PHAA Immunisaton Conference. Adelaide 5-7 June 2018

Transcription

1 PHAA Immunisaton Conference Adelaide 5-7 June 2018

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3 Good Public Health Messaging

4 Reporting back Cold Chain Nurse Practitioner Immunisation

5 Cold Chain Use of and access to thermostability data has been limited NSW project Thermostability data New Cold Chain Management Process Saved lots approx $407,000 Increased provider and PHU time

6 Cold Chain during storm - SA Pharmaceutical fridges lost temperature quicker Nurses went over and above to maintain cold chain Surge in calls Ability to update website to get information out

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8 What happened? Over 300 cold chain breaches 40% SA Immunisaiton Provider effected 85% of calls from General Practice Why weren t there more? Back up plans in place including generators, UPS Time of day mid afternoon Influenza programme largely completed

9 Nurse Practitioner Role Several models presented but all linked to hospital children service Clinical lead able to: scripts for non schedule and special groups, order tests refer to other specialists

10 Meningococcal Vaccines Mary Nowlan Immunisation Advisory Centre Immunisation Workshop

11 Transmission differs from other invasive bacterial infections Vetter V (2016) Exp Rev Vaccines 15(5):

12 Meningococcal disease in NZ Age group (years) Year Total Average annual rate < to to to to to to Total Data from ESR 3

13 Meningococcal disease in NZ 112 cases in 2017 Rate 2.3 / 100,000 mainly groups B and C W and Y increasing Group W high CFR (14.3% NZ) Older adults atypical presentation Data from ESR The Immunisation Advisory Centre

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15 Meningococcal conjugate vaccines Trade name Antigens Conjugate Indicated age range Licensed in NZ NeisVac-C MenC Tetanus toxoid From 8 weeks Y Mentorix Hib-MenC Tetanus Toxoid From 6 weeks 2 years N Menveo MenACWY Diphtheria CRM From 2 months N Nimenrix MenACWY Tetanus toxoid 12 months 55 years Y Menactra MenACWY Diphtheria toxoid 9 months 55 years Y 6

16 Meningococcal conjugate vaccines High levels of bactericidal antibody provide protection and reduce transmission Best protection achieved through establishment of herd immunity Target adolescents and young adults with highest carriage rates mass campaign with catch-up Then introduce scheduled doses to infants and adolescents Booster doses maintain antibody levels 7

17 Meningococcal B Highest annual average rate in infants 13.9 / 100,000 population aged <1y 2.2 / 100,000 Māori and Pacific Overall average rate = 0.9 / 100, MenB polysaccharides unsuitable for a conjugate vaccine <1 1 to 4 5 to 9 10 to 14 Age group 15 to to to Parikh, S. R., et al. (2016). Lancet, 388(10061), ESR data

18 Bexsero (4CMenB) Bexsero (GSK) recombinant vaccine, 4 components includes MeNZB OMV Targets multiple MenB strains - ~75% UK introduced Bexsero as infant schedule at 2, 4 & 12m in Sept 2015 plus preschool booster to maintain antibody levels. Risk of MenB halved in vaccine-eligible infants within 10 months Two doses in infants 82.9% effective against all circulating MenB Herd immunity data limited B Part of It study, S Australia Potential cross-protection with other meningococcal groups (including W)? Parikh Lancet (10061) Ladhani 2016 Emerg Inf Dis 22(2)

19 Bexsero safety Moderately reactogenic in children and adults Prophylaxic paracetamol recommended Lower rates of fever in toddlers at 2y Awareness required for ED paediatricians to reduce hospital admissions and invasive investigations of infants presenting with fever following vaccination. Harcourt S, et al. Vaccine 2018;36(4): Nainani V et al Arch Dis Childhood 2017;102(10): Kapur S et al Arch Dis Childhood. 2017;102(10):

20 Australian experiences Life time cost of IMD direct and lifetime costs vs vaccine High healthcare costs in infants and young children Loss productivity and disability of adults MenACWY replaced MenC in adolescents from July 2018 W & Y becoming prevalent in infants age 3-12m Outbreaks of W in SA and WA mass vaccination campaigns NIC2018 Adelaide The Immunisation Advisory Centre 11

21 Australian experiences Rates of MenB overall rate 11.1/100,000 < 1 year-olds Indigenous 4 times non indigenous Australian rates support MenB and MenACWY vaccination of all at 12m and adolescents (15-19y) and ALL Aboriginal children aged <15y Recommendations under public consultation NIC2018 Adelaide 12

22 Considerations and questions How can we best protect the most vulnerable from IMD - infants, elderly and immune compromised? Can the MenACWY vaccines and Bexsero provide herd immunity against Men W and B disease? Mass catch-up campaign for all children and young adults. Is any cross-protection from Bexsero clinically relevant? 13

23 Antigen literature reviews 14

24 High risk groups and those at risk Infants Close contacts of case Immunocompromised splenectomy, complement component deficiencies, eculizumab, HIV, HSCT Laboratory workers and those at increased occupational risk Travellers particularly young adults Visiting meningitis belt in Africa and other high risk countries Hajj pilgrims Other groups Smokers Indigenous peoples Young adults living in shared accommodation (uni students, prison, barracks) Funded vaccines for special groups July factsheet 15

25 PHAA Conference Adelaide Vaccine safety and active surveillance reporting. The how s and why s of active surveillance Current situation in Australia Slides from AusVaxSafety and SmartVax Credit Kristine Macartney and the team and NCIRS.

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27 Western Australia pop 2.2 million 2010 Flu season Passive reporting system FC children 10 years 25 spontaneous reports 16 in WA, 14 notified on 20 April 2010 Compared with 5 in 2008 and 1 in 2006 Estimated 1/110 within 4-6 hours Programme suspended

28 New Zealand Pop 4.38 million 2010 Flu season No signals from Passive Surveillance 24 th April there was 1 post Celvapan, 3 post Fluvax and 1 brand unknown Rapid analysis of admission data for Starship and Kids First hospitals (Auckland region 1.5million) Database extraction No more FC than normally expected (~25 per week)

29 Passive monitoring data CARM Seasonal Influenza Vaccine Fever and Fever Convulsions by Age and Vaccine Fluvax Vaxigrip Influvac Unknown Reports <2y 2-8y 9-15y 16-24y 25-64y 65y plus Age N=435 Data from the Centre for Adverse Reaction Monitoring (CARM)

30 AusVaxSafety a timeline Horvath Review FAST, SmartVax surveillance in WA NCIRS-led national pilot study of influenza vaccine safety in kids SmartVax joins AusVaxSafety (replaced FAST) STARSS RCT in SA Influenza vaccine safety surveillance in all ages Safety signal in <5s receiving flu vaccine Nationwide suspension of paediatric influenza immunisation Vaxtracker surveillance in NSW AusVaxSafety established (FAST + Vaxtracker) Influenza vaccine safety surveillance in kids <5 years Pertussis booster in kids and zoster vaccine safety surveillance School-based surveillance of HPV vaccine safety

31 AusVaxSafety s active vaccine safety surveillance system Nationwide (270+ sites) Participant-based (70% participation rate) Automated software Safety signal analysis Early detection of potential safety concerns

32 Vaccination encounter at sentinel immunisation clinic Data only identifiable at practice-level SmartVax database Auto SMS to patient: Any reactions to the vax? 3 days later 1. SMS link: Brief survey of symptoms Yes 2. SMS: Did you see a doctor for reaction? No No responses No Yes enable AEFI rate calculation Analysis and safety signal detection (weekly-monthly) Reports to Government de-identified data from central SmartVax database Feedback to immunisation providers and the public at Flagged for follow-up by immunisation clinic

33 3 days after vaccination

34 Active vaccine safety surveillance Pertussis booster Zoster HPV Maternal pertussis Influenza

35 Active vaccine safety surveillance results Percent of Respondents 20% 15% 10% 5% No safety signals have been detected to date. Any adverse event Medical attendance 0% Pertussis booster HPV Influenza Maternal pertussis Zoster Participants 45,982 7, ,785 (2018) ,666 Group 1-6 years years 6 months Surveillance since (annually) Pregnant women years

36 2018 Influenza vaccine safety surveillance results No safety signals were identified. 165,785 participants! Percent of Respondents Rates low and within expected ranges 0 6 months-2 years 3-4 years 5-17 years years Pregnant women 65 years Any adverse event Medical attendance

37 Acknowledgements

38 PHAA Immunisation Conference June 2018 Improving whole of life immunisation Lisbeth Alley Regional Advisor IMAC

39 Plenary: Improving whole of life immunisation Ms Sharon Appleyard First Assistant Secretary, Office of Health Protection, Dept of Health: Australia has a National Immunisation Strategy with 8 key priority areas: 1. Improve immunisation coverage 2. Effective governance of the NIP 3. Secure supply and efficient use of vaccines 4. Enhance vaccine safety monitoring systems onal-immunisation-strategy-for-australia

40 Priority areas cntd. 5. Promote community confidence through effective communication strategies 6. Strengthen monitoring and evaluation of the NIP 7. Ensure skilled immunisation workforce 8. Maintain Australia s strong contribution to the Asia-Pacific region

41 Optimising protection for pregnant women & infants from serious infectious disease Professor Helen Marshall, Robinson Research Inst., U. of Adelaide Imms in pregnancy only way to prevent influenza in infants <6m age Also for pregnant women risk of complications high Uptake of vaccines is suboptimal Limited awareness and access due to lack of provider recommendation, parental concerns re safety Need to increase confidence, introduce standard pregnancy care models

42 Childhood immunisation: what have I missed? Assoc. Prof Tom Snelling, Wesfarmers Centre of Vaccines and Infectious diseases NIP changes reflecting epidemiology of VPDs Focus on changing recommendations for influenza, meningococcus, pneumococcus, HPV HPV Introduction of 9vHPV in 2 doses (0m, 12m) as of Jan 2018 Influenza- low coverage in young children, since Most jurisdictions funding vaccination of children <5yo,?vaccination of school-aged children

43 Childhood immunisation: what have I missed? cntd. Meningococcus Near elimination of MenC; rates of MenB, except in SA rates of MenW, especially in remote Aus rates of MenY A number of jurisdictions funding late adolescent MenACWY MenACWY (Nimenrix )to replace Hib-MenC at 12m from July 2018 Positive recommendation for late adolescence MenACWY on NIP SA to fund infant MenB program (on top of adolescent MenB evaluation)?waning protection from MenC and MenACWY vaccines?need for booster

44 Childhood immunisation: what have I missed? cntd. Pertussis rates over past 2 decades ( and better testing) Severe disease and almost all deaths in babies with no doses Focus on mitigation rather than elimination Move from 5 dose to 7 dose schedule with re-intro of 18m booster and antenatal vaccination Control is precarious, even removal of adolescent booster could impact on disease in young infants. What s next? On-going risk to babies born to unvaccinated mothers Pneumococcus Move from 3+0 schedule to 2+1 schedule (2, 4, 12m) from July 2018 Except for high risk and Aboriginal children (3+1) What s next??vaccine catch-up of older Aboriginal children/ adolescents

45 The Forgotten People adults aged >65 years Dr Robert Menzies, Uni of NSW, School of PH and Community Medicine Est. 3 m Australians > 65yrs with >50% are under-vaccinated with medical risk factors Large age range, more difficult to find and monitor not on AIR Added to AIR but no 2 way data flow Medically at-risk of serious complications from influenza Pregnant women - influenza vaccine & pertussis vaccine Aboriginal and Torres Strait Islander people Annual influenza vaccination PPV23 vaccine years & with medical risk factors No KPIs, incentives

46 Equity in disease prevention vaccines for the elderly Professor Raina MacIntyre, Uni of NSW, School of PH and Community Medicine Aust pop to rise: >65 will be 1:4. 1:10 will be employed >65. Low awareness by pts and providers- especially in 2 o care Unconscious bias and ageism Ethics of withholding care and Tx. High dose flu vaccines VE >25% to 35% vs adjuvanted flu vaccine >25-35%. Zostavax VE of Shingrix around 90% plus in older people - so can respond well to vaccines Vaccines effectiveness is equal to other preventative strategies (incl. stopping smoking) and increases when adjusted for frailty