Opportunistic immunising in the paediatric emergency department : Are patients due vaccines?

Background
The aim of this study was to identify if patients presenting to a paediatric emergency department were due National Immunisation Program recommended vaccines in order to determine missed opportunities for vaccination or vaccination referral.

Method
A hospital chart audit assessed the documentation of an immunisation history, in comparison to the immunisation histories available from national and state immunisation databases to determine accuracy; to identify if patients were due vaccines as determined by the National Immunisation Program; and to identify factors associated with those due vaccines.

Results
Potential opportunities to vaccinate children due vaccines were missed (10/114, 8.8%); with less than half (4/10, 40%) correctly documented as due vaccines. Despite identification of due vaccines, no vaccines were administered. Almost one third of patients (34/114, 30%) had no immunisation history documented in the chart. ‘Medically at risk’ children (Odds Ratio [OR] 29.7, 95% CI 4.5–196, p < 0.001) were statistically more likely to be due vaccines. Likelihood of being due vaccines was higher, but not statistically significant, for those with no identified general practitioner (OR 4.5, 95% CI 0.96–20.6, p = 0.08), and for those presenting with injury rather than illness (OR 2.0, 95%CI 0.51–8.1, p = 0.48).

Conclusion
Opportunities to vaccinate children presenting to the emergency department are currently being missed. A particular focus is needed for ‘medically at risk’ children and those with no identified general practitioner. Larger studies may confirm other risk factors. Further research is required into the attainment of an immunisation history during the hospital admission process and the accuracy of these methods.