ACEP Pediatric Emergency Department Vaccination Toolkit
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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
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.
