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Background Generally, seasonal influenza does not cause severe infection in healthy adults, but for the elderly, an infection can pose a serious health concern. Although several measures can help prevent influenza, vaccination is considered the most effective. This study aimed to assess influenza vaccine uptake among elderly with chronic diseases in Tunisia during the 2018–2019 influenza season, and to identify knowledge, attitudes and barriers associated with influenza vaccine uptake. Methods During influenza season of 2018–2019, we conducted a national cross-sectional study among elderly with chronic disease who were attending primary and secondary health care facilities in Tunisia. We collected data regarding practices, general knowledge and attitudes related to influenza and influenza vaccine, using a standardized questionnaire. A multivariate analysis by logistic regression was performed to assess the factors influencing willingness to receive influenza vaccine. Results Among the 1191 surveyed elderly, 19.4% (95%CI 14.1–21.9) were vaccinated during the 2018–2019 influenza season and 64.7% (61.9–67.3) expressed willingness to be vaccinated in the next season regardless of vaccination status in the 2018–2019 season. Previous vaccination in the 2018–2019 influenza season was the most significantly associated factor with willingness to receive influenza vaccine (adjusted OR = 16.5 [3.7–72.4]). Significant associations were also observed between knowledge of influenza severity for the elderly as well as for those with chronic diseases and willingness to be vaccinated ( p  &lt; 0.01). Likewise, participants who were convinced by flu vaccine effectiveness and those who were not concerned about vaccine side effects were more likely to be vaccinated ( p  &lt; 0.001). The main reason that may lead to vaccine acceptance was a doctor’s recommendation (41.1%), while the two main reasons that may lead to vaccine refusal were concerns about side effects (71.5%) and a belief that vaccine was ineffective in averting influenza illness (33.9%). Doctors were the most trusted source for information about influenza vaccine (91.5%). Conclusion Our study revealed low influenza vaccination coverage among Tunisian elderly with chronic diseases believed to be at higher risk for severe acute respiratory infections and death if infected with influenza. Treating physicians’ role in promoting influenza vaccination in this high-risk group seems to be crucial.

Influenza vaccination knowledge, attitudes, and practices among Tunisian elderly with chronic diseases