The Australian Immunisation Handbook 10th Edition 2013

3.3 GROUPS WITH SPECIAL VACCINATION REQUIREMENTS
This chapter considers the use of vaccines in persons who have special
vaccination requirements, persons who may experience more frequent
adverse events following immunisation and persons who may have a
suboptimal response to vaccination. Recommendations for vaccination of
persons at occupational or lifestyle-associated risk are also included. Although
recommendations are discussed under each sub-heading in this chapter, it is
also important to refer to the relevant disease-specific chapters in Part 4 for
further information.
Administration of certain vaccines is a priority for some persons with
medical conditions that increase the risk of infectious diseases, even in the
absence of specific immune defects, for example, the use of influenza and
pneumococcal vaccines in individuals with an increased risk of complications
from these diseases. The presence of additional recommendations specific to
groups discussed in this section underpins the importance of pre-screening
those attending for immunisation and being certain to regularly review the
vaccination needs of those seeking medical attention for any reason.
3.3.1 Vaccination of persons who have had an adverse event
following immunisation
Adverse reactions after being given a vaccine (also known as ‘vaccine side
effects’) do sometimes occur. It is usually not possible to predict which
individuals may have a mild or a rare, serious reaction to a vaccine. However, by
following guidelines regarding when vaccines should and should not be used,
the risk of adverse effects can be minimised. The term ‘adverse event following
immunisation’ (AEFI) refers to any untoward medical occurrence that follows
immunisation, whether expected or unexpected, and whether triggered by the
vaccine or only coincidentally occurring after receipt of a vaccine dose. 1 For more
information on AEFI, see 2.3.2 Adverse events following immunisation.
Serious adverse events occur rarely after immunisation. Recognised rare
and serious AEFI are described in 2.3.2 Adverse events following immunisation.
Pre-vaccination screening should identify persons who have experienced an
AEFI and also identify persons with conditions that are precautions and/or
contraindications to vaccines (see Table 2.1.1 Pre-vaccination screening checklist).
The relevant disease-specific chapter(s) in Part 4 of this Handbook should be
consulted for each vaccine regarding contraindications and precautions that are
relevant. In general, persons who have had a non-serious adverse event can be
safely revaccinated by their usual immunisation service provider. Determining
whether revaccination should be provided after a serious event has occurred
following vaccination can be more challenging. At the individual patient
level, an assessment should be made as to whether the vaccine(s) was causally
related to the adverse event. This includes a thorough medical assessment,
including determining the need for, or availability of, specific tests to predict
130 The Australian Immunisation Handbook 10th edition