Vaccinating children with a history of serious reactions after vaccination or of egg allergy

Objective: To describe the results of vaccinating children with a history of serious adverse reactions after vaccination or of egg allergy at a special clinic established for that purpose. Design: Retrospective case series. Patients: Children who attended the clinic between 1 August 1994 and 31 July 1996 after being referred by vaccine providers. Setting: A clinic conducted in the Emergency Department of The Canberra Hospital, Australian Capital Territory. Main outcome measures: Reasons for referral; vaccinations given; and subsequent adverse vaccination events. Results: 91 children received 155 vaccinations at the clinic, and only one serious event - a hypotonic/hyporesponsive episode (HHE) after diphtheria-tetanus-whole-cell pertussis (DTPw), oral polio and Haemophilus influenzae type b vaccination - was subsequently reported; this child recovered spontaneously. Fifty-three children referred because of a previous serious adverse vaccination event were revaccinated at the clinic with whole-cell pertussis vaccine (47), combined diphtheria and tetanus vaccine (4), tetanus toxoid (1), and typhoid vaccine (1). Three children (referred because of previous meningitis, subdural haemorrhage or parental suspicion of allergy to DTPw) received their first dose of pertussis vaccine at the clinic. The remaining 35 children had a history of egg allergy and were given measles-mumps-rubella vaccine. Conclusions: We successfully vaccinated children with histories of serious reactions to vaccination, including HHEs, convulsions, apnoea, high temperatures and persistent screaming, as well as those with egg allergy. We believe special clinics can improve vaccination coverage.