title: Canadian paediatricians' approaches to managing patients with adverse events following immunization: The role of the Special Immunization Clinic network.
abstract: BACKGROUND
  When moderate or severe adverse events occur after vaccination, physicians and patients may have concerns about future immunizations. Similar concerns arise in patients with underlying conditions whose risk for adverse events may differ from the general population. The Special Immunization Clinic (SIC) network was established in 2013 at 13 sites in Canada to provide expertise in the clinical evaluation and vaccination of these patients.
  
  
  OBJECTIVE
  To assess referral patterns for patients with vaccine adverse events or potential vaccine contraindications among paediatricians and to assess the anticipated utilization of an SIC.
  
  
  METHODS
  A 12-item questionnaire was distributed to paediatricians and subspecialists participating in the Canadian Paediatric Surveillance Program through monthly e-mail and mail contacts.
  
  
  RESULTS
  The response rate was 24% (586 of 2490). Fifty-three percent of respondents practiced general paediatrics exclusively and 52% reported that they administer vaccines. In the previous 12 months, 26% of respondents had encountered children with challenging adverse events or potential vaccine contraindications in their practice and 29% had received referrals for such patients, including 27% of subspecialists. Overall, 69% of respondents indicated that they would be likely or very likely to refer patients to an SIC, and 34% indicated that they would have referred at least one patient to an SIC in the previous 12 months.
  
  
  CONCLUSIONS
  Patients who experience challenging adverse events following immunization or potential vaccine contraindications are encountered by paediatricians and subspecialists in all practice settings. The SIC network will be able to respond to a clinical need and support paediatricians in managing these patients.
authors.affiliation: Department of Paediatrics, Dalhousie University and Canadian Center for Vaccinology, IWK Health Centre, Halifax, Nova Scotia;
authors.forename: Karina A
authors.initials: KA
authors.lastname: Top
authors.affiliation: Department of Social and Preventive Medicine, Laval University;
authors.forename: Joseline
authors.initials: J
authors.lastname: Zafack
authors.affiliation: Department of Social and Preventive Medicine, Laval University; ; Institut National de Santé Publique du Québec, Québec, Quebec.
authors.forename: Gaston
authors.initials: G
authors.lastname: De Serres
authors.affiliation: Department of Paediatrics, Dalhousie University and Canadian Center for Vaccinology, IWK Health Centre, Halifax, Nova Scotia;
authors.forename: Scott A
authors.initials: SA
authors.lastname: Halperin
keywords: Adverse events; Immunization; Referral