1. Immunisation Update

2. Changes to the immunisation schedule Contraindications and precautions to vaccination Epidemic update

3.  Three significant changes to the immunisation schedule in 2008: –New pneumococcal vaccine for infants –MeNZB vaccine programme –HPV vaccine programme

4. New pneumococcal vaccine for infants  PCV7 (Prevenar®) vaccine has been added  Effective in children < 2 years  Previous vaccine 23PPV (Pneumovax  23) not effective in infants  Given at 6 weeks, 5 and 15 months  Children at high risk still have PCV7 + 23PPV

5. MeNZB vaccine programme   in cases group B meningococcus  MeNZB now removed from National immunisation schedule

6. Contraindications and precautions to vaccination

7. VaccineContraindications All VaccinesAnaphylactic type reaction to a previous dose of that vaccine, or to anyvaccine component (not trace element) Pertussis-containing vaccines Previous encephalopathy within seven days after a previouspertussis-containing vaccine Evolving (undiagnosed) neurological problem Measles, Mumps, Rubella, MMR,Varicella, Yellow Fever, Oral Polio Immunosuppressed individuals If blood, plasma or immunoglobulin were given in the last 11 months Pregnancy Influenza, Yellow FeverAnaphylactic reaction to chickens, including eggs, egg protein, feathers etc

8. Precautions There are a number of precautions to vaccination:  Giving a live vaccine less than four weeks after another live vaccine  Pregnancy.  Allergy to Vaccine components  History of Guillain Barré Syndrome  Thrombocytopenia or history of thrombocytopenic purpura and MMR  Haemophilia and related bleeding disorders

9. False contraindications  The following conditions or circumstances are not contraindications to vaccination:  Minor infections without significant fever or systemic upset  Asthma, hayfever, eczema, “snuffles”  Food or medications allergy  Treatment with antibiotics or locally acting steroids  Pregnancy in the child’s mother  A child who is breastfeeding  Neonatal jaundice  Low weight in an otherwise healthy child (continued on next slide)

10. False contraindications (..contd)  The child being over the usual age for immunisation  Family history of vaccine reactions, seizures or Sudden Infant Death Syndrome  Prematurity in an otherwise well infant who is not in hospital  Established neurological conditions such as cerebral palsy or Down syndrome  Contact with an infectious disease  Clinical history of pertussis, measles, mumps or rubella (clinical history without laboratory confirmation can not be taken as proof of immunity)

11. Epidemic update  Pertussis  Measles

12. Pertussis  New Zealand has a pertussis epidemic every four to five years – currently in early phases  Infants are vulnerable to disease  The best way to contain an epidemic is immunisation and effective management of confirmed cases  Exclude confirmed cases from school or work  Pertussis is a notifiable disease to MOH

13. Measles   in cases since start of 2009  95% of popn must be immunised to avoid outbreaks  Difficult as efficacy of measles vaccine is 90-95%  All children should be vaccined at 15 months and 4 years