20 October 2012

Dear Editor,

I agree with Way et al.[1] that ‘opportunities exist in emergency departments (EDs) and paediatric inpatient wards for ensuring that all children are protected against vaccine-preventable diseases’, but I disagree with their suggestion that the appropriate response is to ‘immunise overdue children, both in emergency departments and prior to discharge from inpatient wards’.

Immunising children in hospital EDs and wards will send a message that hospitals are appropriate places to come for routine immunisations. Is this what we want to achieve? Why is there no mention in the article of the central role of general practitioners? The family's usual general practice is the appropriate setting to provide catch-up immunisations for children who have missed out on vaccines. In addition to this, while providing the immunisations, the family's usual general practice will also review all aspects of the child's long-term growth, development and health, discuss the reasons for any repeated attendances at hospital EDs and advise parents about how they can seek care more appropriately, which in most cases will be at or through the family's usual general practice.

The authors state: ‘The finding […] supports the need for a system of ensuring that no child is discharged from hospital without ensuring that they are fully age-appropriately vaccinated’. I contend that no child should be discharged from hospital without ensuring that the child's parents understand that the child's immunisations are overdue and that these should be administered immediately at the family's usual general practice. The hospital should ensure that it informs the family's usual general practice about the need and about the advice that has been given to the child's parents. Because almost all general practices now use electronic clinical records, the hospital should communicate this information electronically, by using a secure messaging system such as Argus or Medical Objects.


  1. Top of page
  2. Reference