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s2010; 7(5):319-325
© Ivyspring International Publisher. All rights reserved

tionnaires were distributed to health care workers in the three countries during the period of
July-October 2009. Results: Among 993 respondents, the vaccination rate was 24.7%, 67.2%
and 46.4% in UAE, Kuwait and Oman, respectively. The different motivating factors that in-
fluenced the health care workers to take the vaccine was assessed and found that the most
c o m m o n f a c t o r t h a t i n f l u e n c e d t h e i r d e c i s i o n t o t a k e t h e v a c c i n e w a s f o r t h e i r s e l f p r o t e c t i o n
(59%). On the other hand, the most common reason that discouraged HCWs to take the
vaccine was “lack of time” as reported by 31.8% of the respondents. Other reasons for not
taking the vaccine were unawareness of vaccine availability (29.4%), unavailability of vaccine
(25.4%), doubts about vaccine efficacy (24.9%), lack of information about importance (20.1%)
and concerns about its side effects (17.3%). Conclusions: influenza immunization by
healthcare workers in the studied countries was suboptimal which could be improved by
setting different interventions and educational programs to increase vaccination acceptance
among HCWs.
Key words: Influenza, healthcare workers, vaccination
INTRODUCTION
Healthcare workers (HCWs) pose a potential
risk of transmitting communicable diseases in the
hospital settings where they usually work.
1
Healthy
individuals who are infected with influenza virus,
including those with subclinical infections, can
transmit influenza virus to other individuals who are
at higher risk of complications from influenza
2
i.e.
elderly and immune-compromised patients. As these
patients belong to the risk groups, they must be vac-
cinated against influenza. Vaccination rates among
t h e s e g r o u p s v a r y w i d e l y a m o n g c o u n t r i e s a n d e v e n i f

tries.
7,8
In the US for example, the vaccination rate
among HCWs was only 43 % i n 2005.
8

Most of the Middle East countries adopt the
recommendations and guidelines set by the interna-
tional health agencies and provide vaccination pro-
grams to all HCWs against influenza virus both sea-
sonal and pandemic. In the United Arab Emirates for
example, in 2009, the pandemic influenza vaccines
were distributed to all health care facilities and were
available free of charge to the most vulnerable group
based on priorities as follow; pilgrims, adults with
chronic diseases, Health care workers who are in di-
rect contact with patients with the priority for emer-
g e n c y r o o m ( E R ) , I n t e n sive care unit (ICU), outpatient
clinics and Primary health centers (PHC) healthcare
workers.
9
However, the rate of influenza immuniza-
tion among HCWs and barriers to influenza vaccina-
tions are not fully addressed in the Middle East
countries.
The purpose of the present study is to determine
the current vaccination rates of HCWs in three Gulf
countries: United Arab Emirates (UAE), Kuwait and
Oman and also, to identify the different variables as-
sociated with the noncompliance of HCWs to the

The questionnaire composed of two parts; Part 1 ad-
dressed the demographic information of the partici-
p a n t s , h i s t o r y o f i n f l u e n z a l i k e s y m p t o m s ( f r e q u e n c y ) ,
absence from work due to influenza illness, frequency
of receiving vaccination (if taken on regular basis),
participants’ knowledge of Centre of Disease Control
(CDC) recommendations on seasonal influenza. P a r t 2
comprised of subdivisions, the first group of ques-
tions were addressed to those who had received the
vaccine and enquired about reasons for taking the
vaccine, time of vaccine administration and whether
vaccine intake was beneficial.
The second group of questions were addressed
to those who did not receive the influenza vaccina-
tion, and assessing different factors that might have
inhibited their influenza vaccine uptake.
The study protocol was approved by the Re-
search and Ethics Committee at Dubai Pharmacy
College and approval for distributing the question-
naire was obtained from the administration of each
health care facility (HCF) participated in the survey.
The study protocol was also approved by internal
committees of the participated health care facilities.
Data Analysis
Data were entered and analyzed using SPSS
software version 17; (SPSS
®
, Inc, Chicago, IL). Statis-
tical analyses were performed using χ
2

participants in the three countries (p-value <0.0001)
with the highest vaccination rate in Kuwait (67.2%)
compared to 46.4% in Oman and only 24.7% in UAE.
A small proportion of the respondents reported
t h a t t h e y g o t i n f l u e n z a l i k e s y m p t o m s o n r e g u l a r b a s i s
(11.6%) and the majority of the participants reported
that they got it rarely (53.0%). When the respondents
were asked about their awaeness of the CDC
recomendations for influenza vaccination, around
f i f t y o n e p e r c e n t o f t h e r e s p o n d e n t s r e p o r t e d t h a t t h e y
are aware of the CDC recommendations regarding
immunization against seasonal influenza. Data are
summarized in table 1.
The association between the respondents’
charactarestics and the vaccination status were tested
to identify the different variables associated with the
likelihood of vaccination aganist influenza among
HCWs. The data are summarized in table 2. T h e r e was
no significant association between HCWs age and the
vaccination status in both UAE and Kuwait with a
p-value > 0.05 (χ
2
test) with highest vaccination rate
being within the age range of > 45 years (32.2%)in
UAE and within the age range of 36-45 years of age
(69.5%) in Kuwait.In Oman, there was a significant
difference in the vaccination rate among the different
age groups (P = 0.005) with the age range of 36-45
years of age (56.3%) having the highest vaccination
rate. The lowest vaccination rate was within the age

n (%)
Total
n (%)
Age <25yrs 31 (7.7) 3 (1.6) 47 (13.1) 79 (8.0)
25-35yrs 163 (40.6) 18 (7.8) 170 (47.2) 351 (35.3)
36-45yrs 120 (29.9) 141 (60.7) 87 (24.2) 350 (35.2)
>45yrs 87 (21.7) 70 (30.2) 56 (15.6) 213 (21.5)
Gender Male 115 (28.8) 107 (46.1) 122 (33.9) 344 (34.6)
Female 286 (71.2) 125 (53.9) 238 (66.1) 649 (65.4)
Professional group Professionals 224 (55.9) 182 (78.4) 254 (70.6) 660 (66.5)
Paramedic 103 (25.7) 43 (18.5) 46 (12.8) 192 (19.3)
Other 74 (18.5) 7 (3.0) 60 (16.7) 141 (14.2)
Previous history of Influenza Never 160 (39.9) 76 (32.8) 116 (32.2) 352 (35.4)
Regularly 41(10.2) 33 (14.2) 41 (11.4) 115 (11.6)
Rarely 200 (49.9) 123 (53.0) 203 (56.4) 526 (53.0)
Awareness of CDC recom-
mendation
Yes 195 (48.6) 110 (47.4) 177 (49.2) 482 (48.5)
No 206 (51.4) 122 (52.6) 183 (50.8) 511 (51.5)
Vaccination Vaccinated 99(24.7) 156(67.2) 167(46.4) 422 (42.5)**
Total 401 232 360 993
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322
T a b l e 2 . Bivariate analysis of association between vaccination status and respondent characteristics and multivariate analysis
of likelihood of vaccination.

Professionals 26.3 73.7 75 25 50 50
Paramedic 25.2 74.8 70 30 34.8 65.2
Others 18.9 81.1 0.434 57.1 42.9 0.798 40 60 0.090
Previous in-
fluenza history
Never 18.8 81.3 63.2 36.8 66.4 33.6
Regularly 24.4 75.6 63.6 36.4 51.2 48.8
Rarely 29.5 70.5 0.063 70.7 29.3 0.484 52.7 47.3 0.004 0.662
(0.519-0.844)
Working while
sick
Yes 70.1 29.9 66 34 60.2 39.8
No 21.3 78.7 0.051 68.1 31.9 0.735 42 58 0.191
Awareness of
CDC recom-
mendations
Yes 26.7 73.3 65.5 34.5 56.5 43.5
No 22.8 77.2 0.371 68.9 31.1 0.582 36.6 63.4 0.000 2.205
(1.407-3.456) On the other hand, the study showed that in-
fluenza vaccinated healthcare workers often continue
to work while getting sick with influenza illness
compared to none vaccinated individuals. In UAE,
there was a significant difference (p-value =0.05) ob-
served between the vaccination status of the respon-
dents who continue to work despite their infection
with influenza (70.1%).
Participants’ awareness of the CDC recommen-

Data are summarized in Table 3.
On the other hand, self reported reasons among
HCWs on refusal to take influenza vaccine were as-
sessed and showed that the most common reason that
discouraged HCWs to take the vaccine was “lack of
time” as reported by 31.8% of the respondents. Other
reasons for not taking the vaccine were unawareness
of vaccine availability (29.4%), unavailability of vac-
cine (25.4%), doubts about vaccine efficacy (24.9%),
lack of information about importance (20.1%) and
concerns about its side effects (17.3%). Data is shown
in table 4.
The most common reason for not taking the
vaccine in UAE & Oman was the unawareness of
vaccine availability (21.5% and 31.6%, respectively)
while in Kuwait “lack of time” was the main reason
for not being vaccinated (90.9%) among HCWs.
The most common reasons among HCWs for not
taking the vaccine were similar in the three countries
but there were statistically significant differences for
some factors among the three countries. HCWs’ ap -
prehensions of experiencing side effects was more in
UAE (19.5%) compared to 13.2% and 15.5% in Kuwait
and Oman, respectively. Lack of time was extremely
important factor as reported by the majority of res-
Int. J. Med. Sci. 2010, 7

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323
pondents from Kuwait (90.9%) to be the main reason

of side effects
8.1 11.5 14.4 11.8 0.674
Self protection 56.6 54.5 64.7 59 0.109
patients and workers
Protection
32.3 46.2 52.7 45.5 0.241
Influenza epidemic 25.2 28.8 24.0 26 0.912 Table 4. Reasons for not-taking vaccine among health care
workers in three countries.
Reasons UAE
%
Kuwait
%
Oman
%
Total
%
Chi-square
Side effects 19.5 13.2 15.5 17.3 0.000
Lack of time 14.6 90.9 19.7 31.8 0.000
Doubts about efficacy 20.9 56.6 18.7 24.9 0.016
Lack of information
about importance
16.6 32.9 20.7 20.1 0.638
Unavailability of vaccine 19.5 44.7 26.9 25.4 0.930
Low risk of infection 13.6 26.3 11.4 14.5 0.125
Unaware of availability
or access to vaccine

In another study done in
Australia, the percentage of vaccine recipients among
HCWs was only 22%. However, a similar study done
in Saudi Arabia, another Gulf country, reported that
almost half of HCW’s who participated in the study
were vaccinated regularly.
12

The highest vaccination rate was reporte d i n
Kuwait (67.2%) despite the fact that almost half of the
respondents in the three countries were aware of the
CDC recommendations which indicate that more
compliance to the CDC recommendations was the
highest in Kuwait compare Oman and UAE.
There are several factors which may influence
influenza vaccination acceptance among HCWs.
Findings from the current study suggests that if a
HCW gets vaccinated against influenza; he would do
so more often for his self protection rather than to
prevent the transmission of disease to the patients.
This result is in consistence with other studies that
identified the main reason for taking the vaccines by
HCWs to be for self protection.
12,13
However, a study
conducted in Australia revealed that the most impor-
tant reason for vaccine uptake was to protect their
patients against transmission of the disease, where
almost three quarters of the participants identified
patient protection to be the main reason for taking up