The Australian Immunisation Handbook 10th Edition 2013

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4.2 DIPHTHERIA 4.2.1 Bacteriology Diphtheria is an acute illness caused by toxigenic strains of Corynebacterium diphtheriae, a Gram-positive, non-sporing, non-capsulate bacillus. The exotoxin produced by C. diphtheriae acts locally on the mucous membranes of the respiratory tract or, less commonly, on damaged skin, to produce an adherent pseudomembrane. Systemically, the toxin acts on cells of the myocardium, nervous system and adrenals. 4.2.2 Clinical features The incubation period is 2 to 5 days. The disease is communicable for up to 4 weeks, but carriers may shed organisms for longer. Spread is by aerosol transmission or by direct contact with skin lesions or articles soiled by infected persons. The disease can involve almost any mucous membrane. Pharyngeal diphtheria, by far the commonest form of disease in the unimmunised, is characterised by an inflammatory exudate that forms a greyish or green membrane in the upper respiratory tract, which can cause acute severe respiratory obstruction. Life-threatening complications from diphtheria toxin include myocarditis and neuritis (usually affecting motor nerves). The casefatality rate in the last three decades has been reported as up to 16%. 1 Diphtheria antitoxin, which neutralises unbound toxin, was first used in the 1890s. Together with antibiotics, antitoxin is the mainstay of treatment for diphtheria, but this may not always be successful. The first death from diphtheria in Australia for over 20 years occurred in 2011 in an unvaccinated person. 2 Effective protection against diphtheria is only achieved by active immunisation with diphtheria toxoid-containing vaccines. 1,3 4.2.3 Epidemiology In the early 1900s, diphtheria caused more deaths in Australia than any other infectious disease, but increasing use of diphtheria vaccines since World War II has led to its virtual disappearance. 4 The current epidemiology of diphtheria in Australia is similar to that in other developed countries. Almost all recent cases in the United Kingdom and the United States have been associated with imported infections. 5 In Australia, there have been two imported infections identified, one case in 2001 and one imported infection in 2011, resulting in two additional cases, including one death. 2,6 The 2011 fatal case of pharyngeal diphtheria occurred in an unvaccinated person infected by a friend who acquired diphtheria in a less developed country. 2 182 The Australian Immunisation Handbook 10th edition
4.2.4 Vaccines Diphtheria toxoid is available in Australia only in combination with tetanus and other antigens. The acronym DTPa, using capital letters, signifies child formulations of diphtheria, tetanus and acellular pertussis-containing vaccines. The acronym dTpa is used for formulations that contain substantially lesser amounts of diphtheria toxoid and pertussis antigens than child (DTPa-containing) formulations; dTpa vaccines are usually used in adolescents and adults. Diphtheria vaccination stimulates the production of antitoxin, which protects against the toxin produced by the organism. The immunogen is prepared by treating a cell-free preparation of toxin with formaldehyde, thereby converting it into the innocuous diphtheria toxoid. Diphtheria toxoid is usually adsorbed onto an adjuvant, either aluminium phosphate or aluminium hydroxide, to increase its immunogenicity. Antigens from Bordetella pertussis, in combination vaccines, also act as an effective adjuvant. The circulating levels of antitoxin required for protection from diphtheria are well described. Antitoxin levels of 0.1 IU/mL are associated with more certain and prolonged protection. 7 Complete immunisation induces protective levels of antitoxin lasting throughout childhood, but, by middle age, at least 50% of persons not vaccinated since childhood have levels
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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
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Any serious or unexpected adverse e
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Consumers and immunisation service
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When relevant, immunisation service
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National Human Papillomavirus Vacci
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Immunisation service providers enro
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PART 3 VACCINATION FOR SPECIAL RISK
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Thus, a vaccine to prevent Hib dise
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3.1.2 Adults Hepatitis B Indigenous
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een low in younger Indigenous adult
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3.2 VACCINATION FOR INTERNATIONAL T
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• vaccination history (including
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departure to allow for the period w
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Selected vaccines based on travel i
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Tick-borne encephalitis Tick-borne
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3.2.5 Vaccinating the traveller wit
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• Travel health and quarantine se
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Page 147 and 148: (see Appendix 1 Contact details for
Page 149 and 150: PART 3 VACCINATION FOR SPECIAL RISK
Page 157 and 158: avoided, except in situations where
Page 159 and 160: 3.3.3 Vaccination of immunocompromi
Page 161 and 162: Use of live viral or live bacterial
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: 4.1.11 Adverse events The inactivat
Page 199 and 200: • Adacel - Sanofi Pasteur Pty Ltd
Page 201 and 202: antibodies at an age when waning of
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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
Page 211 and 212: 4.3.11 Public health management of
Page 213 and 214: In recent years, hepatitis A notifi
Page 215 and 216: Inactivated hepatitis A vaccines ar
Page 217 and 218: Co-administration with other vaccin
Page 219 and 220: Recommendations for the use of comb
Page 221 and 222: 4.4.10 Adverse events The most comm
Page 223 and 224: 4.5.3 Epidemiology The prevalence o
Page 225 and 226: 4.5.4 Vaccines Monovalent hepatitis
Page 227 and 228: For older children and young adults
Page 229 and 230: Vaccine Age of vaccine recipient Do
Page 231 and 232: Combination hepatitis A/hepatitis B
Page 233 and 234: Management of infants born to mothe
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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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