Uptake, willingness, and practices toward seasonal influenza vaccination among healthcare workers in China: a cross-sectional study

Background Seasonal influenza remains a major public health burden globally, with healthcare workers (HCWs) at heightened risk due to occupational exposure and potential for nosocomial transmission. Despite this, influenza vaccination rates among HCWs in China remain suboptimal. Objectives To assess the uptake, willingness, and influencing factors related to seasonal influenza vaccination among HCWs in a major tertiary hospital in Xi’an, China, during the post-COVID-19 era. Methods A cross-sectional, single-center survey was conducted in December 2023 among 1,196 HCWs at Tangdu Hospital (Xi’an, Shaanxi Province). Data were collected via a validated, anonymous online questionnaire covering demographics, vaccination history, attitudes, and barriers. Multivariate logistic regression was used to identify factors associated with vaccination uptake and willingness. Results Only 19.65% of HCWs reported receiving at least one influenza vaccination in the past 2 years. Vaccination rates declined significantly from 2022 to 2023. In multivariable models, influenza vaccine uptake was positively associated with household vaccination rates (adjusted OR = 7.89, 95% CI: 5.61–11.09, p < 0.001), willingness to be vaccinated (adjusted OR = 1.51, 95% CI: 1.11–2.07, p = 0.009). Willingness to be vaccinated was higher among HCWs with recent flu-like symptoms (adjusted OR = 1.52, 95% CI: 1.16–1.99, p = 0.002) and lower among female HCWs (adjusted OR = 0.58, 95% CI: 0.41–0.82, p = 0.002). Conclusion Despite positive attitudes, influenza vaccine uptake among Chinese HCWs remains low, with signs of post-pandemic decline. Addressing safety concerns, improving access, and targeted education may improve coverage and strengthen healthcare system resilience.