The Australian Immunisation Handbook 10th Edition 2013

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4.5 HEPATITIS B 4.5.1 Virology Hepatitis B virus (HBV) contains circular, partially double-stranded DNA. The outer surface of the virus is glycolipid, which contains the hepatitis B surface antigen (HBsAg). Other important antigenic components are the hepatitis B core antigen (HBcAg) and hepatitis B e antigen (HBeAg). HBcAg is not detectable in serum, but can be detected in liver tissue in persons with acute or chronic hepatitis B infection. HBeAg, and antibodies against HBeAg (anti-HBe) or the HBcAg (anti-HBc), are serological markers of HBV infection. Antibodies against HBsAg (anti-HBs) indicate immunity, which may result from either natural infection or immunisation (in which case there would not be any markers of HBV infection). Persistence of HBsAg denotes infectivity, which is greater if HBeAg and/or HBV DNA are also positive. 1 Occult hepatitis B infection is characterised by the presence of HBV DNA in the liver (with or without detectable HBV DNA in the serum) and negative HBsAg. 2 4.5.2 Clinical features In approximately 30 to 50% of adults, infection causes symptomatic acute hepatitis, but in neonates and young children, particularly those
4.5.3 Epidemiology The prevalence of chronic HBV infection differs in different parts of the world, and may be quite variable within countries. The prevalence of chronic HBV infection varies from less than 0.5% among Caucasians in the United States, northern Europe and Australia, 1 to 5% in the Mediterranean countries, parts of eastern Europe, Africa, Central and South America, up to greater than 10% in many sub-Saharan African, East and Southeast Asian and Pacific island populations. 7-10 In regions of moderate to high prevalence of HBsAg (where ≥2% of the population is HBsAg-positive), infections are mainly acquired perinatally or in early childhood. 1 Chronic infection and its sequelae, including cirrhosis and hepatocellular carcinoma, contribute to the majority of HBV disease burden in Australia. In recent decades, the burden from such disease has been increasing, concurrent with the increasing number of immigrants from regions of high HBV prevalence. 11 Aboriginal and Torres Strait Islander people, and migrants born in Asia and Pacific islands, North Africa, Middle Eastern and Mediterranean countries, have a significantly increased prevalence of chronic HBV infection compared with the rest of the Australian-born population. 12,13 First-generation immigrants of culturally and linguistically diverse background, who are mostly from countries of high HBV endemicity, usually retain the prevalence of chronic HBV infection of their country of origin. Other population groups with an increased prevalence of markers of HBV infection include patients with HIV infection, persons who used injected drugs between 1980 and 1990, and household contacts of someone diagnosed with hepatitis between 1980 and 1990. 13 Notification of chronic HBV infection depends on levels of hepatitis B testing and reporting, and a substantial proportion of persons with chronic HBV infection remain undiagnosed. It has been estimated by mathematical modelling that, in 2010, about 170 000 people were living with HBV infection in Australia, with about 335 deaths due to HBV infection in that year. 14 Newly acquired cases of HBV infection in Australia mostly occur in young adults, through injecting drug use, skin penetration procedures or sexual contact. 15 Between 2006 and 2010, the notification rate of newly acquired hepatitis B in Australia ranged from 1.0 to 1.4 per 100 000 population. Since 2001, the rate of diagnosis of newly acquired infections has declined substantially among people aged 15–29 years and has remained relatively stable among people aged ≥30 years. 14-16 However, some new HBV infections are asymptomatic and may go undetected. Similar to chronic infection, higher rates of notified cases of newly acquired hepatitis B, or hospitalisation due to acute hepatitis B, have been reported among Aboriginal and Torres Strait Islander people compared with the general Australian population. 17,18 In one United States study, adults with diabetes mellitus had a greater chance of developing acute hepatitis B disease than PART 4 VACCINE-PREVENTABLE DISEASES 209 4.5 HEPATITIS B
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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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whether the AEFI is likely to recur
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(see Appendix 1 Contact details for
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avoided, except in situations where
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3.3.3 Vaccination of immunocompromi
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Use of live viral or live bacterial
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Influenza vaccination is recommende
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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
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: 4.4.10 Adverse events The most comm
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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Page 239 and 240: immune memory persists and is thoug
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Page 243 and 244: Table 4.5.3: Post-exposure prophyla
Page 245 and 246: 4.6 HUMAN PAPILLOMAVIRUS 4.6.1 Viro
Page 247 and 248: women. The prevalence of high-risk
Page 249 and 250: • Gardasil - CSL Limited/Merck &
Page 251 and 252: If scheduled doses have been missed
Page 253 and 254: However, some adult males may gain
Page 255 and 256: 4.6.9 Contraindications The only ab
Page 257 and 258: 4.7 INFLUENZA 4.7.1 Virology The in
Page 259 and 260: Figure 4.7.1: Influenza notificatio
Page 261 and 262: Always check annual seasonal influe
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Page 265 and 266: Table 4.7.1: Recommended doses of i
Page 267 and 268: • Chronic respiratory conditions,
Page 269 and 270: Residents of residential aged care
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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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The Australian Immunisation Handbook 10th Edition 2013

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