Childhood Immunisation Counselling – OSCE Guide

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This guide aims to provide a template of a generic immunisation counselling station which could be applied to any of the immunisations mentioned (you wouldn’t be expected to cover all of the immunisations in this guide in one station). The guide covers explaining what immunisations are, why we do them and what the process involves.


Opening the consultation

Wash your hands and don PPE if appropriate.

Introduce yourself to the parent(s) including your name and role.

Confirm the child’s name and date of birth.

Ask about the ideas, concerns and expectations of the parent(s).

Determine the parent(s) prior knowledge of immunisations.

Example

“Hello, 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 your baby’s name, date of birth and who you are?”

“What are your thoughts about immunisations?”

“Was there anything you were concerned about?”

“What were you hoping we’d do today?”

“What do you know about immunisations?”


Explanation

Vaccinations help protect children from serious diseases and also provide protection for society as a whole (known as 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 to protect 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 so that we can stop the disease completely – this happened with smallpox in some countries.” 

Check the parent’s understanding:

  • “Does everything I’ve said so far make sense?”  
  • “Do you have any questions?”

Routine vaccinations

Below are details on specific vaccines which are included in the routine vaccination schedule for children in the UK. It’s important to have some understanding of each vaccine and the disease it prevents. You should also be aware of the differences between the vaccines (e.g. live vaccines vs toxin-based vaccines). Don’t bombard parents with lots of technical information and instead highlight only the key points.

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

Routine vaccinations for children in the UK include:

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

Whooping cough

Organism

Bordetella pertussis

Clinical features

Incubation period: 6-14 days

Illness typically lasts for 6-8 weeks and has three phases:

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

Complications

  • Encephalopathy
  • Death (up to 20% mortality in children less than 12 months old)

Type of vaccine

Inactivated bacteria are administered in the vaccine to induce an immune response.

Measles

Organism

RNA paramyxovirus

Clinical features

Symptoms:

  • Cough
  • Low-grade fever
  • Conjunctivitis
  • Rash

Complications

7.5% of children experience complications including:

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

Type of vaccine

Live attenuated vaccine

Mumps

Organism

Paramyxovirus

Clinical features

Incubation period: 14-24 days

Symptoms:

  • Cervical lymphadenopathy
  • Malaise

Complications

Complications can include:

  • Meningoencephalitis
  • Orchitis
  • Pancreatitis
  • Unilateral deafness

Type of vaccine

Live attenuated vaccine

Rubella

Organism

Common RNA virus

Clinical features

Incubation period: 14-21 days

Symptoms:

  • Cervical lymphadenopathy (typically posterior lymph node chains)
  • Rash: initially on the head and neck, before becoming more widespread
  • Typically causes a mild illness in children

Complications

Complications are rare but potentially serious and include:

  • Encephalopathy
  • Arthritis
  • Guillain-Barré syndrome

Transmission from mother to fetus can be devastating:

  • Sensorineural deafness
  • General learning disability
  • Insulin-dependent diabetes
  • Congenital heart disease
  • Microcephaly
  • Cataracts
  • Pigmentary retinopathy

Type of vaccine

Live attenuated vaccine

Diphtheria

Organism

Corynebacterium diphtheriae

Clinical features

Incubation period: 2-5 days and the child is infectious for up to 4 weeks

Symptoms:

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

Complications

Complications of Diptheria can include:

  • Paralysis of the palate and hypopharynx
  • Cranial nerve lesions
  • Diaphragmatic paralysis
  • Atrioventricular block
  • Death (up to 16% of patients)

Type of vaccine

Inactivated bacterial toxin

Tetanus

Organism

Clostridium tetani

Clinical features

Spread via spores in soil, house dust and faeces.

Incubation period: 3-14 days

Symptoms:

  • Spasms in jaw muscles (lockjaw/trismus).
  • Late symptoms include widespread spasms, tetany, drooling, hyperhidrosis and dysphagia.

Type of vaccine

Inactivated bacterial toxin

Polio

Organism

Single-stranded RNA virus

Clinical features

Faecal-oral transmission

Incubation period: 3-21 days

Typically affects younger children

Symptoms:

  • Progressive paralysis (replicates in motor neurones)

Type of vaccine

Inactivated virus

HiB

Organism

Haemophilus influenza B

Clinical features

Symptoms:

  • Cough
  • Shortness of breath
  • Ear pain
  • Sore throat
  • Fever
  • Irritability

Complications

Complications can include:

  • Pneumonia
  • Otitis media
  • Epiglottitis
  • Eye infections
  • Bloodstream infection
  • Meningitis
  • Intellectual impairment
  • Deafness
  • Seizures

HiB has high morbidity ~11% HiB meningitis sufferers are seriously affected by intellectual impairment, deafness and/or convulsions.

Type of vaccine

Polysaccharide extract vaccination


What to expect on vaccine day

Explain that the practitioner will administer the injection after screening for contraindications:

“When you come into the clinic, the nurse will ask a few questions about how your baby is, including whether they have been unwell recently, whether they have any medical conditions and if they have any allergies. This is to make sure it is suitable to give the vaccination.”

“The vaccination will be given as an injection, usually in the thigh.”

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

“It is normal for your 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 including giving some Calpol for the temperature and making sure they are still drinking regularly. In about 1 in 10 children, the place of injection can be a bit red and sore for a day or so – this again should be relieved by Calpol, some reassurance and a cold compress may also help.”

Explain the rare, but more serious reactions which sometimes 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. Children sometimes can experience seizures when they have a raised temperature and if this happens you should seek medical review.

“Complications of vaccines are very rare (less than 1 in 1000, with the chance of anaphylaxis being 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 results in less discomfort for your baby.”


Closing the consultation

Summarise the topics covered:

“Just to summarise – with your consent,  your child will have ….vaccination(s). The reason for the vaccination is to reduce any potential harm to your baby from specific infections as well as protecting more vulnerable children who are unable to be vaccinated. 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 you think your baby is experiencing a much rarer severe reaction or there is anything you are worried about, we advise you to contact a doctor straight away.”

Check parental 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 appointments for specific vaccinations.

Thank the parent(s) and child (if relevant).

Dispose of PPE appropriately and wash your hands.


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