Consent For Vaccination In Children: Importance And Protocol

Valid consent for any medical procedure

Discuss about the Case Study of Immunization for Australian Technical Advisory.

Valid consent for any medical procedure defined as a verbal agreement of an individual in the specific method after receiving a detailed explanation of risk factors, health benefits and potential side effects. As a part of the consent procedure, sufficient information about the disease and some information about the protocols of health centers should be given to the patient to receive consent from the individual to be vaccinated. According to Australian Immunization Register Act 2015, it was stated that before 18 years both the parents could permit on behalf of children for proceeding with vaccination (Humanservices.gov.au. 2018). Moreover, family act law (1975), which predominately deals with divorced or separated parents define that the power of deciding for child exclusively given to the parent who has custody of the child (Legislation.gov.au. 2018).In that context, Albert, father of Mia and Rose, mother of Mia both equally share legal custody for Mia. Therefore, both the parent holds the hierarchy for deciding on behalf of Mia. In that context, consent of Albert without Mia’s mother will not get prime priority for vaccination procedure. 

It is suggested to proceed with vaccination process after completing the pre-vaccination assessment and obtaining consent from Mia’s father. The prime reason for this decision solely revolves around the health of the child. To protect the health and safety of children Government of Australia has given authority to one of the parents to provide the consent of vaccination for severe outbreak such as Pertussis. In all possible cases, the government of Australia legislated rules where the physician should solely focus on the best interest of children, which supported by scientific evidence of risk factors mentioned by a physician (Australian Technical Advisory Group on Immunisation 2017.)In this above scenario, Mia who is five years old is in custody of both parents. Therefore, both the parents share the same rights on Mia in consent for vaccination of severe disease. Therefore, approval of Albert is not enough to proceed with treatment. On a contradictory, due to a severe outbreak of Pertussis in the locality where 72% coverage of vaccination observed, high chances for Mia to be infected with Borrelia pertussis, which causes whooping cough. In case of children vaccination for younger than ten years  DTap (Diphtheria, tetanus and pertussis) should be recommended for preventing wide spread of deadly diseases for. Besides, the vulnerability degree of Mia also extremely high as last vaccination she has received two years ago. There are chances that Mia will be infected with influenza as the secondary disease. Moreover, Mia’s stepmother Talia is a first week pregnant with a child. There are probabilities that a newborn will also be infected due to low immunity. Antibodies produced by injecting vaccination protect women and passes to the newborn in the first week of the pregnancy where newborns are most vulnerable (Australian Government Department of Health 2018). Therefore, for the best interest of Mia, Stepmother and newborn, supported by all shreds of evidence and records, histories of vaccination it is preferable to proceed with Albert’s consent. 

Australian laws for vaccination of children

In recent years, Countries such as the USA and Australia has faced many outbreaks of many severe diseases that threatened many lives. On a different note, Refusal of vaccination also increases simultaneously. A considerate number of parents requested to modify the technique of vaccination in addition to the composition of the vaccine to avoid the side effects of vaccines. In most of the scenario, parents become paranoid to give consent for vaccination due to negative side effects, some them think vaccinations are not that important for curing severe diseases like influenza, whooping cough and varicella (Dube, Vivion, and MacDonald 2015). A small portion of the community also suspected chemical compositions of vaccines as the culprit of negative side effects such as anaphylaxis reaction or general allergy (Ward et al. 2017). Moreover, the internet has a huge effect on the refusal of consent vaccination. Majority of individuals with no sound knowledge about biology show prime dependence on the internet as a result of which they hold on to old believes of vaccination. The Internet may show negative impacts of vaccination which become believe of parents in the recent era of technology. Bided by the rules, there is almost no probability for medical experts to go beyond the protocol for the proper medical procedure unless patient suffers for a disease that shortens lifespan, in that case, immediate action should be taken. Therefore, immunization and prevention of killer diseases become more difficult to cure. However, researchers found out several different ways of communicating with parents regarding vaccination and gain their trust to proceed with the certain medical procedure. Communication can be verbal where patient or family of the patient can interact, or explanation of benefits of vaccination can be done using writing materials, kits to provide sound knowledge about the disease to family members (Kahan 2016). In the above scenario, the situation is quite similar. In the above scenario, Mia is 5years child whose mother refuses to give to consent for vaccination who might have erogenous information about vaccination or previous unpleasant experiences involving vaccination. As a consultant or physician of Mia, I will communicate with Mia’s mother. First, as a medical officer, I will pay attention and response to the emotional narrative of Mia’s mother, Rose. After that, I will try to address her specific concerns then I will explain her different perspectives on vaccination. I will explain her benefits of vaccination for vaccine-preventable disease such as pertussis, diphtheria, influenza. I will explain the major risks of untreated pertussis and epidemiology of influenza and all the necessary information to make a rational decision for vaccination. Besides, I will explain the concept of herd immunity to Mia’s mother. Herd immunity is an immunization process, which limits the spreading of the disease within peers (Mallory, Lindesmith and Baric 2018). Besides, herd immunity has a huge contribution to curing life-threatening disease in children younger than 5years. In this context, Mia’s vaccination will help many another individual in surroundings to fight diseases like influenza and Pertussis. 

Importance of proper consent for vaccination

Anaphylaxis is a life-threatening multi-organ involving acute disease that observed due to the release of an inflammatory mediator. In children, it is a response triggered by food allergen or administration of vaccination, which eventually leads to IgE mediated anaphylaxis reaction (Palmiere, Tettamanti and Scarpelli 2017). Anaphylaxis is a sudden onset reaction where the cardiovascular system and respiratory system are a prime location for a shock. Generally, bronchoconstriction and laryngeal oedema observed in severe cases of anaphylaxis along with the involvement of the central nervous system, mainly hypoxia (McNeil et al. 2016).Early signs that observed in anaphylaxis involved skin where urticaria, erythema and other adverse effects in subsequent tissues. Other common symptoms for this shock are abdominal pain, vomiting and diarrhea. In routine vaccination, anaphylaxis is rare but fetal. Fainting (vasovagal episode) is also a widespread phenomenon in adolescence, but children rarely faint. However, in children, sudden loss of consciousness consider as major physical identification of anaphylaxis, especially if the physician observed that central pulse is not present where central pulse present in fainting during vaccination. Biochemistry also confirms the anaphylaxis phenomenon during the routine course of vaccination. For the identification of the prime biomarker, mast cell tryptase of serum to be measured (Mercurio et al. 2018). For measurement of the severity of the reaction, Meuller grading system will be used to severity.  In the first stage, malaise, itching along with generalized urticaria observed. In the second stages, the symptoms such as tightness of the throat or chest, vomiting, nausea, abdominal pain observed. In the third stages, hoarseness, dysphagia, confusion, weaknesses are key symptoms. In forth stage or severe most stage, collapse, hypotension and loss of consciousness observed (Klaver et al. 2016).

In order to manage the anaphylaxis, immediate administration of first-line drug adrenaline should be recommended as a physician. Anaphylaxis is life threatening if non treated correctly and overtreatment leads to allergy. If the patient is unconscious, then keeping him or her in the leftward for receiving clear airways should be recommended. If the patient is conscious then keeping him or her supine should be recommended. If any respiratory or cardiovascular symptoms observed, then injection 1: 1000 adrenaline into the anterolateral thigh with the dose of 0.01 mL/kg body weight up to a maximum of 0.5 mL should be recommended. This injection helps to disperse systemically. Adrenaline auto-injector also recommended for those individuals who have an exceptionally high risk of anaphylaxis due to existing allergy from food, and it should be administrated in mid-thigh (Umasunthar et al. 2015). However, an auto-injector should not be used for the underweight child. Oxygen mask should be used in case of absence of oxygen. The repeated dose of adrenaline in every five minutes should be used in case of no improvement. To check the stability of breathing performing cardiopulmonary resuscitation (CPR) should be recommended (Fleming et al. 2016).For optional drug, antihistamines are used to management anaphylactic patient (Dhami et al. 2014). Besides, other drugs such as diphenhydramine should be administrated orally. It also used as intramuscular injections with the standard dose is 1–2 mg/kg body weight for managing the severe case (Arruda et al. 2017) 

Risks and benefits of vaccination

Vaccination is a process that induces the immunization into the body so that it can strongly response to antigens. Sometimes, vaccination through attenuated or living biological entities manages to induce the predictable mild adverse reaction. However, there is a high probability of undetectable effects of vaccination in individuals. Therefore world health organization classified those adverse effects as “adverse events following immunization (AEFIs)”( World Health Organization 2018).Adverse effect defined as any unwanted symptoms or an unpleasant sign of a particular disease. Anaphylaxis is one of the rare adverse effects that mostly observed in vaccination, which can be fatal. Adverse events following immunization can be divided into two key categories; one is common expected AEFI and another one is rare and unexpected AEFI. All drugs give rise to few side effects that sometimes similar with symptoms of other diseases ,which excepted to observe in few individual such as redness, pain, swelling, itching and burning sensation (Mahajan et al. 2015). In order to avoid such events as a physician it is recommended that Before giving consent to any immunization process, detailed information of clinical symptoms should be clarified from the medical expert.  Registration of vaccination should be clarified from experts. Biological characteristics of vaccines and carrier molecule such as adjuvant should be noted to get the proper vaccination. In order to avoid any adverse reaction, any other medical histories or disability in any part of the body should be rectified, and detailed information about medical procedure should be rectified from healthcare experts. Ensuring the appropriate vaccination and detailed information proper dose of vaccination should be taken.  Parents should confirm that Vaccinations that provided to patients should be strictly for that specific age group. Medical experts should clarify the dilutions of vaccination in proper amount. Health care expert should provide correct intervals for additional vaccination. Parents should ensure that vaccines that administrated to the patient should be properly stored in low temperature. Even after successful vaccination if patient experience fever, in that case, appropriate dose or ibuprofen or paracetamol should be given to the patient( World Health Organization, 2016).The local reaction to vaccination generally does not require the assistance of a medical expert. However, the systematic reaction in the body requires assistance trained medical experts. On the other hand, the occurrence of the adverse event following immunization rarely observed and it actively involved neurology, immunology. Mostly observed effects in vulnerable individuals are seizures, hypotonic-hyporesponsive episodes (HHE), thrombocytopenic, allergic reaction and anaphylaxis (Gore et al. 2016). In order to avoid this adverse effect thorough check-up of individuals should be recommended. Examination of Any food habits or pollen allergy from health expert should be recommended. Inappropriate route of immunization should be avoided. To avoid further infection disposal of clinical waste, as well as sharps and immunizing agent vials should be recommended. After vaccination, it should be recommended to cover the side of vaccination. By following this guideline, parents will be able to feel secure about vaccination for their child and avoid any traumatic experience of vaccination. 

Addressing parental concerns about vaccination

References:

Australian Government Department of Health. (2018). Free whooping cough and influenza vaccines for pregnant women | Australian Government Department of Health. [online] Available at: https://beta.health.gov.au/news-and-events/news/free-whooping-cough-and-influenza-vaccines-for-pregnant-women [Accessed 17 Jul. 2018].

Australian Technical Advisory Group on Immunisation (ATAGI) 2017, The Australian immunisation handbook, 10th edn (2017 update), Australian Government Department of Health, Canberra, 17 January 2018, Retrivedfrom: https://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home

Dhami, S., Panesar, S.S., Roberts, G., Muraro, A., Worm, M., Bilò, M.B., Cardona, V., Dubois, A.E.J., DunnGalvin, A., Eigenmann, P. and Fernandez?Rivas, M., 2014. Management of anaphylaxis: a systematic review. Allergy, 69(2), pp.168-175.

Dube, E., Vivion, M. and MacDonald, N.E., 2015. Vaccine hesitancy, vaccine refusal and the anti-vaccine movement: influence, impact and implications. Expert review of vaccines, 14(1), pp.99-117.

Fleming, N.T. and Haruta, S., G2B Pharma Inc., 2016. Intranasal Formulation for the Treatment of Cardiopulmonary Resuscitation (CPR), Cardiac Life Support (CLS), Anaphylaxis and/or Anaphylactoid Reactions. U.S. Patent Application 14/916,098.

Gore, R.S., Garg, Y.R., Jain, S. and Dahiya, A., 2016. A rare side effect to pentavalent vaccine. International Journal Of Community Medicine And Public Health, 3(7), pp.1972-1974.

Humanservices.gov.au. (2018). Australian Immunisation Register – Australian Government Department of Human Services. [online] Available at: https://www.humanservices.gov.au/individuals/services/medicare/australian-immunisation-register [Accessed 18 Jul. 2018].

Kahan, D.M., 2016. Protecting the Science Communication Environment: The Case of Childhood Vaccines.

Klaver, C.C., Moriyama, M., Shinohara, K., Kawasaki, Y. and Yamazaki, M., 2015. International photographic classification and grading system for myopic maculopathy. American journal of ophthalmology, 159(5), pp.877-883.

Legislation.gov.au. (2018). Australian Immunisation Register Act 2015. [online] Available at: https://www.legislation.gov.au/Details/C2017C00258 [Accessed 17 Jul. 2018].

Mahajan, D., Dey, A., Cook, J., Harvey, B., Menzies, R. and Macartney, K., 2015. Surveillance of adverse events following immunisation in Australia annual report, 2013. Commun Dis Intell Q Rep, 9(3039), p.3.

Mallory, M.L., Lindesmith, L.C. and Baric, R.S., 2018. Vaccination-Induced Herd Immunity: Successes and Challenges.

McNeil, M.M., Weintraub, E.S., Duffy, J., Sukumaran, L., Jacobsen, S.J., Klein, N.P., Hambidge, S.J., Lee, G.M., Jackson, L.A., Irving, S.A. and King, J.P., 2016. Risk of anaphylaxis after vaccination in children and adults. Journal of Allergy and Clinical Immunology, 137(3), pp.868-878.

Mercurio, I., Cornacchia, F., Capano, D., Ricci, L., Piergiovanni, D. and Gabbrielli, M., 2018. Serum tryptase, Immunoglobuline E assay and circumstantial data are fundamental tools for the post-mortem diagnosis of food anaphylaxis: a case. ROMANIAN JOURNAL OF LEGAL MEDICINE, 26(1), pp.47-50.

Palmiere, C., Tettamanti, C. and Scarpelli, M.P., 2017. Vaccination and anaphylaxis: a forensic perspective. Croatian medical journal, 58(1), pp.14-25.

Umasunthar, T., Procktor, A., Hodes, M., Smith, J.G., Gore, C., Cox, H.E., Marrs, T., Hanna, H., Phillips, K., Pinto, C. and Turner, P.J., 2015. Patients’ ability to treat anaphylaxis using adrenaline autoinjectors: a randomized controlled trial. Allergy, 70(7), pp.855-863.

Ward, P.R., Attwell, K., Meyer, S.B., Rokkas, P. and Leask, J., 2017. Risk, responsibility and negative responses: a qualitative study of parental trust in childhood vaccinations. Journal of Risk Research, pp.1-14

World Health Organization, 2016. Immunization safety surveillance: guidelines for immunization programme managers on surveillance of adverse events following immunization.

World Health Organization, 2018. Causality assessment of an adverse event following immunization (AEFI): user manual for the revised WHO classification.