B E Y O N D | J A N . T O M A R . 2 0 2 2 | I S S U E 2 7All the doctors volunteering in UBD VC were given access to the Ministry of Health electronic patient recordsystem, Brunei Darussalam Healthcare Information and Management System (BruHIMS). This easy access toBruHIMS allowed the doctors on duty to refer to the individuals’ electronic records for their clinical status andcurrent medications. The doctors on duty were also able to consult directly with members of the Ministry ofHealth’s COVID-19 Vaccine Technical Committee and hospital Specialists with whom the patients were under,in order to seek advice and to obtain authorisation for the patients to receive the relevant COVID-19 vaccines.Examples of these were patients with cancer and severe autoimmune conditions receiving chemotherapy andimmunosuppresants. A total of 129 individuals were referred from UBD VC to RIPAS Hospital for vaccination. These individuals werereferred because they had history of anaphylaxis and severe allergic reactions and were recommended tohave their COVID-19 vaccinations in a hospital setting. Individuals with a history of anaphylaxis to any othersubstance have an increased risk of an anaphylactic response to COVID-19 vaccines. Prevention of anaphylaxisis therefore critically important, hence the doctors on duty at UBD VC had the responsibility to screen thepatients for a history of anaphylaxis and identify potential risk factors. The management of anaphylaxisincludes intravenous access for fluid resuscitation, endotracheal intubation and other advanced life-supportinterventions. These interventions are best performed by competent and trained staff in safe and appropriatehospital settings.Out of 129 individuals, 111 (86.0%) were referred because of their previous history of anaphylaxis and severeallergic reactions to food or medications. In 20 of these cases, the nature of the food or medications were notidentified or documented. Three individuals (2.3%) with history of Guillain-Barré Syndrome, 1 (0.8%) withSteven-Johnson Syndrome and 1 (0.8%) who had seizures following Pertussis vaccine as a child were alsoreferred. Table 2 (see below) shows the types of allergies and the number of patients referred to RIPASHospital for vaccination. A further 17 individuals (13.2%) were referred to RIPAS Hospital for vaccinationbecause of their history of complications after receiving first or second doses of COVID-19 vaccines. Thedoctors on duty felt that because of the history of possible allergic reactions to COVID-19 vaccines theseindividuals were recommended to have their subsequent doses to be administered in a hospital setting (Table3, see below). One individual (0.8%) who was hypertensive and found to be in atrial fibrillation before hisvaccination was also referred to RIPAS Hospital for vaccination. 4Table 2 (left): Individuals with history of anaphylaxis and severeallergic reactions referred to RIPAS Hospital. (MSG = monosodiumglutamate; NSAIDS = non-steroidal anti-inflammatory drugs).Table 3 (top): Patients with history of possible reactions after firstor second dose of COVID-19 vaccinations referred to RIPASHospital for subsequent vaccination. All individuals who received COVID-19 vaccinations had to undergo routine post-vaccination observation. It isrecommended that all individuals undergo observation for 15 minutes. Individuals with history of atopy (asthma,atopic dermatitis, etc.) and non-severe allergic reactions to food or medications were required to be observedfor 30 minutes. Individuals may be observed for longer based on clinical concern. With the help of theparamedic students and nursing students with paramedic qualifications, the doctors on duty at UBD VCmonitored all individuals post-vaccination in the Observation Area. Individuals with clinical concerns were observed and managed in the designated Treatment Room. During theoperational period, a total of 87 individuals were managed in the Treatment Room. There were 53 females and34 males presenting with symptoms during the post-vaccination observation period. Table 4 (see next page)shows the symptoms and the number of patients treated in the Treatment Room.
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