Referrals pathways for Regional Paediatric model
Index:
Contraindications & precautions
Immunisation concerns are common in the community, both from caregivers and from medical and allied health professionals. The following topics will assist with many questions often considered.
Further information can be obtained from the Australian Immunisation Handbook.
Immunisation schedule
Please visit the Victorian State Government website.
Children with missing or incomplete immunisations, including refugees and other immigrants, require a modified immunisation catch up program.
Please visit the Royal Children's Hospital website.
Those at higher risk for vaccine preventable diseases may require extra immunisations, including:
- those with significant underlying medical problems
- those born at <2000 grams or < 32 weeks gestation
- Aboriginal and Torres Strait Islanders
- For vaccine schedule changes please visit the Victorian State Government website
For travel vaccination information, please refer to the International travel section of the Australian Immunisation Handbook.
Other special circumstances:
- immunocompromised patients - avoid live vaccines in those with:
- oral prednisolone 2 mg/kg/day > 1 week or 1 mg/kg/day > 2 weeks or any other immunosuppressive medication
- haematological or reticuloendothelial malignancy
- chemotherapy within 6 months
- primary immunodeficiency
- recent organ or bone marrow transplant.
- immunocompromised family members - avoid OPV only.
- pregnancy and breast feeding - avoid live vaccines when pregnant only, all others are fine.
- egg allergy - can give MMR, suggest specialist referral for influenza if true egg allergy.
- prematurity - give all vaccines based on chronological (not corrected) age, also see high risk groups above.
- blood transfusions - delay live vaccines for 3 months post whole blood transfusions.
Given the declining immunisation rates in many areas, whooping cough (pertussis) has again become common. Although this disease is not generally severe in children and adults, when newborns and infants contract whooping cough they are commonly hospitalised with a severe cough and difficulties breathing. The rates of death related to whooping cough in infants has jumped dramatically in the last few years.
Due to this, recommendations are now for a whooping cough (pertussis) 'booster' (Boostrix) to be given to all pregnant women, as well as their partners and other family members or friends who will have prolonged close contact with their newborn. The Victorian State Government provides Boostrix to all pregnant women and their partner for free.
Please see the Victorian State Government whooping cough vaccine program for information.
Contraindications and precautions to immunisation
Contraindications to giving an immunisation are rare. These are:
- absolute contraindications:
- encephalopathy within 7 days of previous dose
- anaphylaxis
- live vaccines if immunocompromised (see At Risk Groups above)
- Relative contraindications:
- undiagnosed progressive neurological condition (not stable neurological condition e.g. CP)
Precautions to giving immunisations (consider delaying) include:
- temperature > 38.5 degrees celcius
- major illness
Parental concerns & conscientious objection
Parental concerns regarding immunisation are common. Listening to their concerns and providing reliable sources of information in a a non-judgemental framework can be helpful. It is very important that families have the chance to ask questions and explain their concerns, although they must understand several aspects of vaccines and vaccine-preventable disease, including:
- Vaccine preventable diseases are all potentially very dangerous conditions that have become increasingly less common and/or less dangerous due to the introduction of vaccines.
- It is also important to acknowledge that immunisation side effects can occur, and that mild local reactions are quite common, however more serious reactions are far less common and are outweighed by the risks that the diseases themselves protect children from.
- The concept of 'herd immunity' exists, whereby when large percentages of a population are immunised against a disease, that disease is unlikely to spread within any community (even to immunised individuals), and that once the numbers immunised in a population drop below a certain level, herd immunity is lost and even those who are immunised are then at risk of these diseases.
- The Victorian State Government has carefully considered all evidence regarding the negatives and positives for and against immunisations for children, and decided that failing to immunise children is a significant public health risk, not just for the individual, but for the community as a whole - in January 2016 the No Jab No Play policy was introduced, preventing enrolment into childcare and kindergarten services for children without up to date immunisations.
- Conscientious objection to immunisation is no longer recognised as an exemption by the Victorian State Government to the above No Jab No Play policy, which is a stance now taken by several countries throughout the world. Exemption from immunisation may now only be given under medical grounds.
- Immunisation undertaken using alternative medical therapies is not recognised by the Victorian State Government and does not allow children to be registered as immunised. There is very little good quality evidence to support the use of these in any circumstances.
For further information on each vaccine preventable disease, please see Consumer information - vaccine preventable diseases.
The Victorian State Government has carefully considered all evidence regarding the negatives and positives for and against immunisations for children, and decided that failing to immunise children is a significant public health risk, not just for the individual, but for the community as a whole.
In January 2016 the No Jab No Play policy was introduced, preventing enrolment into childcare and kindergarten services for children without up to date immunisations. Conscientious objection to immunisation is no longer recognised as an exemption by the Victorian State Government to the above No Jab No Play policy.
Please visit the website Victorian State Government No Jab No Play website for further information.
Referrals and further resources
- Referrals
- Paediatric outpatient services referral can be considered for further discussion around high risk groups, anaphylaxis to vaccines or specific immunisation related concerns.
- Royal Children's Hospital Immunisation Clinic - free drop in clinic providing immunisations and advice (bookings required for non-routine immunisations).
- Further resources
- Australian Childhood Immunisation Register (ACIR)
- National Centre for Immunisation Research & Surveillance (NCIRS - independent evidence based organisation with multiple helpful fact sheets)
- Myths and realities (responding to arguments against immunisation)
- The Science of Immunisations (Australian Academy of Science - endorsed by RACP & AMA)
- Jabbed (SBS documentary exploring the pros and cons of immunisation)
- Consumer information - vaccine preventable diseases (disease specific information sheets)
- Victorian Immunisation Schedule
- Australian Immunisation Handbook
- Catch up immunisation schedule
- Whooping cough vaccine program
- No Jab No Play website
- International travel (advice for travel related vaccine recommendations)