Vaccine safety OSCE — pre-vaccination screen, anaphylaxis drill and false-contraindication counselling

Station objectives

1. Perform a structured pre-vaccination safety screen. [1]
2. Separate true contraindications from precautions and false barriers. [1] [4]
3. Manage vaccine anaphylaxis with adrenaline first. [2]
4. Communicate AEFI follow-up and antigen-specific planning. [2] [5]
5. Avoid converting myths into permanent under-immunisation. [4] [6]

Candidate brief

You are the paediatric doctor in a community immunisation clinic attached to an acute paediatric service. Station A is 10 minutes. Station B is 8 minutes. Examiners score safety language, prioritisation and partnership. [1] [2]

Station A — Pre-vaccination screen and counselling

Setup: Caregiver of a well 4-month-old with mild rhinitis. Concerns include antibiotics last week, family history of febrile seizures, and “vaccines cause autism.” Vaccines are due today. [1] [4]

Expected actions:

• Confirm identity, record and vaccines due. [1]
• Screen anaphylaxis history, immunocompromise, severe illness, pregnancy/live relevance, recent antibody products. [1] [3]
• Classify mild rhinitis, antibiotics and family seizure/autism concerns as non-contraindications. [1] [4]
• Decide to vaccinate if screen clear; explain expected reactions and safety-net. [1]
• Use non-judgemental evidence language on autism without overloading jargon. [4] [6] [7]

Station B — Anaphylaxis drill

Setup: Minutes after injection the child has generalised urticaria, wheeze and becomes floppy with poor perfusion. [2]

Expected actions:

• Declare anaphylaxis and call for help. [2]
• Give IM adrenaline anterolateral thigh immediately. [2]
• Airway support/oxygen; fluids if shocked; repeat adrenaline if needed. [2]
• Avoid leading with antihistamine or steroid. [2]
• Plan observation/admission, AEFI report, chart flag for culprit vaccine, and specialist follow-up for future antigens. [2] [5]

Marking anchors

Clear pass: correct three-bucket triage, vaccinate through false barriers, adrenaline-first anaphylaxis management, clear AEFI documentation plan. [1] [2] [4]
Borderline: right labels but delays vaccination for mild illness, or adrenaline delayed while fetching antihistamine. [1] [2]
Fail: accepts autism family history as contraindication; calls syncope-only features anaphylaxis without systemic allergy logic; no reporting or future-plan after anaphylaxis. [4] [2] [5]

Debrief pearls

• Mild illness ≠ contraindication. [1]
• Anaphylaxis is rare; unreadiness is the preventable failure. [2]
• Passive AEFI lists are not automatic proof of causation. [5]
• ITP after MMR is rare and usually self-limited; do not abandon all vaccines without a plan. [8]