1. Immunisation Update March 2016 Mackay Public Health Unit

2. Overview  National Immunisation Program Schedule (NIPS)  Changes to the NIPS in 2016  School Immunisation Program  No Jab No Pay  Vaccine administration – Did you know??  dTpa for pregnant women  Influenza Program  Common Vaccine Errors  Adverse Events Following Immunisation (AEFI)  Contra indications to Immunisation  Vaccine Management  Question time???

4. What’s New in 2016  Hepatitis A catch-up can now be given to children up to 10 years of age  DTPa Booster at 18 months will be available early March  No formal catch-up any child presenting for 18 month immunisations eligible for DTPa booster  All children born after October 2014 without a DTPa at 18 months will be considered overdue  Once the 18 month immunisations are introduced 4 year old immunisations have to be given at 4 years of age and not 3 ½  MMR at 4 will be taken off the new schedule  Zostavax will be introduced late 2016

5. New & Updated Resources  Australian Immunisation Handbook  Bubba Jabs influenza posters  Pertussis booster at 18 months poster  Post immunisation reaction pads  National Immunisation Schedule Program Feb 2016  ATAGI Influenza statement for health professionals Currently in Development:  Multiple injection site poster  Pertussis and Flu in pregnancy poster  Updated Bubba Jabs posters; brochures, magnets

6. What’s New in 2016  ACIR will become AIR  Now taking all immunisations for children <10 years of age including overseas histories (current and retrospective)  VIVAS recording all immunisations including those given >10 and will eventually transfer data to ACIR.  HPV register will become the School Immunisation Register  QHIP are now called IPU  2015 AIH updates available online as PDFs at NCIRS  To be updated: AIH Influenza chapter – online update only

7. School Immunisation Program 2016 Grade 7 & 8 HPV3 Doses – 0, 2 and 6 months Diphtheria, tetanus, pertussisOne dose VaricellaOne Dose Catch up - Grade 9 only HPV3 Doses – 0, 2 and 6 months Diphtheria, tetanus, pertussisOne dose VaricellaOne Dose Catch up - Grade 11 only Diphtheria, tetanus, pertussisOne dose

8. School Based Vaccines  For more information about the School Immunisation Program Contact the School Immunisation Program Co-ordinator : Carmel Bannon 4753 9000  School Immunisation Program Consent forms: http://www.health.qld.gov.au/public- health/schools/immunisation/clinics/default.asp

9. No Jab No Pay & Childcare Legislation  ‘No Jab No Pay’ laws came into effect nationally on the 1 st January 2016  Child care centre's will be able to create their own policies as to whether they will exclude children not vaccinated  All children up to 19 years of age who have received partial or no recommended childhood immunisations will be recognised as unimmunised  Grace Period until 18 th of March 2016 (this has been extended due to delays of the transferring of vaccination records to ACIR  All families of un-immunised children without a medical exemption will no longer receive: FTB-A end-of-year supplement, Child Care Benefit (CCB) and Child Care Rebate (CCR)

10. Catch-up Immunisations for 10-19 year olds  ‘Catch-up’ childhood immunisations are available and will be funded for children from 10- 19 years of age if their parents receive family benefits  You will be able to order required catch-up vaccines from IPU from this week with your usual monthly order  Vaccines included in catch-ups for over 10’s are:  Boostrix  Boostrix IPV / Adacel Polio  HBVaxII Paed (10-19 years of age) 3 doses (0, 1, 2 months)  HBVaxII Adult (11-15 years of age) 2 doses (0, 4 months)  dT – (Mass Biologics)  Proquad (<14years)  Varivax (only funded for children born after 1/05/2004)  NeisVacC  Ipol Do you have enough room in your vaccine fridge?? Do you need more baskets for vaccine storage?

11. Vaccine Administration Did you know??  Page 65 of the AIH states: ‘Gloves are not routinely recommended for immunisation service providers, unless the person administering the vaccine is likely to come into contact with body fluids or has open lesions on the hands’.  Page 70 of the AIH states:  ‘Provided the skin is visibly clean, there is no need to wipe it with an antiseptic. If the immunisation service provider decides to clean the skin, alcohol and other disinfecting agents must be allowed to dry before vaccine injection’ WHY??  Page 72 of the AIH states:  ‘If using a narrow 25 gauge needle for an IM injection, the vaccine must be administered over a count of 5 seconds’ WHY??

12. dTpa for pregnant women  Protects against Pertussis  1 in 125 babies under 6 months with pertussis dies from pneumonia or brain damage  Vaccine to use – Adacel  Funded for all pregnant women in EVERY pregnancy in their third trimester (from 28 weeks onwards)  Gives some protection to infants for up to 6 weeks  Data collection of dTpa on VIVAS  Information Sheet  Consent to vaccination  Consent to release of data

13. Influenza Program Funded vaccine available from April 2016 Quadrivalent vaccine for funded program Double strain change – A (H1N1) California/7/2009 like virus – A (H3N2 Hong Kong/4801/2014 like virus – B/Phuket/3073/2013 like virus – B/Brisbane/60/2008 like virus Eligibility – All adults 65yrs+ – Pregnant women at any stage – ATSI OVER 15years – ATSI 6mths – 5years – Medical at risk >6mths of age As per AIH

14. FLU - What to do now  Discard all your 2015 influenza vaccine  Check your vaccine fridge. Is there enough storage space for additional vaccine  Do your staff know who is eligible?  Fluvax is not to be given to children <9yrs

15. Influenza Notes:  Children aged 6mths to <9years require 2 doses (at least 4weeks apart)  If this second dose is missed in the first year it is given, 1 dose should be given the following year.  Children under 3 can only receive a paediatric dose of FluQuadri Junior  Adult doses of the quadrivalent influenza vaccine CAN NOT be used as a half dose in children <3

16. Common Vaccine Errors  RotaTeq – always use the RotaTeq wheel  Remember For infants presenting for their 2 nd dose after reaching 29 weeks of age, a 2 nd and final dose can be given, provided the upper age limit of 32 weeks has not been reached. Page 378 of the Australian Immunisation Handbook 10 th edition 2014  Check minimum acceptable ages for vaccinations Page 46-48 of the Australian Immunisation Handbook 10 th edition 2014

17. Common Vaccine Errors  Minimum Intervals between vaccine doses Page 50 of the Australian Immunisation Handbook 10 th edition 2014  MMRV as Dose 1 in a child less than 4yrs of age  Extra MMR at 4yrs of age

18. Contraindications to vaccination There are only two absolute contraindications applicable to all vaccines:  anaphylaxis following a previous dose of the relevant vaccine  anaphylaxis following any component of the relevant vaccine Two further contraindications applicable to live vaccines:  Live vaccines should not be administered to persons who are significantly immunocompromised regardless of whether the immunocompromise is caused by disease or treatment  Generally, live vaccines should not be administered during pregnancy & women should be advised not to become pregnant within 28 days of receiving a live vaccine

19. False contraindications  Mild illness without fever (T<38.5 c)  Family history of any adverse events following immunisation  Past history of convulsions  Treatment with antibiotics  Treatment with locally acting (inhaled/low dose topical steroids)  Asthma, eczema, atop, hay fever  Prematurity  Low weight in otherwise healthy child  Neurological conditions eg. Cerebral palsy, Downs syndrome  Contact with an infectious disease  Breastfeeding( mother or child)

20. Why is maintaining cold chain important? To ensure that all people receive effective & potent vaccines and reduce our family’s and our community’s risk of acquiring a vaccine preventable disease or cancer.

21. Cold Chain is...  Maintaining the temperature of vaccines during transport and storage between…. +2°C to +8°C  When does Cold Chain begin? from the point of manufacture  and end? on administration of the vaccine  Decreasing vaccines exposure to? Heat Freezing Light

22. What to do? Immediately isolate the vaccines and label ‘Do Not Use’ on fridge door and advise all colleagues Keep vaccines refrigerated between +2 and 8 degrees Contact IPU 3328 9888 (9-3pm) Do not discard any vaccines until advised so by MPHU For privately purchased vaccines contact the manufacturer for advice If an equipment error contact the company that services your equipment If a power failure use alternate energy source if available; find out how long the power failure may be then start preparing for alternate vaccine storage options i.e.. cooler

23. Important Reminders All vaccines loose potency gradually, even at correct storage temperatures Always check expiry dates Any loss of vaccine potency due to exposure to temperatures outside of 2-8 degrees, or light is irreversible Damage to the vaccines due to repeated exposures to freezing, heat or light is cumulative If you use expired vaccines or vaccines exposed to freezing, heat or light that have not been cleared to use by TPHS then you will need to recall the person or people you have immunised with these vaccines to re-vaccinate

24. Important Reminders A cold chain breach can mean a disruption of vaccine services The value of the vaccines in an average vaccine fridge is around $5,000 to QH but to purchase these vaccines privately would cost up to $25 000 It can take up to 2 hours to ‘sweat’ freezer blocks in air- conditioning

25. Vaccine Management Resources “The Vaccine Management Bible” Strive for 5, 2 nd Edition

26. Questions?