The Australian Immunisation Handbook, 10th Edition What’s new – 2017 update This slide set has been developed by the staff of NCIRS for education and teaching purposes Prepared October 2017

Introduction – the Handbook The Australian Immunisation Handbook is a clinical practice guideline for health professionals regarding the safe and effective use of all vaccines available in Australia The 10th Edition Handbook was published in March 2013 – the hard copy is now out of date Updates are available electronically only From 2014, updates occur annually and as needed

The most recent update – 2017 This slide set outlines updates made in the 10th Edition Handbook in 2017 Minor factual changes or clarifications are not described in this slide set Updates to the 10th Edition Handbook published in 2017 are published online only www.immunise.health.gov.au

Where to go for more details Immunise Australia website: www.immunise.health.gov.au

On the Immunise Australia website You will also find a summary of all updates, by date

So, what’s new in the latest 2017 update of the 10th Edition Australian Immunisation Handbook

Part 3 – vaccination for special risk groups 3.3 Groups with special vaccination requirements 3.3.3 Vaccination of immunocompromised persons

3.3 Groups with special vaccination requirements 3.3.3 Vaccination of immunocompromised persons Addition of text to provide more detail on who is considered immunocompromised with regard to the use of live vaccines Persons who have received recent chemotherapy Persons who have had solid organ or bone marrow transplants (within 2 years of transplantation) Transplant recipients who are still taking immunosuppressive drugs, or others on highly immunosuppressive therapy

3.3 Groups with special vaccination requirements – cont. Addition of a new table to better illustrate recommendations on timing of administration of live attenuated vaccines in adults and children who are on corticosteroids (specifically the prednisone equivalent dose) Addition of text on CD4+ count (≥350 per µL) in which persons with asymptomatic HIV infection can receive zoster vaccine

Part 4 – vaccine-preventable diseases Diphtheria Varicella Hepatitis A Yellow fever Measles Zoster Mumps Rabies Rubella Tuberculosis Typhoid

Diphtheria Addition of text clarifying vaccination in laboratory workers Persons who may be occupationally exposed to toxigenic Corynebacterium diphtheriae should consider a booster dose of either dTpa or dT (as appropriate) if more than 10 years have elapsed since the last dose of dT-containing vaccine

Hepatitis A Correction of text in table illustrating recommended doses and schedules for use of inactivated hepatitis A and hepatitis A combination vaccines 2nd dose to be given between 6 and 36 months after the 1st dose

Measles, Mumps, Rubella Source of gelatin in combination MMR vaccines was specified as porcine: M-M-R II ProQuad Amendment of text on storage of vaccine Reconstituted ProQuad vaccine should be used immediately If storage is necessary, hold at +20°C to +25°C for not more than 1 hour or at +2° to +8°C for not more than 2.5 hours

Rabies Amendment of text relating to the use of immunoglobulin KamRAB Rabies Immune Globulin is not registered by the TGA but has been made available under the Special Access Scheme due to critical shortage of alternatives Clarification of text relating to administration of rabies vaccine Intradermal administration should be particularly discouraged for post-exposure prophylaxis

Rabies – cont. Amendment of text regarding risk associated with exposure to dead animals Removal from Category I of text referring to exposure to an animal that has been dead for more than 4 hours Addition of supporting evidence and text to clarify the need for a risk assessment which should take into account exposure to a live or dead animal

Rabies – cont. Additional detail about exposures that may be difficult to categorise when conducting a detailed risk assessment A person with an intellectually disability An intoxicated person A child or a person who has been sleeping in a confined space with a bat present

Tuberculosis Addition of text to clarify when BCG vaccination should be deferred in people with skin condition BCG vaccination should only be deferred if active skin disease is at or near the site of vaccination Typhoid Source of gelatin was specified as bovine: Vivotif Oral

Varicella Yellow fever Source of gelatin in varicella vaccines was specified as porcine: Varivax Refrigerated ProQuad Yellow fever Addition of text to reinforce specific situations where a booster dose may be needed A booster dose should also be considered for travellers to meet specific countries’ vaccination requirements for travel or due to a higher risk of yellow fever virus infection

Zoster Addition of text clarifying zoster vaccine is contraindicated in persons who are immunocompromised, including: Persons on oral corticosteroids ≥20mg per day of prednisone equivalent dose for ≥14 days Persons receiving biologic or targeted synthetic disease modifying anti-rheumatic drugs Persons suffering from malignant conditions of the reticuloendothelial system, even if not receiving active treatment Addition of a new table to better illustrate recommendations for use of zoster vaccine in persons on immunosuppressive therapy

Zoster – cont. Addition of detail in recommendations for immunocompromised persons A person’s medical history and medication use must be reviewed to ensure vaccine is not contraindicated e.g. immunocompromised persons The safety of administering zoster vaccine to persons who are potentially immunocompromised should always be considered on a case-by-case basis Addition of text on how to manage inadvertent vaccination in immunocompromised persons Management of patient may include the need for specific clinical investigations and/or pre-emptive or therapeutic use of antiviral medication

Zoster – cont. Addition of text on CD4+ count (≥350 per µL) in which persons with asymptomatic HIV infection can receive zoster vaccine Additional clarity provided on the following: Healthy adults found to be seronegative should receive 2 doses of varicella vaccine in preference to 1 dose of zoster vaccine

Remember The information and recommendations in the online Handbook are now updated as required The printed 10th Edition Handbook is out of date The annual updates are available electronically on the Immunise Australia website Online updates are found at www.immunise.health.gov.au Subscribe to the Australian Immunisation Professionals network to receive an email notification of when new updates are available https://mailman.sydney.edu.au/mailman/listinfo/ncirs-aip

Additional resources NCIRS: www.ncirs.edu.au Stand-alone printable Handbook tables Disease and safety fact sheets Childhood and adult vaccine schedule tables Vaccine history tables Australian Government Department of Health: www.immunise.health.gov.au Electronic version of the 10th Edition Handbook Up-to-date NIP schedule cards ATAGI CDNA Series of National Guidelines (SoNGs): www.health.gov.au/cdnasongs National vaccine storage guidelines – Strive for 5 (2nd edition): www.health.gov.au/internet/immunise/publishing.nsf/Content/IMM77-cnt ACIR: www.humanservices.gov.au/customer/services/medicare/australian-childhood-immunisation-register TGA: www.tga.gov.au ASCIA: www.allergy.org.au WHO, yellow fever vaccination requirements: www.who.int/csr/disease/yellowfev/en

Disclaimer and Copyright Although every effort has gone into ensuring the content of this presentation is correct, NCIRS and its staff cannot guarantee the information provided is accurate, and accepts no liability for any loss or damage if a person suffers directly or indirectly due to any information provided. Any mistakes in this information that are brought to our attention will be corrected as soon as possible. New recommendations and updates are only published online, and health professionals are encouraged to review the full Handbook and the Department of Health website before implementing any practices. NCIRS claims copyright ownership of this presentation. This slide set may be reproduced and distributed for educational use only, provided NCIRS is acknowledged and referenced on any copies made. The slide set cannot be used for commercial purposes, without written permission from NCIRS.

Special thanks to: All those involved in the development of the Handbook All health professionals involved in immunisation programs who utilise the Handbook and enable the effective and safe use of vaccines in Australia