ISSN ONLINE: 2558-815X
ISSN PRINT: 1584-9244
ISSN-L: 1584-9244

Knowledge, attitudes, and practices towards the influenza vaccine among adult population in Plovdiv, Bulgaria


Introduction. Vaccination is the most effective and safest means of preventing influenza infection. The coverage with influenza vaccine is not satisfactory across Europe and one of the main obstacles is vaccine hesitancy.
The objective of the study was to assess the knowledge, attitudes, and practices of the population towards the seasonal influenza vaccine.
Materials and methods. Between November 2016 – February 2017 a cross-sectional study using a semi-structured questionnaire was conducted in Plovdiv (Bulgaria), covering 545 people over 18 years old. Standard descriptive statistics was used to summarize demographic characteristics. Differences between observed and theoretical distributions were tested using chi-square test for independence. A 2-sided p-value of <0.05 was considered statistically significant.
Results. The vaccine uptake was 11%. An association was found between the age of the respondents and administration of the vaccine (χ2=16.687 p=0.005), vaccination status and educational level (χ2=27.002, p=0.00002). 27.6% of the unvaccinated respondents were uncertain about the effectiveness of the vaccine and 26.8% had the perception this is not a serious disease. More than half of the respondents (51.1%) were willing to change their attitude towards the influenza vaccination, the recommendation from a doctor being the most important (40.8%).
Conclusions. Seasonal influenza vaccine uptake was low in our study and the main drivers for vaccine hesitancy were concerns regarding its safety and effectivenes. Recommendation of the vaccine from a general physician was the most important source  for influencing the attitudes towards the vaccine. This highlights the importance of general physicians’ involvement and the need to spread public awareness regarding the efficacy and benefits of seasonal influenza vaccination.
Keywords: influenza, vaccination, attitudes, knowledge, practices, hesitancy.


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Address for correspondence:
Department of Epidemiology and Disaster Medicine, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
Address: Blvd Vasil Aprilov 15A, Plovdiv, Bulgaria
Email:; Phone: +359883403683


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Rangelova V, Kevorkyan A, Raycheva R, Amudzhiyan D, Aleksandrova M, Sariyan S. Knowledge, attitudes, and practices towards the influenza vaccine among adult population in Plovdiv, Bulgaria. Arch Balk Med Union. 2021;56(3):329-335.