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Willingness of Hong Kong healthcare workers to accept pre-pandemic influenza vaccination at different WHO alert levels: two questionnaire surveys

BMJ 2009; 339 doi: (Published 26 August 2009) Cite this as: BMJ 2009;339:b3391
  1. Josette S Y Chor, assistant professor1,
  2. Karry LK Ngai, postdoctoral fellow2,
  3. William B Goggins, assistant professor1,
  4. Martin C S Wong, associate professor1,
  5. Samuel Y S Wong, associate professor1,
  6. Nelson Lee, associate professor3,
  7. Ting-fan Leung, professor4,
  8. Timothy H Rainer, professor5,
  9. Sian Griffiths, professor1,
  10. Paul K S Chan, professor2
  1. 1School of Public Health and Primary Care, Chinese University of Hong Kong, School of Public Health, Prince of Wales Hospital, Shatin, Hong Kong
  2. 2Department of Microbiology, Chinese University of Hong Kong, Prince of Wales Hospital
  3. 3Division of Infectious Diseases, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital
  4. 4Department of Paediatrics, Chinese University of Hong Kong, Prince of Wales Hospital
  5. 5Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Prince of Wales Hospital
  1. Correspondence to: P K S Chan paulkschan{at}
  • Accepted 13 August 2009


Objective To assess the acceptability of pre-pandemic influenza vaccination among healthcare workers in public hospitals in Hong Kong and the effect of escalation in the World Health Organization’s alert level for an influenza pandemic.

Design Repeated cross sectional studies using self administered, anonymous questionnaires

Setting Surveys at 31 hospital departments of internal medicine, paediatrics, and emergency medicine under the Hong Kong Hospital Authority from January to March 2009 and in May 2009

Participants 2255 healthcare workers completed the questionnaires in the two studies. They were doctors, nurses, or allied health professionals working in the public hospital system.

Main outcome measures Stated willingness to accept pre-pandemic influenza vaccination (influenza A subtypes H5N1 or H1N1) and its associating factors.

Results The overall willingness to accept pre-pandemic H5N1 vaccine was only 28.4% in the first survey, conducted at WHO influenza pandemic alert phase 3. No significant changes in the level of willingness to accept pre-pandemic H5N1 vaccine were observed despite the escalation to alert phase 5. The willingness to accept pre-pandemic H1N1 vaccine was 47.9% among healthcare workers when the WHO alert level was at phase 5. The most common reasons for an intention to accept were “wish to be protected” and “following health authority’s advice.” The major barriers identified were fear of side effects and doubts about efficacy. More than half of the respondents thought nurses should be the first priority group to receive the vaccines. The strongest positive associating factors were history of seasonal influenza vaccination and perceived risk of contracting the infection.

Conclusions The willingness to accept pre-pandemic influenza vaccination was low, and no significant effect was observed with the change in WHO alert level. Further studies are required to elucidate the root cause of the low intention to accept pre-pandemic vaccination.


  • We thank Dr Ian Stepheson for his invaluable advice and experience in constructing the questionnaires and generous support from the chiefs of service in the participating departments. We also thank Ms Kate TC Ng for organising the questionnaire administration.

  • Contributors: JSY Chor and PKS Chan designed the study, interpreted the findings, and wrote the manuscript; KLK Ngai collated the survey data; WB Goggins and SYS Wong performed statistical analyses; MCS Wong, N Lee, TF Leung, TH Rainer administered the survey; S Griffiths supervised the study. All authors, external and internal, had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding: This study did not receive any external funding.

  • Competing interests: None declared.

  • Ethical approval: The study was approved by the Survey and Behavioural Research Ethics Committee of the Chinese University of Hong Kong.

  • Data sharing: no additional data available.

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