The American College of Emergency Physicians (ACEP) working group on emergency departments (ED) pediatric vaccinations strongly advocates for childhood vaccinations. As frontline providers and the primary safety net for underserved populations, EDs and their staff play a key public health role for many public health initiatives. Providing and advocating for pediatric vaccinations is part of our public health mission.
The role of the ED in participating in public health initiatives is well-described. EDs have historically implemented a number of preventive interventions, ranging from screening for HIV infection, screening and referral to therapy for alcohol use disorder, and fall prevention interventions.1-4 In terms of vaccinations, EDs have provided post-exposure prophylaxis (PEP) for rabies and tetanus and have served an important role for adult patient immunizations during influenza outbreaks and the COVID-19 pandemic.5-8 Similarly, the ED can play an active and important role in the delivery of vaccinations in children, with the purpose of post-exposure prophylaxis, routine childhood vaccinations, and epidemiologically relevant vaccinations (i.e., seasonal vaccinations and vaccination programs during local outbreaks). The rising ED volumes continue to include a disproportionately increasing underserved, uninsured and minority population that is less likely to have had adequate preventive and primary care access and are more likely to be under-immunized.9 For these reasons, EDs represent a potentially important public health opportunity to vaccinate under vaccinated children.
ACEP supports a tailored (site-specific) approach for EDs, with consideration of population-centered immunization rates and needs, temporal and geographic epidemiological patterns, and local resources. In this document, we present a comprehensive, adaptable toolkit for the development of ED vaccination programs for pediatric patients.
The document provides guidance, practical approaches and ‘smart phrases’ for general assessment of childhood vaccinations status, referrals for vaccinations within the community, delivery of vaccines in the ED, and vaccination discussions with ED patients and parents. We also discuss factors to consider when determining the most appropriate vaccination program for each ED.
Formation of the ACEP Working Group on ED Pediatric Vaccinations
The ACEP working group on ED pediatric vaccinations consisted of eight members, included experts in pediatrics, pediatric emergency medicine, vaccine delivery, ED preventive interventions, and vaccine hesitancy. The Initial meeting was in January 2023 (with four additional meetings in addition to asynchronous work). The process included biweekly meetings with consensus on all topics among group members and was guided by a review of the best available evidence, expert opinion, and observational experience. The working group was supported by Centers for Disease Control and Prevention grant (NU50CK000570C6). The contents of this toolkit do not necessarily represent the policy of Centers for Disease Control and Prevention or Health and Human Services and should not be considered an endorsement by the Federal Government.
ACEP Pediatric Emergency Department Vaccination Working Group Members
- Sandy Schneider, MD, FACEP (American College of Emergency Physicians)
- Michael Waxman, MD, MPH, FACEP (Department of Emergency Medicine, Albany Medical College)
- Lance Rodewald, MD (Centers for Disease Control and Prevention)
- Peter G. Szilagyi, MD, MPH (Department of Pediatrics, UCLA Medical School)
- Sharon G. Humiston, MD, MPH, FAAP (Department of Pediatrics, UMKC School of Medicine)
- Robert Rodriguez, MD (Department of Emergency Medicine, USCF School of Medicine)
- Asalim Thabet, MD (Department of Emergency Medicine, Upstate Medical University)
- Christopher Woll, MD (Departments of Emergency Medicine and Pediatrics, Albany Medical College)
Acknowledgements
- Drishti Patel (Albany Medical College), Shreya Srivastava (Albany Medical College), Marla Payne (American College of Emergency Physicians)
- This Identify-Isolate-Inform tool was adapted with permission from a tool conceived by Dr. Kristi L. Koenig, County of San Diego EMS Medical Director & Professor Emerita, UC Irvine.
References
- Gordon JA, Goldfrank LR, Andrulis DP, D'Alessandri RM, Kellermann AL. Emergency department initiatives to improve the public health. Acad Emerg Med 1998;5(9):935-7. DOI: 10.1111/j.1553-2712.1998.tb02827.x.
- Haukoos JS, Lyons MS, Rothman RE. The Evolving Landscape of HIV Screening in the Emergency Department. Ann Emerg Med 2018;72(1):54-56. DOI: 10.1016/j.annemergmed.2018.01.041.
- Barata IA, Shandro JR, Montgomery M, et al. Effectiveness of SBIRT for Alcohol Use Disorders in the Emergency Department: A Systematic Review. West J Emerg Med 2017;18(6):1143-1152. DOI: 10.5811/westjem.2017.7.34373.
- Hammouda N, Carpenter CR, Hung WW, et al. Moving the needle on fall prevention: A Geriatric Emergency Care Applied Research (GEAR) Network scoping review and consensus statement. Acad Emerg Med 2021;28(11):1214-1227. DOI: 10.1111/acem.14279.
- Hsu SS, Groleau G. Tetanus in the emergency department: a current review. J Emerg Med 2001;20(4):357-65. DOI: 10.1016/s0736-4679(01)00312-2.
- Gibbons K, Dvoracek K. Rabies postexposure prophylaxis: What the U.S. emergency medicine provider needs to know. Acad Emerg Med 2023. DOI: 10.1111/acem.14755.
- Slobodkin D, Kitlas J, Zielske P. Opportunities not missed--systematic influenza and pneumococcal immunization in a public inner-city emergency department. Vaccine 1998;16(19):1795-802. DOI: 10.1016/s0264-410x(98)00183-2.
- Rodriguez RM, O'Laughlin K, Eucker SA, et al. PROmotion of COvid-19 VA(X)ccination in the Emergency Department-PROCOVAXED: study protocol for a cluster randomized controlled trial. Trials 2022;23(1):332. DOI: 10.1186/s13063-022-06285-x.
- Waxman MJ, Ray M, Schechter-Perkins EM, et al. Patients' Perspectives on Emergency Department COVID-19 Vaccination and Vaccination Messaging Through Randomized Vignettes. Public Health Rep 2022:333549221085580. DOI: 10.1177/00333549221085580.
