Coverage and appropriateness of influenza vaccination in adults ≥ 60 y: Provider contribution and adherence to Italian national recommendations.

The aim of the present study is to evaluate the 2023/24 and 2024/25 influenza vaccination campaigns in Liguria (Italy), specifically analyzing how the transition toward a proximity-based model impacted vaccine appropriateness across different age groups (60-64 y, ≥65 y) and providers. Data regarding seasonal influenza vaccine administrations were extracted from the official Local Health Units (LHUs) immunization registries, which aggregate immunization records from different providers [LHUs, General Practitioners (GPs), pediatricians and community pharmacies]. To evaluate prescriptive appropriklateness, administered vaccines were cross-referenced with national guidelines based on the patient's age. A 6% overall decrease in coverage rates between the two seasons was recorded while the provider landscape shifted significantly. Unfortunately, while enhancing proximity (General Practitioners and pharmacies), this evolution introduced wide variability in prescriptive appropriateness. Our analysis reveals a persistent mismatch between national recommendations and real-world clinical practice and only 65% (2023/24 season) and 73% (2024/25 season) among ≥65 y individuals received enhanced vaccines. Strengthening clinical governance and targeted professional training for pharmacists and GPs is essential to ensure that the convenience of proximity-based vaccination does not compromise clinical efficacy through the use of sub-optimal vaccine platforms for high-risk cohorts.