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Measles continues to be a public health concern world-wide. Vulnerable individuals including those in which vaccinations is contraindicated, may be reliant on normal human immunoglobulin (NHIG) prophylaxis in an aim to prevent disease. This paper will summarise and discuss a tertiary paediatric hospital's clinical experience and the practicalities of administering intramuscular (IM) NHIG to paediatric patients as per the current measles prophylaxis guidelines in Australia. Following potential exposure within the emergency department, 17 paediatric patients (0-15 years) were recommended IM NHIG for prophylaxis. The dose of NHIG ranged from 0.6 to 15 mL and required multiple (2-8) injections. Two patients required sedation for staff to safely administer the injections. Staff involved with these cases reported administering multiple injections to paediatric patients to be a traumatising experience. They also expressed views that the injection of large volumes via the IM route was an impractical method of administration. Based on this experience, we recommend intravenous immunoglobulin be considered when large volumes of NHIG are recommended intramuscularly.

The aim of this study was to identify (a) emergency department staff knowledge, opinion and practices in relation to childhood vaccines and opportunistic immunisation in the emergency department and (b) differences between nursing and medical staff knowledge, opinion and self reported practices.A self-administered, cross-sectional survey was offered to a convenience sample of medical and nursing staff (n=86) working in a tertiary paediatric emergency department. Variables of interest were described using frequencies and odds ratios to report differences between medical and nursing staff responses.An 87% survey response was achieved. The majority of staff agreed that childhood vaccines were safe (96%), effective (99%) and necessary (97%). Less than half (45%) of the staff correctly identified that there is no association between measles, mumps and rubella (MMR) vaccine and autism. Medical staff were more likely than nurses to disagree that giving multiple vaccines overloads the immune system (p0.01), or that complementary therapies reduced the need for a child to be vaccinated (p0.006). These knowledge deficits exist despite a reported awareness of immunisation resources. The majority (96%) of those surveyed reported that the Australian Immunisation Handbook was as a useful resource.Overall, the majority of staff agreed vaccines are safe, effective and necessary. This study highlighted that staff knowledge deficits and misconceptions about vaccines and vaccine management may be barriers to promoting opportunistic immunisation practices in ED.

Immunisation has been identified by World Health Organisation as one of the most cost beneficial health prevention strategies. Opportunistic immunising within the Paediatric Emergency Department (PED) gives healthcare professionals access to a hard to reach population. This study which used a cross-sectional survey design aimed to benchmark staffs’ knowledge, opinions and practices to opportunistic immunising in the PED, identifying if barriers exist. Addressing barriers that exist for the health professional within the PED will facilitate optimal immunisation uptake, especially for the hard to reach populations.