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PUID: 51 || PLAB 2 Mock 4 :: Vaccination3: 2 Years Influenza Vaccination

Summary:

This PLAB 2 station involves counselling a parent who is hesitant to vaccinate their child against the flu, primarily due to concerns about adverse events observed in another child. The consultation focuses on explaining the flu vaccine, addressing vaccine misconceptions, assessing medical suitability, and navigating ethical communication with empathetic reassurance.



Key Points:


Flu Vaccine Overview

  • Live attenuated influenza vaccine (LAIV), administered nasally.

  • Recommended annually for children aged 2–17.

  • Not mandatory but highly recommended in the UK.

  • Contraindicated in:

    • Immunocompromised children

    • Those on long-term steroids or aspirin

    • Children with severe egg, gelatin, or neomycin allergies


Child-Specific Assessment

  • Ask about:

    • Fever or recent infections (may defer vaccination)

    • Past medical history, especially immune status

    • Current medications, especially immunosuppressants

    • Allergies (egg, gelatin, neomycin)

    • Milestone development and general well-being


Addressing Misconceptions

  • Do not speculate about another child’s health.

  • Avoid explaining febrile seizures unless directly relevant.

  • Emphasize no proven link between flu vaccine and fits.

  • Validate concerns and redirect focus to factual safety data.


Important Considerations:

  • Live attenuated vaccines can cause mild symptoms due to immune response, but not the flu itself.

  • Parental consent is essential; no treatment can be forced under NHS policy.

  • Cultural sensitivity is vital in refusal cases.

  • Use ICE (Ideas, Concerns, Expectations) to guide the conversation.

  • Respect parental autonomy but ensure informed refusal.


Diagnostic Approach:

  1. Confirm identity of the parent and child.

  2. Establish the reason for the consultation and parent's concerns.

  3. Review child’s recent symptoms and general health.

  4. Elicit full medical, allergy, and medication history.

  5. Ask about previous vaccine experiences and any adverse reactions.


Management:

  • Explain:

    • Flu vaccine is a live attenuated nasal spray.

    • It primes the immune system for future protection.

    • Mild symptoms (e.g., runny nose, fatigue) are normal post-vaccine.

  • Clarify:

    • There is no evidence linking the vaccine to seizures.

    • Previous tolerance to the vaccine supports safety.

  • Provide:

    • Leaflet on flu vaccine and immunization schedule.

    • Safety netting: seek medical help for high fever or persistent symptoms.

    • Offer follow-up if further concerns arise.

    • Discuss school-based vaccination and consent logistics.


Communication Skills:

  • Use clear, jargon-free explanations.

  • Empathetic phrases:

    • "I completely understand your concerns."

    • "Many parents share the same worries."

  • Validate feelings and offer reassurance.

  • Encourage open questions and summarize key points.

  • Avoid assumptions and maintain professional tone throughout.


Ethical Considerations:

  • Respect for parental autonomy and cultural beliefs.

  • Ensure valid informed consent or informed refusal.

  • Clarify the child's rights to health, but avoid coercion.

  • Avoid judgment and remain supportive, per GMC guidance.


Additional Resources:

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