Coverage and Vaccine Hesitancy of Influenza Vaccination Among Reproductive-Age Women (18–49 Years Old) in China: A National Cross-Sectional Study

<b>Background</b>: Influenza is a significant global respiratory infection, and vaccinating reproductive-age women, particularly in densely populated countries like China, cannot be overlooked. In this study, we aimed to determine influenza vaccination coverage, vaccine hesitancy, as well as associated factors among Chinese women aged 18-49 years old. <b>Methods</b>: A cross-sectional survey among women aged 18-49 years was conducted in China from 15 to 30 March 2023. We collected information such as past-year influenza vaccination, demographic characteristics, health-related factors, COVID-19-related factors, and perceived susceptibility and severity of influenza. Influenza vaccine acceptance among participants who did not receive influenza vaccination in the past year was also investigated. Multivariable logistic regression analyses were employed to investigate the influencing factors of vaccine coverage and vaccine hesitancy. <b>Results</b>: A total of 1742 reproductive-aged women were included in the final analysis. The past-year influenza vaccine coverage among women aged 18-49 years old was only 39.32% in China. Age ≥ 35 years (aOR = 0.72, 95% CI: 0.56-0.94), renting accommodation (aOR = 0.57, 95% CI: 0.44-0.75), and history of COVID-19 infection (aOR = 0.65, 95% CI: 0.47-0.89) and COVID-19 vaccine hesitancy (aOR = 0.39, 95% CI: 0.29-0.54) were all identified as negative correlates of influenza vaccine coverage among Chinese reproductive-aged women, while participants with a history of chronic diseases (aOR = 1.57, 95% CI: 1.23-2.01) and noticeable pandemic fatigue due to COVID-19 (aOR = 1.45, 95% CI: 1.05-2.00) were prone to have higher vaccination rates. Among reproductive-aged women who did not receive influenza vaccination in the past year, the hesitancy rate regarding future influenza vaccination was 31.79%. Factors such as older age, urban residence, living with others, poor self-rated health status, absence of chronic diseases, completion of full COVID-19 vaccination, COVID-19 vaccine hesitancy, pandemic fatigue, and failure to perceive the susceptibility and severity of influenza might increase influenza vaccine hesitancy. <b>Discussion</b>: Overall, a lower coverage rate of influenza vaccine was notably observed among Chinese reproductive-age women, as well as the hesitancy regarding future vaccination. To effectively mitigate the impact of influenza and reduce the incidence of associated diseases, it is imperative to devise targeted intervention strategies and policies tailored to reproductive-age women.