The Discrepancy Between Influenza Vaccine Recommendation and Uptake Among Healthcare Workers in China: A Multicenter Cross-Sectional Study

Background: Healthcare workers (HCWs) are pivotal in influenza containment, serving as both high-risk individuals and vaccine advocates. However, influenza vaccination coverage among Chinese HCWs remains suboptimal. Existing research is often constrained by limited geographic representativeness or non-robust designs. This study provides a robust, nationwide assessment of influenza vaccine uptake and recommendation behaviors among HCWs in China. Methods: A multicenter cross-sectional survey was conducted in late 2025 across four Chinese provinces (Shanghai, Shandong, Chongqing, and Hubei). A total of 390 frontline HCWs—only those defined as directly engaged in influenza management and prevention—from 48 hospitals (primary, secondary, and tertiary levels) completed validated electronic questionnaires. A multinomial logistic regression model was employed to identify determinants of personal vaccine uptake behavior among HCWs. Results: Overall influenza knowledge was moderate, with notable gaps in recognizing typical symptoms (29.23%), southern China’s peak season (31.03%), and optimal vaccination timing (55.38%). A striking “recommendation-uptake disparity” was observed: while 93.6% of HCWs recommended the vaccine to patients, only 22.3% received it annually themselves. A multinomial regression revealed that being a nurse (vs. doctor: OR = 3.11, 95% CI: 1.28–7.53) or female (vs. male: OR = 3.08, 95% CI: 1.28–7.44) was positively associated with annual vaccination, whereas clinical technicians (vs. doctors: OR = 0.18, 95% CI: 0.03–0.94) showed lower odds. Primary barriers to personal vaccination included inconvenience (49.5%), perceived high cost (16.2%), and efficacy concerns (19.5%). Conclusions: This study highlights a significant gap between high recommendation rates and low personal uptake among HCWs in China. The findings underscore the need for multifaceted interventions, including workplace-based reminder systems, free vaccination policies, and tailored education, to optimize coverage and strengthen the role of HCWs in national influenza prevention.