Queensland Adult Specialist Immunisation Service (QASIS)

Health professionals

QASIS provides specialist reviews and immunisation services for all Queensland adults who have experienced an adverse event following immunisation (AEFI) with a vaccine.  QASIS also accepts referrals for adults who are identified as at risk of experiencing an adverse event following immunisation.

QASIS is a multidisciplinary team that provides individualised advice to adults who meet referral guidelines either face to face or via telehealth.  QASIS operates out of a specialised facility at the Royal Brisbane and Women’s Hospital equipped to vaccinate individuals who require additional
supervision.

Most individuals with an adverse event following immunisation (AEFI) and with complex medical histories can proceed safely to vaccination after appropriate consultation and counselling.

Who should be referred to QASIS?

In scope

The service is available to Queenslanders aged 16 years and up. Examples of patients for review in QASIS prior to vaccination may include:

1. A history of anaphylaxis or generalised allergic reaction to any component of a vaccine to be administered (e.g., PEG or polysorbate 80)
2. A history of confirmed mastocytosis with recurrent anaphylaxis that requires treatment.
3. A history of a previous serious AEFI.  An AEFI is considered serious if it is life-threatening, requires hospitalisation, results in persistent or significant disability/incapacity, or requires intervention to prevent permanent impairment or damage.

Adults that have experienced a significant adverse event following a previous dose of COVID-19 vaccine should have their AEFI reported to Queensland Health. Under the Public Health Act 2005.

AEFI are a notifiable condition. It is very important that all AEFI are reported, particularly if serious or unexpected, as this will enable vaccine safety issues to be identified and managed appropriately as soon as possible. Following this, they can be referred to QASIS for review and management of
future COVID-19 vaccination. Examples of significant AEFI include:

1. Confirmed thrombosis with thrombocytopenia syndrome
2. Experienced immediate (within 4 hours) and generalised symptoms of an allergic reaction following receipt of a COVID-19 vaccine
3. Capillary leak syndrome
4. Guillain-Barre syndrome. Please note: these patients should be reviewed by a relevant specialist (neurologist) prior to referral.
5. Pericarditis / myocarditis. Please note: these patients can also be reviewed by a cardiologist prior to referral. Evaluation of post-vaccination chest pain syndrome should follow ATAGI/CSANZ guidelines, and these investigations should be included in referral. COVID-19 vaccination – Guidance on Myocarditis and Pericarditis after mRNA COVID-19 vaccines (health.gov.au)
6. Immune thrombocytopenia. Please note: these patients should be reviewed by a relevant specialist (haematologist) prior to referral

Out of scope

Children under the age of 16 years are recommended to be discussed with the Queensland Children’s Hospital service, Queensland Specialist Immunisation Service (QSIS). Queensland Specialist Immunisation Service (QSIS) – Information for health professionals

Referrals to QASIS specifically requesting the completion of a vaccine exemption will be rejected. Vaccine exemptions can be provided by an approved list of health care professionals to individuals who meet a limited set of criteria. QASIS clinicians will only provide medical exemptions where it is clinically indicated.

Referrals to QASIS specifically seeking assessment and opinion for a compensation claim will be rejected.

Patients who have experienced minor, common, or expected side effects to a  vaccine do not need to be referred to QASIS.

A list of expected side effects for each brand COVID-19 vaccine can be found at COVID-19 vaccination – Patient resources

QASIS does not provide vaccination requiring anaesthetic support i.e. procedural sedation. For consideration of Sedation Vaccinations please seek a referral to your local Hospital and Health Service.

To find the closest local Hospital and Health Service (HHS)

• Go to https://www.qld.gov.au/health/contacts/service-finder
• Click on the Hospital tab and search your postcode on the populated map.

Vaccination after testing positive for COVID-19

For further details please refer to COVID-19 vaccine – Clinical considerations

Who can and how to refer to QASIS?

All referrals must be made by a medical practitioner (e.g. no self-referrals).

Referrals with incomplete information or not made by a medical practitioner will not be accepted.

It is the responsibility of the referring clinician to ensure that their referrals meet referral guidelines and follow-up patients that have their referrals rejected to ensure that they receive timely vaccination.

Inappropriate referrals can lead to unnecessary delays in vaccination leaving patients vulnerable to infection.  If your patient does not meet referral guidelines and you require extra support, please contact your local Public Health Unit.

What must be included in your referrals to QASIS?

• History and supporting evidence of specific underlying medical condition
• Relevant medical conditions or GP concern and how it fits with QASIS referral guidelines
• Relevant detailed history that outlines the reaction to the vaccine (e.g. urticaria, angioedema, hypotension with vitals such as blood pressure, heart rate and oxygen saturation) AND time of onset after vaccination and observations
• Treatment provided to manage the outlined reaction
• Current medications and dosages and if any new medications were initiated at the time of the reaction
• Known or previous adverse drug reactions or other allergies, outlining the details of the reaction and when they occurred.
• Vaccination history and if the patient tolerated the vaccine.
• Any investigations done and the relevant results
• Other relevant Medical History and any other information important in relation to vaccination.

With specific conditions, it is important that all relevant information be included with the referral. These details were listed above in “Who should be referred to QASIS?”

Referrals will be returned if:

• patient is not eligible for vaccine
• incomplete referral
• does not meet referral criteria

Referrals that contain incomplete or inadequate information will be rejected.

Telephone advice

For health professionals within the community, immunisation enquiries should be directed to your local Public Health Unit. For questions unable to be answered by Public Health, health professionals should refer to your local public hospital infectious diseases or immunology physician. Patients and families with immunisation and child health enquiries are encouraged to call Queensland Health 13 HEALTH (13 43 25 84) to speak to a health professional.