Prepared by Kym Bush

Immunisation Coordinator

Public Health Unit

June 2014

Current Vaccination Program

ANI Update

Authorisation to immunise

To maintain authority to immunise, a RN must annually

review best practice policy for immunisation

This may be, but is not limited to, attendance at updates or

seminars on current practices

A statement of proficiency in CPR is also mandatory

Cannot transfer authority to non-authorised nurse

PD 2008_033 Immunisation Services –Authority for RNs

www.health.nsw.gov.au/policies/pd/2008/PD2008_033.html

Authorisation to immunise (cont.)

Employment in a vaccination program or medical practice

Administers vaccines in connection with the vax program

Successfully completed immunisation education program

Follows guidelines within the Handbook

Must have adrenaline available

Must report all AEFIs to PHU

MO must be contactable whilst vaccinating

Recent changes to NSW schedule

Children born FROM 1 January 2012

Combined measles, mumps, rubella and varicella (MMRV)

vaccine Priorix-Tetra ® is given to children at 18 months of

age

Combination Haemophilus influenzae type b +

meningococcal C vaccine, Menitorix® is given to children at

12 months of age

Priorix-Tetra ®

The first dose of MMR vaccine at 12 months remains the

same although it is supplied as MMRII which needs to be

given sub-cutaneously (SC)

The second dose of MMR moves to 18 months. Priorix-

Tetra ® will be supplied and can be given either SC or

intra-muscularly (IM)

MMRV is NOT recommended for use in persons 14 years

and over

Menitorix®

Single valent meningococcal C vaccine will no longer be

available

Care should be taken to ensure that Menitorix® is

reconstituted before use

When required Menitorix® can be used in catch-up

schedules for meningococcal C in children < 10 years of

age

Administration at the same time as another Hib containing

vaccine is not preferred but may be acceptable for catch up

if no alternative vaccine is available

NSW Immunisation Schedule (for children from 1 July 2013)

Childhood VaccinesAge Children born BEFORE

1 January 2012

Children born AFTER

1 January 2012

Birth H-B-VAX II® H-B-VAX II®

2 months(can be given as early as 6 weeks)

INFANRIX HEXA®

PREVENAR 13®

ROTARIX®

INFANRIX HEXA®

PREVENAR 13®

ROTARIX®

4 months INFANRIX HEXA®

PREVENAR 13®

ROTARIX®

INFANRIX HEXA®

PREVENAR 13®

ROTARIX®

6 months INFANRIX HEXA®

PREVENAR 13®

INFANRIX HEXA®

PREVENAR 13®

12 months MENINGITEC®

HIBERIX®

MMR

MENITORIX®

MMR

18 months VARICELLA PRIORIX-TETRA®

4 years(can be given as early as 3½ years)

INFANRIX-IPV®

MMR

INFANRIX-IPV®

NSW Immunisation ScheduleAdolescent and adult vaccines

Age Disease Vaccine

ADOLESCENT VACCINES

Year 7 Human Papillomavirus

Varicella (catch up only)

Diphtheria, Tetanus, Pertussis

GARDASIL

VARILRIX

BOOSTRIX

Year 9 (males only in 2013 & 2014) Human Papillomavirus GARDASIL

ADULT VACCINES

All - 6 months and over (with

medical risk factors)

Aboriginal -15years+

Pregnant women

65 years+

Influenza INFLUENZA

All – 65 years and over

Aboriginal – 50 years+

Aboriginal – 15-49 years with

medical risk factors

Pneumococcal PNEUMOVAX 23

Neonatal hepatitis B

Commenced in 2000

– Transmission from an infected mother to neonate

(vertical transmission) usually occurs at or around the

time of birth

– Person-to-person (horizontal transmission) with a

household contact

Number of infants who have received a dose of hepatitis B

vaccine within 7 days of birth is improving

Policy Directive 2005_222 Hepatitis B Vaccination

www.health.nsw.gov.au/policies/PD/2005/PD2005_222.html

Myths and Realities, 5th edition

The 5th edition of Myths and Realities was released in

June 2013 and includes updated information on:

– the notifications of vaccine preventable diseases;

– the risk of intussusception following rotavirus vaccine;

– MMR vaccine and autism;

– influenza vaccine; and

– reporting adverse events following immunisation

The Handbook, 10th edition

NHMRC approved amendments to the 10th edition of the

Handbook which was then updated in January 2014 and

includes:

– Revised Hib catch up schedule for children 5 years of

age

– Reference to Strive for 5 second edition

– Changes to intussusception cases

– Age range for 13vPCV (Prevenar 13) now registered for

use in up to 17 year olds

Strive for Five, 2nd edition

Released in 2013 and includes:

– Vaccine purpose built fridges are the best practice

option for vaccines. Bar fridges and cyclic defrost

domestic fridges must not be used

– You must check and record the vaccine fridge

temperatures twice daily

– Vaccine fridge is to be serviced every 12 months

– Data loggers to be recalibrated annually

Changes in recommendations for diphtheria,

tetanus and pertussis

dTpa vaccine can be given during the third trimester of

pregnancy as an alternative to post-partum or pre-conception

vaccination

Children of mothers who receive pertussis vaccine in the third

trimester should receive an additional booster dose at 18

months of age (DTPa-IPV on script)

Infanrix-hexa and Infanrix-IPV can be used for primary or

booster doses in children aged up to 10 years (previously 8

years)

Adults aged ≥ 65 years should be offered a single dTpa

booster if they have not received one in the previous 10 years

For adults at risk of acquiring pertussis, or transmitting it to

vulnerable persons – booster 10 years after receipt of

prior pertussis-containing vaccine

This interval can be shortened to 5 years in the context of

pregnancy

For high risk travel a 5 yearly booster dose should be

considered for protection against tetanus. In other

travellers, a booster dose should be provided if 10 years

have elapsed since the previous dose

Changes in recommendations for

diphtheria, tetanus and pertussis (cont)

Changes in recommendations for

diphtheria, tetanus and pertussis (cont)

Wound management has been updated to include

recommendations for use of tetanus immunoglobulin

(TIG) in immunocompromised persons

Ensure parents, grandparents and carers of infants up

to 6 months of age have been offered all vaccines

recommended for their age group, including dTpa

NSW current recommendationsPneumococcal

New handbook has updated catch-up tables with

recommendations for pneumococcal vaccines up to 5 years

ATAGI made the following recommendations about

Pneumovax 23:

– a dose of Pneumovax 23 should be given to all adults aged 65

years

– a second dose continues to be recommended for those with any

predisposing conditions as listed in the Handbook

– recommendations for Aboriginal and Torres Strait Islander people

aged <65 years of age are unchanged from the Handbook

ATAGI statement:

http://immunise.health.gov.au/internet/immunise/publishing.nsf/Content/pneu

mo23-atagi-statement-cnt.htm

NSW current recommendationsRotavirus

RotaTeq is no longer supplied in NSW. If either dose 1 or

dose 2 is given as RotaTeq a third dose of Rotarix should

be given provided that the upper age limit and vaccine

intervals are maintained

Updated factsheets for parents and guardians regarding

rotavirus and intussusception on Immunise Australia

website

New evidence of slight increase to 14 cases of

intussusception per 100, 000 infants vaccinated per year in

Australia however the benefits of rotavirus vaccination far

outweigh the risks associated with it

ATAGI and TGA statement:

http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/immu

nise-rotavirus

NSW current recommendations Influenza

The Australian 2014 influenza vaccine contains the

following 3 strains:

– A (H1N1): an A/California/7/2009 (H1N1)- like strain;

– A (H3N2): an A/Texas/50/2012 (H3N2)- like strain;

– B: a B/Massachusetts/02/2012-like strain

NSW current recommendationsInfluenza

Free seasonal flu vaccine is available for:

– Aged over 6 months with medical conditions

– All individuals aged over 65 years

– All ATSI aged 15 years and over

– Pregnant women

NSW current recommendationsChildren and influenza vaccine

Two doses of influenza vaccine, at least one month apart, are

recommended for children aged 6 months to less than 10

years who are receiving influenza vaccine for the first time

(regardless of if they have had pandemic flu H1N1 )

Vaxigrip® and Fluarix® are the preferred vaccines for

children

Fluvax® MUST NOT be used in children!

NSW School Based Vaccination 2014

Focus is on free school based delivery

Catch-up vaccination for missed doses at subsequent

school clinics

To be given by GP if school clinic missed

NSW School Based Vaccination 2014 (cont)

From 2013 boys in Year 7 will be offered HPV annually.

Year 9 boys will be offered the vaccine as part of a national

‘catch-up’ program in 2013 and 2014

As well as protecting males from HPV infections it will also

help to protect women from infection

Boostrix and varilrix will continue to be offered in Year 7

MMR is being offered to students who do not have a history

of two doses of MMR at targeted schools in NSW in third

term 2014 as part of a catch up campaign

Other vaccines

GP immunisation providers can access free vaccines for:

– catch up vaccination of refugees,

– children within the appropriate age group who missed out

on vaccination at school,

– adults for whom hepatitis B vaccination is recommended

– unvaccinated MMR individuals born after 1966, and

– post-exposure treatment for Australian Bat Lyssavirus or

rabies

Meningococcal B

Bexsero® (4CMenB vaccine) has been registered for use

in Australia for people ≥ 2 months of age (but may be given

to infants from 6 weeks of age)

There are currently no administration recommendations in

the Handbook

ANIs are not authorised to administer Bexsero® vaccines

independently without a medical officer’s script

ATAGI recommends prophylactic paracetamol 30 minutes

prior to vaccination and 30 minutes after vaccination to

reduce risk and severity of fever