{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T06:58:18Z","timestamp":1775804298826,"version":"3.50.1"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Volunteer firefighters are crucial for decentralized emergency response systems but operate outside standardized occupational health frameworks. Despite elevated exposure to biological hazards, systematic data on vaccination knowledge, immunization status, and preventive health engagement in this population are limited. To better understand the determinants of their preventive health engagement, and to inform strategies that strengthen operational readiness and public health resilience, this study examined vaccination behavior among German volunteer firefighters and identified determinants of immunization uptake.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Between April 2025 and August 2025, semi-structured interviews were conducted with 150 active volunteer firefighters. Data were analyzed using inductive qualitative content analysis, following Mayring's framework. Vaccination status, evaluation of vaccination, and willingness to undergo medical surveillance were assessed. K-means cluster analysis identified behavioral typologies, and Spearman's correlations examined the associations between risk perception, social integration, and vaccination behavior.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Approximately one-third of the participants could not confirm their current immunization status. The most common vaccinations recorded among the 150 firefighters were tetanus (\n                      <jats:italic>n<\/jats:italic>\n                      = 110) and hepatitis B (\n                      <jats:italic>n<\/jats:italic>\n                      = 100). Three distinct behavioral clusters emerged: health-engaged prevention-oriented individuals (predominantly healthcare workers), vaccine-supportive but surveillance-resistant firefighters (craftsmen\/trading backgrounds), and vaccine-ambivalent personnel open to alternative prevention (logistics\/technical fields). Hazard perception was weakly correlated with vaccination status (\u03c1 = +0.300,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.035). Social proximity correlated positively with vaccination willingness (\u03c1 = +0.33,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.037) and negatively with hazard perception (\u03c1 = \u22120.43,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.024). Vaccination rates varied by occupation, ranging from 100% in IT\/technical professionals, to 66.7% in healthcare workers, and 50 % craftsmen\/trading workers.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Substantial vaccination knowledge gaps, incomplete documentation, and heterogeneous behavioral patterns shaped by professional background and institutional trust characterized the population surveyed. Effective interventions require differentiated strategies that address structural barriers, transparent communication, integration with valued occupational health surveillance, and recognition of distinct motivational profiles across volunteer firefighter subgroups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1803949","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T06:02:53Z","timestamp":1775800973000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Vaccination gaps in decentralized emergency response: understanding immunization barriers among volunteer firefighters. A cross-sectional mixed methods study"],"prefix":"10.3389","volume":"14","author":[{"given":"Andrea","family":"Baron","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein","place":["Luebeck, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Over-M\u00fcller","sequence":"additional","affiliation":[{"name":"Medical Clinic III, University of Luebeck","place":["Luebeck, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Swantje","family":"Brandt","sequence":"additional","affiliation":[{"name":"Medical Clinic III, University of Luebeck","place":["Luebeck, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ole","family":"Franzen","sequence":"additional","affiliation":[{"name":"Ministry of the Interior, Municipal Affairs, Housing and Sports","place":["Kiel, Germany"]},{"name":"Stormarn Technical Operations Management, Stormarn District Fire Brigade Association","place":["Travenbr\u00fcck, Germany"]},{"name":"Reinfeld Volunteer Fire Brigade","place":["Reinfeld, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ingo","family":"Me\u00dfer","sequence":"additional","affiliation":[{"name":"Reinfeld Volunteer Fire Brigade","place":["Reinfeld, Germany"]},{"name":"Asklepios Klinik am Kurpark","place":["Bad Schwartau, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai","family":"Mortensen","sequence":"additional","affiliation":[{"name":"Cardiology Kiel","place":["Kiel, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peer","family":"Franzen","sequence":"additional","affiliation":[{"name":"Reinfeld Volunteer Fire Brigade","place":["Reinfeld, Germany"]},{"name":"Hamburg Fire Brigade, Ministry of the Interior and Sport of the Free and Hanseatic City of Hamburg","place":["Hamburg, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"M\u00fcnstedt","sequence":"additional","affiliation":[{"name":"Anaesthesiology and Intensive Care Medicine, DRK Hospital Ratzeburg","place":["Ratzeburg, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernhard","family":"Elsner","sequence":"additional","affiliation":[{"name":"Institute f\u00fcr Gesundheitswissenschaften, University of Luebeck","place":["Luebeck, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maik","family":"von der Forst","sequence":"additional","affiliation":[{"name":"Crisis and Disaster Management Unit, Medical Faculty Heidelberg, Heidelberg University","place":["Heidelberg, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus","family":"Ries","sequence":"additional","affiliation":[{"name":"Crisis and Disaster Management Unit, Medical Faculty Heidelberg, Heidelberg University","place":["Heidelberg, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Dr\u00f6mann","sequence":"additional","affiliation":[{"name":"Medical Clinic III, University of Luebeck","place":["Luebeck, Germany"]},{"name":"Airway Research Center North, Member of the German Center for Lung Research (DZL)","place":["Gro\u00dfhansdorf, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Ristau","sequence":"additional","affiliation":[{"name":"Faculty of Applied Health Sciences, Deggendorf Institute of Technology","place":["Deggendorf, Germany"]},{"name":"Institute for Social Medicine and Epidemiology, University of L\u00fcbeck","place":["Luebeck, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Klaas F.","family":"Franzen","sequence":"additional","affiliation":[{"name":"Medical Clinic III, University of Luebeck","place":["Luebeck, Germany"]},{"name":"Reinfeld Volunteer Fire Brigade","place":["Reinfeld, Germany"]},{"name":"Airway Research Center North, Member of the German Center for Lung Research (DZL)","place":["Gro\u00dfhansdorf, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1167","DOI":"10.15585\/mmwr.mm7034e4","article-title":"Effectiveness of COVID-19 vaccines in preventing SARS-CoV-2 infection among frontline workers before and during B","volume":"70","author":"Fowlkes","year":"","journal-title":"MMWR Morb Mortal Wkly Rep."},{"key":"B2","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1111\/jfr3.12313","article-title":"Trust and the communication of flood risks: comparing the roles of local governments, volunteers in emergency services, and neighbours","volume":"11","author":"Seebauer","year":"2018","journal-title":"J Flood Risk 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