Referrals to a pediatric immunization service Findings from a practice-based audit of a UK specialist immunization clinic

Against a background of new developments and updated clinical guidelines, health care professionals (HCPs) administering childhood and adolescent immunizations require access to expert advice and support when appropriate. The clinical records of all pediatric referrals seen at a UK-based facility-the Stockport Specialist Immunization Clinic (SSIC)-between 01/10/2006 and 31/03/2007 were reviewed to determine the stated reason(s) for referral to a specialist immunization service and the outcome of that process. During the 6 month audit period, 430 case notes were identified and 410 (95%) were audited. Reasons for referral were primarily due to the medical condition of the child [118/410 (29%)], the child having experienced a previous vaccine adverse event [86/410 (21%)], or preterm birth of the child [86/410 (21%)]. The majority of referrals were from primary care [234/410 (57%)]. A total of 351 (85.6%) cases were categorized as appropriate referrals and 36 (11.6%) and 23 (5.6%) were categorized as inappropriate and equivocal, respectively. Four hundred and eight children completed a primary program; for two children the parents declined the advice offered. National data show that a small number of children remain susceptible to vaccine preventable diseases because they fail to access or complete immunization programs through their General Practitioner (GP) and this may be in part because the HCP is unsure about vaccine indications/contra-indications. Clearly a number of referring HCPs in this audit had some level of uncertainty when immunizing children with a pre-existing medical condition or a previous history of vaccine associated AEFI in the child/family, and this may be indicative of a more general problem among HCPs. A consistent approach to providing expert advice and support to primary care professionals in the UK would therefore be expected to make a significant impact on the immunization service by building confidence for parents/guardian, professionals and organizations involved in delivering it. The authors recommend a dedicated specialist immunization clinical service be considered as one approach to achieving this.