Print Friendly, PDF & Email

Explaining immunisations can be a bit daunting!  This is a quick template of a general counselling station (in most OSCE situations you wouldn’t be expected to get this all out in one!) It’s more just trying to be comprehensive in order to cover several different stations along the same theme that may arise. Examples include explaining what immunisations are and why we do them, explaining the need and benefits of some immunisations, explaining the process of getting an immunization and the good old “MMR” scandal. Check out the explaining immunisations OSCE mark scheme here.



Opening the consultation

Introduce yourself – explain your role

 

Confirm parent and child’s details – name / DOB

“Hello, Mrs/Mr xxxxx? I’m one of the student doctors working with the practice today. I’ve been asked to come and speak with you, is that okay? Can I just confirm baby’s name and date of birth, and who you are please?”

 

Establish why present, check understanding and ask what they want to find out

“Why have you come to clinic today?”

“What would you like to know about the vaccination programme? What do you already know?”

“Is there anything particular that concerns you regarding the vaccination programme?” 


Explanation

Vaccinations help protect children from serious disease and also provide protection for society as a whole (herd immunity).

“The vaccination programme is very safe, and almost all babies will have them. The reason for vaccination is both to protect your child from harm, and the community as a whole.”

“Giving a child a vaccination against a disease dramatically lowers the risk of them catching the illness which could be extremely harmful to them both in the short and long-term. By stopping the disease developing in your child, we also stop your child being able to spread the disease, so it can be considered a public health benefit too. The aim is to immunize enough people that we can stop the disease completely – this happened with smallpox in some countries”

 

Check understanding

“Does everything I’ve said so far make sense?”  

“Do you have any questions?”


Routine vaccinations

Below are details on the specific vaccines commonly administered.

It’s important to have some understanding of each vaccine and the disease it prevents.

Also be aware of the differences between the vaccines (e.g. live vs toxin).

Don’t bombard parents with lots of technical information, instead highlight the key points.

Check the parent’s understanding after your explanation and provide an opportunity for questions.

 

Routine vaccine summary

  • Bordetella pertussis
  • Diphtheria
  • Haemophilus influenza B
  • Human papilloma virus (HPV)
  • Measles
  • Mumps
  • Pneumococcus
  • Polio
  • Rotavirus
  • Rubella
  • Tetanus

 

Whooping cough

Bordetella pertussis

Serious infection in infantsup to 20% mortality <12m

Incubation period 6-14 days

 

Illness continues for 6-8 weeks in 3 phases:

  • Catarrhal (week 1-2, URTI symptoms)
  • Paroxysmal (usually lasts up to a month: coughing interrupted by ‘whoop’ stridor)
  • Convalescent (lasts around 2 weeks, persistent chronic cough)

 

Complications:

  • Encephalopathy
  • Death

 

Inactivated bacteria given

 

Measles

RNA paramyxovirus

Symptoms –  cough / low grade fever /conjunctivitis /rash

 

7.5% experience complications:

  • Pneumonia
  • Otitis media
  • Encephalitis (1 in 5000, significant morbidity and mortality).

 

Live attenuated vaccine

 

Mumps

Paramyxovirus

Incubation period 14-24 days

Symptoms – cervical lymphadenopathy / malaise

 

Complications include:

  • Meningoencephalitis
  • Orchitis
  • Pancreatitis
  • Unilateral deafness

 

Live attenuated vaccine

 

Rubella

Common RNA virus

Incubation 14-21 days

 

Symptoms:

  • Cervical lymphadenopathy (posterior groups)
  • Rash initially on head and neck, then spreads
  • Usually mild illness in the child

 

Complications are rare but include:

  • Neuritis
  • Arthritis

Transmission from mother to fetus is devastating – congenital rubella

Live attenuated vaccine

 

Diphtheria

Corynebacterium diphtheriae

Symptoms:

  • Sore throat
  • Greyish pseudomembrane on tonsils/pharynx/nasal cavity
  • Low fever

Incubation 2-5 days, infectious up to 4 weeks

Complications involve the heart and nervous system

Death rate up to 16% in infection

Inactivated bacterial toxin

 

Tetanus

Clostridium tetani

Produces spores

Incubation 3-14 days

Symptoms:

  • Spasms in jaw muscles (lock jaw / trismus) – early symptom
  • Worsening spasms throughout all muscle groups
  • Tetany – sudden powerful, painful contractions of muscle groups
  • Drooling / Hyperhidrosis / Dysphagia / Incontinence – late symptoms

 

Not transmitted person-to-person

Inactivated bacterial toxin

 

Polio

Single-stranded RNA virus

Faecal-oral transmission

Incubation 3-21 days

More commonly affects younger children

Symptoms – progressive paralysis (by replicating in motor neurones)

Inactivated virus given

 

HiB

Haemophilus influenza B

Causes many things – meningitis, epiglottitis(!)

Has a high morbidity as an infectious agent ~11% HiB meningitis sufferers are seriously affected by intellectual impairment, deafness and/or convulsions

Polysaccharide extract vaccination 


What to expect on vaccine day

Explain the practitioner will give the injection after screening for contraindications:

“When you come in, the nurse will ask a few questions about how baby is  – whether they have been unwell recently, started on any new medication, had any new diagnoses or any allergic reactions. This is to make sure it is suitable to give the vaccination.”

“The vaccination will be given as an injection, usually in the thigh (can be given in the upper arm of children older than 1 year).”

 

Explain normal reactions (crying, irritability, low fever) and measures the carer can take:

“It is normal for baby to be a bit upset by the injection and cry at the time. You may find they are a little more irritable for 48 hours afterwards, and may have a bit of a temperature. If this occurs there are a few things you can do to help – ensure baby keeps up their fluids, and you can give Calpol. In about 1 in 10 children, the place of injection can be a bit red and sore for a day or so – this again is relieved by Calpol, some reassurance and a cold compress may help.”

 

Explain more extreme reactions which may occur:

“If there is a large swelling at the site of injection, or you notice any rashes or swelling elsewhere (especially around the lips and mouth) it is important to contact the doctor urgently. Very occasionally, a child may have an adverse reaction to the vaccine and may have a temperature that does not respond to Calpol or a seizure. If this happens contact the hospital.”

“Complications of vaccines are very rare (less than 1 in 1000, and anaphylaxis in less than 1 in 500,000). Complications of the diseases which we are vaccinating against are more common and often more serious, and that is why we feel it is for the best to immunize children.”


But what about MMR, doesn’t that cause autism?

Explain the study which was conducted, and the new evidence that has come to light since:

“There was a piece of research published a number of years ago, claiming a link between MMR and autism. Since its release it has been discredited – the research was on a very small group of individuals and the outcomes were biased by several factors. The research has since been withdrawn and the researchers have been struck off.”

“Giving the MMR as one injection rather than 3 separate ones is shown to be just as safe, and arguably gives baby less pain to go through”


Closing the consultation

Summarise the topics covered:

“Just to summarise – with your consent,  your child will have ….vaccination(s). The reason for vaccination is both to benefit baby and reduce any potential harm to them, as well as in the interest of public health and reduction of spread of disease. Vaccinations are safe, but may have some minor side-effects including a slight fever and some irritability; this can usually be managed with Calpol and some reassurance. If baby has a more severe reaction or there is anything you are worried about, we advise you to contact a doctor straight away.”

 

Check parental/carer understanding and elicit any concerns:

“Does that all seem to make sense? Are there any questions you would like to ask?”

 

Offer an information leaflet on the relevant vaccinations

Arrange follow-up/schedule vaccination appointments

Thank the parents and patient