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Revaccination of large GP cohort due to inappropriate immunisation: Lessons learnt from an incident in Ireland

Mary Ward

Background: In Ireland, 335 children were identified as having been inappropriately vaccinated by their medical practitioner over a 16 year period. Aims: This revaccination exercise attempted to identify the cohort of children who had been inappropriately vaccinated in order to revaccinate them according to recommended national schedule.

Methods: Children who received any or all of their primary childhood immunisations from the medical practitioner were identified from relevant databases. A customised age appropriate revaccination schedule was devised and offered to each child

Results: Between August 31st, 2012 and September 19th, 2013, 225 identified children attended designated revaccination clinics. An additional 39 children were referred to their current medical practitioner of whom 31 attended for revaccination. In total, in excess of 80% of the invited cohort was re-vaccinated either completely or partially in the health service clinics or by their medical practitioner. This attendance and completion rate was higher than anticipated and also higher than previously reported in revaccination exercises elsewhere. No child in this cohort was notified as having any of the relevant 11 vaccine preventable diseases. There were 41 (14.8%) adverse reactions recorded in those who had commenced vaccination. All were local reactions 35 children had painful red arms and 6 had more severe local reactions. The direct cost of this revaccination exercise was estimated at €230,000. Conclusion: There was a high attendance rate at the revaccination clinics. The most challenging activity was accurately identifying the cohort for revaccination. A multifaceted approach including mandatory professional education for medical and nursing personnel involved in the delivery of immunisation, regular audit of immunisation practice and considerations of sanctions for non compliance with contractual requirements must be considered to ensure delivery of a high quality immunisation service in primary care.