Immunisation — physicians call for vigilance not complacency
Published in NPS Direct
Date published: About this date
General practitioners and nurse immunisers administer the bulk of vaccines to children in Australia. The 2012 Royal Australasian College of Physicians Immunisation Position Statement supports a holistic approach to immunisation, including improving communication with patients, parents or carers; advocating the benefits of routine vaccination; and keeping up to date with current immunisation recommendations. Practical advice on ways to encourage full uptake of available immunisations, as well as managing adverse events and opposition to vaccination, is also included in the statement.
- The Royal Australasian College of Physicians supports the immunisation policies and programs of both the Australian and New Zealand governments.
- Immunisation schedules are complex and change frequently.
- Consult the Australian Immunisation Handbook for current recommendations. To keep up to date with new recommendations, and for information on which recommmended vaccines are funded through the National Immunisation Program, see the Immunise Australia Program.
- Be aware of alerts and vaccine-preventable diseases affecting specific patient groups.
- Be well informed about managing adverse events following immunisation.
- Optimising immunisation also involves several other approaches, including better communication, encouraging complete immunisation, and advocating the benefits of vaccination for patients, clinicians and their staff.
While Australia has high overall immunisation rates, some groups need special attention, including children experiencing socioeconomic disadvantage, Aboriginal and Torres Strait Islander children, Maori children and some children born overseas.
Adults and children who are immunocompromised, either through disease or treatment, and people with other specified conditions, may require extra doses of certain vaccines1 or administration of vaccines not routinely given to the rest of the population.1 In certain cases some vaccines may actually be contraindicated in these patient subgroups.1
All people who will be travelling, including children, should not only be immunised with all scheduled routine vaccinations, such as those for measles, mumps and rubella, but should also receive timely vaccination with any destination-specific vaccines well before departure.2 This may include vaccines to prevent hepatitis A, typhoid, meningococcal disease, Japanese encephalitis or rabies.
Occupational requirements for immunisation are now in place in many healthcare institutions and some other industries.1 Ensure all health professionals and staff who have direct contact with patients are appropriately vaccinated, not only to protect themselves but also to reduce the risk of infecting vulnerable patients who may not otherwise be able to be vaccinated.1,3
Discuss with patients their immunisation status and advocate and arrange for all to catch up any missed doses.3,4The increasing use of social media to rapidly communicate health information means that many patients or parents may have read about or already discussed some of their immunisation concerns before a consultation.5 Some patients or their carers may source and use unreliable and misleading information. Be aware of vaccine program changes, alerts of diseases and vaccine side effects and region-related patient or parental concerns.3 While parents who are absolutely opposed to any vaccines are unlikely to change their minds,6 some parents and carers of children who are opposed to vaccines may be agreeable to selected vaccination of their child.
Adverse events following immunisation (AEFI) are generally mild and rarely serious.7 AEFI may be coincidental or vaccine related, and good communication with concerned patients or parents is important at this time.3,7 Report AEFI according to individual State or Territory requirements.7 Specialist clinics are available where immunisation can be carried out under supervision. Contact your local State or Territory health department for local AEFI clinic details.
- The current 9th edition of The The Australian Immunisation Handbook.
- The current Australian National Immunisation Program Schedule.
- New vaccines listed on the Australian National Immunisation Program starting 1 July 2013.
- Information regarding how to report AEFI in Australia.
- For vaccine-brand-specific AEFI notification data for Australia refer to the Therapeutic Goods Administration, Database of Adverse Events Notifications.
- For a variety of immunisation resources, including the MMR Decision Aid, vaccine fact sheets history tables, see the National Centre for Immunisation Research & Surveillance of Vaccine Preventable Diseases (NCIRS).
- Contact your State or Territory health department for further immunisation guidance, including any healthcare worker immunisation requirements.
- Australian Government Department of Health and Ageing. The Australian Immunisation Handbook. 9th edition. 2008. http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook-home (accessed 3 December 2012).
- Australian Government Department of Health and Ageing. The Australian immunisation handbook. 9th edn. Part 2.2 Vaccination for international travel. 2008. http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook-travel (accessed 3 December 2012).
- Royal Australian College of Physicians. Paediatrics & Child Health Division. Immunisation Position Statement, October 2012. http://www.racp.edu.au/page/paed-policy (accessed 3 December 2012).
- Australian Government Department of Health and Ageing. The Australian Immunisation Handbook. 9th edn. Part 1.3 Pre-vaccination procedures. 2008. http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/handbook-prevaccination (accessed 3 December 2012).
- Betsch C, Brewer NT, Brocard P, et al. Opportunities and challenges of Web 2.0 for vaccination decisions. Vaccine 2012;30:3727–33. [PubMed]
- Meszaros JR, Asch DA, Baron J, et al. Cognitive processes and the decisions of some parents to forego pertussis vaccination for their children. J Clin Epidemiol 1996;49:697–703. [PubMed]
- Australian Government Department of Health and Ageing. The Australian Immunisation Handbook. 8th edn. Part 1.5 Post-vaccination procedures. 2008. http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook-post-vaccination (accessed 3 December 2012).