Vaccinations in children of non-European origin: The Vax4globe survey.

Background: An equitable immunization coverage to "leave no one behind" is one of the World Health Organization Sustainable Development Goals. However, disparities in vaccination coverage exist. The present study aims to investigate vaccine attitude of non-European parents living in Italy and those factors affecting vaccine uptake and equity.

Methods: A cross sectional survey, named Vax4globe, on knowledge and immunization compliance in childhood and pregnancy of non-European (non-EU) parents was carried out among general pediatrician and Vaccine Centers located in Lazio Region, between February and July 2023. Logistic regression models were used in univariate and multivariate analyses to examine the socio-demographic parameters mainly associated with the vaccination status.

Results: A total of 310 parent/child pair were included in the study. Most children were born in Italy (262/310; 86.5 %), while while 40/310 (13.2 %) migrated from country of origin and 1/310 (0.3 %) was adopted. Mandatory vaccines were perfomed by 270/306 (88 %) children, however flu, papillomavirus and meningococcal group B were vaccines most commonly refused by 208/289 (72 %), 11/36 (31 %) and 9/36 (25 %) parents, respectively. A lower educational degree of parents (p = 0.040) and the migration status of children (p < 0.001) were associated to incomplete or missed immunization. As to maternal immunization 164/310 (53 %) non-EU women decided not to vaccinate and received less information (155/297;52 %) compared to childhood immunization (268/305; 88 %) (p < 0.0001). The educational degree (p = 0.017), the origin from non-EU European countries (p = 0.008) and the age 25-40 years (p = 0.036) and > 40 years (p = 0.007) were associated to lack of immunization during pregnancy. Finally, while 279/310 (90 %) parents were vaccinated against Sars-CoV-2, only 60/199 (30 %) children had been immunized with this vaccine mainly due to the non-mandatory vaccine request at pediatric age and to the doubts about its value according to 39/127 (31 %) and 29/127 (23 %) parents, respectively.

Conclusion: Our study highlights the need for targeted strategies to improve vaccine uptake both in childhood and in pregnancy among non-EU individuals living in Italy. Further, to achieve vaccination equity the role of institutions and healthcare personnel is pivotal to overcome vaccine hesitancy.