The Australian Immunisation Handbook 10th Edition 2013

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Respiratory syncytial virus monoclonal antibodies A humanised mouse monoclonal antibody to respiratory syncytial virus (RSV) produced by cultured cells, palivizumab, is registered in Australia for prevention of serious lower respiratory tract disease caused by RSV in children at high risk of RSV disease. There is no consensus regarding the use of palivizumab in Australia. 14 This product is given by IM injection each month to children at high risk of severe RSV disease, during the seasonal period of exposure to RSV. Palivizumab has been found to reduce the absolute risk of hospitalisation from about 10% to about 5% for babies born prematurely, for babies with chronic neonatal lung disease, and also for babies with haemodynamically significant congenital heart disease, particularly when complicated by large left-to-right shunts leading to pulmonary hypertension. 14-22 It has not been shown to reduce the incidence of more severe outcomes, such as the need for ventilation, nor has it been shown to reduce mortality. 20,21 There are currently a number of clinical trials assessing a recombinant humanised antibody, motavizumab. 23 • Synagis – Abbott Australia (palivizumab). Supplied in single-use vials of powder, to be reconstituted with sterile water for injection; 50 mg in 4 mL vial; 100 mg in 10 mL vial. The dose of palivizumab is 15 mg/kg once a month, to be given by IM injection, preferably in the anterolateral thigh. Where possible, the 1st dose should be administered before commencement of the RSV season. Tetanus immunoglobulin Tetanus immunoglobulin (human) for intramuscular use Tetanus immunoglobulin (TIG) should be used for passive protection of persons who have sustained a tetanus-prone wound, where the person has not previously received 3 or more doses of a tetanus toxoid-containing vaccine or where there is doubt about their tetanus vaccination status. In persons who have a humoral immune deficiency, TIG should be provided after a tetanus-prone injury, regardless of the time since their last dose of tetanus-containing vaccine. TIG provides immediate protection that lasts for a period of 3 to 4 weeks. 24 For wounds not categorised as tetanus-prone, such as clean cuts, TIG is unnecessary. Detailed information on appropriate tetanus prophylaxis measures in wound management, including use of TIG, are outlined in Table 4.19.1 in 4.19 Tetanus. The recommended dose for TIG is 250 IU, to be given by IM injection as soon as practicable after the injury. If more than 24 hours have elapsed, 500 IU should be given. Because of its viscosity, TIG should be given to adults using a 21 gauge needle. For children, it can be given slowly using a 23 gauge needle. A tetanus toxoid-containing vaccine should be given at the same time in the opposite 462 The Australian Immunisation Handbook 10th edition
limb with a separate syringe, and arrangements should be made to complete the full course of tetanus toxoid-containing vaccinations. Details for accessing TIG should be obtained from the Australian Red Cross Blood Service (see 5.1.1 Availability of immunoglobulins above). Tetanus immunoglobulin (human) for intravenous use • Tetanus Immunoglobulin-VF (human, for intravenous use) – CSL Limited. 55–65 mg/mL immunoglobulin (mainly IgG) prepared from human plasma containing high levels of antibody to the toxin of Clostridium tetani. Single vials containing 4000 IU human tetanus antitoxin. Contains maltose. Tetanus immunoglobulin for IV use (TIVG) is used in the management of clinical tetanus. 24 The recommended dose is 4000 IU, to be given by slow intravenous infusion. Detailed protocols for administration of this product and management of adverse events should be consulted if its use is contemplated. Requests for TIVG should be directed to the Australian Red Cross Blood Service in your state/ territory (see 5.1.1 Availability of immunoglobulins above). Diphtheria antitoxin Diphtheria antitoxin is prepared by immunising horses against the toxin produced by Corynebacterium diphtheriae. Advice should be sought with respect to diphtheria antitoxin access and dosage, and special arrangements made if hypersensitivity is suspected; this can be coordinated through the relevant state/territory health authority (see Appendix 1 Contact details for Australian, state and territory government health authorities and communicable disease control). 5.1.5 Potential interaction with vaccines Live attenuated viral vaccines Immunoglobulin preparations can interfere with the response to certain live attenuated viral vaccines by preventing vaccine virus replication after administration. Therefore, administration of live attenuated viral vaccines, such as measles and varicella vaccines (but not rotavirus, zoster or yellow fever vaccines), should be deferred, dependent on the clinical status of the patient, for at least 3 months after the IM administration of NHIG, and for at least 8 months after the administration of intravenous NHIG. 25 For detailed information on recommended intervals, see 3.3 Groups with special vaccination requirements, Table 3.3.6 Recommended intervals between either immunoglobulins or blood products and MMR, MMRV or varicella vaccination. For the same reason, if vaccination has occurred, administration of immunoglobulin products should be PART 5 PASSIVE IMMUNISATION 463 5.1 PASSIVE IMMUNISATION USING IMMUNOGLOBULIN PREPARATIONS
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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
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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
Page 425 and 426: BCG vaccination procedures BCG vacc
Page 427 and 428: Occupational groups There is some e
Page 429 and 430: 4.20.13 Variations from product inf
Page 431 and 432: In developed countries, typhoid fev
Page 433 and 434: A 4th capsule taken on day 7 has be
Page 435 and 436: 4.21.8 Pregnancy and breastfeeding
Page 437 and 438: 4.22 VARICELLA 4.22.1 Virology Vari
Page 439 and 440: as a case of wild-type varicella oc
Page 441 and 442: Reconstituted Varivax Refrigerated
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Page 445 and 446: eceived varicella vaccine while bre
Page 447 and 448: immunoglobulin and other blood prod
Page 449 and 450: eported in a 9-year follow-up of 70
Page 451 and 452: high-dose intravenous NHIG are like
Page 453 and 454: 4.23 YELLOW FEVER 4.23.1 Virology Y
Page 455 and 456: Co-administration with other vaccin
Page 457 and 458: 4.23.8 Pregnancy and breastfeeding
Page 459 and 460: Vaccine-associated neurotropic adve
Page 461 and 462: 1000 cases per 100 000 population i
Page 463 and 464: administration of Zostavax with 23-
Page 465 and 466: diagnosis. In addition, the risk of
Page 467 and 468: Laboratory testing to check for an
Page 469 and 470: 4.24.12 Variations from product inf
Page 471 and 472: the immunoglobulin preparations con
Page 473 and 474: Prevention of measles Measles vacci
Page 475: who are being treated with immunosu
Page 479 and 480: APPENDIX 1: CONTACT DETAILS FOR AUS
Page 481 and 482: APPENDIX 2: LITERATURE SEARCH STRAT
Page 483 and 484: APPENDIX 3: COMPONENTS OF VACCINES
Page 485 and 486: Vaccine component* Vaccine brand
Page 487 and 488: APPENDIX 4: COMMONLY ASKED QUESTION
Page 489 and 490: When should preterm infants be vacc
Page 491 and 492: If a parent decides not to have a c
Page 493 and 494: Should vaccines be given to persons
Page 495 and 496: eason not to vaccinate. Asthma, ecz
Page 497 and 498: Does MMR vaccine cause inflammatory
Page 499 and 500: (either alone or in combination) fo
Page 501 and 502: A4.5 Questions about the need for i
Page 503 and 504: APPENDIX 5: GLOSSARY OF TECHNICAL T
Page 505 and 506: Enzootic enzootic infections are pr
Page 507 and 508: Rotavirus a virus that is a common
Page 509 and 510: APPENDIX 6: COMMONLY USED ABBREVIAT
Page 511 and 512: OPV oral poliomyelitis vaccine PCEC
Page 513 and 514: Year Vaccine 2003 Varicella 2003 Me
Page 515 and 516: identifying the injection site, 79-
Page 517 and 518: Australian Capital Territory advers
Page 519 and 520: and travellers, 119 vaccines, 177-1
Page 521 and 522: abies and other lyssaviruses (inclu
Page 523 and 524: HPV Vaccination Program, 234 human
Page 525 and 526: 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
Page 539 and 540:
INDEX 525 INDEX
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The Australian Immunisation Handbook 10th Edition 2013

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