Immunizing Patients With Adverse Events After Immunization and Potential Contraindications to Immunization: A Report From the Special Immunization Clinics Network.
For patients who have experienced adverse events following immunization (AEFI) or who have specific medical conditions, there is limited evidence regarding the best approach to immunization. The Special Immunization Clinics (SICs) Network was established to standardize patient management and assess outcomes after reimmunization. The study objective was to describe the first 2 years of the network's implementation.



Twelve SICs were established across Canada by infectious diseases specialists and allergists. Inclusion criteria were as follows: local reaction ≥ 10 cm, allergic symptoms < 24 hours postimmunization, neurologic symptoms and other AEFI or medical conditions of concern. Eligible patients underwent a standardized evaluation, causality assessment was performed, immunization recommendations were made by expert physicians and patients were followed up to capture AEFI. After individual consent, data were transferred to a central database for analysis.



From June 2013 to May 2015, 151 patients were enrolled. Most were referred for prior AEFI (132/151, 87%): 42 (32%) for allergic-like reactions, 31 (23%) for injection-site reactions, 20 (15%) for neurologic symptoms and 39 (30%) for other systemic symptoms. Nineteen patients (13%) were seen for underlying conditions that complicated immunization. Reimmunization was recommended for 109 patients, 60 of whom (55%) were immunized and followed up. Eleven patients (18%) experienced recurrence of their AEFI; none were serious (eg, resulting in hospitalization, permanent disability or death).



The most frequent reasons for referral to a SIC were allergic-like events and injection site reactions. Reimmunization was safe in most patients. Larger studies are needed to determine outcomes for specific types of AEFI.
From the *Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada; †Centre hospitalier universitaire de Québec, Université Laval, Québec, Quebec, Canada; ‡Ministère de la Santé et des Services sociaux du Québec, Quebec, Canada; §McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada; ¶Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada; ‖Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada; **Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; ††Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada; ‡‡Vaccine Evaluation Centre, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; §§Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada; ¶¶Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada; ‖‖Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; and ***Institut national de santé publique du Québec, Université Laval, Québec, Quebec, Canada.
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D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D000075202:Contraindications; D016208:Databases, Factual; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007114:Immunization / Q000009:adverse effects* / Q000706:statistics & numerical data; D007223:Infant; D008297:Male; D011446:Prospective Studies