Past behavior predicts future protection: uncovering key drivers of influenza vaccine acceptance in Italy in the post-pandemic era

OBJECTIVES: Influenza is a seasonal viral respiratory disease causing significant global mortality but preventable through vaccination. Despite WHO recommendations, vaccination rates in Italy remain low due to mistrust, misinformation, and vaccine hesitancy. This study investigates determinants of influenza vaccine uptake in the post-COVID-19 era to identify barriers and guide targeted interventions. METHODS: A cross-sectional survey was conducted on a representative sample of 8067 Italian adults between December 2024 and January 2025 through an anonymous online questionnaire. The survey explored sociodemographic characteristics, infectious disease behaviors, COVID-19 pandemic experiences, and vaccination attitudes. RESULTS: Overall, 33.7% of respondents received the influenza vaccine, while 61.8% reported no vaccination intention. Multinomial logistic regression identified three key domains of predictors. Sociodemographic determinants associated with uptake included age 65-75 years (OR = 1.89; 95% CI: 1.11-3.19), inactive employment status (OR = 1.73; 95% CI: 1.12-2.67), and comorbidities (OR = 1.23; 95% CI: 1.00-1.50). Past vaccination history emerged as the strongest driver of uptake (OR = 8.19; 95% CI: 3.98-16.84). Finally, behavioral factors, specifically the perception of mask usefulness, were significantly associated with vaccination intention among the unvaccinated (OR = 1.39; 95% CI: 1.11-1.75). CONCLUSIONS: Influenza vaccination adherence in Italy is influenced by sociodemographic factors and preventive health practices, but most strongly by past vaccination behavior that should, thus, strength long-term engagement with vaccination programs.