Background & Hypothesis: Annually, seasonal influenza causes a significant disease burden worldwide. Despite recommendations and guidelines by health authorities, the uptake of influenza vaccination among healthcare workers (HCWs) remains low.

Methods: Relevant original and review articles published from 1 January 2003 to 31 March 2015 were identified using the search terms: "knowledge", "attitude", "practices", "belief", "influenza", "vaccination", "flu", "flu vaccine", "healthcare worker", "hospital healthcare worker", "Singapore", in PubMed Central, PubMed, Google Scholar and Cochrane Library databases.

Results: We identified 78 studies, 18 of which were included in our review. Influenza vaccination rate ranged from 4% to 93%. Barriers that were consistently reported by HCWs were wide ranging but usually stemmed from misconceptions of influenza infection and influenza vaccine such as fear of vaccine adverse reactions (4-64%), doubts about vaccine efficacy (10-60%) and lack of perception of infection risk (16-58%). On the other hand, self-protection (38-95%) was found to be the most common motivator for those who got vaccinated. As for predictive factors, we included 10 studies, and identified that previous receipt of influenza vaccination was the most described positive factor with the strength of association ranging from 4.6 (95% CI 1.8-12.8) to 36.0 (95% CI 21.4-60.8).

Discussion & Conclusion: Hospitalised patients are at risk of complications from influenza infection. It is crucial to improve influenza vaccination acceptance and uptake among HCWs to prevent nosocomial transmission. Education on influenza infection and vaccine to address HCWs' misconceptions, and the provision of influenza vaccination services at HCWs' work areas ("doorstep") could increase HCWs' uptake of influenza vaccination.

Annals of the Academy of Medicine Singapore, S2