Author's Response


22 October 2012

The response by Frank[1] is an excellent complement to our emergency department (ED) missed opportunities study. A family's usual general practice is a preferred setting for providing catch-up immunisations for children who have missed out on vaccines.

The relevance of referral to general practice is borne out by a local follow-up study (Stephenson et al. in preparation). Because of the intriguing finding of a higher risk of missed opportunities in tertiary hospitals,[2] we collaborated with a tertiary hospital ED to determine the true opportunities for offering immunisation in EDs and attendant costs.

Among children who identified as incompletely vaccinated according to the Australian Childhood Immunisation Register, direct follow-up found that 40% were actually age-appropriately immunised, 8% were conscientious objectors and 20% had contraindications to immunisation during their ED presentation. The remaining parents were supportive of having their child immunised during the ED presentation. However, given the small absolute numbers of children who might benefit, it would be difficult to justify establishing immunisation infrastructure in this ED.

These findings suggest that ED staff should rather focus on always asking parents/guardians whether their child is fully vaccinated, as this was not always recorded in local ED records. For children who are not age-appropriately immunised, it is essential to ascertain whether the family has access to a general practitioner or Aboriginal medical service prior to arranging referral for vaccination.