The Australian Immunisation Handbook 10th Edition 2013

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known that a new influenza vaccine strain is circulating in the community to which cross-protective immunity in the population is low (such as in the setting of an influenza pandemic), it may be appropriate that immunocompromised persons receive 2 doses of inactivated influenza vaccine, a minimum of 4 weeks apart, to achieve an optimal immune response. For example, in the 2009–2010 H1N1 global influenza pandemic it was shown that seroconversion to influenza vaccination in immunocompromised adolescents and adults was improved following receipt of 2 vaccine doses. 77 Further information and annual influenza vaccine recommendations are available on the Immunise Australia website (www.immunise.health.gov.au). The recommendations in this section for the use of vaccines in immunocompromised persons have been divided where applicable into paediatric (0–18 years) and adult (≥19 years) recommendations. This distinction has been made on the basis of scientific evidence, where available, and to assist in vaccine delivery in paediatric and adult special risk settings. Immunocompromise associated with corticosteroid administration The dose and duration of therapy with corticosteroids determines the impact on the immune system. In adults, daily doses of oral corticosteroids in excess of 60 mg of prednisolone (or equivalent) for more than 1 week are associated with significant immunocompromise. In children, doses in excess of either 2 mg/kg per day for more than 1 week or 1 mg/kg per day for more than 4 weeks are associated with significant immunocompromise. Live attenuated vaccines are generally contraindicated in such persons (see also below). In addition, for both children and adults, even lower doses may be associated with some impairment of the immune response. 78 It is also important, once treatment with corticosteroids is ceased, to assess whether the person has other underlying immunocompromising disease or is receiving other immunosuppressive therapy that may influence decisions about whether vaccines, particularly live vaccines, can be given. For adults treated with systemic corticosteroids in excess of 60 mg per day for more than 1 week, live attenuated viral vaccines (such as MMR, MMRV, zoster, varicella and yellow fever vaccines) should be postponed until at least 1 month after treatment has stopped. Children receiving >2 mg/kg per day or ≥20 mg per day in total of prednisolone (or equivalent) for more than 1 week should not receive live attenuated vaccines until after corticosteroid therapy has been discontinued for at least 1 month. Children on daily doses of ≤2 mg/kg per day of systemic corticosteroids for less than 1 week, and those on lower doses of 1 mg/kg per day or alternateday regimens for periods of up to 4 weeks, may be given live attenuated viral vaccines. Some experts suggest withholding lower doses of steroids 2 to 3 weeks prior to vaccination with live viral vaccines if this is possible. 79,80 146 The Australian Immunisation Handbook 10th edition
Use of live viral or live bacterial vaccines in immunocompromised persons There is a risk that the administration of live vaccines to immunocompromised persons may result in adverse events or vaccine-related disease due to unchecked infection (replication) of the vaccine virus or bacteria. This is particularly so for measles-, mumps-, rubella-81,82 and VZV-containing (varicella and zoster) vaccines 83 and for bacille Calmette-Guérin (BCG) vaccine. 49,84 However, the risk of disease varies by vaccine and by individual. Caution is required for vaccination in the setting of immunocompromise, and in significantly immunocompromised persons most live vaccines are contraindicated. The following is a list of current recommendations for use of live vaccines in immunocompromised persons. • Tuberculosis vaccine (BCG) is always contraindicated. • Live vaccines, such as MMR- and VZV-containing (varicella and zoster) vaccines, should not be given to persons with severe immunocompromise. Severely immunocompromised persons include those who have active leukaemia or lymphoma, generalised malignancy, aplastic anaemia, graft-versus-host disease or congenital immunodeficiency. Others in this category include persons who have received recent chemotherapy, persons who have had solid organ or bone marrow transplants (within 2 years of transplantation) or transplant recipients who are still taking immunosuppressive drugs, or others on highly immunosuppressive therapy, including high-dose corticosteroids (see above). Dependent on their age, persons infected with human immunodeficiency virus (HIV) with CD4 + cell counts of
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The Australian Immunisation Handboo
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FOREWORD Since 1932, when Governmen
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TABLE OF CONTENTS PART 1 INTRODUCTI
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LIST OF TABLES Table 2.1.1: Pre-vac
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List 4.13.1: Conditions associated
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PREFACE The 10th edition of The Aus
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Secretariat support, Australian Tec
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PART 1 INTRODUCTION TO THE AUSTRALI
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1.2 DEVELOPMENT OF THE 10TH EDITION
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1.3 HOW TO USE THE 10TH EDITION HAN
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1.4 WHAT’S NEW All chapters have
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2.2 Administration of vaccines •
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• The section on vaccination of p
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4.6 Human papillomavirus • HPV va
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• For Aboriginal and Torres Strai
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Part 5 Passive immunisation • Inf
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without the harmful consequences of
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(vaccine failure). Often such infec
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will occur following receipt of a s
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cases, both the doctor issuing the
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Should a child or adolescent refuse
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• check that the correct time int
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Note: Please discuss this informati
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Condition or circumstance of person
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Condition or circumstance of person
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Table 2.1.3: Live attenuated parent
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An online ‘catch-up calculator’
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Use of serological testing to guide
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• For some vaccines, catch-up vac
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Figure 2.1.1: Catch-up worksheet fo
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Vaccine Minimum age for 1st dose in
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Table 2.1.6: Number of vaccine dose
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Catch-up guidelines for individual
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If 13vPCV is not available, and 10v
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Previous vaccination history 2 prev
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PART 2 VACCINATION PROCEDURES 57 Ta
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PART 2 VACCINATION PROCEDURES 59 Ta
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Catch-up schedules for persons ≥1
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For additional details on these rec
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2.2 ADMINISTRATION OF VACCINES 2.2.
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• Never freeze a vaccine after it
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PART 2 VACCINATION PROCEDURES 69 In
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2.2.5 Vaccine injection techniques
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Interruption to a vaccination If th
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2.2.7 Positioning for vaccination I
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Children ≥12 months of age Cuddle
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2.2.8 Identifying the injection sit
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• Place the palm over the greater
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2.2.9 Administering multiple vaccin
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2.3 POST-VACCINATION 2.3.1 Immediat
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Management of an immediate adverse
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Management of anaphylaxis Rapid IM
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Autoinjectors are generally not app
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Australia. 16 This vaccine is no lo
Page 109 and 110: Any serious or unexpected adverse e
Page 111 and 112: Consumers and immunisation service
Page 113 and 114: When relevant, immunisation service
Page 115 and 116: National Human Papillomavirus Vacci
Page 117 and 118: Immunisation service providers enro
Page 119 and 120: PART 3 VACCINATION FOR SPECIAL RISK
Page 121 and 122: Thus, a vaccine to prevent Hib dise
Page 123 and 124: 3.1.2 Adults Hepatitis B Indigenous
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Page 127 and 128: 3.2 VACCINATION FOR INTERNATIONAL T
Page 129 and 130: • vaccination history (including
Page 131 and 132: departure to allow for the period w
Page 133 and 134: Selected vaccines based on travel i
Page 135 and 136: Tick-borne encephalitis Tick-borne
Page 141 and 142: 3.2.5 Vaccinating the traveller wit
Page 143 and 144: • Travel health and quarantine se
Page 145 and 146: whether the AEFI is likely to recur
Page 147 and 148: (see Appendix 1 Contact details for
Page 157 and 158: avoided, except in situations where
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Page 163 and 164: Influenza vaccination is recommende
Page 169 and 170: Haematopoietic stem cell transplant
Page 171 and 172: Vaccine Months after HSCT Comments
Page 173 and 174: depending on the number of vaccines
Page 175 and 176: Persons with functional or anatomic
Page 177 and 178: Table 3.3.5: Recommendations for va
Page 179 and 180: Persons with autoimmune diseases an
Page 181 and 182: Table 3.3.6: Recommended intervals
Page 183 and 184: 3.3.7 Vaccination of persons at occ
Page 185 and 186: Occupation Vaccine Providers of hom
Page 187 and 188: against certain vaccine-preventable
Page 189 and 190: 3.3.11 Vaccination of persons who i
Page 191 and 192: waters. All cases of cholera report
Page 193 and 194: Children aged 2-6 years Three doses
Page 195 and 196: 4.1.11 Adverse events The inactivat
Page 197 and 198: 4.2.4 Vaccines Diphtheria toxoid is
Page 199 and 200: • Adacel - Sanofi Pasteur Pty Ltd
Page 201 and 202: antibodies at an age when waning of
Page 203 and 204: children aged
Page 205 and 206: 4.3 HAEMOPHILUS INFLUENZAE TYPE B 4
Page 207 and 208: • Hiberix - GlaxoSmithKline (PRP-
Page 209 and 210: 4.3.7 Recommendations Infants A Hib
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4.3.11 Public health management of
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In recent years, hepatitis A notifi
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Inactivated hepatitis A vaccines ar
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Co-administration with other vaccin
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Recommendations for the use of comb
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4.4.10 Adverse events The most comm
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4.5.3 Epidemiology The prevalence o
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4.5.4 Vaccines Monovalent hepatitis
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For older children and young adults
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Vaccine Age of vaccine recipient Do
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Combination hepatitis A/hepatitis B
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Management of infants born to mothe
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Household or other close (household
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with occult hepatitis B infection.
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immune memory persists and is thoug
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to suggest that a higher proportion
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Table 4.5.3: Post-exposure prophyla
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4.6 HUMAN PAPILLOMAVIRUS 4.6.1 Viro
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women. The prevalence of high-risk
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• Gardasil - CSL Limited/Merck &
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If scheduled doses have been missed
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However, some adult males may gain
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4.6.9 Contraindications The only ab
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4.7 INFLUENZA 4.7.1 Virology The in
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Figure 4.7.1: Influenza notificatio
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Always check annual seasonal influe
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7.5 µg of viral haemagglutinin (in
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Table 4.7.1: Recommended doses of i
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• Chronic respiratory conditions,
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Residents of residential aged care
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influenza vaccine prior to administ
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4.8 JAPANESE ENCEPHALITIS 4.8.1 Vir
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28 days following vaccination with
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When using JEspect in children aged
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4.8.8 Pregnancy and breastfeeding I
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4.9 MEASLES 4.9.1 Virology Measles
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4.9.4 Vaccines Monovalent measles v
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4.9.6 Dosage and administration The
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Table 4.9.1: Recommendations for me
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increase in adverse events from vac
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Immunoglobulin or blood product adm
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approximately 5%. 2,25 There is als
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Table 4.9.2: Post-exposure prophyla
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4.10 MENINGOCOCCAL DISEASE 4.10.1 B
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4.10.4 Vaccines There are different
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Polysaccharide vaccines Quadrivalen
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Interchangeability of meningococcal
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• Children (aged ≥9 months) and
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Appendix 1 Contact details for Aust
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4.11 MUMPS 4.11.1 Virology Mumps is
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Trivalent measles-mumps-rubella (MM
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4.11.7 Recommendations Infants aged
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Vaccination with other live attenua
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acquired from healthcare workers. 1
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demonstrated a more rapid decline,
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• Boostrix-IPV - GlaxoSmithKline
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in the previous 10 years. 19,45 Adu
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(see ‘Women who are planning preg
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an HHE. An HHE may last from a few
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The product information for Quadrac
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4.13 PNEUMOCOCCAL DISEASE 4.13.1 Ba
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non-Indigenous children (88%). 19,2
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10-valent pneumococcal conjugate va
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lesser antibody responses to 2nd or
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Table 4.13.1: Recommendations for p
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Category B: Conditions associated w
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Children aged >5 years to 15 years)
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Non-Indigenous adults A single dose
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Adults who have a condition listed
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4.13.11 Adverse events 10-valent pn
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5 years with a condition(s) associa
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virtually eradicated in India, but
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formaldehyde, glutaraldehyde, polys
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4.14.8 Pregnancy and breastfeeding
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4.15 Q FEVER 4.15.1 Bacteriology Q
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4.15.4 Vaccine • Q-Vax - CSL Limi
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individuals, which can be accessed
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Refer to 3.3 Groups with special va
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4.16 RABIES AND OTHER LYSSAVIRUSES
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4.16.4 Rabies vaccines • Mérieux
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of an even more accelerated schedul
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Pre-exposure prophylaxis for rabies
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The relevant state/territory health
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Although data are limited on the ef
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Table 4.16.2: Post-exposure prophyl
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Figure 4.16.2: Post-exposure prophy
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Figure 4.16.3: Booster algorithm fo
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allergic reaction occurs following
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age group11,12 and affecting 3.8% o
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of age, the risk of IS was increase
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Interchangeability of rotavirus vac
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gestational age; median 34 weeks) w
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Infants living in households with p
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4.17.12 Variations from product inf
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2003, rubella notifications in Aust
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zoster virus [Oka strain]). Lyophil
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children
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A number of commercial assays for t
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Germany indicates that no case of v
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case. Seronegative women of child-b
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4.19 TETANUS 4.19.1 Bacteriology Te
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Formulations for children aged
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4.19.5 Transport, storage and handl
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foreign bodies (especially wood spl
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studies indicate that the adverse r
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The product information for Adacel
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of MDR-TB cases identified has incr
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BCG vaccination procedures BCG vacc
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Occupational groups There is some e
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In developed countries, typhoid fev
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A 4th capsule taken on day 7 has be
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4.22 VARICELLA 4.22.1 Virology Vari
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as a case of wild-type varicella oc
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Reconstituted Varivax Refrigerated
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adequate protection from varicella.
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eceived varicella vaccine while bre
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immunoglobulin and other blood prod
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eported in a 9-year follow-up of 70
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high-dose intravenous NHIG are like
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4.23 YELLOW FEVER 4.23.1 Virology Y
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Co-administration with other vaccin
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Vaccine-associated neurotropic adve
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1000 cases per 100 000 population i
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administration of Zostavax with 23-
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diagnosis. In addition, the risk of
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Laboratory testing to check for an
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the immunoglobulin preparations con
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Prevention of measles Measles vacci
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who are being treated with immunosu
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limb with a separate syringe, and a
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APPENDIX 1: CONTACT DETAILS FOR AUS
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APPENDIX 2: LITERATURE SEARCH STRAT
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APPENDIX 3: COMPONENTS OF VACCINES
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Vaccine component* Vaccine brand
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APPENDIX 4: COMMONLY ASKED QUESTION
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When should preterm infants be vacc
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If a parent decides not to have a c
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Should vaccines be given to persons
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eason not to vaccinate. Asthma, ecz
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Does MMR vaccine cause inflammatory
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(either alone or in combination) fo
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A4.5 Questions about the need for i
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APPENDIX 5: GLOSSARY OF TECHNICAL T
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Enzootic enzootic infections are pr
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Rotavirus a virus that is a common
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APPENDIX 6: COMMONLY USED ABBREVIAT
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OPV oral poliomyelitis vaccine PCEC
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Year Vaccine 2003 Varicella 2003 Me
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identifying the injection site, 79-
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Australian Capital Territory advers
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and travellers, 119 vaccines, 177-1
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abies and other lyssaviruses (inclu
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HPV Vaccination Program, 234 human
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interferon-gamma release assays (IG
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mercury, in vaccines. see thiomersa
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Northern Territory ACIR reporting,
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and Haemophilus influenzae type b (
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espiratory syncytial virus monoclon
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Therapeutic Goods Administration (T
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varicella-zoster immunoglobulin, 45
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INDEX 525 INDEX
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