2018 Immunisation Update

Transcription

1 2018 Immunisation Update A puzzling time?!! Sometimes the hardest pieces of a puzzle to assemble, are the ones missing from the box. Dixie Waters, Author

2 The Puzzle Pieces Immunisation coverage rates NSW Immunisation Schedule School Vaccination Program 2018 Influenza Program Cold Chain Catch Up Other stuff

3 Immunisation Coverage Data Illawarra Shoalhaven Public Health Unit 405,936 (66%) South Eastern NSW Primary Heath Network 611,214

4 reports/hc42/resources/immunisation_rates_for_childr en_2016%e2%80%9317_factsheet.pdf

5 NCIRS-Annual-Immunisation-Coverage-Report pdf

6 Immunisation Coverage (%) All Children years 2 years 5 years SEPHN Aus

7 Immunisation Coverage (%) ATSI Children years 2 years 5 years SEPHN Aus

8 Immunisation Coverage (%) All Children Illawarra Shoalhaven LHD year 2 years 5 years Wollongong Shellharbour-Kiama Shoalhaven

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10 1yr old coverage

11 2yr old coverage

12 5yr old coverage

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14 Helping Parents With the Puzzle

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16 campaigns.health.gov.au/immunisationfacts

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19 /immunisation-order-form.pdf

20 NSW Immunisation Schedule Interim schedule from 1 st April 2018 until 30 th June 2018 Changes: Influenza vaccine funded for ALL children aged 6 months - under 5 years Removal of Varicella for year 7 students Addition of Meningococcal ACWY for students in years Different vaccine brands

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22 Unconfirmed changes from 1/7/18 Birth, 6 weeks and 4 months: unchanged 6 months: DTPa/Hib/HepB/Polio only 12 months: MMR, Meningococcal ACWY, PCV13 18 months: MMRV, Hib, DTPa 4 years: unchanged

23 Australian Immunisation Handbook Update 9/4/18

24 Australian Immunisation Handbook Update 9/4/18

25 Australian Immunisation Handbook Update 9/4/18

26 Things to remember DO NOT give birth dose hep B after 7 days of life 6 weeks is the EARLIEST vaccines can be given Rotavirus is age limited Extra dose hep B recommended at 12 months for babies born <2000g or <32 weeks (regardless of weight) Extra dose of Prevenar13 at 12 months for babies born <28 weeks + Pneumovax23 at age 4-5 years Schedule point is 4 years NOT 3.5 years for ALL children **Stick with the schedule points unless good reason for giving early - contact PHU for advice**

27 Things to remember Combination vaccines are OK to use for catch up Can give Prevenar13 and influenza vaccine together 2 doses of varicella vaccine are recommended but only one is funded Don t use MMRV as dose 1 - increased risk of fever / febrile seizure Meningococcal B vaccine is recommended but not funded for anyone who wishes to protect themselves New vaccine - Trumenba NOT for use in <10 yrs

28 *Total population of ISLHD = 405,936*

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30 New Child Care Vaccination Requirements From 1 January 2018: Children who are unvaccinated due to their parent s conscientious objection will no longer be able to be enrolled in child care Further information for parents available on NSW Health website

31 Accepted forms for enrolment: AIR Immunisation History Statement which shows that the child is up to date with their scheduled vaccinations or AIR Immunisation History Form on which the immunisation provider has certified that the child is on a recognised catch-up schedule (temporary for 6 months only) or AIR Immunisation Medical Exemption Form which has been certified by a GP No other form of documentation is acceptable (i.e. the Interim Vaccination Objection Form or Blue Book)

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33 No Jab No Pay *From January 1st 2016* Parents who do not fully immunise their children (up to 19 years of age) will cease to be eligible for Child Care Benefit, Child Care Rebate and the Family Tax Benefit Part A Children with medical contraindications or natural immunity for certain diseases will continue to be exempt from the requirements Conscientious objection and vaccination objection on non-medical grounds will NO LONGER be a valid exemption for immunisation requirements

34 Delivered through all high schools throughout the Illawarra Shoalhaven LHD Catch up provided at subsequent visits for students who are absent on the day of the clinic Any student can commence or complete the course with the GP, however if they have commenced with a GP they must complete with a GP Parent needs to withdraw from School Program by ringing Public Health Unit Records are kept and can be provided by the PHU Before completing any course commenced at school, please contact the PHU to ensure correct dose intervals are observed

35 Things to remember Gardasil 9 Coverage against 5 extra high-risk associated with cancer 2 doses: 6 months apart for students <15 years 3 doses: 0, 2 & 6 months for students 15 years and those with significant immunocompromised or on significant immunosuppressive therapy Discard any Gardasil you have left in your fridge Contact the PHU for any tricky dosing issues Continue to report doses to the HPV Register

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37 Things to remember MMR In NSW, 123,636 adolescents aged between yrs (as at 31/12/15) had not received dose 2 of MMR In 2016, 10,880 (8.8%) had received dose 2 - possibly due to No Jab No Pay Think about checking MMR for travellers and any adolescent you see Age Appropriate Vaccines DTPa vaccines i.e. Infanrix / Tripacel are for use in children <10 yrs dtpa vaccines i.e. Boostrix / Adacel are for use in adolescents/adults 10 yrs Lower dose of antigens required for adults

38 Things to remember Meningococcal Healthy adolescents who missed MenCCV in childhood (or high school) should receive a catch up dose 2 doses of Meningococcal B vaccine (Bexsero or Trumenba) are recommended for yr olds - especially for those living in close conditions

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43 Shingles Things to remember Catch up for yrs continues until 31/10/2021 After infection, wait 1 year before vaccinating Immunocompromised patients should not be vaccinated GP must order - not on list of vaccines for Authorised Nurse Immunisers

44 Things to remember

45 Things to remember

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48 Asplenia

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50 spleen.org.au

51 spleen.org.au

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53 HCWs & Students Infectious Disease Diphtheria Tetanus Pertussis Measles Mumps Rubella Hepatitis B Varicella Influenza Tuberculosis Vaccine (used in Aust.) dtpa - Boostrix or Adacel (not ADT) MMR II or Priorix H-B-Vax II or Engerix B Varilrix or Varivax Vaccines vary seasonally Assessment +/- screening required www1.health.nsw.gov.au/pds/activepdsdocuments/pd2018_009.pdf

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55 Things to remember Serology Evidence of seroconversion to Hepatitis B vaccine required = Anti-BSs 10mIU/mL (taken 4-8 weeks post vaccination) DO NOT test for immunity to pertussis Serology is NOT REQUIRED after completion of a documented MMR or VZV vaccination course Use the AIR and the PHU to help with vaccination records

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57 New things Influenza Mandatory annual influenza vaccination for workers employed in a Category A High Risk position must be vaccinated by 1 June each influenza season Antenatal, perinatal and postnatal wards including labour wards and recovery rooms and antenatal outreach programs Neonatal intensive care units, special care units, any home visiting health service provided to neonates Paediatric intensive care units Transplant and oncology wards Intensive care units

58 New things Varicella Verbal history of disease is no longer accepted as evidence of compliance Must show evidence of: 2 doses of varicella vaccine at least 1 month apart (1 dose in those vaccinated before 14 years of age); OR Positive serology; OR 1 dose of Zostavax in those aged 50 years or over

59 New things Diphtheria/Tetanus/Pertussis All Category A workers (direct physical contact with patients/clients) are required to have a 10 yearly booster for dtpa LHD is responsible for cost

60 Influenza

61 Seed virus used to make vaccine mutated during production H3N2 strain most affected vaccine only ~ 30% effective Different H3N2 strain used in 2018 vaccine Ongoing issues with using chicken eggs to produce a vaccine for humans

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66 Free vaccine 6 months to < 5 years (new in selected states only) Aboriginal & Torres Strait Islander people 15 years Pregnant women (any trimester) 65 years 6 months with medical risk conditions Health Care Workers (working within NSW Health Facilities)

67 Influenza hospitalisations ISLHD 2017 by age

68 2016 Recorded Influenza Vaccination 6 months - < 5 years

69 Vaccine funded medical conditions - risk of influenza & associated complications

70 Things to remember Vaccine is strongly recommended (but not funded) for people with: Down Syndrome Obesity (class III), defined as BMI 40kg/m 2 Chronic liver disease Egg allergy is NOT a contraindication to influenza vaccination Patients with anaphylaxis to eggs can be vaccinated with a full vaccine dose in facilities with staff experienced in the recognition and treatment of anaphylaxis Keep patient for 30mins post vaccination Prevenar13 & Influenza vaccines Recent data has not suggested an association between co-administration and febrile seizure

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72 Things to know ATAGI Statement

73 Things to remember

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76 *Will be sent out towards the end of the season when FluQuadri supplies are exhausted*

77 *Fluad will be sent out first, then Fluzone*

78 *Stickers will be sent with vaccine order to assist with easy identification*

79 Things to know Fluzone and Fluad Higher immunogenicity Trivalent Formulated to provide protection for older people - esp. against A/H3N2 which is more common & more severe in older people Increase reports of injection site & systemic reaction NOT registered or licensed for other age / risk groups No preference for either vaccine Use of multiple types of vaccine i.e. QIV and TIV in an individual has not been studied

80 Things to know Timing Vaccination prior to onset of season recommended Peak season usually = June to September Vaccine takes 2 weeks to become effective Protection is expected for whole season - optimal protection occurs within first 3-4 months post vaccination Never too late Revaccination is not recommended but not contraindicated

81 Things to know Latex in vaccines DO NOT CONTAIN: FluQuadr Junior Fluquadr Afluria Quad Fluzone High Dose DO CONTAIN: Fluarix Tetra Fluad Removable needle shield

82 The Cold Chain Puzzle

83 1. Purpose-built vaccine refrigerator Key Principles 2. Nominate a staff member + a back up to be responsible for vaccine management 3. Have a facility policy - based on National Vaccine Storage Guidelines 4. All staff have training 5. Vaccine storage self-audits 6. Monitor temperatures twice daily 7. Have plans to respond to and manage breaches and power failures 8. Use ice packs & monitor coolers as per Guidelines 9. Report breaches to PHU 10. Have a maintenance plan

84 1. Purpose-built Vaccine Fridge

85 2. Staff Having one person responsible ensures consistency Multiple components of Vaccine Storage Management Ordering Monitoring Auditing Organising maintenance for fridge, thermometers & data logger

86 3. Policy

87 4. Staff Training

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102 5. Self-Audits

103 6. Temperature monitoring

104 All providers MUST have Min/max thermometer Battery powered Fridge monitoring For fridge and or cooler temperature monitoring during a power outage Data logger In-built or external for continuous monitoring. Download data once per week to check for excursions outside +2 C to +8 C (known as a cold chain breach)

105 7. Cold Chain Breach Management

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110 8. Pack Cooler as per Guidelines

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112 9. Report Breaches to Public Health Unit Immunisation Team or

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114 10. Maintenance Plan

115 Annual Fridge Service

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117 Sometimes the most difficult puzzle!! Decreased since the initial No Jab No Pay rush Free vaccines for catching up adolescents aged years (ongoing) Resources: Australian Immunisation Handbook (online version) ISLHD PHU Catch Up Tools + PHU phone support NSW Ministry of Health Tools Immunise Australia Guidelines

118 General Rules Investigate ALL avenues to find all the puzzle pieces before assuming doses have not been given Ensure intervals between previously given doses are valid and therefore acceptable in Australia Number of doses for some vaccines may decrease or even be unnecessary with age i.e. conjugate vaccines Build on previous doses - no need to start courses again (except for oral cholera - timing of doses important) Give all vaccines due at the first visit - use multiple limbs Can use combination vaccines that contain antigens that are not required i.e. Infanrix hexa

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122 Other Stuff

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126 thanks for listening