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CASE STUDY 2Parents’ experiences of an Adverse EventFollowing Immunisation in South Australia – aqualitative studyEffective systems are required to monitor vaccinesafety and to provide ongoing support for those whoexperience an Adverse Event Following Immunisation(AEFI). This study aimed to better understand theexperience and implications for parents when theirchild suffers an AEFI. Semi-structured interviewswere conducted in the homes of 10 parents whosechild had an AEFI reported during April 2005.Most parents were aware of the risk of commonside effects following immunisation however werenot aware of adverse reactions. Although they hadreceived varying amounts of information aboutcommon side effects they believed that knowledgeabout vaccine common side effects and adversereactions is necessary to enhance the immunisationprocess.Parents’ belief in immunisation remained unchangedand they all said they would continue to vaccinatetheir children, but with an increased knowledgeand heightened awareness of the risks of adversereactions. Their satisfaction with the managementof health services during and after the event wasaffected by the interest shown by health professionalsand the timeliness of the service.The parents in this study were not deterred fromcontinuing their child’s vaccination schedule followingan AEFI; however their needs changed, and they nowrequire more information about adverse reactions.Delivery of a timely service by an interested healthprofessional maintained parental satisfaction with themanagement of the health services.For further information contact Susan Lewis, SAImmunisation Coordination Unit:susan.lewis@health.sa.gov.auCASE STUDY 3Uptake of varicella vaccine in South Australia – across sectional survey of parental attitudes tovaricella vaccinationVaricella (chickenpox) vaccine was licensed for usein Australia in March 2000 and was included butnot funded in the Australian Standard VaccinationSchedule (ASVS) in 2003. This study aimed to assessthe uptake of varicella vaccine in South Australianchildren and to examine the main reasons thatdetermine a parent’s decision to have their childimmunised with varicella vaccine.A telephone survey was conducted in 2004 anddata were obtained from 613 households containingchildren less than 18 years of age. Six hundred andeighty children (55.7%) had a history of varicellainfection and 446 children (42.0%) had receiveda varicella vaccine. Almost 41% of susceptiblechildren aged 18 months to two years and 30.5%aged 2-4 years have no protection against varicella.Reasons why parents decided to have their childimmunised included concern about acquiring varicella(65.6%) and inclusion of the vaccine on the ASVS(10.8%). Excluding previous varicella infection, themost common reasons cited for not having childrenimmunised included lack of knowledge about thevaccine and cost. Concern about side effects (2.3%)was reported less commonly.Four years after the registration and licensing ofvaricella vaccine and one year following inclusionof the vaccine in the ASVS there is evidence ofincomplete coverage in children in South Australia.Federal Government funding for varicella vaccineshould result in high coverage rates, as the mainreasons why parents choose not to have their childimmunised would be addressed.For further information contact Helen Marshall,University of Adelaide: helen.marshall@adelaide.edu.au28
References1. Chen R and Hibbs B. Vaccine safety: Current andfuture challenges. Pediatr Ann. 1998;27(7):445-455.2. Chen R, Glasser J, Rhodes P, et al. Vaccine SafetyDatalink Project: A new tool for improving vaccinesafety monitoring in the United States. Pediatrics.1997;99(6):765-773.3. National Centre for Immunisation Research andSurveillance of Vaccine Preventable Diseases(NCIRS). Communicable Diseases Intelligence:Vaccine preventable diseases and vaccinationcoverage in Australia, 1999-2000. Canberra: AGPS;2002.4. Chen R. Vaccines risks: real, perceived andunknown. Vaccine.1999;17 (Suppl 3):S41-S46.5. National Institute of Public Health and Environmentin the Netherlands (RIVM). Adverse events followingimmunisation under the national vaccinationprogramme of the Netherlands: Number V11 -Reports in 2000. Bilthoven: RIVM; 2002.6. Gangarosa E, Galazka A, Wolfe C, et al. Impact ofanti-vaccine movements on pertussis control: theuntold story. Lancet. 1998;351:356-361.7. Ada G and Isaacs D. Vaccination: The facts, the fears,the future. St Leonards: Allen & Unwin,; 2000.8. Andrews N, Miller E, Taylor B, et al. Recall bias,MMR, and autism. Arch Dis Child. 2002;87:493-494.9. Ellenberg SS. Safety considerations for new vaccinedevelopment. Pharmacoepidemiol Drug Saf. 2001;10(5):411-415.10. ProMed Mail 6/8/200111. Gillray, J. The Cow Pock-or-the-Wonderful Effects ofthe New Inoculation! Publications of ye Anti-VaccineSociety. June 12, 1802. Available from:http://www-micro.msb.le.ac.uk/Tutorials/Pox/Pox13.html12. Schieferdecker CC. Dr. C. G. G. Nittinger’s Evils ofVaccination. Philadelphia: the editor, 1856. Availablefrom: http://www.sc.edu/library/spcoll/nathist/jenner2.html13. National Health and Medical Research Council(NHMRC). The Australian Immunisation Handbook.7th ed. Canberra: AGPSl 2000.14. Brewer T and Colditz G. Postmarketing surveillanceand adverse drug reactions: Current perspectives andfuture needs. JAMA. 1999;281(9):824-829.15. Jacobson R, Adegbenro A, Pankratz V, et al. Adverseevents and vaccination - the lack of power andpredictability of infrequent events in pre-licensurestudy. Vaccine. 2001;19:2428-2433.16. DeStefano F. The Vaccine Safety Datalink project.Pharmacoepidemiol Drug Saf. 2001;10:403-406Ggg.17. Murphy T, Gargiullo P, Massuodi M, et al.Intussusseption among infants given oral rotavirusvaccine. N Engl J Med. 2001;344:564-572.18. Gold M and Kempe A. Adverse Events FollowingImmunisation (AEFI) in Australia: Surveillanceand management. Adelaide: SA ImmunisationCoordination Unit; 2001.19. Department of Health and Ageing, TherapeuticGoods Administration. Adverse Drugs Reaction Unit.[Last updated 1/07/02, accessed 23/9/05]. Availablefrom: http://www.tga.gov.au/adr/20. Wattigney W, Mootrey G, Braun M, et al.Surveillance of poliomyelitis vaccine adverse events,1991 to 1998: Impact of a sequential vaccinationschedule of inactivated poliovirus vaccine followed byoral poliovirus vaccine. Pediatrics. 2001;107(5):e83.21. Chen R, Haber P, Mullen J. Surveillance of the safetyof simultaneous administration of vaccines. Ann N YAcad Sci. 1995;754:309-320.22. Andrews N. Statistical assessment of the associationbetween vaccination and rare adverse events postlicensure.Vaccine. 2002;20:S49-453.23. Turnbull F, McIntyre P, Achat H, et al. National studyof adverse reactions after vaccination with BacilleCalmette-Guérin. Clin Infect Dis. 2002;34:447-453.24. Dugdale, S. Adverse events in South AustralianChildren, 1997-2002. Master of Public Health Thesis.University of Adelaide; 2003.25. Lawrence G, Menzies R, Burgess M, etal. Surveillance of adverse events followingimmunisation: Australia 2000-2002. Commun DisIntell. 2003;27:307-323.26. Zhou W, Pool V, Iskander J, et al. Surveillancefor safety after immunization: Vaccine AdverseEvents Reporting System (VAERS) - United States,1991-2001. Morbidity and Mortality Weekly Report(MMWR). 2003;52:1-24.27. National Institute of Public Health and Environmentin the Netherlands (RIVM). Adverse events followingimmunisation under the national vaccinationprogramme of the Netherlands: Number V11 -Reports in 2000. Bilthoven: RIVM; 2002.28. Hull B, Lawrence G, MacIntyre CR, McIntyre P.Immunisation Coverage: Australia 2001. Canberra:Commonwealth Department of Health and Ageing;May 2002.29
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