Information to assist you with mandatory immunisation ... · Authored by SLHD Clinical Placement Unit & SLHD Staff Health 2013 Reviewed July 2014 Reviewed March 2016 Reviewed August

Authored by SLHD Clinical Placement Unit & SLHD Staff Health 2013 Reviewed July 2014

Reviewed March 2016 Reviewed August 2016

Reviewed November 2016 Reviewed March 2017

Reviewed by NSW Health and advice approved April 2017

Dear Student,

Information to assist you with mandatory immunisation compliance PLEASE READ!

The following information is supplied to you to ensure that you provide the correct information regarding your immunisation

history/status when being screened to attend a clinical placement within a NSW public health facility. Compliance with NSW

Health policy directives regarding immunisation is mandatory for all local, national and international students enrolled at both the

undergraduate and postgraduate level. There are no exceptions to these requirements.

Please ensure that your GP or vaccination provider completes the supplied ‘vaccination record card’ as outlined in this advice - a

blank vaccination record card and an example of how this document is to be completed are supplied as part of this information

package. You will also be required to complete and submit ‘form 2’ and ‘form 3’. Following review, you will be provided with a

classification status which will determine whether you can commence a clinical placement.

Ensure the GP records your entire immunisation history from childhood records.

The classifications relating to an immunisation status are:

1. ‘Non-Compliant’ – Immunisation status does not comply with NSW Health policy directives. Students who are assigned

this classification ARE NOT eligible for a placement within any NSW Health public health facility. This will cancel your

proposed clinical placement.

2. ‘Temporary Hep B/TB Contraindication’ – This indicates that either you have not completed a Hepatitis B course

and/or you require a Mantoux skin test for tuberculosis screening as per the advice issued by the WHO – ensure if you

have had a BCG administered this is recorded on the vaccination card. ‘Temporary’ status is only provided when

evidence has been supplied, which shows that the first dose of Hep B vaccine has been administered, and that all other

vaccination/screening information supplied demonstrates that the student is compliant with all other aspects of the

policy and/or you are required to have a Mantoux test. A full course of Hepatitis B consists of three immunisations

followed by serology to indicate immunity. When classified as ‘Temporary Hep B/TB Contraindication’, the database will

automatically provide you with six (6) months to provide outstanding evidence. If you do not complete the process within

this time frame, the database will automatically convert your file to ‘Non-Compliant’ and your University will be unable to

allocate you to a clinical placement until you provide outstanding documentation. If a student is aware that they are Hep

B antigen or core positive, only disclose this information to the staff health nurse reviewing your immunisation status;

this will remain a confidential discussion. Further advice will be provided. Serology results for Hepatitis B must be

recorded in numerical format only.

Note: temporary status is only awarded to students enrolled in the first year of a degree; not a student presenting for the first time in the second, third or fourth year of a degree. This has been confirmed by NSW Health and the HETI.

For further information refer to http://www.slhd.nsw.gov.au/CCPU/students.html

3. ‘Compliant’ – Immunisation status meets all mandatory policy requirements and the student may proceed to

placement.

http://www.slhd.nsw.gov.au/CCPU/students.html





Adult Diphtheria, Tetanus, and Pertussis (Whooping Cough) or dTpa

Student Instructions:

• You must provide evidence of having received one adult diphtheria, tetanus, and pertussis (Whooping Cough) vaccine in the last 10-years. If the vaccine was administered

more than 10-years ago or is due to expire before the end of your degree, a booster dose

will be required. Ensure that your GP administers diphtheria, tetanus and pertussis (dTpa)

vaccine and not an adult diphtheria and tetanus (dT) vaccine. Correct documentation from

the GP or vaccination provider must include the ‘batch number’, ‘date of vaccination’,

‘provider’s name’, ‘signature’ and ‘practice stamp’ to validate the entry. Ensure the GP

records on the vaccination card that the vaccination administered contained the diphtheria,

tetanus and pertussis component. If a batch number is not available, simply have the GP or

vaccination provider supply a letter confirming that the vaccine administered contained the

diphtheria, tetanus and pertussis component. If it is not possible to obtain a dTpa

vaccination record, one dTpa vaccine must be administered and recorded as detailed above.

NSW Health must be able to identify that the student has received the correct vaccination.

• Serology results for diphtheria, tetanus and pertussis vaccination are NOT ACCEPTED.

Hepatitis B Student instructions:

• The student must provide evidence of an age-appropriate course of hepatitis B and serology to show immunity. An age-appropriate course of hepatitis B consists of three

vaccinations which can be completed over a period of a minimum of four months (at least

one month between doses one and two and at least four months between dose one and

dose three). Alternatively, if you received the Hepatitis B vaccine course at school, you will

have received two doses of vaccine four to six months apart, this is also an age-appropriate

course of hepatitis B vaccine and is acceptable; but MUST be recorded. All Hepatitis B vaccination history must be recorded on the vaccination card. Serology must be

recorded as a numerical value - the phrase “positive”, “immune” or “detected” is not

appropriate and will not be accepted. If you are unable to provide an initial history of a

primary hepatitis B course, a verbal history is acceptable, provided that it is a reliable history

of an age-appropriate course of hepatitis B vaccine. If serology indicates you are a ‘non-

responder’ to hepatitis B vaccine, you will need to discuss this with your GP as you may





require additional doses and will require serology to demonstrate immunity. You can also

contact the SLHD Clinical Placement Unit at [email protected] for further advice.

• Correct documentation from the GP or vaccination provider must include; evidence of a full

hepatitis B course (or a reliable verbal history of hepatitis B vaccination course); ‘batch

number’, ‘date of vaccination’, ‘provider’s name’, ‘signature’ and ‘practice stamp’ to validate

the entry and serology - remember serology must be recorded as a numerical value; not ‘positive’, ‘negative’ or ‘immune’.

Measles, Mumps and Rubella (MMR) Student Instructions:

• You must provide evidence of two doses of MMR vaccine (at least one month apart) or positive serology to all three diseases (include the serology report with your application for

assessment which must be in English) or if you were born before 1966, evidence of

vaccination or serology is not required. If you do not have a complete MMR vaccination

record of vaccination and your serology indicates a ‘negative’ result, you will require two

doses of MMR vaccine at least one month apart with no follow-up serology required. Correct

documentation from the GP or vaccination provider must include, ‘batch number’, ‘date of

vaccination’, ‘provider’s name’, ‘and signature ’and‘ practice stamp’ to validate the entry.

Varicella (Chicken Pox)

• Student Information: If you were vaccinated when you were 14 years or older, you must

provide a vaccination record with evidence of two varicella vaccinations (one month apart)

recorded. If you received your varicella vaccination when you were less than 14 years of

age, you only require evidence of one dose of varicella vaccine. Alternatively, evidence of

positive varicella serology (which must be positive) or a history of having had the chicken

pox disease, may be provided as evidence.

• Correct documentation from the GP or vaccination provider must include; ‘batch number’,

‘date of vaccination’, ‘provider’s name’, ‘signature’ and ‘practice stamp’ to validate the entry.

mailto:[email protected]





Tuberculosis Screening Student Information:

• A completed ‘Form 2’ and ‘Form 3’ must be included with your documentation. Form 2 is a

legal declaration that assists in determining if you require TB screening; please ensure you

have completed this document fully noting all countries to which you have lived in or

travelled to and note the length of time in that country in order to assist in determining if you

require screening for tuberculosis. If you have had a BCG, ensure the GP records the

approximate year that your BCG was administered. If you have lived in or travelled to a

country with a high incidence of TB (list of countries included in this information pack), for a

period of more than three-months within a three year period, or you have been in contact

with a person who has tuberculosis in any circumstance, you will be required to have a

Mantoux test and provide the result ensuring that the GP has recorded whether you have or

have not had a BCG administered.

• At this time a Mantoux test is the only test that is acceptable to NSW Health to determine if

you have been exposed to tuberculosis.

• Mantoux tests can be performed at a recognised chest

clinic http://www.health.nsw.gov.au/Infectious/tuberculosis/Pages/chest-clinics.aspx or at the

University of Sydney Medical Centre http://sydney.edu.au/health-service/services/

• If the Mantoux test shows a reaction greater than 8mm without having had a BCG or 10mm

having had a BCG you will be required to have a chest X-Ray.

• If the first Mantoux test result was ‘negative’ with the student having had a BCG, you will be

required to have what is called a “two-step Mantoux”, i.e. another Mantoux test within one-

month of screening to ensure the first result was not a ‘false-negative’.

• NSW Health advises that at this time ‘Quantiferon Gold’ assay tests are not accepted.

• Where a parenteral live vaccine has been administered recently, Mantoux testing should be

delayed for at least one month after vaccination. However if required, a Mantoux test can be

administered at the same time as a live vaccine using separate injection sites.

• Please record all tuberculosis screening on the ‘vaccination record card’ and the results of

any further investigations such as CXR. Ensure the GP or vaccination provider signs the

vaccination record card entry and provides their practice stamp to validate the entry.

http://www.health.nsw.gov.au/Infectious/tuberculosis/Pages/chest-clinics.aspx

http://sydney.edu.au/health-service/services/





Final Advice to students

• If the student in unable to obtain ‘compliant’ status, this will prevent the student from

attending a clinical placement within any NSW Health facility. There are no exceptions to this

requirement.

• NSW Health is not responsible for factors that affect a student meeting these mandatory

requirements. If a student is unable to meet any of these requirements the placement will not

proceed. NSW Health strives to ensure that all patients, staff and students are not placed at

risk when attending a clinical placement.

• The student should commence an immunisation review immediately as it may take several

weeks to obtain documentation to demonstrate compliance with mandatory immunisation

requirements.

• The student should review all advice before submitting any documentation for review to

ensure what has been advised is in the format requested.

• Pictures of documentation taken on smartphones are not acceptable - documentation must

be in pdf format only. JPEG or other graphic files are not acceptable.

• Student verification video’s (produced by HETI) to assist with what it is required are

accessed from this URL http://www.heti.nsw.gov.au/verification

http://www.heti.nsw.gov.au/verification

PD2011_005 OCCUPATIONAL ASSESSMENT, SCREENING AND VACCINATION AGAINST SPECIFIED INFECTIOUS DISEASES

Recommended actions following serology that does not indicate full immunity to measles, mumps and rubella or varicella To promote consistency of interpretation across all health services, the following table provides advice on actions to be taken when serology indicates incomplete immunity to measles, mumps and rubella. Expert consultation and referral of sera to a reference laboratory are recommended where there is difficulty interpreting any results.

Post vaccination serology is not recommended, but if it has been undertaken and incomplete immunity is indicated, then the following vaccination and serology recommendations should be followed.

Documented doses

Serology result Vaccination

recommended Yes/No

Further serology recommended

Yes/No

0 dose

Serology is positive1 or 2

for

of the following diseases: but not all 3

Measles Mumps Rubella

Serology for measles or mumps or rubella or varicella is

Negative | Equivocal | Borderline |Low positive | Low level immunity

Yes, 2 doses with a minimum 4 week interval between

No*

1 dose


Negative | Equivocal | Borderline |Low positive | Low level immunity

Yes, 1 dose No*

2 doses


Negative | Equivocal | Borderline

Yes, 1 dose No*


Low positive | Low level immunity

No No

(Prepared with the assistance of the National Centre for Immunisation Research and Surveillance)

* Eight weeks after the last dose of MMR vaccine (as per the table either the 2 doses or the single dose) only women of child bearing age should have their rubella titres checked. A number of commercial assays for testing immunity to rubella are available. These vary according to the method used to determine the positive cut-off value (the WHO cut-off is 10 IU/mL but, at present, there is no recommended Australian minimal level). Available data support the presumption that an antibody level found by use of a licensed assay to be above the standard positive cut-off for that assay can be considered evidence of past exposure to rubella virus. Antibody levels below the cut-off are likely not to be protective, particularly if the antibodies have been generated by vaccination rather than by natural infection. Expert consultation and referral of sera to a reference laboratory are recommended if there is a difficulty interpreting these results.

Occupational assessment, screening and vaccination against specified infectious diseases

PROCEDURES

PD2011_005 Issue date: January 2011 Page 24 of 25

FORM 2. – Tuberculosis (TB) assessment tool

- A New Recruit/Student will require TST screening if he/she was born in a country with a high incidence of TB, or has resided for a cumulative time of 3 months or longer in a country with a high incidence of TB, as listed at: http://www.health.nsw.gov.au/publichealth/Infectious/a-z.asp#T.

- The Health Service will assess this form and decide whether clinical review/testing for TB is required. Indicate if you would prefer to provide this information in private consultation with a clinician.

- New recruits will not be permitted to commence duties if they have not submitted this Form and Form 1: New Recruit Undertaking/Declaration to the employing health facility. Failure to complete outstanding TB requirements within the appropriate timeframe(s) may affect the new recruit’s employment status

- Students will not be permitted to attend clinical placements if they have not submitted this Form and the Form 3: Student Undertaking/Declaration to their educational institution’s clinical placement coordinator as soon as possible after enrolment. Failure to complete outstanding TB requirements within the appropriate timeframe(s) will result in suspension from further clinical placements. The educational institution will forward the original or a copy of these forms to the health service for assessment.

Clinical History Cough for longer than 2 weeks Yes No Please provide information below if you have any of the following symptoms: Haemoptysis (coughing blood) Yes No

Fevers / Chills / Temperatures Yes No

Night Sweats Yes No

Fatigue / Weakness Yes No

Anorexia (loss of appetite) Yes No

Unexplained Weight Loss Yes No

Assessment of risk of TB infection Were you born outside Australia?

Yes No If yes, where were you born? ……….…………………………………………………. Have you lived or travelled overseas?

Yes No

Country Amount of time lived/ travelled in country

……………………………. …………..…….…

……………………………. …………..…….…

……………………………. …………..…….…

Have you ever had:

Contact with a person known to have TB? If yes, provide details below Yes No

Have you ever had: TB Screening Yes No

If yes, provide details below and attach documentation

If you answered YES to any of the questions above, please provide details (attach extra pages if required).

I declare that the information I have provided is correct

Name ____________________________________________________________________________________

Phone or Email ____________________________________________________________________________

Student ID (or date of birth) __________________________________________________________________ Educational institution (student) ______________________________________________________________

Health Service/Facility (new recruit) ___________________________________________________________

Signature _______________________________________________ Date _____________________________

http://www.health.nsw.gov.au/publichealth/Infectious/a-z.asp#T�

Occupational assessment, screening and vaccination against specified infectious diseases

PROCEDURES

PD2011_005 Issue date: January 2011 Page 25 of 25

FORM 3. – Student Undertaking/Declaration All students must complete each part of this Form 3: Student Undertaking/Declaration Form and the Form 2: Tuberculosis (TB) Screening Assessment Tool and return these forms to their educational institution’s clinical placement coordinator as soon as possible after enrolment. (Parent/guardian to sign if student is under 18 years of age.)

Students will not be permitted to attend clinical placements if they have not submitted Form 3: Student Undertaking/Declaration Form and Form 2: Tuberculosis Assessment Tool.

Failure to complete outstanding hepatitis B or TB requirements within the appropriate timeframe(s) will result in suspension from further clinical placements and may jeopardise the student’s course of study. The educational institution will:

- ensure that all students whom they refer to a health service for clinical placement have submitted these forms, and

- forward the original or a copy of these forms to the health service for assessment.

The health service will: - assess these forms along with evidence of protection against the infectious diseases specified in this

policy directive.

Part 1 I have read and understand the requirements of the NSW Health Occupational Assessment, Screening and Vaccination against Specified Infectious Diseases Policy Directive.

Part 2 I undertake to participate in the assessment, screening and vaccination process and I am not aware of any personal circumstances that would prevent me from completing these requirements.

OR I undertake to participate in the assessment, screening and vaccination process, however I am

aware of medical contraindications that may prevent me from fully completing these requirements and am able to provide documentation of these medical contraindications. I request consideration of my circumstances.

Part 3 I have evidence of protection for: pertussis diphtheria tetanus

varicella measles mumps rubella

Part 4 I have evidence of protection for hepatitis B. OR

I have received at least the first dose of hepatitis B vaccine (documentation provided) and undertake to complete the hepatitis B vaccine course (as recommended in the Australian Immunisation Handbook, current edition) and provide a post-vaccination serology result within six months of commencement of enrolment.

Part 5 I have been informed of, and understand, the risks of infection, the consequences of infection and management in the event of exposure (refer Information Sheet 3: Specified Infectious Diseases: Risks, consequences of exposure and protective measures) and agree to comply with the protective measures required by the health service.

I declare that the information I have provided is correct Name _____________________________________________________________________________________ Phone or Email _____________________________________________________________________________

Date of Birth or Student ID ____________________________________________________________________

Educational institution _______________________________________________________________________

Signature ________________________________________________ Date _____________________________

Documents

Information to assist you with mandatory immunisation ... · Authored by SLHD Clinical Placement Unit & SLHD Staff Health 2013 Reviewed July 2014 Reviewed March 2016 Reviewed August