PHN - Western Victoria Immunisation Forum Stephen Pellissier Manager Immunisation, DHHS 29 July 2017

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1 PHN - Western Victoria Immunisation Forum 2017 Stephen Pellissier Manager Immunisation, DHHS 29 July 2017

2 Herding Cats

3 Again a huge increase in political and media focus on immunisation and vaccination coverage rates Massive increase in social commentary Increased noise but no impact from Anti-Vaxxers. Increased expectations on the underlying structure and the immunisation service delivery field in Victoria. How to use this to our advantage?

4 Australian Immunisation Register (AIR) quarterly immunisation coverage data Victoria, 30 June Age Vic (Aus)% Vic (Aus)% Indigenous 12-<15 months (93.90) (91.90) 24-<27 months (90.50) (86.70) 60-<63 months (5 years) 72-<75 months (6 years) (93.90) (96.30) (94.00) (97.4)

5 Childhood Coverage 24-<27 months by Region March 2017

6 Improved access to AIR overdue reports 1. Centralised process (either by state or by Register) to manipulate11a report DHHS IT 2. Working group (PHN, DHHS, LGAs) to inform specifications/requirements of report 3. Distribution process to 6 Victorian PHNs 4. PHNs distribute relevant report to each immunisation provider

7 Victorian Secondary School Vaccine Program percentage Year 7* students vaccinated *In 2015, dtpa program moved from Year 10 to Year 7. Year 10 participation for dtpa is noted in In 2014, varicella data includes only those students vaccinated; natural immunity included in % 90% 90% 80% 70% 79% 76% (Year 10) (Year 10) 69% 74% 73% 74% 71% 60% 50% 51% 40% dtpa Varicella HPV (3 doses)

8 National HPV 3 dose vaccine coverage for males/females turning 15 years of age in 2015 Females Males

9 Budget : Extension of No Jab No Pay funding Previous policy communication indicated while ongoing consequences for Centrelink payments applied to families of overdue children 0-19 years of age, funded catch-up for years olds would cease 31 December 2017 Recent budget announcement: Measure to provide ongoing catchup vaccines for ALL Australian children aged years of age Applicable to all vaccines on the NIP Provides protection to refugee and other humanitarian entrants years of age PLUS free catch-up vaccines will be provided to adult refugee and humanitarian entrants Access to catch-up vaccine for 0-9 year olds will remain unchanged

10 No Jab No Pay Commonwealth measure On 1 May 2017 the Commonwealth Minister for Health, the Hon Greg Hunt MP, announced that from 1 July 2018, the Australian Government would be strengthening the No Jab No Pay policy by reducing the fortnightly Family Tax Benefit Part A payment by $28 per fortnight for each child who does not meet the immunisation requirements. Commonwealth announcement No Jab No Play

11 Commonwealth Announcement Concerns with definition of enrolment versus attendance

12 Meningococcal

13 Number of notifications Invasive meningococcal disease serogroup and year Victoria: 2000 to 2017 (YTD) MenCCV 12mo dose (from Jan 2003) catch-up 1-19yo's ( ) Y W C B A Not further specified Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3* Year and quarter * Till 7 August 2017

14 Number of Notifications Invasive meningococcal disease - serogroup and year Victoria: 2013 to 2017 (YTD) Y W C 60 B 50 9 not further specified (till 7 August) Year

15 Number of Notifications Invasive meningococcal disease - age group by year Victoria: 2013 to 2017 YTD Age (years) till 7 August

16 MenW epidemiology July 2017 Proportion due to MenW has increased 2013: 4% (1/24) 2014: 12% (4/33) 2015: 31% (17/55) 2016: 62% (48/77) 2017 YTD 44% (18/41) 5 MenW deaths: ages 18, 19, 46, 69 and 73 yrs

17 Meningococcal ACWY vaccine program Eligibility: Targeted school-based vaccine program for all* Years 10, 11 & 12 of secondary school or for all adolescents aged 15 to 19 years from 18 April to 31 December 2017, through community immunisation services. Cessation of program: At this time, program finishes 31 December 2017 Data Collection: An will be sent to councils regarding data that will be requested to inform the evaluation of school-based programs Resources: Immune Hero website: school letter, sample school newsletter, collection statement and FAQ. Immunisation Section website: Health provider FAQ Communication: Education sectors (3) sought support for the program and a letter to principal sent to all schools. All immunisation providers: ed information 6 & 16 June. Project Officer: Dedicated Meningococcal vaccine program project officer (job share) has been employed for one year to support implementation and evaluation of program

18 Menactra - meningococcal ACWY vaccine Single dose vials, 0.5 ml given IMI Liquid for draw up - needles/syringes not supplied Protect from light Once drawn up use on the same day provided cold chain has been maintained Administration in pregnancy: GP discussion risk v benefit Breastfeeding: can be given

19 Rotarix vaccine replacing RotaTeq vaccine from 1 July 2017 Following a recent Commonwealth government tendering process, Rotarix vaccine is to replace RotaTeq vaccine from 1 July 2017 Rotarix given in a 2-dose schedule at 2 months (from 6 weeks) and 4 months of age, will replace RotaTeq vaccine from 1 July Rotarix age restrictions apply. The 1st dose must be administered prior to 15 weeks of age and the 2nd dose prior to 25 weeks of age. During the brand switch period, some infants may potentially receive fewer doses than routinely scheduled when using the RotaTeq brand. A Rotarix wheel, administration advice and the ATAGI advice will be sent with Rotarix deliveries. Live attenuated 1.5ml oral suspension in tube

20 Rotarix vaccine replacing RotaTeq vaccine from 1 July 2017 Prior to July 2017, start to reduce your stock of RotaTeq vaccine in preparation for receiving Rotarix vaccine. Only local council immunisation services will receive the RotaTeq vaccine stock after July until remaining stock is used (~ 1-2 months) to reduce wastage and errors. See 22 June to all councils with this information. Councils will receive Rotarix vaccine automatically once the warehouse stocks of RotaTeq are exhausted It is appropriate to use RotaTeq for all eligible babies if this is the only stock you have From 1 July all jurisdictions will be commencing the switch from RotaTeq to Rotarix Link to ATAGI advice addressing safety issues and common scenario s to manage during the changeover period from RotaTeq to Rotarix

21 2 additional vaccine brands from July 2017 Quadracel or Infanrix IPV is to be supplied at the 4 year old schedule point for DTP-IPV vaccine. Quadracel is an equivalent DTP-IPV containing vaccine for children at the 4th birthday and for catch-up under 10 years of age. Engerix B Paediatric or H-B-Vax II Paediatric is to be supplied for the birth dose of the hepatitis B vaccine and for catch-up under 20 years of age. Engerix B Paediatric vaccine is an equivalent hepatitis B containing vaccine for infants at birth.

22 Shingles vaccine program Shingles vaccine (Zostavax ) commenced 1 November 2016 Eligibility criteria: ongoing program for 70 year olds plus a five-year catch-up program for people aged years. Eighty year olds that were age eligible from 1 November but missed a dose due to supply constraints can still receive a free dose. Reminder: This vaccine is contra-indicated in immunocompromised people Adverse events are reported to SAEFVIC and must include if the person is immunocompromised NCIRS fact sheet:

23 Influenza vaccination during pregnancy Promote recent information from Professor Brendan Murphy (Australian Government Chief Medical Officer ) Vaccination remains the best protection pregnant women and their newborn babies have against influenza. Vaccination rates amongst pregnant remain low - only 1 in 3 pregnant women receiving the influenza vaccine. Can lead to premature delivery and even death in newborns and very young babies. Pregnant women can have the vaccine at any time during pregnancy and they benefit from it all through the year. Health professional: Flu vaccination and pregnancy Free flu shots for pregnant women Pregnant women: Flu vaccination and pregnancy What pregnant women need to know Flu vaccination and pregnancy Vaccinate against flu. Protect your baby too For further information visit the Immunise Australia website Pregnant Women page. Electronic booklet for women:

24 Influenza vaccine for Aboriginal clients Aboriginal and Torres Strait Islander children aged 6 months to 5 years, and adolescents/adults aged 15 years and over, are eligible for free flu vaccine under the NIP. Please remember to check the Aboriginal identification status of all clients to ensure eligible children and adults can receive vaccine.

25 Hep B vaccine eligibility for Aboriginal clients Aboriginal Victorians experience disproportionately higher rates of hepatitis B than non-aboriginal Victorians. Victorian Government now provides free hepatitis B vaccination to all Aboriginal Victorians, with no restriction. This provision is in addition to the free vaccine available to other at- risk groups

26 Aboriginal immunisation program area Currently scoping key areas of Aboriginal immunisation for future engagement Aim to develop health needs analysis to focus immunisation initiatives in this area moving forward. Commenced engagement internally within DHHS through Aboriginal Health & Wellbeing Unit and Divisional Aboriginal Health Network Cancer Council Victoria s evaluation of Aboriginal Adolescent HPV Immunisation Project: Gippsland Regional Pilot due September 2017 Currently focussing on developing relationships with key stakeholders, and looking specifically at data NHPVR and AIR, and Aboriginal identification and impact on data quality.

27 Out of Home Care immunisation project Ongoing collaboration with child protection and OoHC colleagues Three resources available For carers For child protection practitioners and case managers For immunisation providers Immunisation web site new tile Special Risk Populations

28 Refugee Immunisation Project $2.3 million has been allocated by Vic government to support development of a model to ensure catch-up immunisation for newly arriving humanitarian entrants Hume/Whittlesea pilot of revised multi-disciplinary service pathway Proposed co-located nurse immuniser between LGA and settlement service CGD whole of school catch-up program at NPELS ASRC clinic-based immunisation service targeting medicare-ineligible asylum seekers

29 Mature minor consent for immunisation The law recognises that as children become older and more mature, they are more capable of making their own decisions No specific age when a young person may be deemed a mature minor. Requires consideration of whether they have sufficient maturity to understand the nature and effect of a decision to be vaccinated. Relevant factors include: age, level of maturity for their age, understanding of the issues and consequences, living arrangements (independence). In a school setting this determination may be made by the school principal in accordance with the DET Policy on Decision Making by Mature Minors (see In other settings, may be able to be made by a medical practitioner or other health or welfare professional who has sufficient knowledge of the young person and their history and circumstances to assess their maturity.

30 ..and Pertussis in pregnancy HPV 9 valent, 2 dose Pneumococcal in older persons Meningococcal? (Schedule change?)

31 Thank you Immunisation Section enquiries Call: (M to F 9am-12pm & 2pm-3pm) immunisation@dhhs.vic.gov.au Web: