Background and Objectives:
Since August 2021, Italian law provided limitations for subjects without SARS-CoV-2 vaccination, prohibiting attendance of restaurants, gyms, workplaces, and use of public transportation. Subjects with contraindications to vaccination needed certification by authorized physicians. Bari Policlinico General Hospital, in Puglia, has been providing a service for the evaluation of possible causes of contraindication, such as medical conditions and past adverse events following immunization.

Methods:
This is a retrospective observational study. Patients evaluated from August 18, 2021, to August 13, 2022, were included. Subjects were interviewed about their medical history, and clinical documentation was reviewed.

Results:
168 patients were evaluated before anti-SARS-CoV-2 vaccination, with an average age of 46.5 ± 16.2 years (7-82). The male-to-female ratio was 64/104. 71 patients (42.3%) asked for evaluation after suffering from adverse events following previous vaccine administrations, 80 (47.6%) had previous medical conditions, and 9 (5.3%) reported both circumstances. Eight subjects (4.8%) underwent evaluation due to pregnancy. After anamnesis, 149 subjects (88.7%) were found to be affected by at least one medical condition; most conditions were classifiable as either cardiovascular (30.9%), allergies (30.2%) or endocrine/metabolic (28.2%). 41 patients required further specialistic evaluation; most evaluations were requested to allergologists (58,5%). Only 40 evaluations resulted in the release of a vaccination exemption, 39 of which were due to transitory conditions. 42.5% of all exemptions were due to a temporary clinical condition; 32.5% were due to ongoing therapy; 8 cases (20.0%) were related to a complicated pregnancy; in 2 cases (5.0%) the certificate was issued for hypersensitivity to vaccine components. 83 patients (49.4%) did receive at least one vaccine dose after evaluation. 84 (50.0%) still refused vaccination, and another (0.6%) is currently exempt from vaccination.

Conclusions:
The pre-vaccination evaluation service helped strengthening the patients’ trust towards vaccination and physicians and promotes the patients’ empowerment and awareness.