A MRCPCH station on MedMock, start to finish

Hello, I'm Dr Harper, one of the paediatric registrars in the haematology clinic. Can I just check, you're Oscar Bramley's dad? Thank you for coming in today. I understand Oscar's having a nice time with the play specialist, and I was hoping we could have a chat about his vaccinations. Before I say anything, could you tell me a bit about how you and the family came to your decision?

Yeah, that's right, I'm Oscar's dad. Look, we've thought about it carefully as a family. There's a lot of information out there, you know? Some of it worries us. We've read things about side effects and we just feel like with Oscar being as well as he is at the moment, we'd rather not rush into anything. We want to give his body a chance to build its own immunity naturally. I know you've mentioned it before, and we appreciate you bringing it up, but we've made our decision and we're pretty set on it.

Thank you, I can hear you've put a lot of thought into this, and it's clear you want to do the best for Oscar. I'm not here to pressure you, and it is your decision as his parent. It would help me to understand which side effects in particular have worried you, and where you've read about them, so I can make sure I talk about the things that matter to you.

Well, it's mainly things we've seen online, you know. Facebook groups, some websites. There's been talk about allergic reactions and fevers, and we've read about children having seizures after vaccines. That's the big one for us really. Oscar's had no real health problems, he's doing well, and the thought of giving him something that could trigger something like that... we just felt the risk wasn't worth it. Plus there's all the talk about autism, though I know people say that's been disproven. It all just felt like a lot to put into a healthy child's body when he's managing fine as he is.

Those are really understandable worries, and I'm glad you've told me. You're right that some children get a sore arm or a fever for a day or two, and occasionally a high temperature can bring on a febrile seizure, which is frightening to see but is the same kind of fit that ordinary childhood infections cause, and it doesn't cause lasting harm. Serious allergic reactions are very rare, and the nurses giving vaccines are trained and equipped to deal with them straight away. On autism, you're right that it's been disproven: the original study was withdrawn and very large studies of millions of children have found no link. The difficulty with building immunity naturally is that it means Oscar actually catching the illness, and that's where his condition matters.

Right, yeah. I mean, we know he's got the spherocytosis thing, and he's doing well on the folic acid. But I suppose I hadn't really thought about it that way round—that catching something could actually be worse for him because of his condition. What do you mean exactly? Like, if he caught measles or something, would that be more dangerous for him than it would be for another child?

To be honest, measles is a serious illness for any child, it can cause pneumonia and, rarely, brain inflammation. For Oscar there's an extra layer, because with spherocytosis his red cells already break down faster than normal, and when he's unwell with an infection that breakdown can speed up, so he can become more anaemic and jaundiced, and occasionally a child needs a blood transfusion. The bigger issue is for the future: if Oscar ever needs his spleen removed, the spleen is what protects us against certain bacteria like pneumococcus, meningococcus and Hib, which cause meningitis and blood poisoning. Without a spleen those infections can become life-threatening very quickly, and the routine vaccines are the main protection against exactly those bacteria, so we'd want him fully protected well before any operation. Does that make sense so far?

Yeah, that does make sense. I didn't realise it could get that serious if he needed the spleen out. So you're saying the vaccines would protect him against those specific bugs that his spleen normally helps fight? I suppose I hadn't joined those dots really. He's been so well, I kind of thought we could deal with things as they come. But if you're saying he'd need to be vaccinated before any surgery, that makes more sense than doing it now when he's healthy and not needing it. How far off would that operation realistically be?

Honestly, I can't give you a date, and it may never be needed. It depends on how his blood counts, energy and growth go, and whether he needs transfusions or develops gallstones, and where we can, we prefer to wait until children are a bit older. The catch with waiting until then is that vaccines don't work instantly: several of them need more than one dose spaced weeks apart to build proper protection, and sometimes plans change quickly if a child becomes very anaemic. They also protect him now, because pneumococcus, meningitis and measles affect well children too, and at school he'll be mixing with lots of others. The good news is it's not too late, and his GP practice can do a catch-up schedule at a pace you're comfortable with.

Yeah, I hear what you're saying. It's just a lot to take in, isn't it? I suppose I was thinking we'd cross that bridge when we came to it, but you're right—if he does need the operation and we've left it too late, that's not good planning on our part. And I didn't think about him catching these things at school. So if we did want to go ahead, we'd start with his GP? How many jabs are we talking about, roughly? I mean, would it all happen quite quickly or is it spread out over months?

It is a lot to take in, and you've taken it on board really thoughtfully. Yes, the GP practice nurse would do it, following the national catch-up guidance, and it's usually spread over a few months, with a handful of appointments about a month apart and sometimes two injections at one visit. I'll write to his GP with a clear plan and I'll check with our consultant whether Oscar needs anything extra because of his spherocytosis. I'll also give you a leaflet and point you to the NHS website and the Oxford Vaccine Knowledge Project, which are reliable places to read more, and you're welcome to talk it over at home first. Just so I know I've explained it clearly, could you tell me in your own words what you'll take back to the family?

Right, so what you're saying is that Oscar's got this condition that means his blood breaks down faster, and if he catches certain infections they could hit him harder because of that. And the vaccines protect against the really serious ones—measles, meningitis, that sort of thing—which he could catch at school. And if he does end up needing his spleen out down the line, he'll need to be vaccinated before that happens anyway, so we might as well do it now while he's well. We'd start with his GP, do it over a few months with appointments spread out, and you're going to send them a plan. We'll have a chat at home and maybe look at those websites you mentioned.

That's exactly right, you've summed it up really well. In the meantime, whatever you decide, if Oscar has a high fever, or looks unusually pale, yellow or tired, or passes dark urine, please get him seen urgently that day rather than waiting, because infections can make his anaemia worse quickly. I'll give you our haematology nurse's number so you can ring with any questions once you've talked it over, and we'll see him back in clinic as planned to pick this up again. Is there anything else you'd like to ask me before we go and find Oscar?

No, I think that's covered it really. Thanks for explaining it all properly. I'll have a word with Oscar's mum when I get home and we'll look at those websites. And I've got the nurse's number now, so we can ring if we've got questions before we make a final call. It's good to know what to look out for as well—the fever and the yellowing and that. I appreciate you taking the time to go through it all with us rather than just telling us we're wrong, you know. Right then, shall we go grab Oscar from the play specialist?

Thank you, and thank you for being so open with me today. Yes, let's go and find him.

Yeah, of course. Come on then.