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Vaccine
. 2026 May 27:86:128761.
doi: 10.1016/j.vaccine.2026.128761. Online ahead of print.
Drivers of and implementation strategies for influenza vaccination for cardiovascular populations in China: a scoping review
Rong Liu 1 , Yihang Fan 2 , Shangzhi Xiong 3 , Jialing Lin 4 , Anushka Patel 5 , Xin Du 6 , Gian Luca Di Tanna 7 , Hueiming Liu 8
Affiliations
Introduction: Understanding the drivers of influenza vaccine hesitancy, acceptance, demand, and uptake especially in low- and middle-income countries is a priority in preventing seasonal influenza as outlined in the World Health Organization (WHO) global influenza strategy. Individuals with cardiovascular disease (CVD) are a key target group recommended by WHO, yet influenza vaccine coverage in China is reported to be extremely low. We aim to explore drivers of this and implementation strategies used to increase the influenza vaccine coverage among CVD populations in China.
Methods: We conducted a scoping review using academic databases, the Chinese Clinical Trial Registry, and Chinese grey literature repositories from database inception till August 2025, based on predetermined inclusion criteria. Data on potential determinants of vaccine uptake and intervention details were extracted and analyzed using a narrative synthesis. Implementation strategies were mapped to the Availability, Accessibility, Acceptability, and Quality (AAAQ) health service delivery framework.
Findings: Thirteen publications published between 2009 and 2024 were included, with an increase in outputs since the COVID-19 pandemic. Lower vaccine uptake appeared to be associated with lower socioeconomic status and poorer health literacy. Physician recommendations, accessible vaccine clinics, and adequate vaccine supply appeared to be health system related facilitators to vaccination. Four studies reported implementation strategies comprising provider education and recommendations, public funding, and follow-up on vaccination status. Incorporating strategies that addressed a greater number of AAAQ domains appeared to result in higher influenza vaccine uptake.
Conclusion: Drivers and implementation strategies of influenza vaccination have not been widely studied among CVD populations in China. Available information suggests that higher patient sociodemographic status, greater health literacy, presence of physician recommendations, accessible vaccine clinics, and affordable vaccines may positively drive influenza vaccination. Addressing gaps in the AAAQ domains through targeted implementation strategies could improve influenza vaccination. Future strategies should undergo rigorous evaluation.
Registration details: Our protocol is registered at Open Science Foundation (OSF) with registration DOI https://doi.org/10.17605/OSF.IO/XDMBT.
Keywords: Cardiovascular disease; Implementation strategy; Influenza vaccination.
. 2026 May 27:86:128761.
doi: 10.1016/j.vaccine.2026.128761. Online ahead of print.
Drivers of and implementation strategies for influenza vaccination for cardiovascular populations in China: a scoping review
Rong Liu 1 , Yihang Fan 2 , Shangzhi Xiong 3 , Jialing Lin 4 , Anushka Patel 5 , Xin Du 6 , Gian Luca Di Tanna 7 , Hueiming Liu 8
Affiliations
- PMID: 42202423
- DOI: 10.1016/j.vaccine.2026.128761
Introduction: Understanding the drivers of influenza vaccine hesitancy, acceptance, demand, and uptake especially in low- and middle-income countries is a priority in preventing seasonal influenza as outlined in the World Health Organization (WHO) global influenza strategy. Individuals with cardiovascular disease (CVD) are a key target group recommended by WHO, yet influenza vaccine coverage in China is reported to be extremely low. We aim to explore drivers of this and implementation strategies used to increase the influenza vaccine coverage among CVD populations in China.
Methods: We conducted a scoping review using academic databases, the Chinese Clinical Trial Registry, and Chinese grey literature repositories from database inception till August 2025, based on predetermined inclusion criteria. Data on potential determinants of vaccine uptake and intervention details were extracted and analyzed using a narrative synthesis. Implementation strategies were mapped to the Availability, Accessibility, Acceptability, and Quality (AAAQ) health service delivery framework.
Findings: Thirteen publications published between 2009 and 2024 were included, with an increase in outputs since the COVID-19 pandemic. Lower vaccine uptake appeared to be associated with lower socioeconomic status and poorer health literacy. Physician recommendations, accessible vaccine clinics, and adequate vaccine supply appeared to be health system related facilitators to vaccination. Four studies reported implementation strategies comprising provider education and recommendations, public funding, and follow-up on vaccination status. Incorporating strategies that addressed a greater number of AAAQ domains appeared to result in higher influenza vaccine uptake.
Conclusion: Drivers and implementation strategies of influenza vaccination have not been widely studied among CVD populations in China. Available information suggests that higher patient sociodemographic status, greater health literacy, presence of physician recommendations, accessible vaccine clinics, and affordable vaccines may positively drive influenza vaccination. Addressing gaps in the AAAQ domains through targeted implementation strategies could improve influenza vaccination. Future strategies should undergo rigorous evaluation.
Registration details: Our protocol is registered at Open Science Foundation (OSF) with registration DOI https://doi.org/10.17605/OSF.IO/XDMBT.
Keywords: Cardiovascular disease; Implementation strategy; Influenza vaccination.