The Australian Immunisation Handbook 10th Edition 2013

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2.2.4 Preparation for vaccine administration Skin cleaning Provided the skin is visibly clean, there is no need to wipe it with an antiseptic (e.g. alcohol wipe). 3,8 If the immunisation service provider decides to clean the skin, or if the skin is visibly not clean, alcohol and other disinfecting agents must be allowed to dry before vaccine injection (to prevent inactivation of live vaccines and to reduce the likelihood of irritation at the injection site). 9 Distraction techniques The routine use of distraction, relaxation and other measures have been shown to reduce distress and pain following vaccination in young children. 10-13 Reducing children’s distress may enhance parents’ timely attendance for subsequent vaccinations. Distraction measures that may decrease discomfort following vaccination in young children include: 10-13 • swaddling and holding the infant securely (but not excessively) • shaking a noisy toy (for infants and very young children) • playing music • encouraging an older child to pretend to blow away the pain using a windmill toy or bubbles • breastfeeding the infant during administration of the vaccine. Discomfort may also be decreased by administering sweet-tasting fluid orally immediately before the injection (with parental consent). In infants, 15–25% sucrose drops have been used. 14 Topical anaesthetic agents, including vapocoolant sprays, are available but, to be effective, must be applied at the correct time before vaccine administration. Topical anaesthetics, such as EMLA, are not recommended for routine use, but could be considered in a child with excessive fear or dislike of needles; they require application 30 to 60 minutes before an injection. 15 Vapocoolant sprays are applied 15 seconds before vaccination. These sprays have been shown to be more effective in adults than children as children can perceive coldness as painful and spray application may also focus the child more on the procedure. Topical lignocaine/prilocaine is not recommended for children
2.2.5 Vaccine injection techniques Intramuscular injection technique 16,17 • For intramuscular (IM) injection, use a 25 mm needle in most cases (see Table 2.2.2). • Depending on the injection site, position the limb so as to relax the muscle into which the vaccine is to be injected. • Pierce the skin at an angle of 90° to the skin, so the needle can be safely inserted to the hub. 18 Provided an injection angle of >70° is used, the needle should reach the muscle layer. 19 • If using a 25 gauge needle for an IM vaccination, ensure the vaccine is injected slowly over a count of 5 seconds to avoid injection pain and muscle trauma (see Table 2.2.2). • If you have drawn back on the syringe plunger before injecting a vaccine (which is not considered necessary), 10 and a flash of blood appears in the needle hub, withdraw the needle and select a new site for injection. 20 Studies have demonstrated that, for most vaccines, local adverse events are minimised and immunogenicity is enhanced by ensuring vaccine is deposited into the muscle and not into the subcutaneous layer. 10,21-24 However, some vaccines (e.g. inactivated poliomyelitis, varicella and meningococcal polysaccharide vaccines) are only registered for SC administration (see Table 2.2.1). In the instance where a vaccine that is registered for administration only via the IM route is inadvertently administered via the SC route, check the vaccine product information and the ‘Vaccines’ section in relevant disease-specific chapters in Part 4 for additional information. Some vaccines may still be immunogenic when given via the SC route, and as such, would not need to be repeated. One vaccine that should be considered invalid and that therefore needs to be repeated is Rabipur Inactivated Rabies Virus Vaccine (PCECV) (see 4.16 Rabies and other lyssaviruses (including Australian bat lyssavirus)). In general, hepatitis B vaccines should also be repeated if inadvertently given SC. However, in special circumstances, for example, in persons with bleeding disorders, some hepatitis B vaccines may be given via the SC route (see 3.3.5 Vaccination of persons with bleeding disorders). A clinical trial demonstrated that for infant vaccination long (25 mm) needles (with the skin stretched flat and the needle inserted at 90°) were associated with significantly fewer local adverse events, while achieving comparable immunogenicity. Little difference in local adverse events or immune response was found between needles of the same length but with different gauges. 18 PART 2 VACCINATION PROCEDURES 71 2.2 ADMINISTRATION OF VACCINES
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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
Page 33 and 34: without the harmful consequences of
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Page 37 and 38: will occur following receipt of a s
Page 39 and 40: cases, both the doctor issuing the
Page 41 and 42: Should a child or adolescent refuse
Page 43 and 44: • check that the correct time int
Page 45 and 46: Note: Please discuss this informati
Page 47 and 48: Condition or circumstance of person
Page 49 and 50: Condition or circumstance of person
Page 51 and 52: Table 2.1.3: Live attenuated parent
Page 53 and 54: An online ‘catch-up calculator’
Page 55 and 56: Use of serological testing to guide
Page 57 and 58: • For some vaccines, catch-up vac
Page 59 and 60: Figure 2.1.1: Catch-up worksheet fo
Page 61 and 62: Vaccine Minimum age for 1st dose in
Page 63 and 64: Table 2.1.6: Number of vaccine dose
Page 65 and 66: Catch-up guidelines for individual
Page 67 and 68: If 13vPCV is not available, and 10v
Page 69 and 70: Previous vaccination history 2 prev
Page 71 and 72: PART 2 VACCINATION PROCEDURES 57 Ta
Page 73 and 74: PART 2 VACCINATION PROCEDURES 59 Ta
Page 75 and 76: Catch-up schedules for persons ≥1
Page 77 and 78: For additional details on these rec
Page 79 and 80: 2.2 ADMINISTRATION OF VACCINES 2.2.
Page 81 and 82: • Never freeze a vaccine after it
Page 83: PART 2 VACCINATION PROCEDURES 69 In
Page 87 and 88: Interruption to a vaccination If th
Page 89 and 90: 2.2.7 Positioning for vaccination I
Page 91 and 92: Children ≥12 months of age Cuddle
Page 93 and 94: 2.2.8 Identifying the injection sit
Page 95 and 96: • Place the palm over the greater
Page 97 and 98: 2.2.9 Administering multiple vaccin
Page 99 and 100: 2.3 POST-VACCINATION 2.3.1 Immediat
Page 101 and 102: Management of an immediate adverse
Page 103 and 104: Management of anaphylaxis Rapid IM
Page 105 and 106: Autoinjectors are generally not app
Page 107 and 108: Australia. 16 This vaccine is no lo
Page 109 and 110: Any serious or unexpected adverse e
Page 111 and 112: Consumers and immunisation service
Page 113 and 114: When relevant, immunisation service
Page 115 and 116: National Human Papillomavirus Vacci
Page 117 and 118: Immunisation service providers enro
Page 119 and 120: PART 3 VACCINATION FOR SPECIAL RISK
Page 121 and 122: Thus, a vaccine to prevent Hib dise
Page 123 and 124: 3.1.2 Adults Hepatitis B Indigenous
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Page 127 and 128: 3.2 VACCINATION FOR INTERNATIONAL T
Page 129 and 130: • vaccination history (including
Page 131 and 132: departure to allow for the period w
Page 133 and 134: Selected vaccines based on travel i
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Tick-borne encephalitis Tick-borne
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PART 3 VACCINATION FOR SPECIAL RISK
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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
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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
Page 537 and 538:
varicella-zoster immunoglobulin, 45
Page 539 and 540:
INDEX 525 INDEX
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