Abstract
Background: Vaccination rates for adults in Eastern Europe are still not satisfactory, especially for flu, COVID-19, and pneumococcal disease. There isn't much information available about how many Bulgarian adults get vaccinated and what factors affect their decision to do so. This study sought to evaluate vaccination coverage, attitudes, and barriers concerning influenza, COVID-19, and pneumococcal vaccines among hospitalised Bulgarians.
Methods: A cross-sectional study was conducted from June to September 2023, with 222 individuals hospitalised in Plovdiv, Bulgaria. A structured questionnaire assessed sociodemographic factors, comorbidities, immunisation practices, and perceptions regarding adult immunisations. We employed SPSS v25 for descriptive statistics and comparative analyses, including the Mann–Whitney U test and the Z-test. A p-value below 0.05 was considered statistically significant.
Results: The average age of participants was 58 years, with 63.5% identifying as female and 55.9% disclosing at least one comorbid health condition. 52.2% of individuals received at least one of the three immunisations; however, the number of individuals who received each specific vaccine was minimal. Twenty-three point three per cent of participants with comorbidities and eighteen point four per cent of those without comorbidities indicated they had the influenza vaccine in the prior season (p=0.363). Approximately 5% of individuals were immunised against pneumococcal illness, and fewer than 20% were aware of it. The apprehension of adverse effects was a significant concern, particularly for individuals with pre-existing health issues. The absence of a physician's recommendation significantly contributed to the low uptake of the pneumococcal vaccine (45.2% vs. 28.6%, p=0.011). Approximately one in four respondents expressed belief in COVID-19 conspiracy theories. Respondents indicated that they were more likely to trust public institutions and general practitioners for information.
In conclusion, Bulgaria's adult vaccination rates are insufficient, particularly for pneumococcal disease. Concerns regarding safety and the lack of recommendations from medical professionals are two significant issues. To increase adult vaccination rates in the present situation, it is essential to improve collaboration among healthcare providers and the dissemination of public health messaging.