Background

The Victorian Specialist Immunisation Services (VicSIS) network was established in 2021 to help support the COVID-19 vaccine rollout in Victoria. It is coordinated and funded by the Victorian Department of Health (DH) with clinical support provided by SAEFVIC at MCRI, in Melbourne.

The VicSIS team includes a broad range of vaccine experts, including infectious diseases specialists, immunologists, allergists and nurse practitioners. It provides specialist vaccination services for adults and children who have experienced an adverse event following immunisation (AEFI) with a COVID-19 vaccine, or for those who are identified as at-risk of experiencing an AEFI. VicSIS clinicians provide comprehensive consultations and individualised advice, both pre- and post-vaccination either face-to-face or via telehealth appointments. Vaccination under supervision can be facilitated where deemed necessary.

Information specific to the services provided to support COVID-19 vaccination in Victoria and details on the referral processes can be found below.

Adults

  • Which adult patients should be referred to VicSIS?

    Adults with a history of any of the following conditions may be referred VicSIS prior to COVID-19 vaccination as they may be at higher risk of experiencing an adverse event following immunisation (AEFI):

    • anaphylaxis or generalised allergic reaction (without anaphylaxis) to any component of the COVID-19 vaccine to be administered
    • multiple allergic reactions to medications containing PEG (for Comirnaty (Pfizer) or Spikevax (Moderna)) or polysorbate 80 (for Vaxzevria (AstraZeneca) or Nuvaxovid (Novavax))
    • confirmed mastocytosis with recurrent anaphylaxis that requires treatment
    • previous significant* AEFI
    • recent (within the past 3 months) or current inflammatory cardiac illness (myocarditis, pericarditis, endocarditis), acute rheumatic fever or acute rheumatic heart disease, or acute decompensated heart failure (please note these individuals can also be seen by their treating cardiologist).

    Any adult who has experienced a significant* adverse event following a previous dose of any COVID-19 vaccine should first have their adverse event reported to SAEFVIC. They should then be referred to VicSIS for review and management of future COVID-19 vaccination. Examples of significant AEFI include:

    Adults who have undergone pre-vaccination counselling with their usual provider but who require further specialist advice may also be referred to VicSIS.

    *An AEFI is considered significant if it is life-threatening, requires in-patient hospitalisation or prolongation of existing hospitalisation, deemed clinically significant, results in persistent or significant disability/incapacity or requires intervention to prevent permanent impairment or damage.

  • Which allergic conditions require a VicSIS referral?

    A referral to VicSIS allergy services is recommended if an individual has:

    • experienced immediate (within 4 hours) and generalised symptoms of an allergic reaction following receipt of a COVID-19 vaccine
    • a history of anaphylaxis or generalised allergic reaction to any component of a COVID-19 vaccine (eg. PEG or polysorbate 80)
    • a history of confirmed mastocytosis with recurrent anaphylaxis that requires treatment.

    Patients who have experienced a previous allergy to a non-COVID-19 vaccination should be referred to an allergy specialist. As previous anaphylaxis/allergy to a non-COVID-19 vaccine is not a contraindication to COVID-19 vaccination, individuals in this position are encouraged to proceed with COVID-19 vaccination. Other types of allergy (eg. food, latex or venom allergies) do not require a VicSIS referral – vaccines can be safely administered within the community with a routine 15 minute observation period.

    Please refer to Guidance for differentiating anaphylaxis from acute stress response for vaccine providers and Emergency Departments and MVEC: COVID-19 vaccines and allergy for more information.

  • Which adults do not need to be referred to VicSIS?

    Adults who have experienced minor, common or expected side effects to a COVID-19 vaccine do not need to be reported to SAEFVIC or referred to VicSIS.

    A list of the expected side effects of COVID-19 vaccines can be found at:

    For additional guidance on VicSIS referral eligibility please refer to the Clinicians Referral Guide to VicSIS.

  • Can adults requesting medical exemptions be referred to VicSIS?

    Vaccine exemptions can only be provided by an approved list of health care professionals to individuals who meet a limited set of criteria. VicSIS clinicians will only provide medical exemptions where it is clinically indicated. Referrals to VicSIS for the purposes of a medical exemption to COVID-19 vaccination will be rejected.

    More information on vaccine mandates and exemptions can be found at MVEC: Mandatory vaccine directions in Victoria.

  • Can adults with needle phobia be referred to VicSIS for COVID-19 vaccination?

    Generally speaking, it is recommended that individuals with anxiety, intellectual disabilities and needle phobias avoid attending large scale vaccination sites for immunisation. These sites are loud and busy and can increase distress. Smaller settings such as a GP clinic or pharmacy may be preferred. Strategies to assist with vaccination of needle phobic patients can be found at MVEC: Needle phobia.

    Adults (>16 years) who require additional support for addressing severe needle phobia can seek assistance here.

Children

  • Which children require specialist immunisation review?

    Children with a history of any of the following conditions can be referred to VicSIS prior to COVID-19 vaccination as they may be at higher risk of experiencing an AEFI:

    • anaphylaxis or generalised allergic reaction (without anaphylaxis) to any component of the COVID-19 vaccine to be administered
    • multiple allergic reactions to medications containing polyethylene glycol (PEG) (please check the ingredients of the patient’s current/previously tolerated medications as they may contain PEG)
    • a history of mastocytosis with recurrent anaphylaxis that requires treatment
    • a history of recent (eg. within the last 3 months) or current inflammatory cardiac illness (myocarditis, pericarditis, endocarditis), acute rheumatic fever or acute rheumatic heart disease, or acute decompensated heart failure (please note these individuals can also be seen by their treating cardiologist)
    • previous significant* AEFI (eg. anaphylaxis).

    Any child who has experienced a significant* adverse event following a previous dose of a COVID-19 vaccine should first have their adverse event reported to SAEFVIC. They should then be referred for specialist review and management of future COVID-19 vaccination.

    Examples of significant AEFI include:

    Children whose parents/guardians have undergone pre-vaccination counselling with their usual provider but who require further specialist advice may also be referred to VicSIS.

    *An AEFI is considered significant if it is life-threatening, requires in-patient hospitalisation or prolongation of existing hospitalisation, deemed clinically significant, results in persistent or significant disability/incapacity or requires intervention to prevent permanent impairment or damage.

  • Which allergic conditions require immunisation specialist review?

    A referral to VicSIS prior to COVID-19 vaccination is recommended if a child has a history of:

    • anaphylaxis or generalised allergic reaction (without anaphylaxis) to any component of the COVID-19 vaccine to be administered
    • multiple allergic reactions to medications containing polyethylene glycol (PEG) (please check the ingredients of the patient’s current/previously tolerated medications as they may contain PEG)
    • confirmed mastocytosis with recurrent anaphylaxis that requires treatment
    • previous significant allergic AEFI (eg. anaphylaxis).

    Other types of allergy (eg. food, latex or venom allergies) do not require a referral – vaccines can be safely administered in the community with a routine 15 minute observation period.

    Please refer to Guidance for differentiating anaphylaxis from acute stress response for vaccine providers and Emergency Departments for more information.

    Acute generalised urticaria (hives) can occur one to two weeks after vaccination and generally does not need VicSIS review. The patient can go on to have future vaccines in the community with the routine 15 minute observation period.  Persistent delayed urticaria post vaccination not responding to routine treatment can be referred to an allergy specialist for further follow up. 

  • Which children do not need to be referred for specialist advice?

    Children who have experienced minor, common or expected side effects following a COVID-19 vaccine do not need to have symptoms reported to SAEFVIC or be referred for specialist review.

    A list of the expected side effects of COVID-19 vaccines can be found at:

  • Should children who have previously experienced significant AEFI following a non COVID-19 vaccine seek specialist advice prior to receiving a a COVID-19 vaccine?

    Pre-vaccination referrals may be considered for children who have previously experienced a significant adverse event following immunisation (AEFI) with non COVID-19 vaccines. A significant adverse event describes an AEFI that is life-threatening, requires in-patient hospitalisation or prolongation of existing hospitalisation, deemed clinically significant, results in persistent or significant disability/incapacity or requires intervention to prevent permanent impairment or damage.

  • Can children with needle phobia be referred for COVID-19 vaccination?

    Generally speaking, it is recommended that children with anxiety, intellectual disabilities and needle phobias avoid attending large scale vaccination sites for immunisation. These sites are loud and busy and can increase distress. Smaller settings such as a GP clinic or pharmacy may be preferred.

    Further information and strategies to assist with needle phobia can be found at MVEC: Needle phobia.

    If all avenues for addressing severe needle phobia have been exhausted a referral (for those aged 15 years and under) may be submitted to VicSIS for supported vaccine administration.

    Information on which strategies have been trialed and details on the previous or anticipated barriers to vaccinating in the community must be included in the patient referral. Wait times can be significant and patients/families should be made aware of this.

    The following table outlines examples of strategies that should be considered prior to referral to prevent unnecessary delay to vaccination.

    Further information can be found in the COVID-19 vaccinations for children aged 5-11 years.

VicSIS eReferral

  • How do I make a referral to VicSIS?

    Referrals to VicSIS can be submitted by completing an eReferral through the VicSIS centralised referral and triaging system. The eReferral can be accessed via the button at the bottom of this page. Referrals must be completed by a medical practitioner only (ie. No self referrals/parent referrals) and must be complete with all details. Please ensure you include as much clinical detail as possible and attach all relevant documentation to assist in facilitating a timely review.

    Incomplete referrals can lead to unnecessary delays in vaccination, leaving patients vulnerable to infection.

  • Who can refer patients to VicSIS?

    Referrals can only be completed by a medical practitioner. Self or parent referrals will be rejected.

  • What is the expected wait time for an appointment?

    Due to vaccination requirements in Victoria, referring clinicians may need to consider providing patients with a temporary exemption where clinically indicated whilst they await a VicSIS appointment. Inappropriate referrals that do not meet the criteria outlined or have insufficient information will be rejected. The referring clinician will be notified of the referral outcome.

  • Which VicSIS clinic site should patients be referred to?

    Once a referral is received, it is then assessed by VicSIS Central and forwarded to the appropriate clinic based on geographical location and/or specialty. Referring clinicians do not need to identify which clinic or site a patient should be seen at.

    If a patient is already known to a particular health service, this information can be included in the referral as it may be more appropriate for them to be reviewed at the clinic at this site for continuity of care where possible. If the VicSIS clinic a patient previously attended is no longer operational, patients may be reallocated to a different health service.

  • Can referrals be sent via email directly to a specific VicSIS clinic?

    No. Referrals must be submitted via the centralised VicSIS eReferral system. Referrals sent via email directly to clinics will not be accepted and must be re-submitted appropriately as a VicSIS eReferral.

  • Is there notification of the outcome of referrals?

    Yes. Our eReferral portal allows referring doctors to be notified if a referral has been sent on to a clinic for triage or if a referral has not been accepted.
    If a referral is sent to a clinic for triage the referrer will receive correspondence regarding the outcome of the referral (ie. accepted for review or not accepted).

  • I have further questions, how do I get in contact?

    Should you require further information on referrals and appointments or are having issues submitting a referral, please contact VicSIS for support via the button below.

You can submit a eReferral to VicSIS by clicking the button below:

Authors: Nigel Crawford (Director SAEFVIC, Murdoch Children’s Research Institute), Francesca Machingaifa (MVEC Education Nurse Coordinator), Rachael McGuire (MVEC Education Nurse Coordinator), Sally Gordon (VicSIS Manager, Department of Health), Ngaree Blow (VicSIS Lead, Department of Health), Elise Virah Sawmy (Senior Project Officer, VicSIS, Department of Health) and Eleanor Duckworth (Project Officer, VicSIS, Department of Health)

Reviewed by: Rachael McGuire (MVEC Education Nurse Coordinator) and Maaki Dusanovic (VicSIS Practice Manager)

Date: September 30, 2022

Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.

You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.