General Practice Nurses

Transcription

1 General Practice Nurses Annual Update 2016 Prepared by Kym Bush Immunisation Coordinator Public Health Unit April 2016

2 Topics to be covered Vaccine preventable diseases update Current schedule and changes in 2016 Immunisation resources Vaccine ordering and storage AEFIs

3 Vaccine preventable diseases

4 Measles 4 cases of measles in NSW in last fortnight Travellers on flights to Sydney Had spent time in RNSH emergency department Two other cases were young children recently returned from India Flights and visited medical centre and hospital whilst infectious

5 Measles

6 Measles Under vaccinated sub groups i.e. Pacific Islander or conscientious objectors Maternal immunity Pre travel vaccination for young adults post be-dying-from-complication-of-measles go8a03.html

7 Pertussis - new research Neither vaccination nor naturally acquired infection provides lifelong immunity Recent evidence suggests greater protection for infants through maternal vaccination in the 3rd trimester of pregnancy results in utero transfer of maternal antibodies Is likely to provide protection to young infants from disease until pertussis vaccination begins at 6 weeks of age A UK study has shown a 91% reduction in infant pertussis disease Extensive use in UK & US show pertussis vaccine in pregnancy is safe

8 NH&MRC recommendations Pertussis containing vaccine is recommended as a single dose during the 3rd trimester of EACH pregnancy. Vaccination during pregnancy is more effective in reducing the risk of pertussis in young infants than vaccination of the mother post-partum added benefit is due to direct passive protection of the newborn by transplacental transfer of high levels of pertussis antibodies the mother will also be protected against pertussis in the 3rd trimester and less likely to transmit pertussis to her infant after delivery

9 Pertussis

10 NSW Antenatal Pertussis Vaccination Program Hospitals: the postnatal catch-up vaccination will move to an antenatal vaccination program dtpa vaccine should be offered to all pregnant women in the 3rd trimester, ideally at the 28 week visit but can be given at any time during the 3rd trimester up to delivery. Shared care patients: Free vaccine to pregnant women through GPs and Aboriginal Medical Services

11 Other control measures Additional 18 month booster new schedule NSW Adolescent School Vaccination Program Boostrix in Year 7 For adults at risk of acquiring pertussis, or transmitting it to vulnerable persons e.g. staff working in antenatal, maternity and paediatric units booster 10 years after receipt of prior pertussis-containing vaccine Adults aged 65 years should be offered a single dtpa booster if they have not received one in the previous 10 years

12 Other recommendations Infanrix-hexa and Infanrix-IPV can be used for primary or booster doses in children aged up to 10 years (previously 8 years) dtpa can be administered at any time after a dose of ADT. The benefits far outweigh the risk of an adverse event. Administration of pertussis vaccine in persons who have had laboratory confirmed pertussis infection is safe and necessary as natural immunity does not confer life-long protection

13 Tetanus For high risk travel a 5 yearly booster dose should be considered for protection against tetanus. In other travellers, a booster dose should be provided if 10 years have elapsed since the previous dose Wound management recommendations for use of tetanus immunoglobulin (TIG) in immunocompromised persons

14 Rotavirus New evidence of slight increase to 14 cases of intussusception per 100, 000 infants vaccinated per year in Australia however the benefits of rotavirus vaccination far outweigh the risks associated with it ATAGI and TGA statement: nise-rotavirus

15 Invasive meningococcal disease

16 Meningococcal B Bexsero (4CMenB vaccine) has been registered for use in Australia for people 2 months of age (but may be given to infants from 6 weeks of age) There are currently no administration recommendations in the Handbook ATAGI recommends prophylactic paracetamol 30 minutes prior to vaccination or as soon as practicable after each dose to reduce risk and severity of fever Full Clinical Advice 85A C02B4DCA257B640002F38E/$File/ATAGI-advice-bexsero.pdf

17 Recommended schedule of Bexsero by age group Age at commencement of vaccine course 2 months* Primary immunisation Interval between primary doses 3 doses, delivered at ~2*, 4 and 6 months of age; (intervals ~2 months, at least 1 month) Age for booster dose 12 months 3 to 5 months 3 doses 1 2 months 12 months 6 to 11 months 2 doses 2 months 12 months to 10 years 12 months, or 2 months after previous dose, whichever is later 2 doses 2 months No booster required 11 years and above 2 doses 1 2 months No booster required

18 Influenza The Australian 2016 influenza vaccine contains the following 4 strains: A (H1N1): an A/California/7/2009 (H1N1) - like virus A (H3N2): an A/HongKong/4801/2014 (H3N2) - like virus B: a B/Phuket/3073/ like virus B: a B/Brisbane/60/ like virus

19 % of laboratory tests +ve for flu A and B, 1 January 2010 to 3 April 2016

20 Quadrivalent vaccines There are two free vaccines available under the NIP: Fluarix Tetra (GlaxoSmithKline) for people 36 months of age and older FluQuadri Junior (Sanofi Pasteur) for children aged 6 35 months

21 Children and influenza vaccine Eligible children aged 6-35 months should receive FluQuadri Junior while children aged 36 months and older should receive Fluarix Tetra. An information sheet that explains which groups should receive which vaccine (including children) is included with every delivery of influenza vaccine. Two doses of influenza vaccine at least one month apart are recommended for children aged less than 9 years who are receiving influenza vaccine for the first time. The same vial must not be used for the two doses.

22

23 Australian Bat Lyssavirus 8 year old Queensland boy died following exposure to ABLV in All bats, including flying foxes and micro bats, are considered potential sources of infection. Recent wounds should be washed thoroughly with soap and running water for at least 5 minutes followed by the application of an antiseptic containing povidine-iodine or alcohol Contact your local Public Health Unit on for advice and to obtain free post exposure treatment Administer a tetanus booster if needed

24 What s new No Jab No Pay Interim conscientious objection form in NSW Free catch-up for children < 10 years of age Free catch-up for year olds from 1 January 2016 to 31 December 2017 NSW immunisation schedule Expansion of the ACIR

25 New immunisation requirements for Family Assistance Payments No Jab No Pay From 1 January 2016 Only parents of children (< 20 years of age) who are fully immunised or on a recognised catch-up schedule can receive the Child Care Benefit, the 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 An Interim Vaccination Objection Form for enrolment in NSW child care centres is valid from 1 January 2016 to 31 December 2016 whilst Public Health Act is reviewed

26 Free catch-up From 1 January 2016 free catch-up vaccines for all children < 10 years of age on an ongoing basis From 1 January 2016 until 31 December 2017 free catchup for parents who wish to immunise their children in order to continue to receive family assistance payments

27

28 New reporting requirements Reporting/ updating records for up to 19 years PHU can provide a record of vaccination from the SVP

29 Enrolment in child care in NSW in 2016 Conscientious objection is currently as exemption under NSW Public Health Act 2010 The Act is undergoing a 5 yearly review The Commonwealth no longer recognises CO NSW Interim vaccination objection form

30

31 Are GPs required to sign the form? The form does not indicate in any way that the GP supports the parent s decision The form is required under NSW legislation to enrol unvaccinated children in child care If the GP has a firm position not to sign vaccination objection forms then the practice manager should be aware that staff are not to make appointments for patients seeking this

32 Medical exemptions Natural immunity clinical/serology Only GPs can complete and submit this form Anaphylaxis or severe allergic reaction to previous vaccine Adverse Event clinic at Westmead can provide vaccinations administered under close supervision GPs are able to call for advice re complex issues

33

34 Immunisation History You can complete this form and submit if you view record from overseas vaccinations If you start a patient on a catch up schedule this form can be lodged and families can access their payments before the catch up is finished

35

36 Implications for GPs More patients requiring vaccinations Updating vaccination records on ACIR for those < 20 years Up to date software Catch up schedules Strategy for increased calls Incentive payment to GPs if a child is caught up

37 Current schedule

38

39 Changes to the NSW schedule from 1 April 2016 Introduction of an 18-month diphtheria, tetanus and pertussis (DTPa) booster vaccine for all children born from 1 October 2014; In clusion of influenza vaccine for Aboriginal children aged 6 months to <5 years; Removal of the second dose MMR vaccine at 3 ½ to 4 years; Pre-school booster now fixed at 4 years of age; and Introduction of Zostavax vaccine for people aged 70 years (commences in late November 2016).

40 18 month vaccines All children should receive dose one of MMR vaccine at 12 months (Priorix or MMR II ) and dose two at 18 months in combination with varicella given as MMRV (Priorix Tetra or Proquad ) All children born after 1 October 2014 should receive a dose of either Infanrix or Tripacel vaccine

41 Pneumococcal Catch-up tables with recommendations for Prevenar 13 up to 5 years ATAGI made the following recommendations about Pneumovax 23: a dose of Pneumovax 23 should be given to all adults aged 65 years a second dose continues to be recommended for those with any predisposing conditions as listed in the Handbook recommendations for Aboriginal and Torres Strait Islander people aged <65 years of age are unchanged from the Handbook No more than three 23vPPV doses are recommended during a person s life

42 Additional vaccines provided free in NSW GP immunisation providers can access free vaccines for: catch up vaccination of refugees, children within the appropriate age group who missed out on vaccination at school, adults for whom hepatitis B vaccination is recommended unvaccinated MMR individuals born after 1966, and post-exposure treatment for Australian Bat Lyssavirus or rabies

43 Vaccine storage

44 Strive for Five, 2nd edition Released in 2013 and includes: Vaccine purpose built fridges are the best practice option for vaccines. Bar fridges and cyclic defrost domestic fridges must not be used You must check and record the vaccine fridge temperatures twice daily Vaccine fridge is to be serviced every 12 months Data loggers to be recalibrated annually

45 Temporary vaccine storage Select a cooler that meets your service needs minimum size for storing vaccines is 10 litres risk of freezing usually occur in the first 2 hours polystyrene containers are only suitable for storing vaccines for up to 4hours coolers generally have limited cold life and therefore not adequate for vaccine storage over prolonged periods (more than 8hrs) or in extreme conditions.

46 How to Pack an Esky There are 2 storage options available - depending on how long the vaccines need to be stored for and the ambient temperature OPTION ONE can be used for storing vaccines for up to 8 hours OPTION TWO consider alternative vaccine storage arrangement with local hospital or pharmacy

47 How to store vaccines for up to 8 hours Step 1 If time permits chill the inside of the cooler prior to use by placing ice/gel packs in the esky for a few hours and then remove. Place conditioned ice/gel packs on bottom if needed.

48 How to Pack an Esky Step 2 Place polystyrene chips or other suitable insulating material at the bottom of the cooler, this eliminates hot & cold spots (Polystyrene chips are preferred as it promotes air circulation). If using bubble-wrap, avoid wrapping vaccines tightly.

49 How to Pack an Esky Step 3 Place vaccines in esky with a Min/Max thermometer probe in the centre of the vaccine stock.

50 How to Pack an Esky Step 4 Surround the vaccines with packaging material (eg. polystyrene chips) to allow cold air to circulate. Step 5 Place the conditioned ice/gel pack(s) on top, close and seal the lid of the cooler. If using a larger cooler, place conditioned ice/gel packs around the sides of the cooler as well as on top.

51 How to Pack an Esky Step 6 Secure Min/Max thermometer on outside of esky & monitor the temperature before leaving for the session, upon arrival, prior to administrating vaccines and hourly throughout the immunisation session or power outage on appropriate document.

52 Min/Max thermometers Suppliers ACTROL Replace the thermometer every 3 years and record the date of purchase on the back Battery change and ice slurry test must be done every 12 months and recorded on the back of the thermometer Probe should be placed in an empty vaccine box

53 Pre vaccination

54 Authorisation to immunise New Policy Directive PD2015_011 Immunisation Services Authority for Registered Nurses and Midwives Successfully completed immunisation education program To maintain authority to immunise, a RN must annually review best practice policy for immunisation This may be, but is not limited to, attendance at updates or seminars on current practices A annual statement of proficiency in CPR is also mandatory Authority for registered nurses and midwives RNs-and-Midwives-Jan-2014.pdf

55 Authorisation to immunise (cont.) Employed in connection with a vaccination program Administers vaccines in connection with the vax program Follows guidelines within the Handbook and Strive for 5 Must carry an anaphylaxis response kit and administer adrenaline for R x and M x of anaphylaxis Must report all AEFIs to PHU Must report to the ACIR and to the National HPV Register MO must be contactable whilst vaccinating Immunisation Services Authority for Registered Nurses and Midwives

56 Pre vaccination: addressing parent concerns Direct parents to reputable resources and websites for further information The Science of Immunisation: Questions and Answers at

57 Five critical elements of safe vaccine administration The following elements of safe vaccine administration must be followed: Right patient Right vaccine Right dose Right route Right minimal dosing interval

58 Pre vaccination screening Table 2.1.1: Pre-vaccination screening checklist in Handbook Table 2.1.2: Responses to relevant conditions or circumstances identified through the pre-vaccination screening checklist

59 Valid consent Valid consent can be defined as the voluntary agreement by an individual to a proposed procedure, given after sufficient, appropriate and reliable information about the procedure, including the potential risks and benefits, has been conveyed to that individual The table inside the back cover of the Handbook, Comparison of the effects of diseases and side effects of NIP vaccines, can be used to advise the risks and benefits of each vaccine

60 Vaccination

61 Vaccination

62 Recommended injection site <12 months The anterolateral thigh is the recommended site for IM administration of vaccines in infants < 12 months of age

63 Recommended injection site > 12 months The deltoid is the recommended site for IM administration of vaccines in those > 12 months of age and adults

64 Post vaccination

65 Post vaccination: Table 2.3.1: Clinical features that may assist differentiation between a vasovagal episode and anaphylaxis Details for notifying and obtaining vaccine history from the HPV register Description of other state-based registers

66 Managing AEFIs Table 2.3.2: Doses of intramuscular 1:1000 (one in one thousand) adrenaline for anaphylaxis* Approximate age and weight Adrenaline dose <1 year (approx kg) ml 1 2 years (approx. 10 kg) 0.1 ml 2 3 years (approx. 15 kg) 0.15 ml 4 6 years (approx. 20 kg) 0.2 ml 7 10 years (approx. 30 kg) 0.3 ml years (approx. 40 kg) 0.4 ml >12 years and adult (over 50 kg) 0.5 ml

67 Reporting AEFIs au/immunisation/pages/aefi.aspx Fax completed forms to the PHU on