The Australian Immunisation Handbook 10th Edition 2013

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Healthcare workers and other occupations All adolescents and adults (born during or since 1966) should have their vaccination records reviewed to ensure they have received 2 doses of MMR vaccine. This is important for all persons, but especially those working in certain occupations, such as healthcare workers, staff working in early childhood education and care, staff of long-term care facilities and staff of correctional facilities. Those who were born during or since 1966 and are non-immune, or who have only received 1 dose of MMR vaccine, should be vaccinated and have documented evidence of 2 doses of MMR vaccine or serological evidence of immunity to measles (see ‘Adults and adolescents’ above). (See also 3.3 Groups with special vaccination requirements, Table 3.3.7 Recommended vaccinations for persons at increased risk of certain occupationally acquired vaccine-preventable diseases.) Travellers It is especially important that all persons born during or since 1966 have been given 2 doses of measles-containing vaccine (administered at least 4 weeks apart, with both doses administered at ≥12 months of age; see ‘Children’ above) before embarking on international travel if they do not have evidence of previous receipt of 2 doses of MMR vaccine or serological evidence of protection for measles, mumps and rubella (see ‘Adults and adolescents’ above). Infants travelling to countries in which measles is endemic, or where measles outbreaks are occurring, may be given MMR vaccine from as young as 9 months of age, after an individual risk assessment. In these cases, 2 further doses of MMR vaccine are still required. The next dose of MMR vaccine should be given at 12 months of age or 4 weeks after the 1st dose, whichever is later. This should be followed by the routine administration of the next dose of measles-containing vaccine, as MMRV vaccine, at 18 months of age. Serological testing for immunity to measles Serological testing for immunity to measles, mumps, rubella or varicella is not recommended before or after routine administration of the 2-dose childhood schedule of these vaccines. However, serological testing for measles can be performed in cases where a history of natural immunity or 2 doses of vaccine administration is uncertain (see ‘Adults and adolescents’ above). Serology is indicated in special situations, such as pre-pregnancy planning (see also 4.18 Rubella, 4.22 Varicella and 3.3.2 Vaccination of women who are planning pregnancy, pregnant or breastfeeding, and preterm infants). Serological tests to investigate immunity to measles are generally sensitive at detecting antibody produced by both prior natural infection and vaccination, although sensitivity varies by assay and the clinical setting (e.g. time since vaccination). 2 Interpretation of the results of serological testing may be enhanced by discussion with the laboratory that performed the test, ensuring that relevant clinical information is provided. An alternative to serological testing is presumptive administration of MMR vaccine dose(s). There is no known 274 The Australian Immunisation Handbook 10th edition
increase in adverse events from vaccinating those with pre-existing immunity to one or more of the vaccine components (see 4.9.11 Adverse events below). 4.9.8 Pregnancy and breastfeeding MMR-containing vaccines are contraindicated in pregnant women. Pregnancy should be avoided for 28 days after vaccination. 38 MMR vaccines can be given to breastfeeding women. (See also 4.18 Rubella.) MMRV vaccines are not recommended for use in persons aged ≥14 years. There is no risk to pregnant women from contact with recently vaccinated persons. The vaccine virus is not transmitted from vaccinated persons to susceptible contacts. 1 See also 4.18 Rubella, 4.22 Varicella and 3.3 Groups with special vaccination requirements, Table 3.3.1 Recommendations for vaccination in pregnancy for more information. 4.9.9 Contraindications Anaphylaxis to vaccine components MMR and MMRV vaccines are contraindicated in persons who have had: • anaphylaxis following a previous dose of any MMR-containing vaccine • anaphylaxis following any vaccine component. Persons who are immunocompromised Measles-, mumps- and rubella-containing vaccines contain live attenuated vaccine viruses and are contraindicated in persons who are immunocompromised. Thus, MMR-containing vaccines are contraindicated in the following groups: • Persons immunocompromised due to HIV/AIDS. MMR vaccination of asymptomatic HIV-infected persons >12 months of age with an age-specific CD4 + count of ≥15% may be considered39-42 (see ‘HIV-infected persons’ in 3.3.3 Vaccination of immunocompromised persons). Since studies have not been performed using combination MMRV vaccines in asymptomatic HIVinfected persons or persons with an age-specific CD4 + count of ≥15%, it is recommended that only MMR vaccine (and monovalent VV, see 4.22 Varicella) be considered for use in this setting. 41,43-45 • Persons with other medical conditions associated with significant immunocompromise (see 3.3.3 Vaccination of immunocompromised persons). • Persons receiving high-dose systemic immunosuppressive therapy, such as chemotherapy, radiation therapy or oral corticosteroids. MMRcontaining vaccines are contraindicated in persons taking high-dose oral corticosteroids for more than 1 week (in children equivalent to >2 mg/kg per day prednisolone, and in adults >60 mg per day) (see 3.3.3 Vaccination PART 4 VACCINE-PREVENTABLE DISEASES 275 4.9 MEASLES
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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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depending on the number of vaccines
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Persons with functional or anatomic
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Table 3.3.5: Recommendations for va
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Persons with autoimmune diseases an
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Table 3.3.6: Recommended intervals
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3.3.7 Vaccination of persons at occ
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Occupation Vaccine Providers of hom
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against certain vaccine-preventable
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3.3.11 Vaccination of persons who i
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waters. All cases of cholera report
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Children aged 2-6 years Three doses
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4.1.11 Adverse events The inactivat
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4.2.4 Vaccines Diphtheria toxoid is
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• Adacel - Sanofi Pasteur Pty Ltd
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antibodies at an age when waning of
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children aged
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4.3 HAEMOPHILUS INFLUENZAE TYPE B 4
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• Hiberix - GlaxoSmithKline (PRP-
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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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Page 281 and 282: 4.9 MEASLES 4.9.1 Virology Measles
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Page 331 and 332: 4.13 PNEUMOCOCCAL DISEASE 4.13.1 Ba
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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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