Adults have similar perceptions toward the influenza vaccine as do other age groups; those who do not favor the vaccine often believe that the vaccine is not efficacious.9,18 Other reasons for remaining unvaccinated included the belief that the vaccine can cause unwanted side effects, having had a negative reaction to the vaccine previously, and that they do not need to be vaccinated because they rarely become ill.9,18 For those who do get vaccinated, common reasons that explain their decision include taking their doctor’s recommendation, the belief that the vaccine will prevent illness, and among those of older age, understanding they are more susceptible to acquiring the illness.18

Aside from the pediatric population, the most common age group affected by influenza is the elderly. Up to 90% of the mortalities from influenza virus infection are in those aged at least 65 years, and during the 2014-2015 influenza season, an estimated 60% of hospitalizations due to influenza virus infection were in patients aged at least 65 years.19,20 Thus, because the elderly are very susceptible to contracting influenza, it is imperative for primary care providers to understand why many individuals who are older do not get vaccinated.

Factors that have been associated with overall perception of the influenza vaccine among the elderly include social influences and perceived consequences of getting the shot.19 Those who received the influenza vaccine were more likely to believe that getting the shot is the most logical choice.19 Individuals who have at least a high school diploma are also more likely to view the vaccine in a more positive light and therefore get the shot.19 In contrast, among those who decided against getting the vaccine, common explanations included the simple lack of awareness that the influenza vaccine is highly recommended and necessary to prevent influenza virus infection and concerns that vaccination would increase the risk of acquiring influenza or cause adverse side effects.8,19

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Susceptible populations

Certain populations are at an even higher risk for influenza infection due to their medical conditions, including cystic fibrosis, diabetes, and asthma.3,21,22 The rate of vaccination is suboptimal among these susceptible patients. Although the American Academy of Pediatrics and the Immunization Practices Advisory Committee recommend that patients with asthma obtain an influenza vaccine each year, one study has found that fewer than 10% of children with moderate-to-severe asthma follow this recommendation.22 Similar to the populations previously discussed, common reasons why the vaccine is declined among individuals in this group include concern about the vaccine’s potential side effects.22 

Overcoming misconceptions 

Although many studies address some of the more negative perceptions people may have about getting an annual influenza vaccination, progress needs to be made to find a way to combat common misconceptions. However, there are various ways in which clinicians can help correct their patients’ bias toward acquiring the vaccine so that, ultimately, more patients get vaccinated against influenza, become less susceptible to acquiring influenza, and become less likely to spread influenza virus infection. 

Many reports indicate that a clinician’s recommendation heavily influences the patient’s opinion about vaccination.7,9,15,23 Furthermore, the health care provider must also take the time to discuss in detail with hesitant patients the particular reasons why they perceive the influenza vaccine in a negative light. The clinician should respectfully inform the patient of the benefits and risks of the vaccine and correct any misinformation.9,15 By doing so, the clinician may be able to provide reassurance based on solid evidence, so that patients will feel that their concerns have been taken into consideration and addressed instead of pushed aside or criticized and thus may be more inclined to change their previous beliefs about getting vaccinated.9,24

Providing supplementary material for patients to review can also be helpful in debunking the myths associated with influenza vaccination; these are accessible through organizations such as the Centers for Disease Control and Prevention and, for the pediatric population, the American Academy of Pediatrics (Table 6).15 In a similar vein, a community approach emphasizing proper education on the benefits and side effects associated with the influenza vaccine may also be useful, especially when these include other preventive medical provisions such as blood pressure screenings.19

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Although many individuals who choose not to accept the influenza vaccine have negative perceptions regarding its efficacy or benefits, there are many others who are either indifferent to or appreciate the vaccine but forget to obtain one. In such cases, numerous suggestions have been made to remind these patients to get vaccinated. According to the Advisory Committee of Immunization Practices, reminder/call systems may prove useful.3 Mailing postcards can be sent as both helpful reminders and educational tools to help keep patients informed of the reasons why the influenza vaccine is recommended by their clinicians.8 Similarly, in those who are more susceptible to influenza virus infection as a result of chronic medical conditions, a database and reminder system can be used to both track and call these patients to inquire about their current vaccine status and educate them about the significance of getting the influenza vaccine.22