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Referring to the Specialist Immunisation Service

The Specialist Immunisation Service (SIS) is the only state-wide outpatient referral service for infants, children and adolescents who have specific and complex issues regarding immunisations.  The service is not intended for the routine provision of scheduled vaccines.  The referral criteria, outlined below, need to be fulfilled or individual patients can be discussed directly with the Allergy and Immunology consultant (see below).

The purpose of the SIS is to provide for the health-provider, family and individuals a risk/benefit assessment which is evidence based regarding immunisation or re-immunisation for those who have experienced an Adverse Event Following Immunisation (AEFI).  If indicated immunisations are provided in a medically supervised environment. 

The SIS is conjointly funded by SA Health and the Women's and Children's Hospital and is one of the services offered by the Department of Allergy and Immunology though the Women’s and Children’s Hospital.  The SIS is part of a national network of similar services (AEFI-CAN) and contributes to national and international surveillance and investigation of children who experience an AEFI.

Who can be referred?

Infants, children and adolescents can be referred to the SIS for further assessment if they:

  • have experienced a serious or unexpected adverse event following immunisation (AEFI)
  • have a medical condition(s) that may increase their risk of an adverse reaction following a vaccine
  • or their family have significant concerns regarding the safety of vaccines that cannot be addressed by a General Practitioner, immunisation provider, general or specialist paediatrician, the SA Health Immunisation Section or any other health service or provider.
  • are individuals who may be eligible to seek exemption under the Australian Governments Immunisation Approved Exemptions criteria (see 2.6.2.30 CCS). This states that if there is an Unacceptable risk of harm to the child or a person administering the vaccination then the child or adolescent can be assessed by a listed medical practitioner who can then apply to the Chief Medical Officer of Australia for an exemption.  The consultants in SIS are the listed medical practitioners for South Australia.

Some specific conditions that would fulfil referral criteria 

  • a convulsion with or without a fever in close proximity to immunisation
  • persistent and inconsolable screaming for greater than three hours
  • Hypotonic-hyporesponsive episode (HHE)
  • anaphylaxis or suspected anaphylaxis
  • generalised rash and/or angioedema occurring within 12 hours of immunisation
  • any other significant adverse event which is temporally related to immunisation and which is regarded as serious because it resulted in hospitalisation, disability or prevented the completion of the recommended immunisation schedule
  • children who are considered to be at a high risk of experiencing an adverse reaction post immunisation because they have an underlying medical disorder including any immunodeficiency disorder. 

Please note the presence of an underlying food allergy, including egg anaphylaxis, is not a contraindication to immunisation with any of the scheduled vaccines including the Influenza vaccine.  (see  https://www.allergy.org.au/hp/papers/vaccination-of-the-egg-allergic-individual).  These individuals should be immunised in primary care and not referred to SIS. 

How to refer your patient

Referring patients to the SIS is done either through:

  • SA Health's Immunisation Section or
  • Medical Practitioners  can refer by directly contacting the SIS at the Women’s and Children’s Hospital. A referral letter addressed to one of the SIS consultants will be required or
  • By reporting an AEFI to SA Health. When SA Health is notified of any unwanted or unexpected event occurring post immunisation, the Immunisation Section assesses the report and if criteria are met, will refer your patient to the SIS. 

For more information

For more information on referring patients to the SIS contact SA Health's Immunisation Section or to discuss individual referrals, please contact the Allergist on call at the Women’s and Children’s Hospital at 8161 7000 or 8161 8638 (the Department).

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