Walter Maria Sarli, M Peri, Clementina Canessa, Francesca Lippi, Lorenzo Lodi, Francesca Menegazzo, Francesco Puggelli, Chiara Azzari, Silvia Ricci, FRAGI-le (Frontline Response Against Gaps in Immunisation) Group, Federica Barbati, Elisa Buti, Chiara Caparrelli, Paolo Del Greco, Donata Dini, Silvia Favilli, Grazia Fenu, Giacomo Folini, Valentina Guarnieri, Andrea La Tessa, Emanuela Laudani, Ilaria Maccora, Maria Vincenza Mastrolia, Federico Melani, Sonia Muricci, Marco Moroni, Silvia Passantino, Elena Procopio, Sara Renzo, Maria Chiara Sanvito, Luca Scarallo, Lisa Serafini, Gaia Spaziani, Annalisa Tondo, Sonia Toni, Irene Trambusti, Chiara Trapani, Francesca Trevisan, Gaia Varriale
Fragile paediatric patients are at higher risk of vaccine-preventable diseases, yet coverage remains suboptimal. Hospitalisation offers an opportunity to review and update immunisation, but fragmented practices create inequities, with access depending more on hospital context than clinical need. This study aimed to design, implement, and evaluate an in-hospital vaccination pathway for these patients. A mixed-methods approach was undertaken at Meyer Children's Hospital IRCCS, Florence, Italy. Baseline assessment included nine focus groups and an online questionnaire with healthcare professionals from units managing fragile patients, exploring practices, barriers, and needs. Findings informed the co-design of a pathway integrating documentation review, catch-up planning, and in-hospital delivery coordinated by the Immunology Unit. Administrative data on non-SARS-CoV-2 vaccinations in fragile patients (2022-2025) were analysed. Most respondents supported hospital-based vaccination (94.2%) but reported gaps in registry access, spaces, and training. Only 67.6% collected vaccination history systematically, 14.4% always mentioned vaccination in discharge letters, and 15.9% always recommended family immunisation. Despite acknowledging low influenza coverage (60.9% declared coverage <50%), 15.9% expressed hesitancy in administering non-live vaccines, mainly due to efficacy concerns (55.9%). After implementation, vaccine administrations increased from 361 in the 2022-2023 season to 752 in the 2024-2025 season (+108.3%; P < .0001). Increases were observed after staff sensitisation, with further growth following the creation of the hospital vaccination centre. A structured hospital-based vaccination pathway for fragile paediatric patients is feasible, well accepted, and associated with increased vaccine administrations within the hospital care pathway. Broader adoption could reduce inequities and strengthen vaccine access for high-risk children.