Influenza Vaccination Intention Among Caregivers in the Context of Highly Publicized Influenza Events: A Cross-Sectional Survey of Caregivers of Kindergarten and Primary School Children in Zhejiang, China.

Objective

This study assessed the influence of a highly publicized influenza-related death event on caregivers' influenza vaccination intention for kindergarten and primary school children in Zhejiang, China, and identified associated factors.

Methods

A cross-sectional survey was conducted from March to April 2025 using a multi-stage, stratified cluster sampling method across 10 districts/counties. Caregivers completed electronic questionnaires covering sociodemographics, event awareness, vaccination history, hesitancy, and cognitive attitudes. Factors associated with vaccination intention were analyzed using chi-square tests and logistic regression.

Results

Among 2153 caregivers, overall vaccination intention for the 2025 season was 60.10%, markedly higher than the 2024 season's actual rate (27.45%). Caregiver awareness of this event was 91.92%, primarily via social media (92.02%). In univariate analyses, event-related characteristics were significantly associated with vaccination intention: perceived "completely objective" coverage showed the highest willingness (79.68%, χ2 = 79.92, p < 0.001), whereas the "exaggerated risk" (52.44%) and "unaware" (51.15%) groups showed lower willingness. Exposure frequency also correlated positively: low exposure (0-2 times) had 53.39% willingness, moderate (3-5) 61.11%, and high (≥6) 66.10% (χ2 = 27.75, p < 0.001). However, stronger vaccination intention was independently associated with factors such as no prior vaccination refusal [aOR(95% CI) = 2.74(2.03,3.72)] or hesitancy history [1.47(1.13,1.92)], greater information need (aOR = 6.42-8.83), and disbelief in influenza's spontaneous resolution [1.39(1.08,1.77)]. Weaker intention was associated with poorer child health status [0.19(0.04,0.74)], no influenza vaccination in 2024 [0.41(0.30,0.55)], no influenza illness in 2024 [0.73(0.56,0.95)], belief in vaccine protection [0.60(0.46,0.79)], and the perception that most parents have their children vaccinated [0.70(0.53,0.93)].

Conclusions

Following a highly publicized celebrity influenza death, vaccination intention was primarily driven by caregivers' cognitive, psychological, and behavioral experience factors. Caregivers who perceived event coverage as completely objective showed higher vaccination intention, while prior vaccination behavior exhibited inertia. Targeted interventions should enhance information credibility and focus on previously unvaccinated and vaccine-hesitant groups to improve coverage.