phylogenetic Tree ◽

Influenza Vaccination ◽

Vaccine Strain ◽

Influenza A ◽

Seasonal Influenza ◽

Influenza Viruses ◽

Influenza A Viruses ◽

Seasonal Influenza Vaccine ◽

Antigenic Cartography

Seasonal influenza viruses in humans infect approximately 5 [percent] to 15 [percent] of the population and cause an estimated half-million deaths worldwide per year. Among the four co-circulating seasonal influenza viruses, subtype H3N2 and H1N1 influenza A viruses have rapid mutations and frequent antigenic drift events, leading to frequent updates of vaccine strains in the seasonal influenza vaccine. Seasonal influenza vaccination is the primary option to prevent and control influenza epidemics, and the selection of an antigenic matched vaccine strain is one of the keys to the success of seasonal influenza vaccination. Thus, it is critical to have robust and rapid antigenic analyses of epidemic strains and estimates of their genetic and antigenic relationship with the vaccine strain in use. In this study, we present vaccineEvol, an interactive and user-friendly web visualization tool that allows researchers to comprehend large sequence datasets into antigenic and genetic analyses. With the integration of the genomic sequences from the public database, the tool enables the users to track and analyze both genetic and antigenic evolutionary dynamics of seasonal influenza viruses. Primarily, our application can quantify both genetic and antigenic distances among seasonal H3N2 influenza A viruses and display genetic and antigenic variants using phylogenetic tree and antigenic cartography, respectively. The users can also interactively analyze genetic and antigenic variants between the phylogenetic tree and antigenic cartography. The application performs machine learning based computations in the backend, which was previously developed in our lab, and efficient construction of trees and maps in the frontend. In summary, in this study, an interactive web server was developed for rapid antigenic and genetic analyses of seasonal influenza viruses and thus facilitate seasonal influenza vaccine strain selection.

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Intention to have the seasonal influenza vaccination during the COVID-19 pandemic among eligible adults in the UK: a cross-sectional survey

BMJ Open ◽

10.1136/bmjopen-2021-049369 ◽

2021 ◽

Vol 11 (7) ◽

pp. e049369

Author(s):

Susan M Sherman ◽

Julius Sim ◽

Richard Amlôt ◽

Megan Cutts ◽

Hannah Dasch ◽

...

Keyword(s):

Influenza Vaccine ◽

Influenza Vaccination ◽

Positive Attitude ◽

Online Survey ◽

Seasonal Influenza ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Seasonal Influenza Vaccination ◽

The Uk ◽

To Receive

ObjectiveTo investigate the likelihood of having the seasonal influenza vaccination during the COVID-19 pandemic in individuals who were eligible to receive it.DesignWe conducted a cross-sectional online survey in July 2020. We included predictors informed by previous research, in the following categories: sociodemographic variables; uptake of influenza vaccine last winter and beliefs about vaccination.Participants570 participants (mean age: 53.07; 56.3% female, 87.0% white) who were eligible for the free seasonal influenza vaccination in the UK.Results59.7% of our sample indicated they were likely to have the seasonal influenza vaccination, 22.1% reported being unlikely to have the vaccination and 18.2% were unsure. We used logistic regression to investigate variables associated with intention to receive a seasonal influenza vaccine in the 2020–2021 season. A positive attitude to vaccination in general predicted intention to have the influenza vaccine in 2020–2021 (OR 1.45, 95% CI 1.19 to 1.77, p<0.001) but the strongest predictor of intention was previous influenza vaccination behaviour (OR 278.58, 95% CI 78.04 to 994.46, p<0.001).ConclusionsPrevious research suggests that increasing uptake of the influenza vaccination may help contain a COVID-19 outbreak, so steps need to be taken to convert intention into behaviour and to reach those individuals who reported being unlikely or unsure about having the vaccine.

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Knowledge, attitude/perception, and practice related to seasonal influenza vaccination among caregivers of young Thai children: A cross-sectional study

PLoS ONE ◽

10.1371/journal.pone.0253561 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0253561

Author(s):

Chareeya Thanee ◽

Wanitchaya Kittikraisak ◽

Chalinthorn Sinthuwattanawibool ◽

Koonkoaw Roekworachai ◽

Arunee Klinklom ◽

...

Keyword(s):

Young Children ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Seasonal Influenza ◽

Healthcare Providers ◽

P Value ◽

Cross Sectional ◽

National Recommendation ◽

History Of ◽

Influenza Illness

Background Seasonal influenza vaccination uptake among young children in Thailand is low despite national recommendation for vaccination. We implemented a knowledge, attitude/perception, and practice survey to understand determinants of influenza vaccination in children aged six months to two years. Methods Using a cross-sectional design, we interviewed caregivers of 700 children in seven hospitals using a structured questionnaire to collect information on caregivers’ and children’s demographic characteristics, and caregivers’ knowledge of influenza illness and national vaccine recommendation, attitude/perception toward influenza vaccine, and information sources. We verified children’s influenza vaccination status against medical records (vaccinated vs. unvaccinated). Logistic regression was used to examine factors independently associated with children receiving influenza vaccination in the 2018 season using the dataset restricted to only children’s parents. Variables associated with vaccination at p-value ≤0.20 were included in subsequent multivariable logistic models. Significant independent determinants of children’s influenza vaccination and collinearity of covariates were assessed. The final model was constructed using a stepwise backward elimination approach with variables significant at p-value <0.05 retained in the model. Results During August 2018-February 2019, 700 children’s caregivers completed the questionnaire; 61 (9%) were caregivers of vaccinated children. Caregivers of the vaccinated children were statistically more likely to have higher education (61% vs. 38%; p-value<0.01) and to know of influenza illness (93% vs. 76%; p-value = 0.03) than those of the unvaccinated group. Factors associated with children receiving influenza vaccination were identifying healthcare providers as a primary source of information about influenza illness for parents (adjusted odds ratio [aOR], 2.8; 95% confidence interval [CI], 1.3–6.0), parents’ strongly agreeing with the national recommendation for influenza vaccination in young children (aOR, 2.9; 95% CI, 1.5–5.9), using health insurance provided by the government or parent’s employer for children’s doctor visits (aOR, 2.6; 95% CI, 1.1–6.6), and the children’s history of receiving influenza vaccination in the 2017 season or earlier (aOR, 3.2; 95% CI, 1.4–7.8). Conclusion The majority of caregivers of children in this study had knowledge of influenza illness and influenza vaccine. Caregivers reported various sources of information regarding influenza illness and the vaccine, but healthcare providers remained the most trusted source. Children’s history of influenza vaccination in prior season(s) was the strongest determinant of children being vaccinated for influenza in the current season.

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Acceptance of seasonal influenza vaccination among Slovenian physicians, 2016

Slovenian Journal of Public Health ◽

10.2478/sjph-2019-0006 ◽

2019 ◽

Vol 58 (1) ◽

pp. 47-53 ◽

Cited By ~ 1

Author(s):

Veronika Učakar ◽

Alenka Kraigher

Keyword(s):

Influenza Vaccination ◽

Seasonal Influenza ◽

Univariate Analysis ◽

Influenza Viruses ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Web Based ◽

Seasonal Influenza Vaccination ◽

Vaccine Preventable Diseases ◽

Explanatory Variables

Abstract Introduction Vaccination against seasonal influenza is recommended for all healthcare workers including physicians in Slovenia to protect vulnerable individuals and reduce transmission of influenza viruses. The aim of our study is to determine the uptake of seasonal influenza vaccination among Slovenian physicians, to identify factors associated with that vaccination and assess their attitudes and beliefs regarding vaccination and vaccine-preventable diseases. Methods A cross-sectional survey was performed among physician members of the Slovenian Medical Chamber. The link to the anonymous web-based questionnaire was sent to 8,297 physicians. We estimated the overall proportion of physicians who vaccinate against influenza, while the possible associations with collected explanatory variables were explored in univariate analyses. Results The response rate to the survey was 10.8%. 75.9% (95% CI: 73.1–78.7%) physicians vaccinate themselves against influenza (regularly or occasionally) and 24.1% (95% CI: 21.2–26.8%) do not vaccinate (not any more or never). In univariate analysis only, the area of work was statistically significant when associated with vaccinating against influenza (p=0.002). Among physicians who expressed some misconceptions regarding vaccination and vaccine-preventable diseases (it is better to overcome disease naturally as vaccines pose a higher risk than disease) the proportion of vaccinated against influenza was low (43.2%; 95% CI: 27.9–58.4%, 27.3%; 95% CI: 7.1–47.5%). Conclusion Not trusting in vaccination or professional recommendations regarding vaccination and some misconceptions regarding vaccination and vaccine-preventable diseases may influence the decision to be vaccinated against seasonal influenza among Slovenian physicians.

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Healthcare Workers’ Perspectives on the Upcoming COVID-19 Vaccine in Terms of Their Exposure to the Influenza Vaccine in Riyadh, Saudi Arabia: A Cross-Sectional Study

Vaccines ◽

10.3390/vaccines9050465 ◽

2021 ◽

Vol 9 (5) ◽

pp. 465

Author(s):

Leena R. Baghdadi ◽

Shatha G. Alghaihb ◽

Alanoud A. Abuhaimed ◽

Dania M. Alkelabi ◽

Rawan S. Alqahtani

Keyword(s):

Saudi Arabia ◽

Influenza Vaccine ◽

Work Experience ◽

Healthcare Workers ◽

Seasonal Influenza ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Seasonal Influenza Vaccine ◽

History Of

In 2019, a novel severe acute respiratory syndrome (SARS-CoV-2 (COVID-19)) caused a global pandemic. There was an urgent need to develop a vaccine against COVID-19 to reduce its spread and economic burden. The main objective of this study was to understand the attitudes and concerns of healthcare workers (HCWs) towards the upcoming COVID-19 vaccine, whether their decision was influenced by their history of taking the seasonal influenza vaccine, and factors that influence the acceptance of the upcoming COVID-19 vaccine. This was a cross-sectional study conducted in Riyadh, Saudi Arabia. We selected and surveyed 356 HCWs via an electronic self-administered questionnaire. A total of 61.16% of HCWs were willing to receive the COVID-19 vaccine, and 55.9% of them had received the seasonal influenza vaccine in the preceding year (2019–2020). The strongest predictors for taking the COVID-19 vaccine were the HCWs’ belief that the COVID-19 vaccine would be safe, needed even for healthy people, that all HCWs should be vaccinated against COVID-19, and that HCWs will have time to take the vaccine. Being female, being middle aged, having <5 years of work experience, having no fear of injections, and being a non-smoker were predictive factors for taking the upcoming COVID-19 vaccine. No associations were found between the intention to take the COVID-19 vaccine and a history of taking the seasonal influenza vaccine.

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