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Influenza vaccination rate among Chinese health care workers pooled at 27%Factors that help healthcare workers get flu shots in China

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Key Takeaway
Recognize that only 27% of Chinese health care workers were vaccinated against influenza in pooled observational data.

This meta-analysis synthesized data from observational studies to estimate influenza vaccination coverage among health care workers in China and to identify factors associated with vaccination. The pooled sample included 111,544 health care workers. The overall influenza vaccination rate was 27% (95% CI: 21-34%).

Factors positively associated with vaccination included age 40-49 years, female gender, monthly income greater than 3,000 RMB, professional title, prior vaccination history, institutional encouragement or requirement, free vaccination policies, awareness of optimal vaccination timing, and vaccination willingness.

The authors note that the observational nature of the included studies is a key limitation. They specifically caution that the potential role of mandatory policies should be interpreted cautiously due to this observational design. No safety outcomes, adverse events, or tolerability data were reported. Follow-up duration and funding or conflicts of interest were not reported.

The findings provide an evidence base for formulating targeted influenza vaccination strategies for health care workers in China. Because the evidence is observational, associations should not be interpreted as causal, and the pooled vaccination rate reflects the settings and populations of the included studies.

How this fits prior evidence

This meta-analysis extends prior coverage of influenza vaccination strategies by quantifying a low pooled vaccination rate (27%) among health care workers in China and identifying institutional encouragement or requirement as a positive factor. It aligns with prior coverage showing that opt-out nudges reduced the number of unvaccinated medical residents by 81%, supporting the role of institutional policy in vaccination uptake. It also complements prior evidence on vaccine effectiveness and on vaccination in pregnancy, though those address different populations and outcomes. The observational design limits causal inference, consistent with cautions about mandatory policies.

Healthcare workers are on the front lines of patient care, making their protection against the flu a major priority. However, getting these workers vaccinated can be a challenge. A large review of data from over 111,000 workers in China looked at what actually drives people to get their shots.

The findings show that many factors play a role in the decision. People aged 40 to 49, women, and those with higher monthly incomes were more likely to be vaccinated. Other personal factors like having a professional title or a history of getting vaccines also played a part.

Workplace factors are just as important. Policies that offer free shots, clear information on timing, and institutional encouragement all helped increase vaccination rates. While the study notes that mandatory policies might help, the researchers suggest being careful with that conclusion because the data was based on observations rather than a controlled trial.

What this means for you:
Factors like age, gender, income, and workplace support all influence flu vaccination rates among healthcare workers.

Common questions

Who is most likely to get a flu shot among healthcare workers?

The study found that certain groups were more likely to get vaccinated. These included women, people between the ages of 40 and 49, and those with a monthly income over 3,000 RMB. Having a professional title and a history of getting vaccines also made a person more likely to get their shot.

What workplace factors help increase vaccination rates?

Several workplace factors were linked to higher vaccination rates. These included having a policy that offers free vaccinations, clear information about the best time to get vaccinated, and general encouragement or requirements from the institution. These factors help create a better environment for staff to stay protected.

Does making flu shots mandatory work for healthcare staff?

The study noted that institutional requirements or mandatory policies were linked to higher vaccination rates. However, because the data came from observational studies rather than a controlled trial, the researchers suggest that the impact of mandatory policies should be interpreted with caution.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedSep 2026
View Original Abstract ↓
AimsTo systematically evaluate the influenza vaccination rate among health care workers in China and identify influencing factors.DesignSystematic review and meta-analysis of cross-sectional studies.Data SourcesCNKI, Wanfang, VIP, Web of Science, PubMed, Cochrane Library, Scopus, and Embase, searched from database inception to October 4, 2025.Review MethodsTwo reviewers independently screened studies, extracted data, and assessed study quality using the Agency for Healthcare Research and Quality (AHRQ) tool. Random-effects models were used to pool vaccination rates and odds ratios. Heterogeneity was assessed using I2 statistics, with supplementary subgroup analysis, meta-regression, and sensitivity analysis. Publication bias was assessed via funnel plot and Egger's test.ResultsForty-nine studies involving 111,544 participants were included. The pooled influenza vaccination rate was 27% (95% CI: 21–34%). Factors positively associated with vaccination included: age 40–49 years, female gender, monthly income > 3,000 RMB, professional title, prior vaccination history, institutional encouragement or requirement, free vaccination policies, awareness of optimal vaccination timing, and vaccination willingness.ConclusionInfluenza vaccination coverage among Chinese health care workers remains inadequate. Structural interventions-such as free vaccination, institutional encouragement, and on-site services-combined with tailored strategies targeting younger, male, low-income, and vaccine-naïve individuals are recommended. Given the observational nature of the included studies, the potential role of mandatory policies should be interpreted cautiously, pilot implementation in high-risk settings is suggested before broader adoption.ImpactThis study provides an evidence base for formulating targeted influenza vaccination strategies for health care workers in China, which is crucial for reducing nosocomial infection risk and aligning with global public health goals.Patient or Public ContributionNo patient or public contribution.Systematic review registrationPROSPERO registration CRD: 42024553631.
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