The Australian Immunisation Handbook 10th Edition 2013

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the general population; 19 however, there are no published Australian studies examining this. Transmission of HBV may result from inoculation through broken or penetrated skin, or by mucosal contact with blood or other body fluids (mainly vaginal fluids and semen) from an infectious person. There are four major routes of HBV transmission: • perinatal transmission from infected mother to neonate (vertical transmission), usually occurring at or around the time of birth • parenteral or mucosal exposure to infected blood and other bodily fluids; common scenarios include: » sharing of contaminated equipment that penetrates the skin, such as needles (among persons who inject drugs), tattoo equipment, bodypiercing equipment, acupuncture equipment and razor blades » needle-stick injury, for example, in a healthcare setting » contact between infective body fluids and mucous membranes • sexual contact (including vaginal or anal intercourse, although the latter is associated with a higher risk) • non-sexual contact with an infected person (horizontal transmission), including household transmission, for example, child-to-child transmission through contact between open sores or wounds. In Australia, screening of blood and organ donors using nucleic acid amplification testing has virtually eliminated the risk of transmission of hepatitis B through blood transfusion and organ transplants. 20,21 Saliva may contain levels of virus that are likely to be infective only if inoculated directly into tissue (ocular or mucous membranes). The risk of transmission by inadvertent inoculation by other means, such as by toothbrush, razor etc., or through close personal contact in households in which one or more infected persons reside, is low but not negligible. 22-29 The strategy for prevention of hepatitis B through immunisation in Australia commenced in the early 1980s, with vaccination programs targeting individuals with increased risk of HBV exposure, including infants at particular risk of infection at birth. Universal infant vaccination commenced in the Northern Territory in 1990. A universal hepatitis B vaccination program was recommended for infants and adolescents in 1996. The adolescent program commenced in some states and territories in 1997 and the universal infant program, which includes a dose given at birth, began nationally in 2000. The adolescent program will continue until those immunised for hepatitis B in the infant program reach adolescence. 210 The Australian Immunisation Handbook 10th edition
4.5.4 Vaccines Monovalent hepatitis B vaccines • Engerix-B – GlaxoSmithKline (recombinant DNA hepatitis B vaccine). Adult formulation – Each 1.0 mL monodose vial or pre-filled syringe contains 20 µg recombinant hepatitis B surface antigen (HBsAg) protein, adsorbed onto 0.5 mg aluminium as aluminium hydroxide. Paediatric formulation – Each 0.5 mL monodose vial or pre-filled syringe contains 10 µg HBsAg protein, adsorbed onto 0.25 mg aluminium as aluminium hydroxide. Both formulations may contain yeast proteins. • H-B-Vax II – CSL Limited/Merck & Co Inc (recombinant DNA hepatitis B vaccine). Adult formulation – Each 1.0 mL monodose vial or pre-filled syringe contains 10 µg recombinant HBsAg protein, adsorbed onto 0.5 mg aluminium hydroxide. Paediatric formulation – Each 0.5 mL monodose vial or pre-filled syringe contains 5 µg recombinant HBsAg protein, adsorbed onto 0.25 mg aluminium hydroxide. Dialysis formulation – Each 1.0 mL monodose vial contains 40 µg recombinant HBsAg protein, adsorbed onto 0.5 mg aluminium hydroxide. All formulations may contain yeast proteins. Combination vaccines that contain hepatitis B • Infanrix hexa – GlaxoSmithKline (DTPa-hepB-IPV-Hib; diphtheriatetanus-acellular pertussis-hepatitis B-inactivated poliovirus- Haemophilus influenzae type b). The vaccine consists of both a 0.5 mL pre-filled syringe containing ≥30 IU diphtheria toxoid, ≥40 IU tetanus toxoid, 25 µg pertussis toxoid, 25 µg filamentous haemagglutinin, 8 µg pertactin, 10 µg recombinant HBsAg, 40 D-antigen units inactivated poliovirus type 1 (Mahoney), 8 D-antigen units type 2 (MEF-1) and 32 D-antigen units type 3 (Saukett), adsorbed onto aluminium hydroxide/phosphate; traces of formaldehyde, polysorbate 80, polysorbate 20, polymyxin and neomycin; and a vial containing a lyophilised pellet of 10 µg purified Hib capsular polysaccharide (PRP) conjugated to 20–40 µg tetanus toxoid. May contain yeast proteins. • Twinrix Junior (360/10) – GlaxoSmithKline (formaldehyde-inactivated hepatitis A virus [HM175 strain] and recombinant hepatitis B vaccine). Each 0.5 mL monodose vial or pre-filled syringe contains 360 ELISA units of HAV antigens, 10 µg recombinant DNA hepatitis B surface antigen protein; 0.225 mg aluminium as aluminium phosphate/ PART 4 VACCINE-PREVENTABLE DISEASES 211 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
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Vaccine Months after HSCT Comments
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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
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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: 4.5.3 Epidemiology The prevalence o
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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Page 273 and 274: 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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