Immunisation update

Rosemary Morey

Immunisation Nurse

September 2014

Immunisation Schedule: Birth to 6 months

Age Vaccine preventable disease (VPD)

Vaccine brand ® Notes

Birth Hepatitis B H-B-Vax II Paediatric • Ideally given within 24 hours or up to 7 days of birth

• No catch-up for missed dose

2, 4 and 6 monthsCan be given from 6 weeks of age

Diphtheria, Tetanus, Pertussis, Polio, Hib, Hepatitis B

Pneumococcal

Rotavirus

Infanrix hexa

Prevenar 13

RotaTeq

• Early start = early pertussis protection

• All vaccines due on same day

• First dose before 13 weeks of age; third dose before 33 weeks of age

• Virus shedding -1st dose

• Intussusception (contraindication & AEFI)

• Note additional contraindications

Immunisation Schedule: 12 months to 4 years

Age Vaccine preventable disease (VPD)

Vaccine brand ® Notes

12 months Measles, Mumps, Rubella

Haemophilus influenzae type b (Hib), Meningococcal C

M-M-R II / Priorix

Menitorix

Additional vaccines for prematurity and increased medical risk

18 months Measles, Mumps, Rubella, Chickenpox

Priorix-Tetra The risk of febrile seizures is greatly reduced by giving MMR only at 12 months of age

4 yearsCan be given from 3.5 years of age

Diphtheria, Tetanus, Pertussis, Poliomyelitis

Measles, Mumps, Rubella (until end 2015)

Infanrix IPV

M-M-R II / Priorix

From 2016 MMR will cease at 4 years as this cohort of children will have had MMRV vaccine at 18 months of age

Additional vaccines for prematurity and increased medical risk

Age VPD Vaccine brand ® Notes

From 6 months of ageWith underlying medical risk factors

Influenza Fluarix/Vaxigrip/Fluvax* *bioCSL's Fluvax brand not registered for use for children <5 years of age and not recommended in children 5 to 9 years

AnnuallyFrom 6 months to 9 years inclusive, give 2 doses of influenza vaccine a minimum of 1 month apart, in the first year of administration. Paediatric dose 6 months to <3 years (From 2015? - ATSI aged 6mths to 5yrs)

12 months of age premature babies<32 weeks gestation or <2000g birth weight

Hepatitis B H-B-Vax II Paediatric Single booster dose

12 months of ageWith underlying medical risk factors and/or <28 weeks gestation

Pneumococcal Prevenar 13 Single booster dose

4-5 years of ageWith underlying medical risk factors and/or <28 weeks gestation

Pneumococcal Pneumovax 23 See the current edition The Australian Immunisation recommendations

Extra recommended and funded vaccines for babies and children with increased risk categories

Age in months Total Victoria Victoria

Indigenous

Total Australia

12 - <15 91% 87% 91%

24 - <27 93% 93% 93%

60 - <63 (5 yrs) 92% 89% 92%

Provider split GP 56% / Local council 42%

Australian Childhood Immunisation Register Coverage Victoria, 30 June 2014

Measles notifications in Victoria

People at risk of measles:

• Australian born during or since 1966 with no documentation of either 2 doses of a measles-containing vaccine or laboratory-confirmed measles

• immunocompromised

The current Chief Health Officer measles alert recommendations include:

• No active recall for early doses

• Do not give the 1st dose before 12 months of age, unless given specific advice from the Department of Health confirming contact with an infectious case.

• A funded early 2nd dose can be given on parental request

• For measles alert updates see: http://health.vic.gov.au/chiefhealthofficer/alerts/alert-2014-09-measles-cases.htm

Measles cases in Melbourne

Invasive meningococcal disease notifications

Bexsero® Vaccine – Meningococcal B

• Available from March 2014 on the private market (prescription)

• Recommended for children aged <5 years, particularly infants aged <1 year

• Doses recommended depend on the age of commencement.

• Prophylactic use of paracetamol recommended with every dose administered to children <2 years of age

• Can be administered from 6 weeks of age

• Summary clinical advice: www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/atagi-advice-bexsero

Pertussis notifications for Victoria

Pertussis cases aged <6mo and % hospitalised

True contraindications to vaccination

• Surveillance of Adverse Events Following Vaccination in the Community

• Monitoring vaccine safety in children and adults

• Rapidly detect & research vaccine safety concerns

• Immunisation providers and parents can report a significant or unexpected adverse event following vaccination:

– Online: www.saefvic.org.au

– Telephone: 9345 4143

– Fax: 9345 4163

– Email: saefvic@mcri.edu.au

SAEFVIC

Rationale:

• You are at increased risk of exposure to vaccine preventable diseases

• You can transmit infections to susceptible patients and your own family / friends

Recommendations:

• Pertussis (10 yearly)

• Measles, Mumps, Rubella (if born since 1966)

• Varicella (if non-immune)

• Hepatitis B

• Influenza (annually)Source: Australian Immunisation Handbook, 10th Ed.

Health care workers:Be an advocate for vaccination

• Immunise Australia: immunise.health.gov.au

• Immunisation Section: www.health.vic.gov.au/immunisation

– Ph: 1300 882 008

– M – F: 9am to 12pm & 2pm to 3 pm

– Email: immunisation@health.vic.gov.au

• Local council immunisation service

Additional Information

• National Centre for Immunisation Research & Surveillance www.ncirs.usyd.edu.au/

• ‘Communicating with parents about vaccination: a framework for health professionals’, Leask J, Kinnersley P, Jackson C, Cheater F, Bedford HE, Rowles G 2012, ‘Communicating with parents about vaccination: a framework for health professionals’, BMC Pediatrics 12(154):1471–2431: www.biomedcentral.com/1471-2431/12/154.

Health Professional Resources

• Immunise Australia: immunise.health.gov.au

• Better Health Channel fact sheets: www.betterhealth.vic.gov.au

• Royal Children’s Hospital and Monash Medical Centre:

GP referral to Paediatrician. Phone: 1300 882 924

Additional Information

• The Science of Immunisation – Questions and Answers: www.science.org/immunisation.html

• National Centre for Immunisation Research & Surveillance: www.ncirs.edu.au/consumer-resources/index.php

• Chain of Protection: www.chainofprotection.org

Parent Resources

• Posters available to order from the Commonwealth and Victorian Immunisation websites

Acknowledgements:

Vaccine preventable graphs: Communicable Diseases Epidemiology & Surveillance, Department of Health

Resources