Peer-reviewed article

Knowledge, attitudes and practices towards routine vaccination among COVID-19-positive individuals in Lebanon in the post-pandemic period: a case-control study.

Baakliny M, Ghosn N, Saleh N, Maison P · 30 Jun 2026

Abstract

Objectives To evaluate knowledge, attitudes and practices towards routine vaccination in the Lebanese population in the post-COVID-19 period, and to examine differences between COVID-19 vaccinated and non-vaccinated individuals. The study also aimed to identify sociodemographic and behavioural factors associated with vaccination status, and to explore changes in vaccination practices before and after the pandemic. Design Unmatched case-control study. Setting Community-based survey conducted across all regions of Lebanon between July and October 2023. Participants A total of 730 adults were included, comprising 277 COVID-19-positive individuals who were not vaccinated against COVID-19 (cases) and 453 COVID-19-positive individuals who had received at least one dose of a COVID-19 vaccine (controls). Participants were randomly selected from the national COVID-19 surveillance database. Adults aged ≥18 years were eligible; individuals who tested negative for COVID-19 or were unable to provide consent were excluded. Primary and secondary outcome measures Primary outcomes were vaccination knowledge and attitudes, measured using the Zingg knowledge scale and the 7C vaccination attitude scale. Secondary outcomes included self-reported adherence to routine and influenza vaccination before and after COVID-19. Factors associated with non-vaccination were examined using multivariable regression models. Results Vaccinated participants were older and more likely to be employed, have higher education, work in healthcare and report financial coverage for vaccines. They had higher knowledge scores, more positive attitudes towards vaccination and increased adherence to routine and influenza vaccination after COVID-19, while adherence declined among non-vaccinated participants. In multivariable analysis, older age (OR 0.98, 95% CI 0.96 to 0.99), higher education (OR 0.68, 95% CI 0.60 to 0.78), number of children (OR 0.88, 95% CI 0.78 to 1.00) and more positive vaccination attitudes (OR 0.97, 95% CI 0.94 to 1.00) were independently associated with lower odds of non-vaccination. Conclusions Older age, higher education, greater number of children and more positive attitudes were associated with lower odds of non-vaccination. Vaccinated participants also had higher knowledge scores, more positive attitudes and better adherence to routine and influenza vaccination practices than non-vaccinated participants.