Influenza burden, preventive behaviours, and vaccination uptake among multi-ethnic university students in the United Arab Emirates: a cross-sectional study

Influenza burden, preventive behaviours, and vaccination uptake among multi-ethnic university students in the United Arab Emirates: a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Influenza burden, preventive behaviours, and vaccination uptake among multi-ethnic university students in the United Arab Emirates: a cross-sectional study Benzil Binu, Haniel Karmel Jinu, Mohammed Isham Shiju, Sachin Syal, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8448387/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 05 Mar, 2026 Read the published version in BMC Infectious Diseases → Version 1 posted 16 You are reading this latest preprint version Abstract Background Seasonal influenza remains a significant public health concern worldwide. Although young adults are generally considered at lower risk for severe outcomes, they play a critical role in influenza transmission. University environments in the United Arab Emirates (UAE) are highly multiethnic, hosting student populations with diverse cultural beliefs and health practices that may influence the disease burden. As data on influenza prevalence, preventive behaviours, and healthcare-seeking behaviours among multiethnic university students in the UAE are limited, this study aimed to assess these aspects. Methods A cross-sectional, questionnaire-based survey was conducted among university students aged ≥ 18 years across multiple campuses in Ajman, Sharjah, and Dubai, to collect sociodemographic characteristics, influenza history and severity, healthcare-seeking behaviour, preventive practices, vaccination status, financial aspects to vaccination access, and perceptions regarding vaccine effectiveness and safety. Descriptive statistics summarized participant characteristics, and chi-square tests assessed associations. Binary and multivariable logistic regression analyses identified independent predictors of healthcare-seeking behaviour and influenza vaccination uptake. Results A total of 963 students participated (median age: 20 years; 51.4% male), representing diverse ethnic backgrounds. Overall, 82.6% reported experiencing influenza-like illness in the past five years, with significant variation by ethnicity and gender. Nearly half (47.6%) reported attending university while symptomatic. Influenza vaccination coverage last year was 59.2%, and 88.2% reported willingness to vaccinate if provided free of charge, although 40.5% believed vaccination reduces natural immunity. Gender and ethnicity were significant predictors of healthcare-seeking behaviour in the crude model; however, in multivariable analyses, illness severity and symptom duration remain the strongest predictors. Influenza vaccination uptake was independently associated with seeking medical consultation (adjusted odds ratio [AOR] = 1.96), belief in individual protection from vaccination (AOR = 15.68), belief in community-level protection (AOR = 3.21), and perceived public health importance of vaccination (AOR = 2.51). Conclusion Marked ethnic differences exist in influenza burden and clinical experience among UAE university students, and gaps persist between knowledge and preventive action. With clinician endorsement, addressing misconceptions, and improving access to on-campus vaccination, influenza prevention may be enhanced in this high-risk, socially mobile population, ultimately reducing community influenza transmission. Ethnicity Influenza Influenza-like illness Healthcare-seeking behaviour Public health prevention United Arab Emirates University students Vaccination uptake Introduction Influenza (Flu) is a contagious disease that is caused by a range of influenza viruses. Some of these viruses infect humans, while others are specific to animal species. It affects the respiratory tract, and transmission occurs primarily via droplets released while coughing, sneezing, or speaking, and through contact with contaminated objects ( 1 ). Influenza can be transmitted before symptom onset, and infected individuals may remain infectious for 5–7 days. While most healthy individuals recover within a few days, complications such as pneumonia and death are common among immunocompromised individuals, pregnant women, and other high-risk groups. Typical symptoms include rhinorrhea, fever, cough, and sore throat ( 2 , 3 ). Seasonal influenza is a highly contagious viral illness that occurs in annual epidemics and represents a significant global public-health burden. In temperate regions, epidemics typically occur during the fall and winter months, infecting a significant proportion of both adults and children ( 4 ). Older adults (≥ 65 years), young children, pregnant women, people with chronic diseases, including asthma, cardiovascular disorders, diabetes, and immunosuppression, are at increased risk of getting severe infections ( 5 ). Two major human influenza virus types—Influenza A and Influenza B—co-circulate annually and are responsible for most seasonal epidemics. Surveillance data from the Eastern Mediterranean and North African (EMNA) region indicate that A(H1N1) and A(H3N2) strains accounted for 50.8% and 15.9% of influenza-positive cases, respectively, with notable regional variation. Altogether, Influenza A accounted for 67.9% and influenza B accounted for 23.8% of all positive cases. Predominance of this subtype has important implications for vaccine composition, epidemic forecasting, and public health responses ( 6 ). The severity of influenza presentation varies, from self-limiting mild illness to life-threatening manifestations. Mild cases are generally managed with rest and adequate fluid intake, and in some instances with antiviral medications such as zanamivir ( 7 ). In extremely severe cases, influenza may even prove life-threatening if the infection causes a severe inflammatory reaction leading to sepsis.( 8 ). Seasonal influenza imposes a substantial and persistent “public health burden” globally. Centers for Disease Control and Prevention (CDC) documents indicate that, since the 2010–11 season (excluding the unusually low 2020–21 season), influenza in the United States has caused approximately 9.3–41 million infections annually. Additionally, each year, 120,000–710,000 patients were hospitalized, and fatalities were 6,300–52,000 ( 9 ). Furthermore, in the 2023–24 season alone, CDC reported 40 million infections and 18 million hospital visits. Altogether, 470,000 people were hospitalized, and 28,000 had fatal outcomes ( 10 ). These figures illustrate the considerable and variable impact of seasonal influenza in countries with robust surveillance systems. In contrast, data from the EMNA region indicate substantial influenza circulation but relatively limited and heterogeneous estimates of disease burden. A systematic review of 112 studies from the EMNA region reported only 314,058 laboratory-confirmed influenza cases, highlighting major gaps in estimates of hospitalization rates, illness duration, and mortality rates ( 6 ). These gaps reflect variations in reporting practices and viral circulation patterns. It underscores the need to strengthen surveillance systems and standardize burden estimation, thereby informing authorities of effective vaccination and prevention strategies ( 6 ). Furthermore, emerging evidence indicates that the burden of influenza is not evenly distributed across populations. Certain racial and ethnic minority groups are reported to experience disproportionately severe outcomes of influenza infection. In the United States, the influenza-associated rate of hospitalization among Black population (non-Hispanic), American/Alaska Native, and Hispanic adults was approximately 1.8-, 1.3-, and 1.2-fold higher, respectively, than those among White adults across influenza seasons between 2009–10 and 2021–22 ( 11 ). Delayed healthcare-seeking behavior—more common in some minority populations due to cultural norms, mistrust of healthcare systems, or limited access to preventive services—has been associated with increased disease severity ( 11 ). These disparities are also reflected in varying rates of influenza vaccination among adults, with only 42% of Black and 37.9% of Hispanic adults vaccinated, compared with 53.9% of White adults ( 11 ). Differences in vaccination uptake are influenced by socio-cultural beliefs, perceived susceptibility, and attitudes toward preventive healthcare ( 11 ). A U.S. systematic review reported that influenza vaccination uptake among university students is generally suboptimal and remains well below recommended targets. Some studies have identified racial and ethnic differences in vaccination uptake or intention, reporting significantly lower vaccination uptake among certain racial or ethnic minority student groups compared with White students. It highlights the need for further research to clarify these disparities ( 12 ). Influenza vaccination protects against infection at both the individual and community levels. Large-scale community-level vaccination reduces transmission, thus protecting the vulnerable populations. Evidence of “herd protection” indicates that higher population-level vaccination coverage can substantially reduce infection rates, thereby protecting unvaccinated individuals as well ( 13 ). Universities in the United Arab Emirates (UAE) foster multi-ethnic environments, and students often live together and share facilities. Diverse behavioral and cultural practices may affect influenza transmission and disease severity. Understanding ethnic differences in influenza severity, vaccination, and other preventive behaviors in this setting is therefore essential for designing targeted strategies across cultural backgrounds. As seasonal influenza is endemic in the UAE, studying the influence of ethnicity on disease severity, preventive behaviors, and vaccination status among university students from diverse backgrounds can provide evidence to guide healthcare providers and policymakers in implementing influenza prevention and management strategies across populations. Materials and Methods Aim, study design, and sample population Conducted a cross-sectional survey using a structured questionnaire across several university campuses in the UAE, including institutions in Ajman, Sharjah, and Dubai. The aim was to assess the prevalence of influenza-like illness, health-seeking behaviour, vaccination uptake, preventive practices, and perceptions related to influenza. The sample population was university students aged 18 years and above. Sample size calculation The minimum required sample size was calculated using the single-proportion (prevalence) formula for cross-sectional surveys: n = z²pq/d², where z = 1.96 for a two-sided 95% confidence level, p is the expected prevalence, q = 1 − p, and d is the desired absolute precision. To anchor p in closely related UAE influenza evidence, we used the proportion of respondents reporting seasonal influenza vaccination (54%) in a UAE cross-sectional survey (p = 0.54; q = 0.46) ( 14 ). Assuming d = 0.034 (3.4% absolute precision) and an anticipated 10% non-response rate, the target sample size was approximately 900 participants. Our achieved sample exceeded this target. Sampling technique A convenience sampling technique was employed, where participants who were readily accessible and willing to participate were included in the study. Although no quotas were applied, the sample naturally included students from major ethnic groups in the UAE university population (South Asian, Arab, and other ethnicities). Questionnaire development and validation The questionnaire was developed following a comprehensive literature review that covered influenza epidemiology, knowledge, attitudes, and vaccination behaviour ( 15 ) ( 16 ) ( 17 ). Content validity was ensured through expert review by faculty with experience in epidemiology and infectious diseases. A pilot study with ten students assessed clarity, length, and feasibility. Minor linguistic and structural revisions were made in response to feedback. Data from the pilot phase were excluded from the final analysis. The questionnaire developed for this study is attached as a supplementary file. Survey instrument The final self-administered questionnaire consisted of the following sections: Sociodemographic characteristics: It included age, gender, ethnicity, duration of stay in the UAE, economic status, and health insurance status. History, severity, and healthcare-seeking for infection: It included items to capture influenza infection in the past five years, duration of illness, severity of symptoms, consultation with a physician, laboratory confirmation of influenza, use of antivirals for treatment, hospitalization & duration of stay, and complications, if any Knowledge and preventive behaviours for influenza: It included items about awareness of the mode of disease transmission, respiratory hygiene practices, and attending university while symptomatic Vaccination status: It included items to capture the receipt of influenza vaccine in the past years, paid/free access to vaccine, and willingness to vaccinate if free Perceptions and misconceptions regarding influenza vaccine: It included items to capture beliefs regarding vaccine effectiveness at the individual and community level, the importance of vaccination for public health, and the misconception that vaccination lowers natural immunity Data collection The questionnaire was administered online via a secure Google Forms link. Ethical considerations The Institutional Review Board approved the study before commencement. All participants provided informed consent electronically before the initiation of the survey. Participation was voluntary, and no personal identifiers were collected; thus, confidentiality was maintained. All study procedures were conducted in conformity with the “Declaration of Helsinki.” Statistical analysis Data were downloaded as Microsoft Excel and analysed using IBM SPSS Statistics version 29. Descriptive statistics were used to summarize participant characteristics, influenza prevalence, preventive behaviours, and vaccination patterns. The chi-square test was used for associations between demographic variables and key outcomes, including influenza-like illness prevalence, severity, healthcare-seeking behaviour, and vaccination status. A p < 0.05 was considered statistically significant. Binary logistic regression was conducted to calculate crude odds ratios (ORs) for predictors of healthcare-seeking and vaccination uptake. Variables with significance of p < 0.05 in bivariate analysis were included in multivariable logistic regression models, and adjusted odds ratios (AORs) with 95% confidence intervals (CI) were estimated. Results Participant Characteristics A total of 963 university students participated in the study, with a median age of 20 years (18−24 years). Participants were almost equally distributed by gender, with males (51.4%) and females (48.6%). Distribution by ethnicity shows nearly half (48.6%) as South Asians, followed by Arabs from the GCC and Levant (40.8%), with others, including Southeast Asians, Westerners, and Africans, accounting for 10.4%. Most participants reported a high-income background (65.8%), followed by middle-income (30.5%) and low-income (3.6%) backgrounds. The majority had lived in the UAE for more than 5 years (80.4%), 88.3% lived with their families, and 88.5% had access to adequate health insurance. Table 1 Location Table 1 Sociodemographic characteristics of study participants (N = 963) Variable Category n (%) Age (years) 18−24 (Median: 20) − Gender Male 495 (51.4) Female 468 (48.6) Ethnicity South Asian 468 (48.6) Arab (GCC and Levant) 393 (40.8) Others* 101 (10.4) Economic status High income 634 (65.8) Middle income 294 (30.5) Low income 35 (3.6) Duration of stay in the UAE Less than 1 year 35 (3.6) 1–5 years 154 (16.0) More than 5 years 773 (80.4) Living with family in the UAE Yes 848 (88.3) Access to good health insurance Yes 847 (88.5) *Others include Southeast Asians (1.3%), Westerners (5.9%), and Africans (3.2%). Influenza Prevalence and Healthcare-Seeking Behaviour Experiencing flu-like symptoms in the past five years was reported by 82.6%, with a significantly higher prevalence among Arabs (86.0%) and Others (89.1%) than among South Asians (78.2%) ( p = 0.002). Males reported a higher prevalence of influenza (90.9%) than females (73.7%) ( p < 0.001). Overall, 59.9% consulted a physician for influenza symptoms, with statistically significant differences across ethnic groups (more Arabs, 66.2%) and gender (more males, 68.5%). Of those who consulted a physician, 84.5% were laboratory-confirmed cases of influenza, with Arabs having the highest confirmation rate (93.1%) ( p < 0.001). Duration of illness varied significantly across ethnic groups and genders. The majority of participants reported symptoms lasting for 3–5 days; however, prolonged illness with symptoms lasting > 5 days was significantly more common among Arabs and females. Similarly, the severity of illness also varied significantly across ethnic groups, with severe symptoms more commonly reported by Arabs (28.0%). Antiviral medication was used by 72.9%, and hospitalization was reported by 25.5% of the study population. As per ethnicity, Arabs had the highest hospitalization rate (42.9%); and gender-wise, males' hospitalization rate was higher compared to females, though the difference was not statistically significant ( p = 0.067). Complications such as pneumonia were reported by 20.5% of participants, more frequently among South Asians (27.3%) ( p < 0.001). Table 2 Location Table 2 Influenza prevalence and healthcare-seeking behaviour by ethnicity and gender Variable Ethnicity Gender South Asian (N = 468) # Arab (N = 393) # Others* (N = 101) # p-value Male (N = 495) # Female (N = 468) # p-value Never had the influenza 102 (21.8) 55 (14.0) 11 (10.9) 0.002 45 (9.1) 123 (26.3) 0.000 Influenza-like symptoms in the past 5 years 366 (78.2) 338 (86.0) 90 (89.1) 450 (90.9) 345 (73.7) Sought medical consultation 263 (56.2) 260 (66.2) 53 (52.5) 0.000 339 (68.5) 238 (50.9) 0.000 Lab-confirmed influenza (% of those consulted) ** 201 (76.4) 242 (93.1) 44 (83.0) 0.000 275 (81.1) 213 (89.5) 0.006 Symptom duration : − 1–2 days 55 (15.5) 131 (39.7) 23 (25.8) 0.000 142 (32.7) 67 (19.7) 0.000 − 3–5 days 242 (68.4) 118 (35.8) 53 (59.6) 234 (53.9) 179 (52.6) − > 5 days 57 (16.1) 81 (24.5) 13 (14.6) 58 (13.4) 94 (27.6) Severity of influenza experience : − Mild 55 (15.2) 116 (34.5) 29 (33.0) 0.000 105 (23.5) 95 (27.9) 0.320 − Moderate 275 (76.0) 126 (37.5) 56 (63.6) 263 (59.0) 195 (57.2) − Severe 32 (8.8) 94 (28.0) 3 (3.4) 78 (17.5) 51 (15.0) Treated with antivirals 245 (66.9) 286 (84.6) 48 (53.3) 0.000 329 (73.1) 251 (72.8) 0.910 Hospitalized for influenza treatment 42 (12.1) 142 (42.9) 11 (12.6) 0.000 122 (28.1) 74 (22.3) 0.067 − 1–2 days 12 (28.6) 80 (56.3) 8 (72.7) 0.002 79 (64.8) 22 (29.7) 0.000 − ≥ 3 days 30 (71.4) 62 (43.7) 3 (27.3) 43 (35.2) 52 (70.3) Complications (e.g., pneumonia) 100 (27.3) 57 (16.9) 6 (6.7) 0.000 87 (19.3) 77 (22.3) 0.303 # Data presented as n (%) *Others include Southeast Asians (1.3%), Westerners (5.9%), and Africans (3.2%). ** Percentages for lab confirmation are calculated only among those who sought medical consultation. Awareness and Preventive Behaviours The majority of participants (95.0%) were aware that influenza is a viral infection. Awareness of peak transmission periods was also high (88.0%), with no significant differences across ethnic groups. However, awareness of transmission routes (e.g., via coughs or sneezes) was significantly lower among the “Others” group (86.1%) compared to the Arab group (99.5%) ( p < 0.001). By ethnicity, the belief that influenza complications could be fatal was significantly lower among the participants in the “Others” group (81.0%) than among South Asians (92.0%) ( p = 0.003). By gender, awareness of influenza-related complications was higher among males (93.1%) than among females (85.1%) ( p < 0.001). Regarding behaviour, 47.6% of participants reported attending university while ill. This was highest among the “Others” group (67.3%, p < 0.001) and males (51.3%, p = 0.019). Most students reported covering coughs or sneezes with their arm (92.2%), with minor variation across groups. Table 3 Location Table 3 Awareness and preventative behaviours related to influenza by ethnicity and gender Variable Ethnicity Gender South Asian (N = 468) # Arab (N = 393) # Others* (N = 101) # p-value Male (N = 495) # Female (N = 468) # p-value Awareness Influenza is a viral infection 444 (95.7) 378 (96.2) 88 (87.1) 0.001 466 (94.5) 445 (95.5) 0.491 Peak influenza transmission periods 417 (89.1) 343 (87.3) 86 (85.1) 0.472 425 (85.9) 422 (90.2) 0.040 Transmission via coughs/sneezes/dirty hands 451 (96.8) 385 (99.5) 87 (86.1) 0.000 471 (95.5) 453 (98.1) 0.028 Influenza can lead to death from complications 427 (92.0) 343 (87.9) 81 (81.0) 0.003 459 (93.1) 393 (85.1) 0.000 Preventive behaviors and attitudes Attended university when sick (Always/Often) 229 (49.0) 159 (40.8) 68 (67.3) 0.000 254 (51.3) 203 (43.8) 0.019 Use elbow/arm to cover cough or sneeze (Always/Often) 417 (89.7) 371 (95.1) 93 (92.1) 0.013 454 (92.3) 428 (92.0) 0.893 Washes/cleans hands after cough or sneeze on them (Always/Often) 429 (91.8) 338 (86.6) 96 (95) 0.002 458 (92.7) 406 (87.3) 0.042 # Data presented as n (%) *Others include Southeast Asians (1.3%), Westerners (5.9%), and Africans (3.2%). Factors associated with seeking medical consultation for influenza In the bivariate analysis, an increased likelihood of seeking medical consultation for influenza-like symptoms was associated with male sex, Arab ethnicity, severe illness, and longer symptom duration. However, after adjusting for covariates in the multivariable logistic regression model, only illness severity and symptom duration remained significant predictors. Participants experiencing moderate symptoms had nearly twice the odds of seeking medical care compared to those with mild symptoms (reference group) (AOR = 1.99, 95% CI: 1.28−3.09, p = 0.002). Furthermore, those with severe symptoms were more than 13 times as likely to seek medical consultation as the reference group (AOR = 13.30, 95% CI: 5.71–30.99, p < 0.001). Additionally, those reporting symptom duration of 3–5 days had significantly greater odds of seeking medical consultation (AOR = 1.87, 95% CI: 1.19–2.94, p = 0.007) compared to those with 1–2 days symptoms duration (reference group), after adjustments (AOR = 1.43, 95% CI: 0.79–2.60, p = 0.242). However, those with an illness duration of > 5 days did not show a significant difference in consultation-seeking compared with the reference group. Gender and ethnicity were significant predictors of healthcare-seeking behaviour in the crude model; however, they lost statistical significance after adjustment, suggesting that their effects were confounded by clinical severity and illness duration. Table 4 Location Table 4 Crude Odds Ratio and Adjusted Odds Ratio for factors associated with seeking medical consultation for influenza Variable Category Crude OR (95% CI) p-value Adjusted OR (95% CI) p-value Gender Female (ref) 1.00 − 1.00 − Male 0.728 (0.533−0.996) 0.047 0.752 (0.534−1.058) 0.101 Ethnicity South Asian (ref) 1.00 − 1.00 − Arab (GCC & Levant) 1.305 (0.929−1.835) 0.125 1.420 (0.958−2.104) 0.081 Others 0.561 (0.348−0.905) 0.018 0.713 (0.426−1.194) 0.198 Severity of illness Mild (ref) 1.00 − 1.00 − Moderate 2.412 (1.701−3.420) < 0.001 1.989 (1.280–3.089) 0.002 Severe 14.260 (6.337−32.090) < 0.001 13.303 (5.710−30.993) 5 days 2.372 (1.456−3.866) 0.001 1.430 (0.786−2.603) 0.242 Influenza Vaccination Status and Perceptions Awareness of influenza vaccination was generally high (92.5%), with 59.2% vaccinated last year; no significant difference was observed across groups. The intention to vaccinate in the current year was high, with 41.2% willing “at all costs”; however, willingness increased to 88.2% if the influenza vaccine was provided free. Regarding the perceived benefits of vaccination, 79.9% believed it offers direct protection for individuals, and 80.3% perceived it as controlling community spread, with significant differences across ethnic groups and gender; higher perceptions among South Asians and females (both p < 0.001). Approximately 40.5% believed that vaccination reduces natural immunity, with a higher proportion among males (47.3% vs. 33.3%; p < 0.001). Perceptions of vaccination among individuals with chronic illness indicated that 86.0% considered vaccination preventive, with a significant ethnic difference (p = 0.029). Table 5 Location Table 5 Comparison of Influenza Vaccination Status, Access, Intentions, and Perceptions by Ethnicity and Gender Domain Variable Response Category Total (N = 963) South Asian (N = 468) # Arab (N = 393) # Others* (N = 101) # p Ethnicity Male (N = 495) # Female (N = 468) # p Gender Awareness & Status Aware of the influenza vaccine Yes 882 (92.5) 422 (91.3) 369 (94.9) 91 (90.1) 0.086 457 (92.7) 425 (92.4) 0.857 Vaccinated last year Yes 565 (59.2) 290 (62.5) 217 (55.9) 58 (57.4) 0.139 281 (57.5) 284 (61.1) 0.257 Regular annual influenza booster taken Yes 503 (53.3) 241 (53.3) 220 (56.6) 42 (41.6) 0.027 240 (49.9) 263 (56.9) 0.031 Access / Cost Would you take the influenza vaccine if provided free? Yes 846 (88.2) 422 (90.6) 337 (86.2) 87 (86.1) 0.108 431 (87.2) 415 (89.2) 0.337 How was the vaccine obtained last year? Vaccine not taken 345 (36.5) 147 (32.2) 165 (42.3) 32 (32.3) 0.004 195 (39.8) 150 (32.9) 0.085 Paid 131 (13.8) 66 (14.5) 45 (11.5) 20 (20.2) 71 (14.5) 60 (13.2) Free 142 (15.0) 68 (14.9) 65 (16.7) 9 (9.1) 68 (13.9) 74 (16.2) Insurance 328 (34.7) 175 (38.4) 115 (29.5) 38 (38.4) 156 (31.8) 172 (37.7) Intentions & Recommendation Plan to vaccinate this year Never 84 (8.9) 40 (8.6) 30 (7.8) 14 (14.1) 0.140 32 (6.5) 52 (11.4) < 0.001 Yes, if free/covered 472 (49.9) 244 (52.7) 183 (47.8) 44 (44.4) 273 (55.6) 199 (43.7) Yes, at all costs 390 (41.2) 179 (38.7) 170 (44.4) 41 (41.4) 186 (37.9) 204 (44.8) Recommend family vaccination Never 70 (7.3) 28 (6.0) 31 (7.9) 10 (9.9) 0.239 33 (6.7) 37 (8.0) < 0.001 Yes, if free 435 (45.5) 222 (47.9) 176 (44.9) 37 (36.6) 277 (56.3) 158 (34.0) Yes, at all costs 452 (47.2) 213 (46.0) 185 (47.2) 54 (53.5) 182 (37.0) 270 (58.1) Perceptions (Effectiveness & Public Health) Vaccination is effective in preventing influenza (individual) Yes 757 (79.9) 396 (86.5) 276 (71.0) 85 (85.0) < 0.001 370 (75.2) 387 (84.9) < 0.001 Vaccination among community members controls the spread Yes 768 (80.3) 405 (87.3) 281 (71.9) 82 (82.0) < 0.001 369 (74.8) 399 (86.2) < 0.001 Getting vaccinated is necessary for public health Yes 788 (82.2) 418 (89.7) 282 (72.1) 88 (87.1) < 0.001 382 (77.3) 406 (87.3) < 0.001 Influenza is not a serious illness Yes 534 (55.9) 263 (57.0) 220 (56.1) 50 (49.5) 0.381 305 (61.9) 229 (49.6) < 0.001 Vaccination lowers natural immunity Yes 387 (40.5) 180 (39.0) 162 (41.3) 44 (43.6) 0.620 233 (47.3) 154 (33.3) < 0.001 Chronic Illness Do you consider the influenza vaccine a preventive measure if you have a chronic illness? Yes 314 (86.0) 204 (89.1) 74 (77.9) 35 (87.5) 0.029 144 (88.3) 170 (84.2) 0.252 # Data presented as n (%) Table 6 presents the binary and multivariable regression analyses of factors associated with influenza vaccination uptake. In binary regression, visiting a doctor for flu treatment and holding positive beliefs about vaccine effectiveness and public health benefits were strongly associated with higher vaccination uptake. After adjusting for significant predictors in the multivariable model, participants who sought medical consultation for influenza treatment were twice as likely to be vaccinated as the reference group (AOR = 1.96; 95% CI, 1.34–2.87; p = 0.001). Belief that vaccine protects individual remained the strongest independent predictor for vaccination uptake (AOR 15.68; 95% CI 7.52–32.68; p < 0.001), followed by belief that vaccination controls community spread (AOR 3.21; 95% CI 1.54–6.66; p = 0.002) and importance for public health (AOR 2.51; 95% CI 1.20–5.24; p = 0.015). Gender, ethnicity, and the belief that vaccination lowers natural immunity were not significant in the models. Table 6 Location Table 6 Crude Odds Ratio and Adjusted Odds Ratio for Factors Associated with Influenza Vaccination Uptake Variable Category Crude OR (95% CI) p-value Adjusted OR (95% CI) p-value Gender Male (ref) − − − − Female 1.16 (0.90−1.50) 0.257 − − Ethnicity Arab (ref) − − − − South Asian 0.76 (0.58−1.00) 0.052 − − Other 0.81 (0.52−1.25) 0.343 − − Sought medical consultation for influenza treatment No (ref) − − − − Yes 1.71 (1.25 − 2.34) 0.001 1.96 (1.34–2.87) 0.001 The belief that the seasonal influenza vaccine is effective in preventing influenza in an individual No (ref) − − − − Yes 33.90 (19.22 − 59.79) < 0.001 15.68 (7.52–32.68) < 0.001 The belief that seasonal influenza vaccination among community members is the most effective way to control the spread No (ref) − − − − Yes 19.07 (11.79 − 30.82) < 0.001 3.21 (1.54–6.66) 0.002 Belief that getting the influenza vaccination is necessary for public health No (ref) − − − − Yes 14.01 (8.80 − 22.31) < 0.001 2.51 (1.20–5.24) 0.015 Belief that the vaccination lowers natural immunity No (ref) − − − − Yes 1.12 (0.86−1.46) 0.407 − − OR = Odds Ratio; AOR = Adjusted Odds Ratio; CI = Confidence Interval; ref = Reference category. Discussion This study explored the prevalence of influenza, preventive behaviours, and perceptions influencing the vaccination status among multi-ethnic university students in the UAE. As this socially mobile young-adult population plays a central role in community transmission, understanding their cultural beliefs, attitudes, and behaviours is crucial for formulating targeted interventions in higher education settings. Influenza Prevalence and Healthcare-Seeking Behaviour The prevalence of influenza-like illness was high, with more than 80% of university students reporting experiencing symptoms in the past 5 years (Table 2 ). Substantial exposure and transmission potential among young adults (18–24 years) has been supported by documented 80−90% H3N2 seroprevalence in Egypt over the past few years ( 18 ). Due to this high burden, influenza accounts for approximately 21% of acute lower respiratory infection hospitalizations among young adults across the Middle East and North Africa ( 19 ). Ethnic differences were apparent in our sample, with Arabs and students in the “Others” category reporting higher influenza prevalence than South Asians. Additionally, among those who got infected, a relatively lesser proportion of South Asians (56.2%) versus Arabs (66.2%) sought medical consultation, and this hesitancy in seeking medical consultation may be the reason that the symptom duration for the majority of South Asians (68.4%) lasted for 3−5 days compared to only 35.8% of the Arabs, and also for higher rates of complications such as pneumonia (Table 2 ). Ethnic differences in infection and severity have been observed in England, where South Asian, Black, and Mixed populations experienced higher clinical influenza incidence compared to White populations ( 20 ). Gender-related differences were also observed in our study: fewer females reported influenza illness, whereas males were more likely to seek medical care. Additionally, females reported longer illness durations, which may be attributable to hesitancy to seek medical care (Table 2 ). Similar trends have been reported in Egypt, where being female was protective against H3N2 ( 18 ), suggesting that gender influences disease patterns. However, regression analysis in our cohort demonstrated that illness severity and symptom duration were the strongest predictors of healthcare-seeking behaviour, while gender and ethnicity were not independently associated after adjustment (Table 4 ). Consistent with our findings, other studies on influenza-like illness report that greater symptom burden and longer illness duration are the main determinants of consulting a health professional, and socio-demographic characteristics demonstrate weak or inconsistent associations after adjusting for clinical severity ( 21 ), ( 22 ). Awareness and Preventive Behaviours Our cohort exhibits high awareness, with over 90% of students identifying influenza as a viral disease and recognizing respiratory droplets as the primary route of transmission (Table 3 ). Additionally, more than 90% reported covering their sneeze or cough with their elbow or arm. Respiratory etiquette is identified by domestic and international students from Sydney, Australia, as a valuable strategy for controlling disease transmission ( 23 ). However, a knowledge-behaviour gap persists among our student population, with nearly 50% attending university while symptomatic, which could facilitate viral transmission. Similar concepts have been documented internationally, with university students demonstrating high awareness but low adherence to preventive behaviours, such as staying home when symptomatic, highlighting a disconnect between knowledge and practice ( 23 ). Perceptions and Attitudes Toward Vaccination Perceptions of our study participants toward influenza vaccination varied across demographic subgroups: awareness exceeded 90% across groups, whereas belief in its effectiveness differed significantly (Table 5 ). The majority of South Asians (86.5%) demonstrated confidence in vaccine effectiveness, agreeing that the vaccine prevents getting influenza, compared with 71.0% of Arabs. Similarly, 87.3% of South Asians, 71.9% of Arabs, and 82% of participants from Other ethnic groups endorsed the belief that community vaccination reduces influenza transmission. These results broadly align with regional evidence from Saudi Arabia, which reported that approximately 60% of respondents expressed confidence in the influenza vaccine, and nearly 70% were aware of its preventive role in reducing influenza transmission ( 24 ). Gender-based differences were also noted; 84.9% of females versus 75.2% of males agreed that the vaccine prevents influenza, and 87.3% of females versus 77.3% of males believed it was necessary for public health. Greater vaccine acceptance and lower hesitancy by females is reported in other university student populations also ( 25 ). A key misconception identified in 40.5% of our study participants is the belief that influenza vaccination weakens natural immunity. This concern was more frequently observed among males (47.3%) than among females (33.3%), highlighting gender-specific patterns of misinformation. Comparable findings are documented in other populations. For instance, a survey of a Saudi community found that 54.8% of respondents believed that the influenza vaccine weakens the immune system and increases susceptibility to infection ( 26 ). A qualitative study among nurses documented concerns about the manipulation of the immune system by influenza vaccination, indicating that this belief is not confined to any region or demographic group ( 27 ). Research on vaccination hesitancy also shows that concerns about adverse effects and perceptions of vaccine effectiveness remain common barriers to uptake ( 28 ). Taken together, these data suggest that, beyond awareness of vaccine availability and effectiveness, misconceptions about immunity waning and side effects must be actively addressed in health-promotion efforts among university populations. Vaccination Uptake and Access Despite high awareness and generally positive attitudes, influenza vaccination uptake in this population remained moderate, with 59% of students reporting receipt of the influenza vaccine in the preceding year. This coverage is comparable to vaccination rates reported among young adults in China (61.3% over the past three years) ( 28 ) and in 65% in Saudi Arabia ( 24 ). In contrast, lower uptake has been documented in Lebanon, where 47.4% of respondents reported never having been vaccinated, with a regular annual vaccination by only 10.2% of university students ( 15 ), and among Israeli college students, where only 12% received the vaccine during the current season, despite easy access ( 25 ). A persistent knowledge-behaviour gap in our population, i.e., high awareness but compromised vaccination uptake, is consistent with international evidence. For instance, in Yemen, 62.5% of respondents perceived that vaccination was protective, yet only 11.3% had ever been vaccinated against seasonal influenza ( 16 ). Similarly, in Kenya, 87.3% believed seasonal influenza can cause severe illness, but only 17.6% had ever received the vaccination ( 29 ). Among Spanish adults, only 34.4% received the influenza vaccine each year, and 48.3% had never been vaccinated. The primary reasons for vaccination were personal and environmental protection, with healthcare provider recommendation as the main driver. Furthermore, 66.3% of those who did not receive the influenza vaccine in recent years mentioned that it was not recommended to them ( 30 ). Together, these findings suggest that knowledge alone is not sufficient to drive influenza vaccination intention. Instead, engagement with trusted healthcare providers is a strong predictor of translating awareness into preventive action ( 31 ). Interestingly, 88.2% of the students in our study expressed willingness to receive the influenza vaccine if it were provided free, thus underscoring the importance of affordability as a key facilitator of vaccine uptake. Consistent patterns have been reported in Kenya, where the median willingness to pay was only USD 2, which is substantially lower than prevailing private-sector prices of USD 10–15 ( 29 ), highlighting the persistent influence of financial barriers on vaccination decisions, even among educated populations. Determinants of Vaccination Regression analysis demonstrated that vaccination behaviour in this cohort was driven primarily by health-seeking behaviour and belief in vaccine benefits rather than demographic variables (Table 6 ). Students who consulted a physician for influenza-like illness were significantly more likely to be vaccinated. Additionally, strong belief in individual and community protection through vaccination emerged as the strongest predictor of vaccination uptake. These observations align with evidence that a physician's recommendation strongly influences vaccination decisions ( 16 )( 31 ). Prior vaccination is reported as one of the most consistent predictors of future vaccination ( 31 )( 32 ), also evident in our study, as regular annual influenza booster uptake is reported among 53.3% (Table 5 ). Thus, shaping attitudes early in adulthood and ensuring regular on-campus free vaccination opportunities may help establish long-term vaccination habits. Public Health Implications Overall, this study reveals high awareness but inconsistent translation into preventive action among university students, a pattern observed in several other settings. Tailored university-based interventions could meaningfully improve outcomes by offering free on-campus vaccination, integrating physician or nurse endorsement into health services, correcting common misconceptions, and incorporating structured reminder systems. Evidence from regional and international studies suggests that such strategies may effectively convert willingness into action and increase vaccination coverage ( 15 ) ( 30 ) ( 32 ). Strengths and Limitations Strengths of this study include a large, ethnically diverse sample and a comprehensive assessment of influenza-related knowledge, behaviour, and vaccination patterns. Limitations include reliance on self-reported data, potential recall bias over a five-year recall period, and the higher-education setting, which may limit generalizability. Future studies that incorporate the general population, objective vaccination records, and a longitudinal design would strengthen the evidence and enable tracking of changes over time. Conclusion University students in the UAE experience a substantial burden of influenza-like illness, with marked gaps between awareness, preventive behaviors, and vaccination uptake. Although knowledge of influenza and vaccine availability was high, the combination of university attendance while symptomatic and moderate vaccination coverage indicates a significant risk of viral transmission. Healthcare-seeking behavior and strong belief in the individual and community benefits of vaccination were the main determinants of vaccine uptake. Misconceptions about vaccine-related immunity reduction persist. University-based public health interventions, including free on-campus vaccination, clinician-led recommendations, and targeted educational messages, may improve vaccine uptake and reduce influenza transmission in multi-ethnic academic settings, ultimately reducing community influenza transmission. Abbreviations AOR – Adjusted odds ratio CI – Confidence interval CDC – Centers for Disease Control and Prevention GCC – Gulf Cooperation Council ILI – Influenza-like illness EMNA – Eastern Mediterranean and North Africa OR – Odds ratio SPSS – Statistical Package for the Social Sciences UAE – United Arab Emirates WHO – World Health Organization Declarations Acknowledgements The authors are grateful to the study participants who completed the questionnaire and provided the data. Author contributions BB, HKJ, MIS, and SS contributed equally to the conceptualization and design of the study, data collection and analysis, and manuscript preparation. NSK supervised the research study and revised the manuscript. Approval of the final version of the manuscript was done by BB, HKJ, MIS, SS, and NSK. Funding The study received funding support from Gulf Medical University, Ajman. Clinical trial number: Not applicable. Data Availability All data generated or analysed during this study are included in this manuscript. Any other information regarding the dataset used and/or analysed during this study is available from the corresponding author on reasonable request. Ethics approval and consent to participate Ethical approval for the conduct of this study was obtained from the Gulf Medical University Institutional Review Board (Ref. no. IRB-COM-STD-56-APRIL-2023). Informed consent was obtained from participants before the commencement of the study survey. All study procedures were conducted in conformity with the “Declaration of Helsinki.” References Le Sage V, Lowen AC, Lakdawala SS. Block the spread: barriers to transmission of influenza viruses. Annu Rev Virol. 2023 Sep 29;10(1):347–370. DOI: 10.1146/annurev-virology-111821-115447 Morris SE, Nguyen HQ, Grijalva CG, Hanson KE, Zhu Y, Biddle JE, et al. 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Vital signs: influenza hospitalizations and vaccination coverage by race and ethnicity—United States, 2009–10 through 2021–22 influenza seasons. MMWR Morb Mortal Wkly Rep . 2022 Oct 28;71(43):1366–1373. Shon EJ, Choe S, Lee L, Ki Y. Influenza vaccination among U.S. college or university students: a systematic review. Am J Health Promot . 2021;35(5):708–719. DOI: 10.1177/0890117120985833 Eichner M, Schwehm M, Eichner L, Gerlier L. Direct and indirect effects of influenza vaccination. BMC Infect Dis . 2017;17(1):308. DOI: 10.1186/s12879-017-2399-4 Saeed B, Imtiaz B, Alhaj S, Alnoman S, Nouh A, Al Homsi K, et al. Knowledge, attitudes, behaviors and risk perception towards seasonal influenza and vaccination among adult population of UAE. Period Eng Nat Sci . 2022;10(2):30–40. Choucair K, El Sawda J, Assaad S, El Chakhtoura NG, Hassouna H, Sidani N, Yasmin M, Rteil A, Kanj SS, Kanafani ZA. 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DOI: 10.1111/irv.12974 Johnson EK, Sylte D, Chaves SS, Li Y, Mahe C, Nair H, et al. Hospital utilization rates for influenza and RSV: a novel approach and critical assessment. Popul Health Metr . 2021;19(1):31. DOI: 10.1186/s12963-021-00252-5 Davidson J, Banerjee A, Mathur R, Ramsay M, Smeeth L, Walker J, et al. Ethnic differences in the incidence of clinically diagnosed influenza: an England population-based cohort study 2008–2018. Wellcome Open Res . 2021;6:49. DOI: 10.12688/wellcomeopenres.16620.3 Chawla D, Benitez A, Xu H, Whitehill V, Tadesse-Bell S, Shapiro A, et al. Predictors of seeking care for influenza-like illness in a novel digital study. Open Forum Infect Dis . 2023;10(1):ofac675.DOI: 10.1093/ofid/ofac675 Peppa M, Edmunds WJ, Funk S. Disease severity determines health-seeking behaviour amongst individuals with influenza-like illness in an internet-based cohort. BMC Infect Dis . 2017;17(1):238. DOI: 10.1186/s12879-017-2337-5 Seale H, Mak JPI, Razee H, MacIntyre CR. Examining the knowledge, attitudes and practices of domestic and international university students towards seasonal and pandemic influenza. BMC Public Health . 2012;12:307. http://www.biomedcentral.com/1471-2458/12/307 Alharthi MS, Alshehri AA, Baali FH, Altuwairqi NA, Altalhi MH, Almalki RA, et al. Public perceptions and influencing factors of seasonal influenza vaccine uptake in Makkah region, Saudi Arabia: a cross-sectional study. Front Public Health . 2025;13:1534176. DOI:10.3389/fpubh.2025.1534176 Dopelt K, Abudin A, Yukther S, Shmukler T, Davidovitch N. The association between levels of trust in the healthcare system and influenza vaccine hesitancy among college students in Israel. Vaccines (Basel) . 2023;11(11):1728. DOI: 10.3390/vaccines11111728 Aljamili AA. Knowledge and practice toward seasonal influenza vaccine and its barriers at the community level in Riyadh, Saudi Arabia. J Family Med Prim Care . 2020;9(3):1331–1339. DOI: 10.4103/jfmpc.jfmpc_1011_19 Pinatel N, Plotton C, Pozzetto B, Gocko X. Nurses’ influenza vaccination and hesitancy: a systematic review of qualitative literature. Vaccines (Basel) . 2022;10(7):997. https://doi.org/10.3390/vaccines10070997 Wang L, Guo M, Wang Y, Chen R, Wei X. The relationship between influenza vaccine hesitancy and vaccine literacy among youth and adults in China. Front Immunol . 2024;15:1444393. https://doi.org/10.3389/fimmu.2024.1444393 Otieno NA, Kalani R, Ayugi J, Nyawanda BO, Ndegwa LK, Osoro E, et al. Seasonal influenza vaccination in Kenya: what determines healthcare workers’ willingness to accept and recommend vaccination? Vaccine. 2025;54:126963. DOI: 10.1016/j.vaccine.2025.126963 Prada-García C, Toquero-Asensio M, Fernández-Espinilla V, Hernán-García C, Sanz-Muñoz I, Eiros JM, et al. Analyzing changes in attitudes and behaviors towards seasonal influenza vaccination in Spain’s adult population over three seasons. Vaccines (Basel). 2024;12(10):1162. DOI: 10.3390/vaccines12101162 Eilers R, Groenendijk FH, Lehman BA, Rots NY, de Melker HE, Mollema L, van Beek J. Influence of perceived influenza-like symptoms on intention to receive seasonal influenza vaccination. BMC Public Health . 2025;25(1):1124. DOI: 10.1186/s12889-025-22144-1 Amicizia D, Allegretti S, Grammatico F, Astengo M, Marchini F, Battaglini A, et al. Determinants of accepting or rejecting influenza vaccination—results of a survey among Ligurian pharmacy visitors during the 2023/2024 vaccination campaign. Vaccines (Basel) . 2025;13(6):580. https://doi.org/10.3390/vaccines13060580 Additional Declarations No competing interests reported. Supplementary Files QuestionnaireInfluenzaprevalenceseverityandvaccinaionstatus.pdf Cite Share Download PDF Status: Published Journal Publication published 05 Mar, 2026 Read the published version in BMC Infectious Diseases → Version 1 posted Editorial decision: Revision requested 03 Feb, 2026 Reviews received at journal 02 Feb, 2026 Reviewers agreed at journal 27 Jan, 2026 Reviews received at journal 27 Jan, 2026 Reviewers agreed at journal 27 Jan, 2026 Reviews received at journal 25 Jan, 2026 Reviewers agreed at journal 25 Jan, 2026 Reviewers agreed at journal 23 Jan, 2026 Reviewers agreed at journal 23 Jan, 2026 Reviewers agreed at journal 23 Jan, 2026 Reviewers agreed at journal 22 Jan, 2026 Reviewers invited by journal 22 Jan, 2026 Editor assigned by journal 22 Jan, 2026 Editor invited by journal 06 Jan, 2026 Submission checks completed at journal 06 Jan, 2026 First submitted to journal 06 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8448387","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":580613063,"identity":"b0005133-820c-4a7b-984e-4c1a85afe5ce","order_by":0,"name":"Benzil Binu","email":"","orcid":"","institution":"Gulf Medical University","correspondingAuthor":false,"prefix":"","firstName":"Benzil","middleName":"","lastName":"Binu","suffix":""},{"id":580613064,"identity":"20d0cdca-60fc-4430-985e-aa3060c54cf1","order_by":1,"name":"Haniel Karmel Jinu","email":"","orcid":"","institution":"Gulf Medical University","correspondingAuthor":false,"prefix":"","firstName":"Haniel","middleName":"Karmel","lastName":"Jinu","suffix":""},{"id":580613065,"identity":"ccc2fc56-56ab-4e01-ad97-0f76057d3e33","order_by":2,"name":"Mohammed Isham Shiju","email":"","orcid":"","institution":"Gulf Medical University","correspondingAuthor":false,"prefix":"","firstName":"Mohammed","middleName":"Isham","lastName":"Shiju","suffix":""},{"id":580613066,"identity":"0ecb5063-b1cf-4e74-b0ac-ff484349fbf0","order_by":3,"name":"Sachin Syal","email":"","orcid":"","institution":"Gulf Medical University","correspondingAuthor":false,"prefix":"","firstName":"Sachin","middleName":"","lastName":"Syal","suffix":""},{"id":580613067,"identity":"4362c42d-0f5f-4de8-b3bd-db9302d0b7ec","order_by":4,"name":"Nelofar Sami Khan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9klEQVRIiWNgGAWjYFAC5gaGCgYGAwMGBsYHRGphbGA4A9HCbECyFjYJojSYszc2PjhQcc/YnP3sscqvOYcZ+NsPMH74gEeLZc/BZoMDZ4rNLHvy0m7LbjvMIHEmgVlyBh4tBjcS26Q/tiXYGBzIMbstCdTCcIOBQZoHn5b7D9skDv4Dajn/xqwYpEX+BgPz7z94bWEEamlIMDO4kWPG+BGoxeAGA5s0Pu8bnEkE+uVYgrHBjTfG0ozb0nkMzyS2Wfbg03L88MEHB2oSDDeczzH8+HObtZzc8cOHb/zAZw0yYAb6mgccU0QDRqINHwWjYBSMghEFACfPVIj7liMIAAAAAElFTkSuQmCC","orcid":"","institution":"Gulf Medical University","correspondingAuthor":true,"prefix":"","firstName":"Nelofar","middleName":"Sami","lastName":"Khan","suffix":""}],"badges":[],"createdAt":"2025-12-25 10:38:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8448387/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8448387/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12879-026-12944-0","type":"published","date":"2026-03-05T15:57:47+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":104250859,"identity":"19bb1019-93c5-461a-904d-7f1a556c787d","added_by":"auto","created_at":"2026-03-09 16:10:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1994797,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8448387/v1/448181cd-b96e-4aca-bf60-285adad59326.pdf"},{"id":101254501,"identity":"15c6b038-cf01-4b16-9f2b-2ad2b3ee2baa","added_by":"auto","created_at":"2026-01-27 18:35:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":132712,"visible":true,"origin":"","legend":"","description":"","filename":"QuestionnaireInfluenzaprevalenceseverityandvaccinaionstatus.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8448387/v1/c0b0e40e75f4a1ad58021cde.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Influenza burden, preventive behaviours, and vaccination uptake among multi-ethnic university students in the United Arab Emirates: a cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eInfluenza (Flu) is a contagious disease that is caused by a range of influenza viruses. Some of these viruses infect humans, while others are specific to animal species. It affects the respiratory tract, and transmission occurs primarily via droplets released while coughing, sneezing, or speaking, and through contact with contaminated objects (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Influenza can be transmitted before symptom onset, and infected individuals may remain infectious for 5\u0026ndash;7 days. While most healthy individuals recover within a few days, complications such as pneumonia and death are common among immunocompromised individuals, pregnant women, and other high-risk groups. Typical symptoms include rhinorrhea, fever, cough, and sore throat (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSeasonal influenza is a highly contagious viral illness that occurs in annual epidemics and represents a significant global public-health burden. In temperate regions, epidemics typically occur during the fall and winter months, infecting a significant proportion of both adults and children (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Older adults (\u0026ge;\u0026thinsp;65 years), young children, pregnant women, people with chronic diseases, including asthma, cardiovascular disorders, diabetes, and immunosuppression, are at increased risk of getting severe infections (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTwo major human influenza virus types\u0026mdash;Influenza A and Influenza B\u0026mdash;co-circulate annually and are responsible for most seasonal epidemics. Surveillance data from the Eastern Mediterranean and North African (EMNA) region indicate that A(H1N1) and A(H3N2) strains accounted for 50.8% and 15.9% of influenza-positive cases, respectively, with notable regional variation. Altogether, Influenza A accounted for 67.9% and influenza B accounted for 23.8% of all positive cases. Predominance of this subtype has important implications for vaccine composition, epidemic forecasting, and public health responses (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe severity of influenza presentation varies, from self-limiting mild illness to life-threatening manifestations. Mild cases are generally managed with rest and adequate fluid intake, and in some instances with antiviral medications such as zanamivir (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In extremely severe cases, influenza may even prove life-threatening if the infection causes a severe inflammatory reaction leading to sepsis.(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSeasonal influenza imposes a substantial and persistent \u0026ldquo;public health burden\u0026rdquo; globally. Centers for Disease Control and Prevention (CDC) documents indicate that, since the 2010\u0026ndash;11 season (excluding the unusually low 2020\u0026ndash;21 season), influenza in the United States has caused approximately 9.3\u0026ndash;41\u0026nbsp;million infections annually. Additionally, each year, 120,000\u0026ndash;710,000 patients were hospitalized, and fatalities were 6,300\u0026ndash;52,000 (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Furthermore, in the 2023\u0026ndash;24 season alone, CDC reported 40\u0026nbsp;million infections and 18\u0026nbsp;million hospital visits. Altogether, 470,000 people were hospitalized, and 28,000 had fatal outcomes (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). These figures illustrate the considerable and variable impact of seasonal influenza in countries with robust surveillance systems.\u003c/p\u003e \u003cp\u003eIn contrast, data from the EMNA region indicate substantial influenza circulation but relatively limited and heterogeneous estimates of disease burden. A systematic review of 112 studies from the EMNA region reported only 314,058 laboratory-confirmed influenza cases, highlighting major gaps in estimates of hospitalization rates, illness duration, and mortality rates (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). These gaps reflect variations in reporting practices and viral circulation patterns. It underscores the need to strengthen surveillance systems and standardize burden estimation, thereby informing authorities of effective vaccination and prevention strategies (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFurthermore, emerging evidence indicates that the burden of influenza is not evenly distributed across populations. Certain racial and ethnic minority groups are reported to experience disproportionately severe outcomes of influenza infection. In the United States, the influenza-associated rate of hospitalization among Black population (non-Hispanic), American/Alaska Native, and Hispanic adults was approximately 1.8-, 1.3-, and 1.2-fold higher, respectively, than those among White adults across influenza seasons between 2009\u0026ndash;10 and 2021\u0026ndash;22 (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Delayed healthcare-seeking behavior\u0026mdash;more common in some minority populations due to cultural norms, mistrust of healthcare systems, or limited access to preventive services\u0026mdash;has been associated with increased disease severity (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). These disparities are also reflected in varying rates of influenza vaccination among adults, with only 42% of Black and 37.9% of Hispanic adults vaccinated, compared with 53.9% of White adults (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Differences in vaccination uptake are influenced by socio-cultural beliefs, perceived susceptibility, and attitudes toward preventive healthcare (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). A U.S. systematic review reported that influenza vaccination uptake among university students is generally suboptimal and remains well below recommended targets. Some studies have identified racial and ethnic differences in vaccination uptake or intention, reporting significantly lower vaccination uptake among certain racial or ethnic minority student groups compared with White students. It highlights the need for further research to clarify these disparities (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eInfluenza vaccination protects against infection at both the individual and community levels. Large-scale community-level vaccination reduces transmission, thus protecting the vulnerable populations. Evidence of \u0026ldquo;herd protection\u0026rdquo; indicates that higher population-level vaccination coverage can substantially reduce infection rates, thereby protecting unvaccinated individuals as well (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eUniversities in the United Arab Emirates (UAE) foster multi-ethnic environments, and students often live together and share facilities. Diverse behavioral and cultural practices may affect influenza transmission and disease severity. Understanding ethnic differences in influenza severity, vaccination, and other preventive behaviors in this setting is therefore essential for designing targeted strategies across cultural backgrounds.\u003c/p\u003e \u003cp\u003eAs seasonal influenza is endemic in the UAE, studying the influence of ethnicity on disease severity, preventive behaviors, and vaccination status among university students from diverse backgrounds can provide evidence to guide healthcare providers and policymakers in implementing influenza prevention and management strategies across populations.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eAim, study design, and sample population\u003c/h2\u003e \u003cp\u003eConducted a cross-sectional survey using a structured questionnaire across several university campuses in the UAE, including institutions in Ajman, Sharjah, and Dubai. The aim was to assess the prevalence of influenza-like illness, health-seeking behaviour, vaccination uptake, preventive practices, and perceptions related to influenza. The sample population was university students aged 18 years and above.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSample size calculation\u003c/h3\u003e\n\u003cp\u003eThe minimum required sample size was calculated using the single-proportion (prevalence) formula for cross-sectional surveys: n\u0026thinsp;=\u0026thinsp;z\u0026sup2;pq/d\u0026sup2;, where z\u0026thinsp;=\u0026thinsp;1.96 for a two-sided 95% confidence level, p is the expected prevalence, q\u0026thinsp;=\u0026thinsp;1\u0026thinsp;\u0026minus;\u0026thinsp;p, and d is the desired absolute precision. To anchor p in closely related UAE influenza evidence, we used the proportion of respondents reporting seasonal influenza vaccination (54%) in a UAE cross-sectional survey (p\u0026thinsp;=\u0026thinsp;0.54; q\u0026thinsp;=\u0026thinsp;0.46) (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Assuming d\u0026thinsp;=\u0026thinsp;0.034 (3.4% absolute precision) and an anticipated 10% non-response rate, the target sample size was approximately 900 participants. Our achieved sample exceeded this target.\u003c/p\u003e\n\u003ch3\u003eSampling technique\u003c/h3\u003e\n\u003cp\u003eA convenience sampling technique was employed, where participants who were readily accessible and willing to participate were included in the study. Although no quotas were applied, the sample naturally included students from major ethnic groups in the UAE university population (South Asian, Arab, and other ethnicities).\u003c/p\u003e\n\u003ch3\u003eQuestionnaire development and validation\u003c/h3\u003e\n\u003cp\u003eThe questionnaire was developed following a comprehensive literature review that covered influenza epidemiology, knowledge, attitudes, and vaccination behaviour (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Content validity was ensured through expert review by faculty with experience in epidemiology and infectious diseases. A pilot study with ten students assessed clarity, length, and feasibility. Minor linguistic and structural revisions were made in response to feedback. Data from the pilot phase were excluded from the final analysis. The questionnaire developed for this study is attached as a supplementary file.\u003c/p\u003e\n\u003ch3\u003eSurvey instrument\u003c/h3\u003e\n\u003cp\u003eThe final self-administered questionnaire consisted of the following sections:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eSociodemographic characteristics: It included age, gender, ethnicity, duration of stay in the UAE, economic status, and health insurance status.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHistory, severity, and healthcare-seeking for infection: It included items to capture influenza infection in the past five years, duration of illness, severity of symptoms, consultation with a physician, laboratory confirmation of influenza, use of antivirals for treatment, hospitalization \u0026amp; duration of stay, and complications, if any\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eKnowledge and preventive behaviours for influenza: It included items about awareness of the mode of disease transmission, respiratory hygiene practices, and attending university while symptomatic\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eVaccination status: It included items to capture the receipt of influenza vaccine in the past years, paid/free access to vaccine, and willingness to vaccinate if free\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePerceptions and misconceptions regarding influenza vaccine: It included items to capture beliefs regarding vaccine effectiveness at the individual and community level, the importance of vaccination for public health, and the misconception that vaccination lowers natural immunity\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eThe questionnaire was administered online via a secure Google Forms link.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003e The Institutional Review Board approved the study before commencement. All participants provided informed consent electronically before the initiation of the survey. Participation was voluntary, and no personal identifiers were collected; thus, confidentiality was maintained. All study procedures were conducted in conformity with the \u0026ldquo;Declaration of Helsinki.\u0026rdquo;\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData were downloaded as Microsoft Excel and analysed using IBM SPSS Statistics version 29. Descriptive statistics were used to summarize participant characteristics, influenza prevalence, preventive behaviours, and vaccination patterns.\u003c/p\u003e \u003cp\u003eThe chi-square test was used for associations between demographic variables and key outcomes, including influenza-like illness prevalence, severity, healthcare-seeking behaviour, and vaccination status. A p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003cp\u003eBinary logistic regression was conducted to calculate crude odds ratios (ORs) for predictors of healthcare-seeking and vaccination uptake. Variables with significance of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in bivariate analysis were included in multivariable logistic regression models, and adjusted odds ratios (AORs) with 95% confidence intervals (CI) were estimated.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eParticipant Characteristics\u003c/h2\u003e \u003cp\u003eA total of 963 university students participated in the study, with a median age of 20 years (18\u0026minus;24 years). Participants were almost equally distributed by gender, with males (51.4%) and females (48.6%).\u003c/p\u003e \u003cp\u003eDistribution by ethnicity shows nearly half (48.6%) as South Asians, followed by Arabs from the GCC and Levant (40.8%), with others, including Southeast Asians, Westerners, and Africans, accounting for 10.4%. Most participants reported a high-income background (65.8%), followed by middle-income (30.5%) and low-income (3.6%) backgrounds.\u003c/p\u003e \u003cp\u003eThe majority had lived in the UAE for more than 5 years (80.4%), 88.3% lived with their families, and 88.5% had access to adequate health insurance.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cb\u003eLocation\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics of study participants (N\u0026thinsp;=\u0026thinsp;963)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026minus;24 (Median: 20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e495 (51.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e468 (48.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSouth Asian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e468 (48.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eArab (GCC and Levant)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e393 (40.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101 (10.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eEconomic status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e634 (65.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiddle income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e294 (30.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (3.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eDuration of stay in the UAE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess than 1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (3.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e154 (16.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMore than 5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e773 (80.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLiving with family in the UAE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e848 (88.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAccess to good health insurance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e847 (88.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*Others include Southeast Asians (1.3%), Westerners (5.9%), and Africans (3.2%).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eInfluenza Prevalence and Healthcare-Seeking Behaviour\u003c/h2\u003e \u003cp\u003eExperiencing flu-like symptoms in the past five years was reported by 82.6%, with a significantly higher prevalence among Arabs (86.0%) and Others (89.1%) than among South Asians (78.2%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002). Males reported a higher prevalence of influenza (90.9%) than females (73.7%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eOverall, 59.9% consulted a physician for influenza symptoms, with statistically significant differences across ethnic groups (more Arabs, 66.2%) and gender (more males, 68.5%). Of those who consulted a physician, 84.5% were laboratory-confirmed cases of influenza, with Arabs having the highest confirmation rate (93.1%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eDuration of illness varied significantly across ethnic groups and genders. The majority of participants reported symptoms lasting for 3\u0026ndash;5 days; however, prolonged illness with symptoms lasting\u0026thinsp;\u0026gt;\u0026thinsp;5 days was significantly more common among Arabs and females. Similarly, the severity of illness also varied significantly across ethnic groups, with severe symptoms more commonly reported by Arabs (28.0%). Antiviral medication was used by 72.9%, and hospitalization was reported by 25.5% of the study population. As per ethnicity, Arabs had the highest hospitalization rate (42.9%); and gender-wise, males' hospitalization rate was higher compared to females, though the difference was not statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.067). Complications such as pneumonia were reported by 20.5% of participants, more frequently among South Asians (27.3%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e \u003cb\u003eLocation\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInfluenza prevalence and healthcare-seeking behaviour by ethnicity and gender\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eEthnicity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSouth Asian (N\u0026thinsp;=\u0026thinsp;468) \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eArab\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;393) \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOthers*\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;101) \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;495) \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;468) \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNever had the influenza\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e102 (21.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55 (14.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11 (10.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e45 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e123 (26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInfluenza-like symptoms in the past 5 years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e366 (78.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e338 (86.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90 (89.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e450 (90.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e345 (73.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSought medical consultation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e263 (56.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e260 (66.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53 (52.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e339 (68.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e238 (50.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLab-confirmed influenza (% of those consulted) **\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e201 (76.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e242 (93.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44 (83.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e275 (81.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e213 (89.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSymptom duration\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026minus; 1\u0026ndash;2 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55 (15.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e131 (39.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23 (25.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e142 (32.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e67 (19.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026minus; 3\u0026ndash;5 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e242 (68.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e118 (35.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53 (59.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e234 (53.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e179 (52.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026minus; \u0026gt;\u0026thinsp;5 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57 (16.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e81 (24.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13 (14.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e58 (13.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e94 (27.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSeverity of influenza experience\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026minus; Mild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55 (15.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e116 (34.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29 (33.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e105 (23.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e95 (27.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.320\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026minus; Moderate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e275 (76.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e126 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e56 (63.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e263 (59.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e195 (57.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026minus; Severe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94 (28.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3 (3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e78 (17.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e51 (15.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTreated with antivirals\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e245 (66.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e286 (84.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48 (53.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e329 (73.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e251 (72.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.910\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHospitalized for influenza treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42 (12.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e142 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11 (12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e122 (28.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e74 (22.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.067\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026minus; 1\u0026ndash;2 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80 (56.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8 (72.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e79 (64.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e22 (29.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026minus; \u0026ge;\u0026thinsp;3 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30 (71.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62 (43.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3 (27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e43 (35.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e52 (70.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComplications (e.g., pneumonia)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e100 (27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57 (16.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e87 (19.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e77 (22.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.303\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003e#\u003c/sup\u003eData presented as n (%)\u003c/p\u003e \u003cp\u003e*Others include Southeast Asians (1.3%), Westerners (5.9%), and Africans (3.2%).\u003c/p\u003e \u003cp\u003e \u003cb\u003e**\u003c/b\u003ePercentages for lab confirmation are calculated only among those who sought medical consultation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eAwareness and Preventive Behaviours\u003c/h2\u003e \u003cp\u003eThe majority of participants (95.0%) were aware that influenza is a viral infection. Awareness of peak transmission periods was also high (88.0%), with no significant differences across ethnic groups. However, awareness of transmission routes (e.g., via coughs or sneezes) was significantly lower among the \u0026ldquo;Others\u0026rdquo; group (86.1%) compared to the Arab group (99.5%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eBy ethnicity, the belief that influenza complications could be fatal was significantly lower among the participants in the \u0026ldquo;Others\u0026rdquo; group (81.0%) than among South Asians (92.0%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003). By gender, awareness of influenza-related complications was higher among males (93.1%) than among females (85.1%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eRegarding behaviour, 47.6% of participants reported attending university while ill. This was highest among the \u0026ldquo;Others\u0026rdquo; group (67.3%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and males (51.3%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.019). Most students reported covering coughs or sneezes with their arm (92.2%), with minor variation across groups.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e \u003cb\u003eLocation\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAwareness and preventative behaviours related to influenza by ethnicity and gender\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eEthnicity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSouth Asian (N\u0026thinsp;=\u0026thinsp;468) \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eArab (N\u0026thinsp;=\u0026thinsp;393) \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOthers*\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;101) \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;495) \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;468) \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAwareness\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfluenza is a viral infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e444 (95.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e378 (96.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88 (87.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e466 (94.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e445 (95.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.491\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeak influenza transmission periods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e417 (89.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e343 (87.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86 (85.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.472\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e425 (85.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e422 (90.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransmission via coughs/sneezes/dirty hands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e451 (96.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e385 (99.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87 (86.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e471 (95.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e453 (98.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfluenza can lead to death from complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e427 (92.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e343 (87.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81 (81.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e459 (93.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e393 (85.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreventive behaviors and attitudes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttended university when sick (Always/Often)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e229 (49.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e159 (40.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68 (67.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e254 (51.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e203 (43.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse elbow/arm to cover cough or sneeze (Always/Often)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e417 (89.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e371 (95.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93 (92.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e454 (92.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e428 (92.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.893\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWashes/cleans hands after cough or sneeze on them (Always/Often)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e429 (91.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e338 (86.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96 (95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e458 (92.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e406 (87.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003e#\u003c/sup\u003eData presented as n (%)\u003c/p\u003e \u003cp\u003e*Others include Southeast Asians (1.3%), Westerners (5.9%), and Africans (3.2%).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with seeking medical consultation for influenza\u003c/h2\u003e \u003cp\u003eIn the bivariate analysis, an increased likelihood of seeking medical consultation for influenza-like symptoms was associated with male sex, Arab ethnicity, severe illness, and longer symptom duration. However, after adjusting for covariates in the multivariable logistic regression model, only illness severity and symptom duration remained significant predictors.\u003c/p\u003e \u003cp\u003eParticipants experiencing moderate symptoms had nearly twice the odds of seeking medical care compared to those with mild symptoms (reference group) (AOR\u0026thinsp;=\u0026thinsp;1.99, 95% CI: 1.28\u0026minus;3.09, p\u0026thinsp;=\u0026thinsp;0.002). Furthermore, those with severe symptoms were more than 13 times as likely to seek medical consultation as the reference group (AOR\u0026thinsp;=\u0026thinsp;13.30, 95% CI: 5.71\u0026ndash;30.99, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, those reporting symptom duration of 3\u0026ndash;5 days had significantly greater odds of seeking medical consultation (AOR\u0026thinsp;=\u0026thinsp;1.87, 95% CI: 1.19\u0026ndash;2.94, p\u0026thinsp;=\u0026thinsp;0.007) compared to those with 1\u0026ndash;2 days symptoms duration (reference group), after adjustments (AOR\u0026thinsp;=\u0026thinsp;1.43, 95% CI: 0.79\u0026ndash;2.60, p\u0026thinsp;=\u0026thinsp;0.242). However, those with an illness duration of \u0026gt;\u0026thinsp;5 days did not show a significant difference in consultation-seeking compared with the reference group.\u003c/p\u003e \u003cp\u003eGender and ethnicity were significant predictors of healthcare-seeking behaviour in the crude model; however, they lost statistical significance after adjustment, suggesting that their effects were confounded by clinical severity and illness duration.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e \u003cb\u003eLocation\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCrude Odds Ratio and Adjusted Odds Ratio for factors associated with seeking medical consultation for influenza\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCrude OR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAdjusted OR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.728 (0.533\u0026minus;0.996)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.752 (0.534\u0026minus;1.058)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSouth Asian (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eArab (GCC \u0026amp; Levant)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.305 (0.929\u0026minus;1.835)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.420 (0.958\u0026minus;2.104)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.081\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.561 (0.348\u0026minus;0.905)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.713 (0.426\u0026minus;1.194)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.198\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eSeverity of illness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.412 (1.701\u0026minus;3.420)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.989 (1.280\u0026ndash;3.089)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.260 (6.337\u0026minus;32.090)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13.303 (5.710\u0026minus;30.993)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eDuration of illness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;2 days (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ndash;5 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.689 (1.182\u0026minus;2.415)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.871 (1.191\u0026minus;2.940)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.372 (1.456\u0026minus;3.866)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.430 (0.786\u0026minus;2.603)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.242\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eInfluenza Vaccination Status and Perceptions\u003c/h2\u003e \u003cp\u003eAwareness of influenza vaccination was generally high (92.5%), with 59.2% vaccinated last year; no significant difference was observed across groups. The intention to vaccinate in the current year was high, with 41.2% willing \u0026ldquo;at all costs\u0026rdquo;; however, willingness increased to 88.2% if the influenza vaccine was provided free. Regarding the perceived benefits of vaccination, 79.9% believed it offers direct protection for individuals, and 80.3% perceived it as controlling community spread, with significant differences across ethnic groups and gender; higher perceptions among South Asians and females (both p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Approximately 40.5% believed that vaccination reduces natural immunity, with a higher proportion among males (47.3% vs. 33.3%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Perceptions of vaccination among individuals with chronic illness indicated that 86.0% considered vaccination preventive, with a significant ethnic difference (p\u0026thinsp;=\u0026thinsp;0.029).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e \u003cb\u003eLocation\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Influenza Vaccination Status, Access, Intentions, and Perceptions by Ethnicity and Gender\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDomain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eResponse Category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;963)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSouth Asian (N\u0026thinsp;=\u0026thinsp;468) \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eArab (N\u0026thinsp;=\u0026thinsp;393) \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOthers*\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;101) \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep Ethnicity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;495) \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;468) \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003ep Gender\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eAwareness \u0026amp; Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAware of the influenza vaccine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e882 (92.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e422 (91.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e369 (94.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e91 (90.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.086\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e457 (92.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e425 (92.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.857\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVaccinated last year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e565 (59.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e290 (62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e217 (55.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e58 (57.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e281 (57.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e284 (61.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.257\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegular annual influenza booster taken\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e503 (53.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e241 (53.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e220 (56.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e42 (41.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e240 (49.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e263 (56.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eAccess / Cost\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWould you take the influenza vaccine if provided free?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e846 (88.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e422 (90.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e337 (86.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e87 (86.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e431 (87.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e415 (89.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.337\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eHow was the vaccine obtained last year?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVaccine not taken\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e345 (36.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e147 (32.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e165 (42.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e32 (32.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e195 (39.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e150 (32.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePaid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e131 (13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e66 (14.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e45 (11.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e20 (20.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e71 (14.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e60 (13.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e142 (15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e68 (14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e65 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e9 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e68 (13.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e74 (16.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInsurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e328 (34.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e175 (38.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e115 (29.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e38 (38.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e156 (31.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e172 (37.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eIntentions \u0026amp; Recommendation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePlan to vaccinate this year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e84 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e40 (8.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e30 (7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e14 (14.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e32 (6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e52 (11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes, if free/covered\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e472 (49.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e244 (52.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e183 (47.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e44 (44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e273 (55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e199 (43.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes, at all costs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e390 (41.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e179 (38.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e170 (44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e41 (41.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e186 (37.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e204 (44.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eRecommend family vaccination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70 (7.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e28 (6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e31 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e10 (9.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.239\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e33 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e37 (8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes, if free\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e435 (45.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e222 (47.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e176 (44.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e37 (36.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e277 (56.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e158 (34.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes, at all costs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e452 (47.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e213 (46.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e185 (47.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e54 (53.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e182 (37.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e270 (58.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003ePerceptions (Effectiveness \u0026amp; Public Health)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVaccination is effective in preventing influenza (individual)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e757 (79.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e396 (86.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e276 (71.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e85 (85.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e370 (75.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e387 (84.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVaccination among community members controls the spread\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e768 (80.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e405 (87.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e281 (71.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e82 (82.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e369 (74.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e399 (86.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGetting vaccinated is necessary for public health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e788 (82.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e418 (89.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e282 (72.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e88 (87.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e382 (77.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e406 (87.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInfluenza is not a serious illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e534 (55.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e263 (57.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e220 (56.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e50 (49.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.381\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e305 (61.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e229 (49.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVaccination lowers natural immunity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e387 (40.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e180 (39.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e162 (41.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e44 (43.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.620\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e233 (47.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e154 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChronic Illness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDo you consider the influenza vaccine a preventive measure if you have a chronic illness?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e314 (86.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e204 (89.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e74 (77.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e35 (87.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e144 (88.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e170 (84.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.252\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003e\u003csup\u003e#\u003c/sup\u003eData presented as n (%)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e presents the binary and multivariable regression analyses of factors associated with influenza vaccination uptake. In binary regression, visiting a doctor for flu treatment and holding positive beliefs about vaccine effectiveness and public health benefits were strongly associated with higher vaccination uptake. After adjusting for significant predictors in the multivariable model, participants who sought medical consultation for influenza treatment were twice as likely to be vaccinated as the reference group (AOR\u0026thinsp;=\u0026thinsp;1.96; 95% CI, 1.34\u0026ndash;2.87; p\u0026thinsp;=\u0026thinsp;0.001). Belief that vaccine protects individual remained the strongest independent predictor for vaccination uptake (AOR 15.68; 95% CI 7.52\u0026ndash;32.68; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), followed by belief that vaccination controls community spread (AOR 3.21; 95% CI 1.54\u0026ndash;6.66; p\u0026thinsp;=\u0026thinsp;0.002) and importance for public health (AOR 2.51; 95% CI 1.20\u0026ndash;5.24; p\u0026thinsp;=\u0026thinsp;0.015). Gender, ethnicity, and the belief that vaccination lowers natural immunity were not significant in the models.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e \u003cb\u003eLocation\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCrude Odds Ratio and Adjusted Odds Ratio for Factors Associated with Influenza Vaccination Uptake\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCrude OR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAdjusted OR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.16 (0.90\u0026minus;1.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eArab (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSouth Asian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.76 (0.58\u0026minus;1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.81 (0.52\u0026minus;1.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSought medical consultation for influenza treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.71 (1.25\u003c/b\u003e\u0026minus;\u003cb\u003e2.34)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1.96 (1.34\u0026ndash;2.87)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThe belief that the seasonal influenza vaccine is effective in preventing influenza in an individual\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e33.90 (19.22\u003c/b\u003e\u0026minus;\u003cb\u003e59.79)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e15.68 (7.52\u0026ndash;32.68)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThe belief that seasonal influenza vaccination among community members is the most effective way to control the spread\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e19.07 (11.79\u003c/b\u003e\u0026minus;\u003cb\u003e30.82)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e3.21 (1.54\u0026ndash;6.66)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBelief that getting the influenza vaccination is necessary for public health\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e14.01 (8.80\u003c/b\u003e\u0026minus;\u003cb\u003e22.31)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e2.51 (1.20\u0026ndash;5.24)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.015\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBelief that the vaccination lowers natural immunity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.12 (0.86\u0026minus;1.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.407\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eOR\u0026thinsp;=\u0026thinsp;Odds Ratio; AOR\u0026thinsp;=\u0026thinsp;Adjusted Odds Ratio; CI\u0026thinsp;=\u0026thinsp;Confidence Interval; ref\u0026thinsp;=\u0026thinsp;Reference category.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explored the prevalence of influenza, preventive behaviours, and perceptions influencing the vaccination status among multi-ethnic university students in the UAE. As this socially mobile young-adult population plays a central role in community transmission, understanding their cultural beliefs, attitudes, and behaviours is crucial for formulating targeted interventions in higher education settings.\u003c/p\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eInfluenza Prevalence and Healthcare-Seeking Behaviour\u003c/h2\u003e \u003cp\u003eThe prevalence of influenza-like illness was high, with more than 80% of university students reporting experiencing symptoms in the past 5 years (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Substantial exposure and transmission potential among young adults (18\u0026ndash;24 years) has been supported by documented 80\u0026minus;90% H3N2 seroprevalence in Egypt over the past few years (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Due to this high burden, influenza accounts for approximately 21% of acute lower respiratory infection hospitalizations among young adults across the Middle East and North Africa (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Ethnic differences were apparent in our sample, with Arabs and students in the \u0026ldquo;Others\u0026rdquo; category reporting higher influenza prevalence than South Asians. Additionally, among those who got infected, a relatively lesser proportion of South Asians (56.2%) versus Arabs (66.2%) sought medical consultation, and this hesitancy in seeking medical consultation may be the reason that the symptom duration for the majority of South Asians (68.4%) lasted for 3\u0026minus;5 days compared to only 35.8% of the Arabs, and also for higher rates of complications such as pneumonia (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Ethnic differences in infection and severity have been observed in England, where South Asian, Black, and Mixed populations experienced higher clinical influenza incidence compared to White populations (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Gender-related differences were also observed in our study: fewer females reported influenza illness, whereas males were more likely to seek medical care. Additionally, females reported longer illness durations, which may be attributable to hesitancy to seek medical care (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Similar trends have been reported in Egypt, where being female was protective against H3N2 (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), suggesting that gender influences disease patterns. However, regression analysis in our cohort demonstrated that illness severity and symptom duration were the strongest predictors of healthcare-seeking behaviour, while gender and ethnicity were not independently associated after adjustment (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Consistent with our findings, other studies on influenza-like illness report that greater symptom burden and longer illness duration are the main determinants of consulting a health professional, and socio-demographic characteristics demonstrate weak or inconsistent associations after adjusting for clinical severity (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eAwareness and Preventive Behaviours\u003c/h2\u003e \u003cp\u003eOur cohort exhibits high awareness, with over 90% of students identifying influenza as a viral disease and recognizing respiratory droplets as the primary route of transmission (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Additionally, more than 90% reported covering their sneeze or cough with their elbow or arm. Respiratory etiquette is identified by domestic and international students from Sydney, Australia, as a valuable strategy for controlling disease transmission (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). However, a knowledge-behaviour gap persists among our student population, with nearly 50% attending university while symptomatic, which could facilitate viral transmission. Similar concepts have been documented internationally, with university students demonstrating high awareness but low adherence to preventive behaviours, such as staying home when symptomatic, highlighting a disconnect between knowledge and practice (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003ePerceptions and Attitudes Toward Vaccination\u003c/h2\u003e \u003cp\u003ePerceptions of our study participants toward influenza vaccination varied across demographic subgroups: awareness exceeded 90% across groups, whereas belief in its effectiveness differed significantly (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). The majority of South Asians (86.5%) demonstrated confidence in vaccine effectiveness, agreeing that the vaccine prevents getting influenza, compared with 71.0% of Arabs. Similarly, 87.3% of South Asians, 71.9% of Arabs, and 82% of participants from Other ethnic groups endorsed the belief that community vaccination reduces influenza transmission. These results broadly align with regional evidence from Saudi Arabia, which reported that approximately 60% of respondents expressed confidence in the influenza vaccine, and nearly 70% were aware of its preventive role in reducing influenza transmission (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Gender-based differences were also noted; 84.9% of females versus 75.2% of males agreed that the vaccine prevents influenza, and 87.3% of females versus 77.3% of males believed it was necessary for public health. Greater vaccine acceptance and lower hesitancy by females is reported in other university student populations also (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA key misconception identified in 40.5% of our study participants is the belief that influenza vaccination weakens natural immunity. This concern was more frequently observed among males (47.3%) than among females (33.3%), highlighting gender-specific patterns of misinformation. Comparable findings are documented in other populations. For instance, a survey of a Saudi community found that 54.8% of respondents believed that the influenza vaccine weakens the immune system and increases susceptibility to infection (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). A qualitative study among nurses documented concerns about the manipulation of the immune system by influenza vaccination, indicating that this belief is not confined to any region or demographic group (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Research on vaccination hesitancy also shows that concerns about adverse effects and perceptions of vaccine effectiveness remain common barriers to uptake (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Taken together, these data suggest that, beyond awareness of vaccine availability and effectiveness, misconceptions about immunity waning and side effects must be actively addressed in health-promotion efforts among university populations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eVaccination Uptake and Access\u003c/h2\u003e \u003cp\u003eDespite high awareness and generally positive attitudes, influenza vaccination uptake in this population remained moderate, with 59% of students reporting receipt of the influenza vaccine in the preceding year. This coverage is comparable to vaccination rates reported among young adults in China (61.3% over the past three years) (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) and in 65% in Saudi Arabia (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). In contrast, lower uptake has been documented in Lebanon, where 47.4% of respondents reported never having been vaccinated, with a regular annual vaccination by only 10.2% of university students (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), and among Israeli college students, where only 12% received the vaccine during the current season, despite easy access (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA persistent knowledge-behaviour gap in our population, i.e., high awareness but compromised vaccination uptake, is consistent with international evidence. For instance, in Yemen, 62.5% of respondents perceived that vaccination was protective, yet only 11.3% had ever been vaccinated against seasonal influenza (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Similarly, in Kenya, 87.3% believed seasonal influenza can cause severe illness, but only 17.6% had ever received the vaccination (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Among Spanish adults, only 34.4% received the influenza vaccine each year, and 48.3% had never been vaccinated. The primary reasons for vaccination were personal and environmental protection, with healthcare provider recommendation as the main driver. Furthermore, 66.3% of those who did not receive the influenza vaccine in recent years mentioned that it was not recommended to them (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Together, these findings suggest that knowledge alone is not sufficient to drive influenza vaccination intention. Instead, engagement with trusted healthcare providers is a strong predictor of translating awareness into preventive action (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eInterestingly, 88.2% of the students in our study expressed willingness to receive the influenza vaccine if it were provided free, thus underscoring the importance of affordability as a key facilitator of vaccine uptake. Consistent patterns have been reported in Kenya, where the median willingness to pay was only USD 2, which is substantially lower than prevailing private-sector prices of USD 10\u0026ndash;15 (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), highlighting the persistent influence of financial barriers on vaccination decisions, even among educated populations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eDeterminants of Vaccination\u003c/h2\u003e \u003cp\u003eRegression analysis demonstrated that vaccination behaviour in this cohort was driven primarily by health-seeking behaviour and belief in vaccine benefits rather than demographic variables (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). Students who consulted a physician for influenza-like illness were significantly more likely to be vaccinated. Additionally, strong belief in individual and community protection through vaccination emerged as the strongest predictor of vaccination uptake. These observations align with evidence that a physician's recommendation strongly influences vaccination decisions (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Prior vaccination is reported as one of the most consistent predictors of future vaccination (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), also evident in our study, as regular annual influenza booster uptake is reported among 53.3% (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Thus, shaping attitudes early in adulthood and ensuring regular on-campus free vaccination opportunities may help establish long-term vaccination habits.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003ePublic Health Implications\u003c/h2\u003e \u003cp\u003eOverall, this study reveals high awareness but inconsistent translation into preventive action among university students, a pattern observed in several other settings. Tailored university-based interventions could meaningfully improve outcomes by offering free on-campus vaccination, integrating physician or nurse endorsement into health services, correcting common misconceptions, and incorporating structured reminder systems. Evidence from regional and international studies suggests that such strategies may effectively convert willingness into action and increase vaccination coverage (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eStrengths of this study include a large, ethnically diverse sample and a comprehensive assessment of influenza-related knowledge, behaviour, and vaccination patterns. Limitations include reliance on self-reported data, potential recall bias over a five-year recall period, and the higher-education setting, which may limit generalizability. Future studies that incorporate the general population, objective vaccination records, and a longitudinal design would strengthen the evidence and enable tracking of changes over time.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eUniversity students in the UAE experience a substantial burden of influenza-like illness, with marked gaps between awareness, preventive behaviors, and vaccination uptake. Although knowledge of influenza and vaccine availability was high, the combination of university attendance while symptomatic and moderate vaccination coverage indicates a significant risk of viral transmission. Healthcare-seeking behavior and strong belief in the individual and community benefits of vaccination were the main determinants of vaccine uptake. Misconceptions about vaccine-related immunity reduction persist. University-based public health interventions, including free on-campus vaccination, clinician-led recommendations, and targeted educational messages, may improve vaccine uptake and reduce influenza transmission in multi-ethnic academic settings, ultimately reducing community influenza transmission.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAOR – Adjusted odds ratio\u003cbr\u003e\u0026nbsp;CI – Confidence interval\u003cbr\u003e\u0026nbsp;CDC – Centers for Disease Control and Prevention\u003cbr\u003e\u0026nbsp;GCC – Gulf Cooperation Council\u003cbr\u003e\u0026nbsp;ILI – Influenza-like illness\u003cbr\u003e\u0026nbsp;EMNA – Eastern Mediterranean and North Africa\u003cbr\u003e\u0026nbsp;OR – Odds ratio\u003cbr\u003e\u0026nbsp;SPSS – Statistical Package for the Social Sciences\u003cbr\u003e\u0026nbsp;UAE – United Arab Emirates\u003cbr\u003e\u0026nbsp;WHO – World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are grateful to the study participants who completed the questionnaire and provided the data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBB, HKJ, MIS, and SS contributed equally to the conceptualization and design of the study, data collection and analysis, and manuscript preparation.\u003c/p\u003e\n\u003cp\u003eNSK supervised the research study and revised the manuscript. Approval of the final version of the manuscript was done by BB, HKJ, MIS, SS, and NSK.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received funding support from Gulf Medical University, Ajman.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this manuscript. Any other information regarding the dataset used and/or analysed during this study is available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for the conduct of this study was obtained from the Gulf Medical University Institutional Review Board (Ref. no. IRB-COM-STD-56-APRIL-2023). Informed consent was obtained from participants before the commencement of the study survey. All study procedures were conducted in conformity with the “Declaration of Helsinki.”\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLe Sage V, Lowen AC, Lakdawala SS. Block the spread: barriers to transmission of influenza viruses. \u003cstrong\u003eAnnu Rev Virol.\u003c/strong\u003e 2023 Sep 29;10(1):347\u0026ndash;370. DOI: 10.1146/annurev-virology-111821-115447 \u003c/li\u003e\n\u003cli\u003eMorris SE, Nguyen HQ, Grijalva CG, Hanson KE, Zhu Y, Biddle JE, et al. Influenza virus shedding and symptoms: dynamics and implications from a multiseason household transmission study. PNAS Nexus. 2024 Aug 21;3(9):pgae338. DOI: 10.1093/pnasnexus/pgae338 \u003c/li\u003e\n\u003cli\u003eOlson SM, Dawood FS, Grohskopf LA, Ellington S. Preventing influenza virus infection and severe influenza among pregnant people and infants. J Womens Health (Larchmt). 2024 Nov 4;33(12):1591\u0026ndash;1598. DOI: 10.1089/jwh.2024.0893\u003c/li\u003e\n\u003cli\u003eRyu S, Cowling BJ. Human influenza epidemiology. \u003cem\u003eCold Spring Harb Perspect Med\u003c/em\u003e. 2021;11(12):a038356. DOI: 10.1101/cshperspect.a038356 \u003c/li\u003e\n\u003cli\u003eTyrrell CSB, Allen JLY, Gkrania-Klotsas E. Influenza: epidemiology and hospital management. \u003cem\u003eMedicine (Abingdon)\u003c/em\u003e. 2021;49(12):797\u0026ndash;804. DOI: 10.1016/j.mpmed.2021.09.015 \u003c/li\u003e\n\u003cli\u003eSoudani S, Mafi A, Al Mayahi Z, Al Balushi S, Dbaibo G, Al Awaidy S, Amiche A. A systematic review of influenza epidemiology and surveillance in the Eastern Mediterranean and North African Region. \u003cem\u003eInfect Dis Ther\u003c/em\u003e. 2022;11(1):15\u0026ndash;52. DOI: 10.1007/s40121-021-00534-3 \u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Influenza (seasonal) \u0026ndash; fact sheet [Internet]. 2025 [cited 2025 Oct 26]. Available from: https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal)\u003c/li\u003e\n\u003cli\u003eKalil AC, Thomas PG. Influenza virus-related critical illness: pathophysiology and epidemiology. \u003cem\u003eCrit Care\u003c/em\u003e. 2019;23(1):258. DOI: 10.1186/s13054-019-2539-x\u003c/li\u003e\n\u003cli\u003eCenters for Disease Control and Prevention. U.S. Department of Health \u0026amp; Human Services, Atlanta, GA. 2025 [cited 2025 Oct 26]. 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Influenza vaccination among U.S. college or university students: a systematic review. \u003cem\u003eAm J Health Promot\u003c/em\u003e. 2021;35(5):708\u0026ndash;719. DOI: 10.1177/0890117120985833\u003c/li\u003e\n\u003cli\u003eEichner M, Schwehm M, Eichner L, Gerlier L. Direct and indirect effects of influenza vaccination. \u003cem\u003eBMC Infect Dis\u003c/em\u003e. 2017;17(1):308. DOI: 10.1186/s12879-017-2399-4\u003c/li\u003e\n\u003cli\u003eSaeed B, Imtiaz B, Alhaj S, Alnoman S, Nouh A, Al Homsi K, et al. Knowledge, attitudes, behaviors and risk perception towards seasonal influenza and vaccination among adult population of UAE. \u003cem\u003ePeriod Eng Nat Sci\u003c/em\u003e. 2022;10(2):30\u0026ndash;40.\u003c/li\u003e\n\u003cli\u003eChoucair K, El Sawda J, Assaad S, El Chakhtoura NG, Hassouna H, Sidani N, Yasmin M, Rteil A, Kanj SS, Kanafani ZA. Knowledge, perception, attitudes and behavior on influenza immunization and the determinants of vaccination. \u003cem\u003eJ Epidemiol Glob Health\u003c/em\u003e. 2021;11(1):34\u0026ndash;41. DOI: 10.2991/jegh.k.200906.001\u003c/li\u003e\n\u003cli\u003eAhmed WS, Abu Farha R, Halboup AM, Alshargabi A, Al-Mohamadi A, Abu-Rish EY, et al. Knowledge, attitudes, perceptions, and practice toward seasonal influenza and its vaccine: a cross-sectional study from a country of conflict. Front Public Health. 2023;11:1030391. https://doi.org/10.3389/fpubh.2023.1030391 \u003c/li\u003e\n\u003cli\u003eTuohetamu S, Pang M, Nuer X, Mahemuti, Mohemaiti P, Qin Y, et al. The knowledge, attitudes and practices on influenza among medical college students in Northwest China. \u003cem\u003eHum Vaccin Immunother\u003c/em\u003e. 2017;13(7):1688\u0026ndash;1692. DOI: 10.1080/21645515.2017.1293769\u003c/li\u003e\n\u003cli\u003eGomaa MR, Badra R, El Rifay AS, Kandeil A, Kamel MN, Abo Shama NM, et al. Incidence and seroprevalence of seasonal influenza A viruses in Egypt: results of a community-based cohort study. \u003cem\u003eInfluenza Other Respir Viruses\u003c/em\u003e. 2022;16(4):749\u0026ndash;755. DOI: 10.1111/irv.12974\u003c/li\u003e\n\u003cli\u003eJohnson EK, Sylte D, Chaves SS, Li Y, Mahe C, Nair H, et al. Hospital utilization rates for influenza and RSV: a novel approach and critical assessment. \u003cem\u003ePopul Health Metr\u003c/em\u003e. 2021;19(1):31. DOI: 10.1186/s12963-021-00252-5\u003c/li\u003e\n\u003cli\u003eDavidson J, Banerjee A, Mathur R, Ramsay M, Smeeth L, Walker J, et al. Ethnic differences in the incidence of clinically diagnosed influenza: an England population-based cohort study 2008\u0026ndash;2018. \u003cem\u003eWellcome Open Res\u003c/em\u003e. 2021;6:49. DOI: 10.12688/wellcomeopenres.16620.3\u003c/li\u003e\n\u003cli\u003eChawla D, Benitez A, Xu H, Whitehill V, Tadesse-Bell S, Shapiro A, et al. Predictors of seeking care for influenza-like illness in a novel digital study. \u003cem\u003eOpen Forum Infect Dis\u003c/em\u003e. 2023;10(1):ofac675.DOI: 10.1093/ofid/ofac675\u003c/li\u003e\n\u003cli\u003ePeppa M, Edmunds WJ, Funk S. Disease severity determines health-seeking behaviour amongst individuals with influenza-like illness in an internet-based cohort. \u003cem\u003eBMC Infect Dis\u003c/em\u003e. 2017;17(1):238. DOI: 10.1186/s12879-017-2337-5\u003c/li\u003e\n\u003cli\u003eSeale H, Mak JPI, Razee H, MacIntyre CR. Examining the knowledge, attitudes and practices of domestic and international university students towards seasonal and pandemic influenza. \u003cem\u003eBMC Public Health\u003c/em\u003e. 2012;12:307. http://www.biomedcentral.com/1471-2458/12/307\u003c/li\u003e\n\u003cli\u003eAlharthi MS, Alshehri AA, Baali FH, Altuwairqi NA, Altalhi MH, Almalki RA, et al. Public perceptions and influencing factors of seasonal influenza vaccine uptake in Makkah region, Saudi Arabia: a cross-sectional study. \u003cem\u003eFront Public Health\u003c/em\u003e. 2025;13:1534176. DOI:10.3389/fpubh.2025.1534176\u003c/li\u003e\n\u003cli\u003eDopelt K, Abudin A, Yukther S, Shmukler T, Davidovitch N. The association between levels of trust in the healthcare system and influenza vaccine hesitancy among college students in Israel. \u003cem\u003eVaccines (Basel)\u003c/em\u003e. 2023;11(11):1728. DOI: 10.3390/vaccines11111728\u003c/li\u003e\n\u003cli\u003eAljamili AA. Knowledge and practice toward seasonal influenza vaccine and its barriers at the community level in Riyadh, Saudi Arabia. \u003cem\u003eJ Family Med Prim Care\u003c/em\u003e. 2020;9(3):1331\u0026ndash;1339. DOI: 10.4103/jfmpc.jfmpc_1011_19\u003c/li\u003e\n\u003cli\u003ePinatel N, Plotton C, Pozzetto B, Gocko X. Nurses\u0026rsquo; influenza vaccination and hesitancy: a systematic review of qualitative literature. \u003cstrong\u003eVaccines (Basel)\u003c/strong\u003e. 2022;10(7):997. https://doi.org/10.3390/vaccines10070997\u003c/li\u003e\n\u003cli\u003eWang L, Guo M, Wang Y, Chen R, Wei X. The relationship between influenza vaccine hesitancy and vaccine literacy among youth and adults in China. \u003cem\u003eFront Immunol\u003c/em\u003e. 2024;15:1444393. https://doi.org/10.3389/fimmu.2024.1444393\u003c/li\u003e\n\u003cli\u003eOtieno NA, Kalani R, Ayugi J, Nyawanda BO, Ndegwa LK, Osoro E, et al. Seasonal influenza vaccination in Kenya: what determines healthcare workers\u0026rsquo; willingness to accept and recommend vaccination? Vaccine. 2025;54:126963. DOI: 10.1016/j.vaccine.2025.126963\u003c/li\u003e\n\u003cli\u003ePrada-Garc\u0026iacute;a C, Toquero-Asensio M, Fern\u0026aacute;ndez-Espinilla V, Hern\u0026aacute;n-Garc\u0026iacute;a C, Sanz-Mu\u0026ntilde;oz I, Eiros JM, et al. Analyzing changes in attitudes and behaviors towards seasonal influenza vaccination in Spain\u0026rsquo;s adult population over three seasons. Vaccines (Basel). 2024;12(10):1162. DOI: 10.3390/vaccines12101162\u003c/li\u003e\n\u003cli\u003eEilers R, Groenendijk FH, Lehman BA, Rots NY, de Melker HE, Mollema L, van Beek J. Influence of perceived influenza-like symptoms on intention to receive seasonal influenza vaccination. \u003cem\u003eBMC Public Health\u003c/em\u003e. 2025;25(1):1124. DOI: 10.1186/s12889-025-22144-1\u003c/li\u003e\n\u003cli\u003eAmicizia D, Allegretti S, Grammatico F, Astengo M, Marchini F, Battaglini A, \u003cem\u003eet al.\u003c/em\u003e Determinants of accepting or rejecting influenza vaccination\u0026mdash;results of a survey among Ligurian pharmacy visitors during the 2023/2024 vaccination campaign. \u003cstrong\u003eVaccines (Basel)\u003c/strong\u003e. 2025;13(6):580. https://doi.org/10.3390/vaccines13060580\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Ethnicity, Influenza, Influenza-like illness, Healthcare-seeking behaviour, Public health prevention, United Arab Emirates, University students, Vaccination uptake","lastPublishedDoi":"10.21203/rs.3.rs-8448387/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8448387/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSeasonal influenza remains a significant public health concern worldwide. Although young adults are generally considered at lower risk for severe outcomes, they play a critical role in influenza transmission. University environments in the United Arab Emirates (UAE) are highly multiethnic, hosting student populations with diverse cultural beliefs and health practices that may influence the disease burden. As data on influenza prevalence, preventive behaviours, and healthcare-seeking behaviours among multiethnic university students in the UAE are limited, this study aimed to assess these aspects.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional, questionnaire-based survey was conducted among university students aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years across multiple campuses in Ajman, Sharjah, and Dubai, to collect sociodemographic characteristics, influenza history and severity, healthcare-seeking behaviour, preventive practices, vaccination status, financial aspects to vaccination access, and perceptions regarding vaccine effectiveness and safety. Descriptive statistics summarized participant characteristics, and chi-square tests assessed associations. Binary and multivariable logistic regression analyses identified independent predictors of healthcare-seeking behaviour and influenza vaccination uptake.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 963 students participated (median age: 20 years; 51.4% male), representing diverse ethnic backgrounds. Overall, 82.6% reported experiencing influenza-like illness in the past five years, with significant variation by ethnicity and gender. Nearly half (47.6%) reported attending university while symptomatic. Influenza vaccination coverage last year was 59.2%, and 88.2% reported willingness to vaccinate if provided free of charge, although 40.5% believed vaccination reduces natural immunity. Gender and ethnicity were significant predictors of healthcare-seeking behaviour in the crude model; however, in multivariable analyses, illness severity and symptom duration remain the strongest predictors. Influenza vaccination uptake was independently associated with seeking medical consultation (adjusted odds ratio [AOR]\u0026thinsp;=\u0026thinsp;1.96), belief in individual protection from vaccination (AOR\u0026thinsp;=\u0026thinsp;15.68), belief in community-level protection (AOR\u0026thinsp;=\u0026thinsp;3.21), and perceived public health importance of vaccination (AOR\u0026thinsp;=\u0026thinsp;2.51).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eMarked ethnic differences exist in influenza burden and clinical experience among UAE university students, and gaps persist between knowledge and preventive action. With clinician endorsement, addressing misconceptions, and improving access to on-campus vaccination, influenza prevention may be enhanced in this high-risk, socially mobile population, ultimately reducing community influenza transmission.\u003c/p\u003e","manuscriptTitle":"Influenza burden, preventive behaviours, and vaccination uptake among multi-ethnic university students in the United Arab Emirates: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-27 18:35:47","doi":"10.21203/rs.3.rs-8448387/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-03T11:57:35+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-02T17:19:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"110346834573685303726893912063486342226","date":"2026-01-28T00:03:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-27T20:18:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"69041415290177446548532114126683002324","date":"2026-01-27T18:56:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-25T22:15:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"10018475643529736334523656323510249970","date":"2026-01-25T07:09:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"32608809015472630266988877555639316256","date":"2026-01-23T15:55:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"47338766465239565846569037787851580909","date":"2026-01-23T14:18:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"170505700545114858570692413129525566939","date":"2026-01-23T13:12:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"182129953183844856195458998265384520342","date":"2026-01-22T12:32:48+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-22T11:50:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-22T10:58:46+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-06T07:11:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-06T06:39:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2026-01-06T06:26:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d3f6a4d4-cfa7-41a1-b8b7-c75916bd04f9","owner":[],"postedDate":"January 27th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-09T16:06:41+00:00","versionOfRecord":{"articleIdentity":"rs-8448387","link":"https://doi.org/10.1186/s12879-026-12944-0","journal":{"identity":"bmc-infectious-diseases","isVorOnly":false,"title":"BMC Infectious Diseases"},"publishedOn":"2026-03-05 15:57:47","publishedOnDateReadable":"March 5th, 2026"},"versionCreatedAt":"2026-01-27 18:35:47","video":"","vorDoi":"10.1186/s12879-026-12944-0","vorDoiUrl":"https://doi.org/10.1186/s12879-026-12944-0","workflowStages":[]},"version":"v1","identity":"rs-8448387","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8448387","identity":"rs-8448387","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}