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Paediatrics clinic

To sign or not to sign. Dealing with requests for vaccination exemption

Frank H Beard, Nicholas Wood
OPEN ACCESS

Abstract

There are few valid reasons to sign an Immunisation Medical Exemption form. It is important that GPs understand what these are, and how to manage common vaccine concerns that may contribute to exemption requests.

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Anecdotal reports suggest that more parents are presenting to GPs requesting completion of an Australian Immunisation Register (AIR) Immunisation Medical Exemption form since the Federal Government’s ‘no jab, no pay’ policy was introduced on 1 January 2016. The no jab, no pay policy removed the ability for parents to register ‘conscientious objections’ to vaccination, which allowed them to be exempt from the requirement that their children be fully vaccinated to receive certain Federal Government family assistance payments. A new AIR Immunisation Medical Exemption form, which currently only GPs are able to complete, was also introduced on 1 January 2016 and is available online (https://www.humanservices.gov.au/health-professionals/forms/im011).

Immunisation is one of the most successful and cost-effective health interventions. Valid immunisation exemptions are medical contraindication according to the Australian Immunisation Handbook guidelines and natural immunity to a disease.1 To ensure that children are not inappropriately denied the benefits of immunisation, it is important that GPs understand what the true medical contraindications are and what constitutes adequate evidence of natural immunity. It is also important that GPs understand how to recognise and manage common concerns, including those about adverse events after vaccination, that may contribute to parents’ requests for completion of exemption forms. Practice points for GPs are listed in Box 1.

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What are the true medical contraindications to vaccination?

The only true absolute contraindications to vaccination are anaphylaxis following a previous dose of the relevant vaccine (or any component of the relevant vaccine) and significant immunocompromise (for live attenuated vaccines only).1 A range of additional false contraindications are listed in the Australian Immunisation Handbook, including family history of adverse events after immunisation, past history of convulsions, neurological conditions and recent or imminent surgery.1

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Children with acute febrile illness (temperature ≥38.5°C) should have vaccination temporarily deferred; however, an AIR Immunisation Medical Exemption form is not required for deferrals of this nature, which are likely to be of short duration. The provisions for temporary exemption are likely to be relevant only in the case of acute major medical illness when a child is hospitalised and clinically unstable, during pregnancy or when there is significant immunocompromise anticipated to be of short duration (for live attenuated vaccines only).

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 In general, most children who have had an adverse event following vaccination can be safely revaccinated. In some states, immunisation specialist services are available that can advise on whether a particular child requires any additional testing or precautions before receiving further vaccines (see Box 2 for contact details).

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Dr Beard is a Staff Specialist Public Health Physician at the National Centre for Immunisation Research & Surveillance of Vaccine Preventable diseases (NCIRS), Sydney; and Senior Lecturer in the School of Public Health at the University of Sydney. Dr Wood
SERIES EDITOR: Dr Chris Elliot BMed(Hons), FRACP, is General and Developmental Paediatrician, St George Hospital, Sydney; and Conjoint Lecturer, School of Women's and Children's Health, UNSW Sydney, NSW.