Massachusetts Administrator & Director of Nurses Wage & Benefit Update
Immunisation Update for Practice Nurses
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Transcript of 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
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
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
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
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
New vaccines
Future vaccines coming soon
Human Papilloma Virus
Zoster vaccine
RSV vaccine
Rotavirus vaccine
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
Seasonal & Pandemic Flu Issues
Seasonal FLU
Pandemic FLU Avian FLU Avian-mutant Influenza Human Influenza pandemic planning
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
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
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
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
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
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%
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
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
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
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
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
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
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