ABSTRACT NUMBER: ESOC2026A1725 KNOWLEDGE, PERCEPTIONS, AND ATTITUDES TOWARD INFLUENZA VACCINATION IN STROKE PATIENTS

Abstract Background and aims Influenza infection is associated with an increased risk of vascular events, including recurrent stroke. Annual influenza vaccination is recommended as part of secondary stroke prevention, yet uptake among stroke survivors remains low. Vaccine hesitancy related to insufficient knowledge, negative perceptions, and unfavorable attitudes may contribute to this gap. Methods We conducted a cross-sectional study including 117 consecutive patients with ischemic or hemorrhagic stroke. Influenza vaccination status was recorded. Knowledge, perceptions, and attitudes toward influenza and vaccination were assessed using structural interviews. Reported barriers to vaccination were categorized according to established vaccine hesitancy frameworks. Subgroup analyses explored associations with age, prior vaccination history, and estimated recurrence risk. Results Overall influenza vaccination acceptance was 15% (n=18). Vaccinated patients were older and more likely to report prior influenza vaccination. Patients with a history of regular vaccination showed higher perceived benefit and confidence in vaccine safety. In contrast, unvaccinated patients – particularly younger stroke survivors and those without prior vaccination – frequently underestimated their recurrence risk. The main barriers were fear of adverse effects (46%), low perceived benefit for stroke prevention (38%), lack of physician recommendation (34%), and misinformation regarding vaccine safety (29%). Stroke severity and functional disability were not associated with vaccine uptake. Conclusions Influenza vaccination uptake among stroke survivors is critically low, limiting an important secondary prevention strategy. Hesitancy is driven primarily by modifiable knowledge gaps, low risk perception, and insufficient physician engagement rather than clinical disability. Integrating structured vaccination counseling into stroke follow-up may improve acceptance and reduce recurrent vascular events. Conflict of interest Nothing to disclose