The Australian Immunisation Handbook 10th Edition

17 January 2014

Page last updated: 30 August 2016

17 January 2014

The individual amendments made in the January 2014 update of the 10th edition of the Handbook are listed below by chapter/section heading. The amended text is highlighted for easy identification. Page numbers indicate the page on which the amendment occurs in the hard copy version of the Handbook.

1.4 What's new

1.4.1 New chapters and chapters that no longer appear in the Handbook

The sixth bullet point under this heading (page 7) should read as follows:

  • The chapter on smallpox has been deleted. For information on smallpox, see the Guidelines for smallpox outbreak, preparedness, response and management on the Department of Health website.

2.1 Pre-vaccination

2.1.2 Effective cold chain: transport, storage and handling of vaccines

Text in the first shaded box under this heading (page 25) should read as follows:

All immunisation service providers must be familiar with, and adhere to, the National vaccine storage guidelines: Strive for 5 (2nd edition).1 This publication can be accessed free of charge.

References

Reference 1 has been updated to:

National vaccine storage guidelines: Strive for 5, 2nd ed. Canberra: Australian Government Department of Health and Ageing, 2013. (accessed Nov 2013).

(NB. This reference has also been updated in the reference lists for all disease chapters in Part 4 of the Handbook)

2.1.5 Catch-up

Under the sub-heading 'Planning catch-up vaccination', the seventh bullet point (page 42), should read as follows:

  • When commencing the catch-up schedule, the standard scheduled interval between doses may be reduced or extended, and the numbers of doses required may reduce with age. For example, from 16 months of age, only 1 dose of (any) Hib vaccine is required.

In Table 2.1.5: Minimum acceptable age for the 1st dose of scheduled vaccines in infants in special circumstances, in the MenCCV row, the text in the Action (right hand) column (page 47) should read as follows:

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Vaccine Minimum age for 1st dose in special circumstances* Action if a vaccine dose is inadvertently administered prior to the recommended minimum age17
MenCCV 6 weeks If any MenCCV doses are given before 12 months of age, then a booster dose of MenCCV should be given at 12 months of age or 8 weeks after the last dose, whichever is later.

Note: MenCCV is routinely recommended at 12 months of age, although recommendations for children at increased risk of meningococcal disease differ (see 4.10 Meningococcal disease).

In Table 2.1.5: Minimum acceptable age for the 1st dose of scheduled vaccines in infants in special circumstances, the second footnote (†) (page 48) should read as follows:

† If the need to repeat the 1st dose of vaccine is not recognised until the infant is older (e.g. a 4-month-old infant presents for vaccination and has only previously received 1 dose of DTPa-hepB-IPV-Hib or 13vPCV vaccines both at age 28 days), repeat these vaccines now (and count these as dose 1), then proceed with subsequent schedule as per NIP and/or catch-up recommendations for these vaccines described in this chapter.

Table 2.1.8: Catch-up schedule for Haemophilus influenzae type b (Hib) vaccination for children 5 years of age (page 54-55)* - this table has been replaced:

2.2 Administration of vaccines*

2.2.8 Identifying the injection site

Under the sub-heading 'The ventrogluteal area', the first bullet point (page 81), should read as follows:

  • Place the palm over the greater trochanter (the uppermost bony prominence of the thigh bone), with the thumb pointing towards the umbilicus. Point the index finger towards the anterior superior iliac spine, and spread the middle finger so it aims at the iliac crest, thus creating a ‘V’ outlining the ventrogluteal triangular area. The injection site is at the centre of this area as shown in the diagram in Figure 2.2.7. Note: In small children and infants, the placement of the hand in relation to these anatomical markers may vary, as shown in the photograph in Figure 2.2.7.
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2.3 Post-vaccination

2.3.2 Adverse events following immunisation

Under the sub-heading 'Uncommon/rare adverse events following immunisation', the third bullet point (page 93) should read as follows:

  • Oral rotavirus vaccines are associated with a small increased risk of intussusception (IS), a rare form of bowl blockage caused by telescoping of the intestine into itself. This risk appears to be particularly in the 7 days following the 1st vaccine dose; however, a smaller increased risk in the week following the 2nd dose has also been reported.21-25 It is not currently clear whether there is an overall increase in the risk of IS above that which would be expected in the 1st year of infancy without vaccine use. The increased risk represents approximately 6 additional cases of intussusception among every 100 000 infants vaccinated, or 14 additional cases per year in Australia.23 Children who have had IS are recommended to not receive rotavirus vaccine (see 4.17 Rotavirus).

References

Reference 23 has been updated to:

Carlin JB, Macartney KK, Lee KJ, et al. Intussusception risk and disease prevention associated with rotavirus vaccines in Australia’s national immunization program. Clinical Infectious Diseases 2013;57:1427-34.

3.3 Groups with special vaccination requirements

3.3.7 Vaccination of persons at occupational risk

In Table 3.3.7: Recommended vaccinations for persons at increased risk of certain occupationally acquired vaccine-preventable diseases, text in the first row of the Healthcare workers (HCW) column (page 170) should read as follows:

Occupation
Healthcare workers (HCW)
Vaccine
All HCW
Includes all workers and students directly involved in patient care or the handling of human tissue, blood or body fluids
Hepatitis B
Influenza
MMR (if non-immune)ǂ
Pertussis (dTpa)
Varicella (if non-immune)

3.3.8 Vaccination of migrants to Australia

The sixth paragraph under this heading (page 174) should read as follows:

Migrant/refugee adults also need to be targeted for vaccination, especially against rubella, using MMR vaccine. This is particularly important for women of child-bearing age. Some refugees aged between 9 months and 54 years may have been offered MMR as part of a pre-departure screening, but may require a subsequent dose on arrival in Australia.170 It is important to take into account any live attenuated viral vaccines that may have been administered as part of a pre-departure screening, such as measles-containing vaccines or yellow fever vaccine (especially in those persons arriving from central and northern African nations). It is important to allow a minimum 4-week interval before administering any other live attenuated viral vaccines.

References

Reference 170 has been updated to:

Australian Government Department of Immigration and Border Protection. Fact sheet 67a – Departure Health Check (DHC). May 2013. (accessed Nov 2013).

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4.3 Haemophilus influenzae type b

4.3.7 Recommendations

Under the sub-heading 'Booster doses', the second paragraph (page 195) should read as follows:

Children aged >15 months and up to 59 months of age at presentation who have not received a primary course of a Hib or Hib-containing vaccine will only require 1 dose of vaccine as catch-up, irrespective of the number of previous doses administered. There should be a minimum 2-month interval between their last dose and the catch-up dose. Catch-up for Hib vaccination for children up to 59 months of age is outlined in Table 2.1.8 Catch-up schedule for Hib vaccination for children <5 years of age in 2.1.5 Catch-up.

4.5 Hepatitis B

4.5.7 Recommendations

Under the sub-heading 'Persons at occupational risk', the first paragraph (page 223) should read as follows:

The risk to persons in certain occupations differs considerably from setting to setting in different parts of Australia. However, it is recommended that all staff directly involved in patient care and/or the handling of human tissue, blood or body fluids should be vaccinated. In addition, standard precautions against exposure to human tissue, blood or body fluids should be used as a matter of routine.71

Under the sub-heading 'Persons at occupational risk', the first bullet point (page 223) should read as follows:

  • police, members of the armed forces, emergency services staff and staff of correctional facilities; these persons should be vaccinated if they are assigned to duties that may involve exposure to human tissue, blood or body fluids

Under the sub-heading 'Serological testing following hepatitis B vaccination' the first bullet point (page 225) should read as follows:

  • those at significant occupational risk (e.g. healthcare workers whose work involves frequent exposure to human tissue, blood or body fluids)

4.5.11 Public health management of hepatitis B

In Table 4.5.3: Post-exposure prophylaxis for non-immune persons exposed to a HbsAg-positive source, in the Perinatal exposure row, text in the Vaccine (right hand) column (page 229) should read as follows:

Type of exposure Hepatitis B immunoglobulin Vaccine
Perinatal (exposure of babies during and after birth)* 100 IU, by IM injection Single dose immediately after birth (preferably within 12 hours of birth and certainly within 48 hours) 0.5 mL, by IM injection Immediately after birth (preferably within 24 hours, no later than 7 days), then at 2, 4 and 6 months of age

4.9 Measles

4.9.7 Recommendations

Under the sub-heading 'Infants aged <12 months', the second paragraph (page 272) should read as follows:

Two doses of measles-containing vaccine should be administered at ≥12 months of age (see ‘Children’ below). This is because maternal antibodies to measles are known to persist in many infants until approximately 11 months of age and may interfere with active immunisation before 12 months of age.2 However, there is some evidence that a dose provided at ≥11 months (but prior to 12 months) of age is sufficiently immunogenic; as such, doses given in this timeframe may not need to be repeated in all circumstances (see also Table 2.1.5 Minimum acceptable age for the 1st dose of scheduled vaccines in infants in special circumstances).

Under the sub-heading 'Children', the fifth paragraph (page 272) should read as follows:

If MMRV vaccine is inadvertently administered as dose 1 of MMR–containing vaccine, the dose does not need to be repeated (providing it was given at ≥12 months of age; see Table 2.1.5 Minimum acceptable age for the 1st dose of scheduled vaccines in infants in special circumstances). However, parents/carers should be advised regarding the small but increased risk of fever and febrile seizures (compared with that expected following MMR vaccine).

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4.13 Pneumococcal disease

4.13.6 Dosage and administration

The fourth paragraph under this heading (page 323) should read as follows:

13vPCV (Prevenar 13) is registered for use in infants and children aged 6 weeks up to 17 years and adults aged ≥50 years.

4.13.12 Variations from product information

The second paragraph under this heading (page 336) should read as follows:

13vPCV is registered for use in children up to 17 years of age and adults aged ≥50 years. The ATAGI recommends a dose of 13vPCV for adults of any age who have a condition(s) associated with the highest risk of IPD (see List 4.13.1, Category A). This is based on the likely benefit outweighing uncertainties and risks, and on immunogenicity and safety data in children.

4.17 Rotavirus

4.17.11 Adverse events

Under the sub-heading 'Intussusception', the sentence beginning 'The increased risk of IS...' in the first paragraph (page 382) should read as follows:

The increased risk of IS following rotavirus vaccination, from the most recent Australian study, is estimated as approximately 6 additional cases of intussusception among every 100 000 infants vaccinated, or 14 additional cases per year in Australia.74

References

Reference 74 has been updated to:

Carlin JB, Macartney KK, Lee KJ, et al. Intussusception risk and disease prevention associated with rotavirus vaccines in Australia’s national immunization program. Clinical Infectious Diseases 2013;57:1427-34.