The National Immunisation Schedule

Providing the strength within

Anna Smith, IMAC

Rationale behind the NZ Schedule

Designed specifically for New Zealand

Strategies differ for each disease:• Pattern of disease and particular risk factors

eg, pertussis control is focused on infants

• Age and vaccine effectiveness

• Duration of immunity

Convenience of delivery:• Minimise number of injections and visits

Why do we want to stop people catching these diseases?

• Pertussis, measlesNo treatment

• Hib, pneumococcal, meningococcal Treatment can’t

guarantee a good outcome

• Hepatitis B, HPVCancer prevention

• Rotavirus, influenza, varicellaPrevent serious

disease complications

Eligibility for funded vaccines

• All children <18 years of age irrespective of immigration status (includes HPV vaccine)

• Adults >18 years of age funded for New Zealand healthcare (HPV up to age of 27 years)

On time!

4 in a row!

By 4 years & 1 month

Check up to date by 14 years of age - not before!

If all due give at same visit

Pregnant women• Influenza

Annual vaccine in any trimesterPrevents serious complications

• Tdap Diphtheria, tetanus & pertussisTiming: 13-38 weeksEach pregnancy to protect newborns

• Immunisation in pregnancyActive immunity for mumPassive immunity for baby

Every pregnant woman needs to know!

Pertussis in infants• Young infants at highest risk

• Hospitalisations: <1 year 50% of infected and 1-2 per 100 of these die

• 2 in 1,000 children end up with permanent brain damage, paralysis, deafness or blindness

• Little, or no maternal protection

• 3 doses of vaccine required for protection

• Delayed immunisation (>30 days) = 4-6 times higher risk of hospitalisation (Grant et al 2003)

For best protection vaccinate our pregnant mothers and ourselves!

Pertussis containing vaccine 13-38 weekseach pregnancy• Passive protection for baby• Immunity for mum – avoids spread to baby• Coverage needs to be increased!• All health workers involved with babies and young

children should also be vaccinated!

• Vaccinate babies on time!

Pregnancy video

Influenza can be transmitted when no symptoms are present!

SHIVERS influenza research sero-survey showed in 2015:

“4 out of 5 people infected show no symptoms of influenza.”

Adult primary programmesTd Diphtheria, tetanus (Tdap from 2020)

x 3

IPV Inactivated poliox 3

MMR Measles, mumps & rubellax 2

HPV <27 years of ageHuman papillomavirusx 3

Immunisation of special groups

Additional funded vaccines for children and adults with particular complex health issues

20 special groups funded for vaccines1. Asplenia2. Chemotherapy 3. Cochlear Implant4. Error of metabolism5. Stem cell transplant 6. Hepatitis A contact7. Hepatitis B* baby of/contact8. Hepatitis C positive person9. Immune deficient10. Influenza11. Kidney disease12. Liver disease13. Meningococcal disease

contact

14. Needle stick15. Non-consensual sexual

intercourse16. Pneumococcal - increased risk17. Pregnancy 18. Rubella - childbearing women19. Solid organ transplant20. Tuberculosis risk < 5 years of

age*

Hepatitis B vaccine for babies born to HBsAg-positive mothers

There is a protocol for managing infants born to hepatitis B positive mothers

Management of a baby of a HBsAg-positive woman

• Hepatitis B immunoglobulin • Hepatitis B vaccineBirth

• Schedule vaccines that includeDTaP-IPV-Hep B/Hib

6 weeks3 months5 months

• Check serology for hepatitis B disease and immunity9 months

Newborn BCG for tuberculosis

Eligibility for at risk children <5 years:

• Living with someone with TB or TB history

• Parents/household members from high TB incidence country

• Lived/will live >3 months in a high TB incidence country during their first 5 years

Meningococcal vaccinesMeningococcal B

• Bexsero (+ prophylactic paracetamol <2 years old)

Meningococcal (A,C,W,Y)• Menactra• Nimenrix

Meningococcal C • NeisVac-C

Menactra/NeisVac-C are the only ones on the Schedule for:• High risk groups and/or outbreak situations

Others are available for private purchase

Pre-vaccination conversation and check

• To gain informed consent• To ensure a safe vaccination event

We all want to keep babies safe

HealthEdwww.healthed.govt.nz

Resources

Immunisation Handbook 2017www.health.govt.nz

IMAC website, fact sheets and videoswww.immune.org.nz

Introduction to Immunisation Course (IMAC)Online – 2 hours - free