Specialist Immunisation Service (SIS)

Please let us know as soon possible by calling the SIS so that we can allocate some-one else to the appointment.

Please let us know as soon possible by calling the SIS on 8161 7524 so that we can allocate someone else to the appointment.

No, it is best that call as soon as possible to let us know. In such situations we can arrange a telehealth appointment, and offer the appointment to someone else.

We will focus on the immunisation issues, but also any concerns that you have within the context of your child’s problems and past immunisation issues. If vaccination is indicated and consent is obtained, then vaccination can be done in the SIS. If we vaccinate your child we will call after one week to find out about any adverse events that have occurred. If any adverse event occurs we will provide you with the SIS contact details so that we can be informed and help manage and investigate the event.

Minor side-effects or reactions can occur after any vaccine and this includes fever, injection site pain and irritability. Serious adverse events are unexpected signs and/or symptoms that occur after a vaccine and may require medical attention. The SIS reviews serious adverse events to determine if the events were caused by the vaccine and to advise on further vaccination. In South Australia, it is mandatory for all health care providers to report a serious AEFI to SA Health. Parents/caregivers and vaccine recipients can also submit an AEFI report.

If your child has had a serious AEFI discuss this with your medical practitioner and decide if a referral to the SIS is indicated.

A medical at-risk (MAR) condition is one that is associated with a greater chance of contracting a vaccine preventable disease and/or having complications of that disease. The following is a list of some of the MAR conditions:

• Medical at-risk conditions (Australian Technical Advisory Group on Immunisation – ATAGI)

If your child has an MAR condition, it is important that they have routine vaccines but additional vaccine doses or other vaccines may also be indicated. Additional doses of the COVID-19 vaccine may also be recommended. The vaccine schedule can be discussed with your general practitioner or medical specialist.

In general, vaccines for children with a MAR condition can safely be given in the community. If your child is an in-patient of the Women’s and Children’s Hospital, or attending an out-patient appointment, they can attend the Patient Immunisation Service.

A medical practitioner or specialist can refer children with an MAR condition to the SIS, if they fulfil the following criteria:

• They are medically unstable and need to vaccinated with specific precautions in place
• The family has significant vaccine hesitancy and a general practitioner or specialist cannot adequately address their concerns.

Fortunately, very few medical conditions increase the risk of a vaccine reaction. Those children with an underlying medical condition may be more likely to get complications from vaccine preventable diseases (including COVID-19) and should be fully immunised according to recommended schedules.

However, there are some serious medical conditions that may cause concern regarding vaccination. It is best to discuss this first with your child’s general practitioner and medical specialist. If there is still concern and/or your child is considered to be medically unstable then a referral to SIS is recommended.

Very rarely, children with the following medical histories may be at increased risk of an allergic reaction to a COVID-19 vaccine and should be referred to the SIS:

• Documented or suspected history of Polyethylene Glycol (PEG) allergy, as this is a component of the COVID-19 mRNA vaccines
• History of vaccine anaphylaxis and/or anaphylaxis to multiple drugs that could be due to PEG
• Medically confirmed mastocytosis (a documented high blood tryptase) with recurrent anaphylaxis that requires treatment (not including skin (cutaneous) mastocytosis only, or non-specific mast cell disorders).

Egg, dairy and nut allergies, including anaphylaxis, are not a risk factor for an allergy reaction to a vaccine, including the influenza and COVID-19 mRNA vaccines.

Further information regarding the safety of these vaccines in people with allergies can be found at the Australasian Society of Clinical Immunology and Allergy website in relation to:

• Influenza vaccines
• COVID-19 vaccines

A complex immunisation schedule is one which requires specific recommendations on the vaccines required and when these should be given because of certain circumstances, for example medical treatments. Children who have undergone stem cell transplant and/or chemotherapy, those who are immunosuppressed because of medication/biologics and those children who have issues with catch-up schedules can have complex immunisation needs.

Most of these children with complex immunisation schedules, who attend the WCH can attend the Patient Immunisation Service but may attend the SIS if further assessment or advice is required.

It is best that these concerns are initially addressed by your general practitioner, medical specialist and/or by referring to recommended sources of vaccine information.

However, if you still have significant concerns about vaccination, a referral to the SIS may be required. The SIS will try to understand your specific concerns around vaccination, discuss the basis of these concerns, provide published information on vaccine side-effects and reactions and discuss any modified vaccine schedules.

No Jab No Pay is a commonwealth scheme administered by Medicare. Your child must meet immunisation requirements if you get Family Tax Benefit (FTB) Part A or child care fee assistance.

Attendance at the SIS is NOT required to obtain a No Jab No Pay exemption, with the exception of a Secretary's exemption.

A registered medical practitioner can provide a medical exemption by completing an Australian Immunisation Register (AIR) Medical Exemption Form . The valid indications for exemption include:

• the child has a medical contraindication to a vaccine because they have had anaphylaxis to that vaccine
• the child has natural immunity to a particular disease
• the child is part of an approved vaccine study
• the vaccine is temporarily unavailable
• the child is vaccinated overseas*, or
• the Secretary of the Commonwealth Government’s Department of Social Services has determined that the child meets the immunisation requirements.

The Family Assistance (Immunisation Principles and Vaccination Schedules) (DSS) Determination 2018 set out the circumstances under which the Secretary of the Commonwealth Government’s Department of Social Services can determine that an individual has met the immunisation requirements for family assistance payments set out in the A New Tax System (Family Assistance) Act 1999.

Attendance at the SIS is required to apply for a Secretary’s exemption to the No Jab, No Pay legislation. The doctors in the SIS are listed medical practitioners, who can provide a recommendation to the Commonwealth Chief Medical Officer that immunisation of a child would result in an unacceptable risk of physical harm to the child or a person administering the vaccine. This is generally granted to children with significant developmental issues that prevent vaccination.

The SIS is unable to provide this recommendation unless there has been an attempt to vaccinate a child using acceptable methods of support, which may range from distraction to sedation.

Currently, childhood COVID-19 vaccines are not mandated and not required for an exemption to the No Jab No Pay requirements.

No Jab No Play occurs under state legislation. To enrol in and attend an early childhood service, children must be fully immunised, or be on an approved catch-up vaccination program, or have an approved exemption from meeting immunisation requirements.

The Chief Public Health Officer (CHPO) of South Australia provides an exemption. The SIS does not provide the exemption but makes a recommendation to the CHPO. Thus, review in the SIS is required to complete this recommendation.

The purpose of the review in the SIS is to understand the complex issues that have resulted in this choice, to provide information on vaccine preventable diseases and to understand the perceived or real risks of immunisation (or non-immunisation) and the risk to the child of not being able to attend early childhood services.

The recommendations are provided to the family who can choose to provide this to SA Health.

In order for the SIS to complete a recommendation the family must apply to SA Health for an exemption to No Jab No Play.

Once the exemption form has been submitted to SA Health your General Practitioner can refer you to SIS to discuss your concerns with vaccination.

Children and adolescents should be referred to the SIS in the following circumstances:

• They have had a severe or serious adverse event following immunisation with a COVID-19 vaccine – regardless of the dose number
• They have a medical condition (such as PEG allergy) that would place them at increased risk of a reaction to a COVID-19 vaccine.
• They have a MAR condition and are medically unstable and/or their family has significant vaccine hesitancy that cannot be addressed within a community setting.

Medical exemptions to the COVID-19 vaccine can be provided by specific medical practitioners in the community and attendance at the SIS is not required for the purpose of obtaining an exemption.

Currently, childhood COVID-19 vaccines are not mandated and not required for an exemption to the No Jab No Play requirements.

Some children or adolescents may need to provide proof of double COVID-19 vaccination for travel, employment, or to attend entertainment venues. The following medical practitioners can provide an exemption:

• general practice registrars on an approved 3GA training placement
• paediatricians
• public health physicians
• infectious disease physicians
• clinical immunologists
• GPs who meet certain criteria.

A medical exemption can be provided for very limited and specific medical conditions, and this is done by an eligible doctor updating the Australian Immunisation register or submitting an exemption form.

Your child does not need to attend the SIS to obtain a medical exemption for a COVID-19 vaccine.