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Next major review to be completed by:    April 2031
Content owner:                                          Emergency Medicine Standards Advisory Committee
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Revision History

1. Purpose and scope

ACEM recognises that immunisation against vaccine-preventable disease is one of the cornerstones of modern public health.

This document is a policy of the Australasian College for Emergency Medicine (ACEM). The aim of this policy is to outline the role of emergency departments (EDs) and ED staff in immunisation within the department.

The policy is applicable to EDs in Australia and Aotearoa New Zealand.

2. Background

Vaccination has reduced mortality and morbidity from vaccine-preventable diseases (VPDs), such as measles, polio, tetanus, diphtheria and influenza, across age groups but particularly for children. Australia and Aotearoa New Zealand overall have very high vaccination rates, which has led to Australia being declared polio free in 2000, the transmission of endemic measles being eliminated in 2014 and the transmission of endemic rubella being eliminated in 2018.[1]

However, since the COVID 19 pandemic Australia and Aotearoa New Zealand have been following the global trend of a gradual reduction in immunisation rates. Consequently, the incidence of many VPDs is increasing and threatening to reverse progress made in reducing the burden of VPDs across the world. This reduction is partly due to missed childhood vaccinations during the COVID pandemic but also due to increasing vaccine hesitancy or postponement especially for children. Incomplete or unvaccinated travellers are also an emerging risk for the spread of VPD.

There are many factors influencing this reduction including acceptance barriers – people’s thoughts and feelings about vaccinations and their social influences – and access barriers – practical difficulties in accessing vaccinations.[2] In 2019 the World Health Organization listed vaccine hesitancy as one of the top 10 threats to global health.[3]

3. Policy

The primary provider of routine vaccinations is the primary health care sector; however opportunistic immunisations can be considered in the ED for incompletely immunised patients who have limited access to other immunisation providers.

Immunisation programs are most effective when delivered as an integrated part of routine patient care in the primary health sector rather than in isolation.[4] This ensures continuation of care and helps to ensure the vaccination schedule is complete. EDs will support primary and public health in the implementation and maintenance of immunisation programs.

ACEM recommends collaboration between public health authorities and hospital resources (including EDs) to ensure a cooperative and efficient approach to urgent responses to infectious outbreaks. ACEM recommends that emergency physicians be involved in any jurisdiction or hospital emergency planning in the event of any future or emerging infectious outbreaks, including rapid community immunisation (see P33 Emergency department disaster preparedness and response).[5]

EDs frequently provide healthcare for incompletely immunised adults and children who may be difficult to reach by other health services and who are at risk of VPD. EDs are well placed to offer opportunistic vaccination to these patient groups and contribute to broader vaccination strategies. Patients requiring immunisations to be given in the ED should be provided with appropriate information regarding the illnesses covered in the immunisation program and the consequences of not vaccinating. 

Given the rising rates of vaccine hesitancy, ED staff should ensure a vaccination history is taken as a part of standard care when appropriate, through an inquisitive and non-judgemental approach and provide evidence-based information as they would for any other health condition. Government and non-government agencies publish resources to assist clinicians and patients make informed decisions about vaccinations and to assist clinicians discuss vaccines and manage vaccination hesitancy. (see 5. Resources)

ACEM strongly recommends the immunisation of all ED staff to prevent transmission of VPD. ED staff should be advised about the benefits of immunisation against VPDs and supported through their employer staff health service to ensure complete immunisation, including for influenza.