Uncertain vaccination history — catch-up counselling OSCE · Paeds Cases

Prompt

4-year-old new to the practice; parent-held book incomplete; some overseas vaccines possible; school forms due.

Objectives

Reconstruct incomplete or overseas vaccination history using register and records. [1] [7]
Explain valid versus invalid doses in plain language. [1] [3]
Offer same-day catch-up without automatically restarting series. [1] [2]
Book the next earliest valid visit and safety-net. [7]

Candidate brief

8-minute station with a parent of a 4-year-old new to the clinic. Parent-held book incomplete; overseas vaccines possible; school forms due. No acute illness and no known severe vaccine allergy. [1] [4]

Expected actions

Open a focused immunisation history and commit to national register review. [1] [7]
Explain that only doses meeting age and interval rules count. [1] [3]
Offer due vaccines today when safe; do not restart valid series. [1] [2]
Book next earliest valid date; mention register reporting and school form pathway without promising one-visit completion. [7]
Screen for contraindications and prior severe reactions; use teach-back. [1] [4]

Marking

Pass: registry-first plan, valid-dose logic, same-day catch-up, booked return, clear counselling. [1] [2] [7]
Fail: restart everything without record review; indefinite serology delay as default; no return booking; ignore exposure urgency if raised. [1] [2] [4]

Model synthesis

After registry and record review, continue from valid doses, catch up remaining antigens with same-day vaccines where safe, separate live injectables by at least 4 weeks if not co-administered, document and report, and escalate to post-exposure pathways if an exposure occurs. [1] [2]

References

[1]Kroger AT General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports, 2006.PMID 17136024
[2]Issa AN Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger - United States, 2025. MMWR. Morbidity and mortality weekly report, 2025.PMID 39819853
[3]Stokley S Evaluation of invalid vaccine doses. American journal of preventive medicine, 2004.PMID 14700710
[4]Abu-Shamsieh A Pediatric Care for Immigrant, Refugee, and Internationally Adopted Children. Pediatric clinics of North America, 2022.PMID 34794672
[5]Dvergsdal ET Low Childhood Vaccination Coverage among Ukrainian Refugees in Norway. A Nationwide, Register-Based Cohort Study, 2022-2023. Journal of immigrant and minority health, 2025.PMID 40668470
[6]Schillie S Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports, 2018.PMID 29939980
[7]Nyinawingeri A Using the Australian Immunisation Register to support general practices to improve childhood vaccination rates. Australian journal of general practice, 2024.PMID 38437660
[8]Hull B Annual Immunisation Coverage Report 2023. Communicable diseases intelligence (2018), 2026.PMID 41730159
[9]Crockett M New faces from faraway places: Immigrant child health in Canada. Paediatrics & child health, 2005.PMID 19668632
[10]Liang JL Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports, 2018.PMID 29702631

Expected actions

Open a focused immunisation history and commit to national register review. [1] [7]

Explain that only doses meeting age and interval rules count. [1] [3]

Offer due vaccines today when safe; do not restart valid series. [1] [2]

Book next earliest valid date; mention register reporting and school form pathway without promising one-visit completion. [7]

Screen for contraindications and prior severe reactions; use teach-back. [1] [4]

Model synthesis

References

[1]Kroger AT General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports, 2006.PMID 17136024
[2]Issa AN Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger - United States, 2025. MMWR. Morbidity and mortality weekly report, 2025.PMID 39819853
[3]Stokley S Evaluation of invalid vaccine doses. American journal of preventive medicine, 2004.PMID 14700710
[4]Abu-Shamsieh A Pediatric Care for Immigrant, Refugee, and Internationally Adopted Children. Pediatric clinics of North America, 2022.PMID 34794672
[5]Dvergsdal ET Low Childhood Vaccination Coverage among Ukrainian Refugees in Norway. A Nationwide, Register-Based Cohort Study, 2022-2023. Journal of immigrant and minority health, 2025.PMID 40668470
[6]Schillie S Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports, 2018.PMID 29939980
[7]Nyinawingeri A Using the Australian Immunisation Register to support general practices to improve childhood vaccination rates. Australian journal of general practice, 2024.PMID 38437660
[8]Hull B Annual Immunisation Coverage Report 2023. Communicable diseases intelligence (2018), 2026.PMID 41730159
[9]Crockett M New faces from faraway places: Immigrant child health in Canada. Paediatrics & child health, 2005.PMID 19668632
[10]Liang JL Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports, 2018.PMID 29702631