Italian healthcare professionals' real-world experience with immunization in children of non-European origin: the Vax4globe survey.

INTRODUCTION

Nowadays vaccine hesitancy represents a significant current global health threat, causing reduced vaccine coverage with relevant effects on vulnerable populations. This study explores Italian healthcare professionals' (HCPs) experience with immunization of non-European (non-EU) origin children to implement targeted strategies for higher vaccine coverage and a "vulnerables-friendly care".

METHODS

The Vax4globe survey was administered to HCPs distributed throughout the Lazio Region from February to July 2024. The survey included HCPs' demographic data and twelve items investigating vaccine compliance and barriers of non-EU origin children in their clinical practice as well as potential strategies to increase immunization.

RESULTS

The survey included 101 HCPs, namely physicians and pediatricians working at vaccination centers and primary care services, caring for approximately 50,000-60,000 children overall, of which approximately 15,000 were of non-EU origin. As stated by HCPs, children's country of origin were mainly from countries in Asia (median 30%; range 0%-80%) and South America (median 20%; range 0%-30%). Of the HCPs, 88% (95% CI: 80.4-93.1) reported that ≤50% of non-EU origin parents were able to provide evidence of their children's immunizations and, according to 80% (95% CI: 71.4-86.8) of HCPs, the Italian National Vaccination Prevention Plan (PNPV) was appropriate in ≤50% of children at first assessment. Therefore, according to HCPs, the vaccination record of the country of origin is essential to verify the immunization status (57%), PNPV vaccines should be recommended according to patient's age and documented immunization status (62%), and priority should be given to mandatory vaccines in children under 7 years of age not compliant with the PNPV (96%). In our survey, adherence to PNPV vaccines was significantly higher than to Sars-CoV-2 vaccine in pediatric age patients (immunization adherence <10%: 3% PNPV vs. 48% Sars-CoV-2; immunization adherence >90%: 42.5% PNPV vs. 0% Sars-CoV-2) (p < 0.0001). Similarly, the adherence to Sars-CoV-2 vaccine was lower in children than in their parents (immunization adherence <10%: 48% vs. 17%, respectively) (p < 0.0001). Finally, according to HCPs, the main barriers to vaccine adherence were linguistic and socio-cultural (75%;95% CI: 66.0-82.6) for PNPV vaccines and safety concerns (52%; 95% CI: 42.8-61.9) for the Sars-CoV-2 vaccine.

DISCUSSION: Our study reports a real-world picture of immunization among non-EU origin children by Italian HCPs and highlights the need for targeted strategies to overcome factors affecting vaccine hesitancy. To date, vaccine health equity is far from being achieved.