Immunisation Update for Practice Nurses

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Immunisation Update for Practice Nurses Dr Peter Eizenberg Director, ‘Doctors of Ivanhoe’ Executive Director, North East Valley Division of General Practice Member, Scientific Advisory Committee, NCIRS Member, NHMRC CCRE Immunisation Reference Group, RCH Immunisation Update for GPs 27 April 2006

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Immunisation Update for GPs 27 April 2006. Immunisation Update for Practice Nurses. Dr Peter Eizenberg - PowerPoint PPT Presentation

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Page 1: Immunisation Update  for Practice Nurses

Immunisation Update for Practice Nurses

Dr Peter EizenbergDirector, ‘Doctors of Ivanhoe’Executive Director, North East Valley Division of General PracticeMember, Scientific Advisory Committee, NCIRSMember, NHMRC CCRE Immunisation Reference Group, RCH

Immunisation Update for GPs27 April 2006

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General Vaccine update Current issues in vaccination

New travel vaccines ‘Vivaxim’ ‘Dukoral’ ‘Boostrix-IPV ’ ‘VIVOTIF Oral’

New vaccines coming soon HPV vaccine Herpes-Zoster vaccine Rotavirus vaccines

Seasonal FLU & Pandemic FLU update

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AGE / VACCINE Birth

Hepatitis B1

2 months

Hepatitis B2,3 DTPa Hib1,2 IPV 7vPCV

4 months

Hepatitis B2,3 DTPa Hib1,2 IPV 7vPCV

6 months

Hepatitis B2 DTPa Hib1 IPV 7vPCV

12 months

Hepatitis B3 Hib1,2 MMR MenCCV

18 months

***** VZV 23vPPV1

2 years

4 years

DTPa IPV MMR

10 – 13 years Hepatitis B4

VZV1

15 – 17 years

dTpa

50 years and over

dT 23vPPV2 Influenza (annual)2

65 years and over

23vPPV Influenza (annual)

Australian Standard Vaccination Schedule 18 Sep 2003

■ NIP funded from 1 Nov 2005

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Current issues Childhood IPV combination vaccines

Any dose ‘Infanrix–hexa’ requires 4th dose HIB vaccine at 12 mo (‘COMVAX’); (TAS, NSW, SA, ?some VIC)

Caution with ‘Varilrix ’ diluent Need to reconstitute with pellet

‘Tet Tox ’ deletion from Drs bag 1 April 2006

Influenza vaccine for infants 6 months to 2 years Australia currently recommends 0.125mL dose Two doses recommended (at least one month apart) for children

aged under 9 years who are receiving influenza vaccine for the first time.

‘Vaxigrip Junior ’ 0.25 ml syringe

‘Pneumovax’ 23v PPS single 5-yr re-vaccination for all over 65 yrs

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New travel vaccines ‘Vivaxim ’

Hepatitis A + Typhoid ‘Dukoral ’

Oral Cholera vaccine (inactivated) 2-dose schedule (for adults) Effective against Cholera for 6 months Effective against ETEC (Travellers Diarrhoea) for 3 months New chapter in Handbook update to NHMRC 8th Edition AIH

‘Boostrix-IPV ’ now available (approx $70) or monovalent ‘IPOL’ (Sabin supply to end soon)

‘VIVOTIF Oral’ now available (New Typhoid vaccine) 3 doses, alt days, approx $50

? Other ‘new’ travel vaccines MMR - all travellers born >Jan 1966 (if not doc’ed 2 prior doses) Influenza - ? all travellers, all seasons, all destinations

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New vaccines

Future vaccines coming soon

Human Papilloma Virus

Zoster vaccine

RSV vaccine

Rotavirus vaccine

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General Vaccine update - resources

Catch-up calculator (SA Imm website) http://www.healthsa.sa.gov.au/immunisationcalculator/ Applies to all state schedules,

children up to 7 years

‘Strive for 5’ cold-chain publication Range 2-8 degrees C. …but STRIVE for 5 Purpose-built vaccine fridges to replace

domestic fridges

DHS newsletter April 2006 Detailed update

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Seasonal & Pandemic Flu Issues

Seasonal FLU

Pandemic FLU Avian FLU Avian-mutant Influenza Human Influenza pandemic planning

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2006 Seasonal FLU Impact of Seasonal FLU – Australia (est. annual)

Medical consults 1 million Hospitalisations 20-40,000 Deaths 1,500 Days off work 1.5 million Total economic cost $600 million

FLU Vaccination Effectiveness (during FLU season)

70-80% effective against FLU illness 50-60% reduction all RTIs (>65s) 50% reduction hospitalisation, any cause (>65s) 68% reduction death, any cause (>65s) 40-50% reduction absenteeism during FLU season

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2006 Seasonal FLU

FLU vaccine components Season 2006 A/New Caledonia H1N1 A/New York H3N2 B/Malaysia

Influenza vaccine for infants 6 months to 2 years Australia currently recommends 0.125mL dose Two doses recommended (at least one month

apart) for children aged under 9 years who are receiving influenza vaccine for the first time.

‘Vaxigrip Junior’ 0.25 ml syringe

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2006 Seasonal FLU High-risk: age >65 yrs

80% coverage rate (DHS supplies enough to cover 110%)

High-risk: age <65 yrs 40% coverage rate

High-risk: Pregnancy NHMRC recommends: vaccn during any stage of pregnancy

Normal risk (age >6 mo) NHMRC recommends Flu vaccine for:

‘anyone who wishes to reduce their risk of FLU illness’

Travel vaccination (age >6 mo) all people, all destinations, all seasons

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Avian FLU – Human FLU Update on current avian FLU & Human infection

Previous FLU pandemics & future modelling

Anti-viral medications

Pandemic FLU vaccine production

What to do now (global & local)

Current Govt (C’wealth & VIC DHS) preparedness

Critical issues for GPs

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Avian FLU – Human FLU Update on current avian FLU & Human infection

FLU causes recurrent epidemics every 1-3 yrs, for >400 years

Avian FLU vs Avian-mutant influenza ?the next pandemic?

Human FLU types A, B, C Birds are reservoir for type A FLU Significant genetic variation amongst FLU strains

15 haemagglutanins (H), 9 neurominadases (N) Current Avian FLU H5N1

Previous FLU Pandemics 1918, 1957, 1968 Novel type A FLU virus with human & avian components 1918 (H1N1) mutation from avian FLU killed 20-40 million people 1957 – gene reassortment (H2N2) killed 1 million 1968 – gene reassortment (H3N2) killed 1 million Mixing of avian & human FLU genome Requires a host with both influenzae viruses for mixing to occur

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Avian FLU – Human FLU This outbreak

Initially in birds (geese, chickens, wild birds) Spread through migration, importing Host range broadened to include mammals (pigs, humans) Hong Kong outbreak 1997 (18 human cases, 6 deaths) Dec 2003: Sth Korea chicken deaths due to Avian FLU Dec/Jan 2004: Vietnam 10 human cases, 8 children died 2004: also Japan, Indonesia, Thailand, Cambodia, China 2005-6: also Azerbaijan, Iraq, Turkey

Human toll To March 2006: total human cases 186, deaths 105 WHO >80% infections associated with direct bird contact NB Mortality for 1918 Spanish FLU 2.5%

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Avian FLU – Human FLU Clinical picture

Usually contact with chickens 3 days to onset of illness

Fever, cough, SOB Diarrhoea Some sputum production +/- haemoptysis Pleuritic chest pain

Lymphopenia Thrombocytopenia Chest infiltrate on CXR

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Avian FLU – Human FLU Computer modelling:

Shows epidemic containable if:

The number of people affected <30 The 20,000 people closest to them get prophylactic anti-

virals (must be within 21 days)

Based on people infecting only 1.6 other people If more, household quarantine may also be necessary

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Avian FLU – Human FLU Neuraminidase inhibitors

N facilitates release of virus from cells N-inhibitors reduces release of virus & shedding from

patients Needs to be given early – before viral transmission

becomes efficient

Widespread resistance to Amantadine Possibly due to use in birds in China

Osaltamivir & Zanamivir currently being stockpiled ? For use at site of outbreak those at risk Prophylaxis of contacts Patients with confirmed disease

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Avian FLU – Human FLU Vaccines

Vaccine for birds Vietnam 2005 20 million shots (aiming for 400 million) Also China, Indonesia

Human vaccine: Current human vaccine against H & N proteins A/New Caledonia H1N1; A/New York/Fujian H3N2; B/Malaysia Humans should have human FLU vaccine Should help prevent co-infection; reduce risk of genetic

rearrangement High risk individuals should also have Pneumovax

Human pandemic vaccine development USA, Australia Tested healthy under 65s – good immunity 2 doses required Actual strain not yet in existance

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Avian FLU – Human FLU The global approach

must assist 3rd world countries in controlling their disease Urgency for vaccine development Share stockpiles of vaccines & drugs Control pandemic at source is the ideal approach

Current observations SARS an important ‘wake-up call’ Avian FLU spreading rapidly, but not a current threat to

humans Pandemic preparation currently rather disjointed & poorly

coordinated ‘Designated hospital’ concept provides a potentially useful

organisational structure Role of anti-virals remains unclear

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FLU Pandemic planning – issues for GPs

Current surveillance expectations DHS definition for case for suspicion

? Is your practice appropriately prepared

Relationships/partnerships in planning? role of General Practice/Local Divisions of GP with DHS with regional Infectious Disease Depts with GPDV/ADGP & C’wealth

Possible models of care, for discussion e.g. General Practice clinics to be ‘Flu-free’ zones Patients with Flu illness go to ‘Fever Clinics’ Home-based care by GPs for mild Flu illnesses

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FLU Pandemic planning – issues for GPs

Pandemic planning issues Communication strategies/efficiencies GP awareness

consistency of info, access to updates, etc staff preparedness Human resource/staffing issues GP staffing of fever clinics Equipment stock

Masks/gowns/anti-Flu medications Anti-Flu medication prescriptions

(availability, role of Amantadine) Practice viability/sustainability Practice security issues