Vaccination under sedation in children with needle phobia or behavioural difficulties: A retrospective study

Children and adolescents with conditions such as needle phobia and neurodevelopmental disorders may have difficultly being vaccinated in the community. Assisted vaccination clinics provide tailored support for children with additional needs surrounding routine scheduled vaccine administration. This study evaluates the efficacy of an assisted vaccination clinic, in Australia over a decade.

This was a retrospective cohort study conducted from 2015 to 2024. The participants included children who were referred to the Assisted Vaccination Clinic at the Children's Hospital Westmead following unsuccessful attempts at vaccination in the community. Study data were extracted from electronic medical records and patients' vaccination records reviewed in the Australian Immunisation Register.

Between 1 January 2015 and 31 December 2024, 169 patients were seen across 227 clinic visits. The median age was 13.3 years (IQR 11.7-14.9 years). Needle phobia (171/227, 75.3%) and autism spectrum disorder (76/227, 33.5%) were the most frequently reported conditions associated with being seen in the clinic. HPV (70.9%, 161/227), dTpa (62.6%, 142/227), and MenACWY (21.6%, 49/227) were the most frequent vaccines required for administration. Inhaled nitrous oxide 96/227 (42.3%) and oral midazolam 22/227 (9.7%) were the most frequently used pharmacological interventions. Oral lorazepam was used as a pre-hospital medication on 26 occasions. Non-pharmacological interventions were employed to optimise patient comfort in 52% of visits. Successful vaccination occurred in 77.1% (175/227) of visits. Long term follow-up was conducted for 87/170 patients who had subsequently turned 17 years of age, 72/87 (82.8%) had received further vaccines in the community and 58/87 (66.7%) were up-to-date with their scheduled vaccines.

Children with needle phobia and/or behavioural difficulties who cannot be vaccinated in the primary care setting may be successfully vaccinated using a tailored sedation service. Vaccine coverage of this group of previously under-vaccinated children managed at this clinic reached that of their peers nationwide.