The Australian Immunisation Handbook 10th Edition 2013

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frequencies between those with or without prior 23vPPV doses. Recipients of concurrent administration of inactivated trivalent seasonal influenza vaccine with 13vPCV reported a higher frequency of systemic but not local reactions. 80 23-valent pneumococcal polysaccharide vaccine The proportion of vaccine recipients reporting local and systemic reactions after a primary or a repeat dose of pneumococcal polysaccharide vaccines varies among different study populations, and possibly with age. 55,57,81 About 50% or more of 23vPPV recipients will experience some soreness after the 1st dose, and swelling and redness are also very common, occurring in approximately 20% of recipients. Moderate or severe local adverse events that limit arm movement are also quite common, occurring in up to 5% of 1st dose recipients. Systemic reactions like myalgia, fatigue and chills are also very common. Fever ≥37.5°C occurs in up to 10% of 23vPPV recipients, but high fever is uncommon. 55,57,81 Larger and more recent studies indicate that both local and systemic adverse events occur more commonly after a repeat dose of 23vPPV than after the 1st dose in adults, particularly more severe local adverse events, which may occur in up to approximately 20% of revaccinated subjects. 55,57,81 These findings effectively supersede the inconsistent findings from some smaller studies, which were limited by subject numbers and methodology. 82-86 Nevertheless, the local adverse events were mostly non-serious and self-limiting. In these studies, the repeat doses were given at least 5 years after the previous dose. Another study, which used hospitalisations coded as cellulitis or abscess of the upper limb within 3 days of pneumococcal vaccination as a proxy measure for very severe local adverse events, showed that these adverse events were significantly more likely when a repeat dose was given within 5 years of the 1st dose. 87 As severe local reactions are also associated with higher antibody levels, 57,62,81,88 this is the likely driver of the relationship with shorter intervals between the repeat and the primary dose and suggests that such local reactions are associated with more robust immunity. 4.13.12 Variations from product information The product information for Prevenar 13 recommends 4 doses of 13vPCV for vaccination commencing at 6 weeks of age, with further doses at 4, 6 and 12–15 months of age; 3 doses for vaccination commencing between 7 and 11 months of age; and 2 doses for vaccination commencing between 12 and 23 months of age. The ATAGI recommends instead that 1 dose less than that stated in the product information be given to healthy children who are not at increased risk of IPD. The ATAGI recommends that the 1st dose be given at 2 months of age, and that this dose can be given as early as 6 weeks of age. The next scheduled doses should be given at 4 months and 6 months of age. 13vPCV is registered for use in children up to 5 years of age and adults aged ≥50 years. The ATAGI recommends a dose of 13vPCV for children aged 336 The Australian Immunisation Handbook 10th edition
5 years with a condition(s) associated with the highest risk of IPD (see List 4.13.1, Category A) who have not completed a primary course of 13vPCV, or who have not received a supplementary dose of 13vPCV before (see 4.13.7 Recommendations above), or for adults of any age who have a condition(s) associated with the highest risk of IPD. This is based on the likely benefit outweighing uncertainties and risks, and on immunogenicity and safety data in younger children. The product information for Pneumovax 23 states that Pneumovax 23 and Zostavax should not be given concurrently. The ATAGI instead recommends that while concurrent administration of Zostavax with pneumococcal polysaccharide vaccine is not routinely recommended, and if possible the two vaccines should be given at least 4 weeks apart, inadvertent administration of Zostavax and pneumococcal polysaccharide vaccine at the same time or at an interval of less than 4 weeks does not require revaccination. References A full reference list is available on the electronic Handbook or website www.immunise.health.gov.au PART 4 VACCINE-PREVENTABLE DISEASES 337 4.13 PNEUMOCOCCAL DISEASE
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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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with occult hepatitis B infection.
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immune memory persists and is thoug
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to suggest that a higher proportion
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Table 4.5.3: Post-exposure prophyla
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4.6 HUMAN PAPILLOMAVIRUS 4.6.1 Viro
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women. The prevalence of high-risk
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• Gardasil - CSL Limited/Merck &
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If scheduled doses have been missed
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However, some adult males may gain
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4.6.9 Contraindications The only ab
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4.7 INFLUENZA 4.7.1 Virology The in
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Figure 4.7.1: Influenza notificatio
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Always check annual seasonal influe
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7.5 µg of viral haemagglutinin (in
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Table 4.7.1: Recommended doses of i
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• Chronic respiratory conditions,
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Residents of residential aged care
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influenza vaccine prior to administ
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4.8 JAPANESE ENCEPHALITIS 4.8.1 Vir
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28 days following vaccination with
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When using JEspect in children aged
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4.8.8 Pregnancy and breastfeeding I
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4.9 MEASLES 4.9.1 Virology Measles
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4.9.4 Vaccines Monovalent measles v
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4.9.6 Dosage and administration The
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Table 4.9.1: Recommendations for me
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increase in adverse events from vac
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Immunoglobulin or blood product adm
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approximately 5%. 2,25 There is als
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Table 4.9.2: Post-exposure prophyla
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4.10 MENINGOCOCCAL DISEASE 4.10.1 B
Page 299 and 300: 4.10.4 Vaccines There are different
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Page 303 and 304: Interchangeability of meningococcal
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Page 307 and 308: Appendix 1 Contact details for Aust
Page 309 and 310: 4.11 MUMPS 4.11.1 Virology Mumps is
Page 311 and 312: Trivalent measles-mumps-rubella (MM
Page 313 and 314: 4.11.7 Recommendations Infants aged
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Page 317 and 318: acquired from healthcare workers. 1
Page 319 and 320: demonstrated a more rapid decline,
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Page 323 and 324: in the previous 10 years. 19,45 Adu
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Page 329 and 330: The product information for Quadrac
Page 331 and 332: 4.13 PNEUMOCOCCAL DISEASE 4.13.1 Ba
Page 333 and 334: non-Indigenous children (88%). 19,2
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Page 339 and 340: Table 4.13.1: Recommendations for p
Page 341 and 342: Category B: Conditions associated w
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Page 345 and 346: Non-Indigenous adults A single dose
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Page 349: 4.13.11 Adverse events 10-valent pn
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Page 357 and 358: 4.14.8 Pregnancy and breastfeeding
Page 359 and 360: 4.15 Q FEVER 4.15.1 Bacteriology Q
Page 361 and 362: 4.15.4 Vaccine • Q-Vax - CSL Limi
Page 363 and 364: individuals, which can be accessed
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Page 367 and 368: 4.16 RABIES AND OTHER LYSSAVIRUSES
Page 369 and 370: 4.16.4 Rabies vaccines • Mérieux
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Page 387 and 388: age group11,12 and affecting 3.8% o
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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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4.20.13 Variations from product inf
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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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4.21.8 Pregnancy and breastfeeding
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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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4.23.8 Pregnancy and breastfeeding
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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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4.24.12 Variations from product inf
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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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