University students, who face an elevated risk of influenza due to close living quarters and frequent social interactions, often exhibit low vaccine uptake rates. This issue is particularly pronounced among Chinese students, who encounter unique barriers related to awareness and access, emphasizing the need for heightened attention to this problem within this demographic. This cross-sectional study conducted in May-June 2022 involved 1,006 participants (404 in the UK, 602 in Mainland China) and aimed to explore and compare the factors influencing influenza vaccine acceptance and intentions between Chinese university students residing in the UK (C-UK) and Mainland China (C-M). The study employed a self-administered questionnaire based on the Theoretical Domains Framework and Capability Opportunity Motivation-Behavior model. Results revealed that approximately 46.8% of C-UK students received the influenza vaccine in the past year, compared to 32.9% of C-M students. More than half in both groups (C-UK: 54.5%, C-M: 58.1%) had no plans for vaccination in the upcoming year. Knowledge, belief about consequences, and reinforcement significantly influenced previous vaccine acceptance and intention in both student groups. Barriers to vaccination behavior included insufficient knowledge about the influenza vaccine and its accessibility and the distance to the vaccine center. Enablers included the vaccination behavior of individuals within their social circles, motivation to protect others, and concerns regarding difficulties in accessing medical resources during the COVID-19 pandemic. The findings of this study offer valuable insights for evidence-based intervention design, providing evidence for healthcare professionals, policymakers, and educators working to enhance vaccination rates within this specific demographic.

This dataset contains information from a population-based survey, which investigated human exposure to live poultry, and population psychological response and behavioral changes of the community members during two waves of influenza A(H7N9) epidemics in Southern China in 2013-2014. The dataset including 3 files. * One file named "population_wt.csv" contained population information of the studied sites; * One file named "H7N9 survey China_Que stionarie_eng.doc" was the survey questionaire; * The third file named "dataset_H7N9.csv" contained datasets acquired during the two waves of A(H7N9) epidemics,a data frame with 1657 observations on the following 44 variables. Survey ##a numeric vector: where the subject live## 1= the first wave () 2= the second wave () Place ##a numeric vector: where the subject live## 5=Guangzhou 10=Zijin County, Heyuan City SG3 ##a numeric vector: the gender of the subject## 1=Female 2=Male SG4_b ##a numeric vector: the age group of the subject, unit=years## 1=18-24 2=25-34 3=35-44 4=45-54 5=55-64 6=65+ SG6 ##a numeric vector: the marital status of the subject## 1=Single 2=Married 3=Divorced /separated 4=Widowed 5=Refuse to answer SG8 ##a numeric vector: the educational attainment of the subject## 1=Illiteracy 2=Primary school 3=Middle school 4=High school 5=College and above SG12 ##a numeric vector: the average income of the subject, unit=Chinese Yuan## 1=Less than l,000 2=1,001—2,000 3=2,001—3,000 4=3,001—4,000 5=4,001—6,000 6=6,001—8,000 7=8,001—10,000 8=10,001—2,000 9=15,001—20,000 10=20,001—30,000 11=More than 30,001 12=No income 13=Don’t know 14=Refuse to answer AX1_a ##a numeric vector: the anxiety level of the subject, I feel rested ## 1=Not at all 2=Sometimes 3=Moderately So 4=Very Much So AX1_b ##a numeric vector: the anxiety level of the subject, I feel content ## 1=Not at all 2=Sometimes 3=Moderately So 4=Very Much So AX1_c ##a numeric vector: the anxiety level of the subject, I feel comfortable ## 1=Not at all 2=Sometimes 3=Moderately So 4=Very Much So AX1_d ##a numeric vector: the anxiety level of the subject, I am relaxed ## 1=Not at all 2=Sometimes 3=Moderately So 4=Very Much So AX1_e ##a numeric vector: the anxiety level of the subject, I feel pleasant ## 1=Not at all 2=Sometimes 3=Moderately So 4=Very Much So AX1_f ##a numeric vector: the anxiety level of the subject, I feel anxious ## 1=Not at all 2=Sometimes 3=Moderately So 4=Very Much So AX1_g ##a numeric vector: the anxiety level of the subject, I feel nervous ## 1=Not at all 2=Sometimes 3=Moderately So 4=Very Much So AX1_h ##a numeric vector: the anxiety level of the subject, I am jittery ## 1=Not at all 2=Sometimes 3=Moderately So 4=Very Much So AX1_i ##a numeric vector: the anxiety level of the subject, I feel “high strung” ## 1=Not at all 2=Sometimes 3=Moderately So 4=Very Much So AX1_j ##a numeric vector: the anxiety level of the subject, I feel over-excited and “rattled” ## 1=Not at all 2=Sometimes 3=Moderately So 4=Very Much So BF4b##a numeric vector indicating the subject's rate of worriness towards H7N9 avian flu, 1 being very mild to 10 being very severe## EM1 ##a numeric vector: How often did you go to wet markets in the past year ## 1=1-2/year 2=3-5/year 3=6-11/year 4=1-3/month 5=1-2/week 6=3-5/week 7=Almost every day 8=Almost not EM2 ##a numeric vector: How often did you buy poultry in wet markets in the past year ## 1=1-2/year 2=3-5/year 3=6-11/year 4=1-3/month 5=1-2/week 6=3-5/week 7=Almost every day 8=Almost not EM3 ##a numeric vector: Did you usually pick up the poultry for examination before deciding to buy it ## 1=Yes 2=No 3=Sometime “yes”, sometime “no” EM4 ##a numeric vector: Where was the live poultry slaughtered when you bought it? ## 1=Always in wet market 2=Usually in wet market 3=Usually in my household 4=Always in my household 5=Other places EM5 ##a numeric vector: Have your habit of buying live poultry changed since the first human H7N9 case was released in the past month ## 1=Yes, not buying since then 2=No, still buying and eating live poultry 3=Still buying but less than before EM6 ##a numeric vector: Would you support permanent closure of live poultry markets in order to control avian influenza epidemics ## 1=Strongly agree 2=Agree 3=Not agree 4=Strongly disagree 5=Don’t know EM8 ##a numeric vector: Have your raised live poultry in your backyard in the past year ## 1=Yes 2=No BF1 ##a numeric vector indicating risk perception of the subject: How likely do you think it is that you will contract H7N9 avian flu over the next 1 month ## 1=Never 2=Very unlikely 3=Unlikely 4=Evens 5=Likely 6=Very likely 7=Certain BF2a ##a numeric vector indicating risk perception of the subject: What do you think are your chances of getting H7N9 avian flu over the next 1 month compared to other people outside your family of a similar age ## 1=Not at all 2=Much less 3=Less 4=Evens 5=More 6=Much more 7=Certain BF3_l ##a numeric vector indicating knowledge of the subject: H7N9 avian flu is spread by the body contact with patients ## 1=Yes 2=No 3=Don’t Know BF3_m ##a numeric vector indicating knowledge of the subject: H7N9 avian flu is spread by touching objects that have been contaminated by the virus ## 1=Yes 2=No 3=Don’t Know BF3_n ##a numeric vector indicating knowledge of the subject: H7N9 avian flu is spread by the close contact with chickens in a wet market ## 1=Yes 2=No 3=Don’t Know BF4 ##a numeric vector: If you were to develop flu-like symptoms tomorrow, would you be... ## 1=Not at all worried 2=Much less worried than normal 3=Worried less than normal 4=About same 5=Worried more than normal 6=Worried much more than normal 7=Extremely worried BF4a ##a numeric vector indicating risk perception of the subject: In the past one week, have you ever worried about catching H7N9 avian flu ## 1=No, never think about it 2=Think about it but it doesn’t worry me 3=Worries me a bit 4=Worries me a lot 5=Worry about it all the time BF5a ##a numeric vector indicating risk perception of the subject: How does H7N9 avian flu compare with seasonal flu in terms of seriousness ## 1=Much higher 2=A little higher 3=Same 4=A little lower 5=Much lower 6=Don’t Know BF5b ##a numeric vector indicating risk perception of the subject: How does H7N9 avian flu compare with H5N1 avian flu in terms of seriousness ## 1=Much higher 2=A little higher 3=Same 4=A little lower 5=Much lower 6=Don’t Know BF5c ##a numeric vector indicating risk perception of the subject: How does H7N9 avian flu compare with SARS in terms of seriousness ## 1=Much higher 2=A little higher 3=Same 4=A little lower 5=Much lower 6=Don’t Know BF7 ##a numeric vector evaluating the current performance of the national government in controlling H7N9 avian flu, (0=extremely poor, 5=moderate, 10=excellent) ## BF7a ##a numeric vector evaluating the current performance of the provincial/city government in controlling H7N9 avian flu, (0=extremely poor, 5=moderate, 10=excellent) ## PM2 ##a numeric vector indicating the preventive behavior of the subject, covering the mouth when sneeze or cough ## 1=Always 2=Usually 3=Sometimes 4=Never 5=Don’t know 6=Not applicable (no sneeze or cough) PM3 ##a numeric vector indicating the preventive behavior of the subject, washing hands after sneezing, coughing or touching nose ## 1=Always 2=Usually 3=Sometimes 4=Never 5=Don’t know 6=Not applicable (no sneeze or cough) PM3a ##a numeric vector indicating the preventive behavior of the subject,washing hands after returning home ## 1=Always 2=Usually 3=Sometimes 4=Never 5=Don’t know 6=Not applicable (never go out) PM4 ##a numeric vector indicating the preventive behavior of the subject,using liquid soap when washing hands ## 1=Always 2=Usually 3=Sometimes 4=Never 5=Don’t know PM5 ##a numeric vector indicating the preventive behavior of the subject,wearing face mask ## 1=Always 2=Usually 3=Sometimes 4=Never 5=Don’t know PM7 ##a numeric vector:If free H7N9 flu vaccine is available in the coming month, would you consider receiving it ## 1=Yes 2=No 3=Not sure 4=Don’t know

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Since 2013 the occurrence of human infections by a novel avian H7N9 influenza virus in China has demonstrated the continuing threat posed by zoonotic pathogens. Although the first outbreak wave that was centred on eastern China was seemingly averted, human infections recurred in October 2013. It is unclear how the H7N9 virus re-emerged and how it will develop further; potentially it may become a long-term threat to public health. Here we show that H7N9 viruses have spread from eastern to southern China and become persistent in chickens, which has led to the establishment of multiple regionally distinct lineages with different reassortant genotypes. Repeated introductions of viruses from Zhejiang to other provinces and the presence of H7N9 viruses at live poultry markets have fuelled the recurrence of human infections. This rapid expansion of the geographical distribution and genetic diversity of the H7N9 viruses poses a direct challenge to current disease control systems. Our results also suggest that H7N9 viruses have become enzootic in China and may spread beyond the region, following the pattern previously observed with H5N1 and H9N2 influenza viruses.