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SARS-CoV-2, Influenza and Other Respiratory Viruses: Preventive Measures Affecting the...
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SARS-CoV-2, Influenza and Other Respiratory Viruses: Preventive Measures Affecting the Determinants of Health and Disease

A special issue of Vaccines (ISSN 2076-393X). This special issue belongs to the section "Epidemiology and Vaccination".

Deadline for manuscript submissions: 31 August 2026 | Viewed by 14845

Special Issue Editors

Dr. Marco Del Riccio

E-Mail Website
Guest Editor
Department of Health Sciences, University of Florence, 50134 Florence, Italy
Interests: SARS-CoV-2; human influenza; respiratory syncytial virus; respiratory infections; epidemiology; public health; vaccines; vaccination strategies
Special Issues, Collections and Topics in MDPI journals
Dr. Saverio Caini

E-Mail Website
Guest Editor
Netherlands Institute for Health Services Research (Nivel), 3513 Utrecht, The Netherlands
Interests: epidemiology; SARS-CoV-2; human influenza; respiratory syncytial virus; respiratory infections; public health
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Respiratory viruses are a common cause of illness in humans. They have a significant impact on global morbidity and mortality rates. This Special Issue focuses on "SARS-CoV-2, Influenza and Other Respiratory Viruses: Preventive Measures Affecting the Determinants of Health and Disease". The goal is to understand recent scientific advancements in this field.

We welcome new research, review papers, and viewpoints.

Dr. Marco Del Riccio
Dr. Saverio Caini
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Vaccines is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • respiratory
  • viruses
  • SARS-CoV-2
  • human influenza
  • respiratory syncytial virus
  • vaccines
  • vaccination strategies
  • disease burden

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Related Special Issue

Published Papers (7 papers)

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Research

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17 pages, 281 KB  
Article
Vaccine Hesitancy and Refusal Among Parents of Children Aged 5–11 Years: Evidence from the COVID-19 Pandemic in the Calabria Region
by Francesca Licata, Concetta Arianna Scicchitano, Emma Antonia Citrino and Aida Bianco
Vaccines 2026, 14(1), 17; https://doi.org/10.3390/vaccines14010017 - 23 Dec 2025
Cited by 1 | Viewed by 927
Abstract
Background/Objectives: This study aims to evaluate COVID-19 parental vaccine hesitancy (CPVH) and refusal among parents of children between 5 and 11 years and to identify potential factors influencing them. A secondary aim was to assess knowledge, concerns, and beliefs associated with COVID-19 and [...] Read more.
Background/Objectives: This study aims to evaluate COVID-19 parental vaccine hesitancy (CPVH) and refusal among parents of children between 5 and 11 years and to identify potential factors influencing them. A secondary aim was to assess knowledge, concerns, and beliefs associated with COVID-19 and immunization. Methods: This cross-sectional study was conducted among parents of children between 5 and 11 years using an anonymous, self-administered questionnaire. Sociodemographic characteristics, knowledge, concerns, and beliefs regarding COVID-19 and immunization in children; CPVH according to Parent Attitudes about Childhood Vaccines short scale; COVID-19 vaccination status and intention; and sources of information about COVID-19 vaccination were investigated. Results: Among 506 participating parents, only 12.7% correctly answered all six knowledge items. High CPVH was found in 60.1% of respondents and was more prevalent among younger parents and those with lower knowledge levels. Compared to having received no information on COVID-19 vaccination, high CPVH was positively associated with having received information from informal sources and trusting them and negatively associated with information from formal ones. More than half (58.3%) had vaccinated their child, and 38.5% had no intention to vaccinate their child against COVID-19. High CPVH, lower knowledge levels, and a need for further information were significant predictors of vaccine refusal. Conversely, refusal was negatively associated with parental COVID-19 vaccination status, and with having received information from formal and from both formal and informal sources compared to not having received information. Conclusions: The findings highlight the need for establishing and investing in platforms to promote vaccine awareness and dispelling misinformation among parents. Full article
(This article belongs to the Special Issue SARS-CoV-2, Influenza and Other Respiratory Viruses: Preventive Measures Affecting the Determinants of Health and Disease)
11 pages, 225 KB  
Article
Evaluating the Influenza Vaccination Knowledge Among People Living in a Rural and Medically Underserved Community of Washington State
by Damianne Brand, Kimberly McKeirnan, Megan Giruzzi and Juliet Dang
Vaccines 2025, 13(12), 1233; https://doi.org/10.3390/vaccines13121233 - 9 Dec 2025
Viewed by 696
Abstract
Background/Objectives: Health literacy and vaccine literacy influence vaccine uptake behavior. Ensuring that people in rural communities are knowledgeable about vaccines can be an important tool in increasing influenza vaccination rates. The goal of this research was to evaluate rural community member knowledge [...] Read more.
Background/Objectives: Health literacy and vaccine literacy influence vaccine uptake behavior. Ensuring that people in rural communities are knowledgeable about vaccines can be an important tool in increasing influenza vaccination rates. The goal of this research was to evaluate rural community member knowledge of influenza and influenza vaccine. Methods: A cross-sectional survey was conducted with residents of a rural a medically underserved community in Washington State. Three thousand rural residents were contacted up to five times by a survey research center with a request to participate, with the goal of receiving 500 returned surveys based on the current population size, a z-score of 95, and an error rate of 5%. The survey evaluated rural resident knowledge and opinions about influenza and influenza vaccine. Results: Participants who were vaccinated against influenza in the last five years were more likely to know that influenza vaccine does not cause influenza (χ2 = 13.44, p < 0.01) and that antibiotics cannot be used to treat influenza (χ2 = 19.36, p < 0.01) than people who were not vaccinated. There was no statistical difference between people who are vaccinated and unvaccinated regarding knowing that influenza is viral rather than bacterial with the majority in both groups responding correctly (χ2 = 0.05, p < 0.82), or that people who have influenza are at higher risk for contracting pneumonia (χ2 = 0.78, p = 0.08) or COVID-19 (χ2 = 1.54, p = 0.21). Unvaccinated people were more likely to have had their opinion about vaccines changed in recent years (p < 0.01) and feel that COVID-19 impacted their ability to trust public health officials (p < 0.01). Conclusions: Understanding gaps that exist in rural resident knowledge about influenza could be valuable in developing future educational outreach efforts in these communities. Full article
(This article belongs to the Special Issue SARS-CoV-2, Influenza and Other Respiratory Viruses: Preventive Measures Affecting the Determinants of Health and Disease)
19 pages, 1166 KB  
Article
Factors Associated with Influenza Vaccination Among Urban Community-Dwelling Chinese Elderly: Results from a Multicity Cross-Sectional Study
by Jiayue Guo, Xitong Jiao, Shuai Yuan and Lili You
Vaccines 2025, 13(11), 1171; https://doi.org/10.3390/vaccines13111171 - 18 Nov 2025
Viewed by 1633
Abstract
Background: Influenza vaccination reduces morbidity and mortality in older adults. This study identifies characteristics and reasons for vaccination uptake among the elderly to inform strategies to improve coverage. Methods: We conducted a cross-sectional survey in December 2024 among community-dwelling adults aged ≥ 60 [...] Read more.
Background: Influenza vaccination reduces morbidity and mortality in older adults. This study identifies characteristics and reasons for vaccination uptake among the elderly to inform strategies to improve coverage. Methods: We conducted a cross-sectional survey in December 2024 among community-dwelling adults aged ≥ 60 years across six Chinese cities. Data collected included socio-demographic and health characteristics, influenza vaccine awareness and uptake, reasons for vaccination or non-vaccination, and intentions for future vaccination. Univariate and multivariable logistic regression were used to identify factors associated with vaccination. To explore motivation patterns, co-occurrence networks of vaccination reasons were constructed, and k-medoids clustering was applied. Results: Among 13,363 adults aged ≥ 60 years, influenza vaccination coverage was 34.0%. Higher education and income, being married, having health insurance, poor self-care ability, and chronic obstructive pulmonary disease were independently associated with vaccination. Vaccinated individuals reported more positive attitudes and were mainly motivated by family and doctor recommendations as well as perceived vaccine effectiveness, with four motivation profiles discovered: social recommendation, comprehensive confidence, clinician-guided, and self-reliant confidence. Among unvaccinated participants, the main reasons for non-vaccination were mild influenza symptoms and the influence of family and friends, forming four motivation profiles: safety concern, low-perceived risk, social influence, and perceived ineffectiveness. Conclusions: Influenza vaccination among older Chinese adults remains suboptimal. Tailored interventions leveraging healthcare provider endorsement, family and social support, and policy-driven strategies such as free or subsidized vaccination are needed, particularly for high-risk populations. Full article
(This article belongs to the Special Issue SARS-CoV-2, Influenza and Other Respiratory Viruses: Preventive Measures Affecting the Determinants of Health and Disease)
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13 pages, 833 KB  
Article
Exploring Patient Trust in Healthcare Provider Influenza Vaccine Information and Recommendations in a Medically Underserved Area of Washington State
by Damianne Brand, Megan Giruzzi, Nick Giruzzi, Kavya Vaitla, Rose Krebill-Prather, Juliet Dang and Kimberly McKeirnan
Vaccines 2025, 13(5), 505; https://doi.org/10.3390/vaccines13050505 - 10 May 2025
Cited by 1 | Viewed by 1188
Abstract
Background/Objective: Patients have historically trusted healthcare providers to be a reliable source of health information. However, with the recent pandemic and subsequent recovery, understanding and developing patients’ trust has become even more important, especially regarding vaccine acceptance. The objective of this work [...] Read more.
Background/Objective: Patients have historically trusted healthcare providers to be a reliable source of health information. However, with the recent pandemic and subsequent recovery, understanding and developing patients’ trust has become even more important, especially regarding vaccine acceptance. The objective of this work is to explore the current level of trust that rural patients have in their healthcare providers concerning influenza vaccination and related recommendations and its impact on vaccine uptake in a rural county in Washington State. Methods: An anonymous survey was conducted by a survey research center using a random sampling of 3000 addresses for people living in Yakima County in Washington State. Yakima County has a high percentage of people who identify as Hispanic or Latino/a and is a medically underserved area. The survey was designed to evaluate factors influencing the decision to be vaccinated against influenza and the level of trust in information from healthcare providers. Results: Results showed that participants who had been vaccinated against influenza in the previous five years were more likely to trust the advice of their primary care provider (p < 0.001), specialty care provider (p < 0.001), pharmacist (p = 0.02), and nurse (p = 0.002). People who were not vaccinated against influenza in the last five years were statistically more likely to report that a recommendation from a healthcare provider would not make a difference in their decision (p < 0.001). People who were vaccinated were more likely to utilize healthcare providers as a source of information about the influenza vaccine (p < 0.001) and people who were unvaccinated were more likely to use their own personal research as a trusted information source (p = 0.04). Conclusions: Healthcare providers continue to be well regarded and trusted by their patients, especially in rurally located counties, though work still needs to be carried out around influenza vaccination importance messaging. This work identified that all healthcare providers need to work collaboratively to reinforce vaccination guideline recommendations and to both provide education and continue successful access-to-vaccination strategies to promote influenza prevention. Full article
(This article belongs to the Special Issue SARS-CoV-2, Influenza and Other Respiratory Viruses: Preventive Measures Affecting the Determinants of Health and Disease)
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10 pages, 531 KB  
Article
Influenza Vaccine Uptake and Associated Hospitalization Risk in Older Adults with or Without Dementia: Differences Between at Home-Living and Nursing Home Residents in Lombardy, Italy
by Lorenzo Blandi and Carlo Signorelli
Vaccines 2025, 13(5), 489; https://doi.org/10.3390/vaccines13050489 - 30 Apr 2025
Cited by 1 | Viewed by 2153
Abstract
Objective: Our population-based cohort study aims to compute the uptake of the influenza vaccine and the associated risk of hospitalization for respiratory diseases of infectious origin based on the residency setting and dementia status of people aged 65 or over. Methods: We conducted [...] Read more.
Objective: Our population-based cohort study aims to compute the uptake of the influenza vaccine and the associated risk of hospitalization for respiratory diseases of infectious origin based on the residency setting and dementia status of people aged 65 or over. Methods: We conducted a retrospective cohort study on the whole population of residents aged ≥65 in Lombardy, the most populated Italian region. Using region-wide administrative data, we computed the seasonal prevalence of vaccination for influenza from 1 October 2022 to 30 April 2023. To estimate the risk of hospitalization, we applied Fine-Gray sub-distribution hazard models, accounting for the competing risk of death and adjusting for confounders. Results: Our study analyzed 2,420,279 individuals aged 65+ in Lombardy. Overall, 51.4% received an influenza vaccination in 2022–2023. Among residents living at home, 50.8% were vaccinated, while nursing home residents had an uptake of 74.0%. People living with dementia reported a vaccination coverage of 62.6%, and vaccination rates were higher among those residing in nursing homes than those who lived at home. The adjusted sub-hazard ratios (SHRs) showed higher hospitalization risks of 1.88 for unvaccinated individuals with dementia and 1.74 for unvaccinated individuals without dementia living at home. In nursing homes, the SHR for respiratory hospitalization was 2.20 for individuals without dementia and 2.40 for dementia patients. Vaccination reduced risks across all groups, but disparities persisted. Conclusions: People living with dementia were more likely to be hospitalized for respiratory diseases. However, they reported an influenza vaccination coverage that was below expectations and similar to the general population, both in nursing homes and home-living settings. Public health institutions should extend and mention dementia as a higher-risk condition. Full article
(This article belongs to the Special Issue SARS-CoV-2, Influenza and Other Respiratory Viruses: Preventive Measures Affecting the Determinants of Health and Disease)
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Review

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15 pages, 271 KB  
Review
The Number Needed to Immunize (NNI) to Assess the Benefit of a Prophylaxis Intervention with Monoclonal Antibodies Against RSV
by Sara Boccalini, Veronica Gironi, Primo Buscemi, Paolo Bonanni, Barbara Muzii, Salvatore Parisi, Marta Borchiellini and Angela Bechini
Vaccines 2025, 13(8), 791; https://doi.org/10.3390/vaccines13080791 - 25 Jul 2025
Cited by 2 | Viewed by 2691
Abstract
Introduction: Respiratory Syncytial Virus (RSV) is the leading cause of lower respiratory tract infections in infants and children, as well as hospitalizations for respiratory infections in the pediatric population, representing a significant public health concern. Nirsevimab, a long-acting anti-RSV monoclonal antibody, has recently [...] Read more.
Introduction: Respiratory Syncytial Virus (RSV) is the leading cause of lower respiratory tract infections in infants and children, as well as hospitalizations for respiratory infections in the pediatric population, representing a significant public health concern. Nirsevimab, a long-acting anti-RSV monoclonal antibody, has recently been approved by the European Medicines Agency (EMA). The aim of this study is to assess the utility of certain parameters, such as the Number Needed to Immunize (NNI), in supporting decision-makers regarding the introduction of nirsevimab as a universal prophylactic measure. Methods: A literature review was conducted to identify the definition and application of the NNI in the context of infectious disease prevention. The following online databases were consulted: Scopus, MEDLINE, Google Scholar, Web of Science, and Cochrane Library. The search was restricted to English-language texts published between 1 January 2000 and 30 January 2025. Results: The NNI represents the number of individuals who need to be immunized to prevent clinical outcomes such as medical visits and hospitalizations caused by infectious diseases. Six studies were identified that utilized this parameter to outline the benefits of immunization and describe the advantages of using monoclonal antibodies for RSV disease. Finelli and colleagues report that to prevent one RSV-related hospitalization, 37–85 infants aged 0–5 months and 107–280 infants aged 6–11 months would need to be immunized with long-acting anti-RSV antibodies. A recent study by Mallah et al. on the efficacy of nirsevimab estimates that the NNI required to prevent one RSV-related hospitalization is 25 infants. Studies by Francisco and O’Leary report NNI values of 82 and 128 infants, respectively, to prevent one RSV-related hospitalization with nirsevimab. Mallah et al. describe NNI as a metric useful to quantify the immunization effort needed to prevent a single RSV hospitalization. A recent Italian study reports that 35 infants need to be immunized to prevent one hospitalization due to RSV-LRTI and 3 infants need to be immunized to prevent one primary care visit due to RSV-LRTI. The studies indicate that the NNI for anti-RSV monoclonal antibodies is lower than the corresponding Number Needed to Vaccinate (NNV) for vaccines already included in national immunization programs. The main limitations of using this parameter include the absence of a shared threshold for interpreting results and the lack of consideration for the indirect effects of immunization on the population. Conclusions: The NNI is an easily understandable tool that can be used to convey the value of an immunization intervention to a variety of stakeholders, thereby supporting public health decision-making processes when considered in association with the uptake of the preventative strategy. At the current status, the estimated NNI of monoclonal antibodies against RSV results favourable and confirms the use in the first year of life for the prevention of RSV disease. Full article
(This article belongs to the Special Issue SARS-CoV-2, Influenza and Other Respiratory Viruses: Preventive Measures Affecting the Determinants of Health and Disease)

Other

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15 pages, 288 KB  
Systematic Review
Interventions to Improve Vaccination Uptake Among Adults: A Systematic Review and Meta-Analysis
by Anelisa Jaca, Lindi Mathebula, Thobile Malinga, Kimona Rampersadh, Masibulele Zulu, Ameer Steven-Jorg Hohlfeld, Charles Shey Wiysonge, Julie C. Jacobson Vann and Duduzile Ndwandwe
Vaccines 2025, 13(8), 811; https://doi.org/10.3390/vaccines13080811 - 30 Jul 2025
Cited by 1 | Viewed by 4760
Abstract
Background: Immunization is a highly effective intervention for controlling over 20 life-threatening infectious diseases, significantly reducing both morbidity and mortality rates. One notable achievement in vaccination efforts was the global eradication of smallpox, which the World Health Assembly declared on 8 May 1980. [...] Read more.
Background: Immunization is a highly effective intervention for controlling over 20 life-threatening infectious diseases, significantly reducing both morbidity and mortality rates. One notable achievement in vaccination efforts was the global eradication of smallpox, which the World Health Assembly declared on 8 May 1980. Additionally, there has been a remarkable 99.9% reduction in wild poliovirus cases since 1988, decreasing from more than 350,000 cases that year to just 30 cases in 2022. Objectives: The objective of this review was to assess the effects of various interventions designed to increase vaccination uptake among adults. Search Methods: A thorough search was conducted in the CENTRAL, Embase Ovid, Medline Ovid, PubMed, Web of Science, and Global Index Medicus databases for primary studies. This search was conducted in August 2021 and updated in November 2024. Selection Criteria: Randomized trials were eligible for inclusion in this review, regardless of publication status or language. Data Analysis: Two authors independently screened the search outputs to select potentially eligible studies. Risk ratios (RR) with 95% confidence intervals (CI) were calculated for each randomized controlled trial (RCT). A meta-analysis was conducted using a random-effects model, and the quality of the evidence was assessed using the GRADE approach. Main Results: A total of 35 randomized controlled trials met the inclusion criteria and were included in this review, with the majority conducted in the United States. The interventions targeted adults aged 18 and older who were eligible for vaccination, involving a total of 403,709 participants. The overall pooled results for interventions aimed at increasing influenza vaccination showed a risk ratio of 1.41 (95% CI: 1.15, 1.73). Most studies focused on influenza vaccination (18 studies), while the remaining studies examined various other vaccines, including those for hepatitis A, COVID-19, hepatitis B, pneumococcal disease, tetanus, diphtheria, pertussis (Tdap), herpes zoster, and human papillomavirus (HPV). The results indicate that letter reminders were slightly effective in increasing influenza vaccination uptake compared to the control group (RR: 1.75, 95% CI: 0.97, 1.16; 6 studies; 161,495 participants; low-certainty evidence). Additionally, participants who received education interventions showed increased levels of influenza vaccination uptake compared to those in the control group (RR: 1.88, 95% CI: 0.61, 5.76; 3 studies; 1318 participants; low-certainty evidence). Furthermore, tracking and outreach interventions also led to an increase in influenza vaccination uptake (RR: 1.87, 95% CI: 0.78, 4.46; 2 studies; 33,752 participants; low-certainty evidence). Conclusions: Letter reminders and educational interventions targeted at recipients are effective in increasing vaccination uptake compared to control groups. Full article
(This article belongs to the Special Issue SARS-CoV-2, Influenza and Other Respiratory Viruses: Preventive Measures Affecting the Determinants of Health and Disease)
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