Immunisation Update
March 2013
Lisbeth Alley
Immunisation Education Facilitator, IMAC
New updated CCMG
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www.immune.org.nz
0800 466 863
National Guidelines for
Vaccine Storage and Distribution 2012
All Immunisation Providers…
- must be CC Accredited (including A and E Depts, public health
services)
- must use a pharmaceutical refrigerator to store
vaccines
- fridge must be located against an internal wall
- must have a data logger and download this monthly
Eligibility for Public Funded Vaccines
• The Health and Disability Services Eligibility Direction 2011
has been gazetted and took effect 16 April 2011.
www.moh.govt.nz/eligibility. These changes clarify that
vaccinations on the Immunisation Schedule are publicly
funded for all children.
• ..a child is defined as a person who is under 18 years old.
• Children ineligible for other health services are eligible to
receive funded Schedule vaccines, and providers may claim
the immunisation benefit for these children.
• All children are also eligible for Well Child/Tamariki Ora
services, regardless of immigration and citizenship status.
See MOH GP Fax 5 Nov 2012
Vaccine funding
• PHARMAC now purchase vaccines on
behalf of the MoH
• Be mindful of the terms ‘fully funded’,
‘vaccine is funded’ and ‘recommended’
• When vaccines are recommended by a
doctor e.g. post chemotherapy, you can
apply to the DHB for funding on a case-bycase basis
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8 month Target commenced 2012
• 85 % of eight month olds will have their
primary course of immunisation (six weeks,
three months and five months immunisation events) on
time by July 2013
• 90 % by July 2014
• 95 % by December 2014.
• Precalls essential
Pertussis update 
2010 - 872 notified cases
2011 - 2015 notified cases
2012 - 5938 in 2012 including 2 deaths, 424 aged < 1 year old
2013 – Jan- 566 new cases notified…30 hospitalised
http://www.surv.esr.cri.nz/PDF_surveillance/PertussisRpt/2013/PertussisreportJanuary2013.pdf
Broad classification of vaccine types
Live attenuated
• Viral
• Measles
• Mumps
• Rubella
• Varicella
• Zoster
• Rotavirus
• Bacterial
• BCG
Killed/Inactivated
Sub unit and toxoid
• Killed refer to
bacterial
• wPertussis
• Inactivated refers
to viral
• Polio
• HepA
• Influenza
• Excreted toxin
• Tetanus
• Diphtheria
• aP toxin
• Selected antigens
• HepB
• Hib
• Pneumococcal
• aPertussis
• HPV
• Meningococcal
Images © Dow AgroSciences
LLC
Fetal safety - rules of thumb
• There is no evidence for risk and no
biologically plausible risk to a developing fetus
from vaccination of the mother using
– Sub unit vaccines
– Inactivated vaccines
– Whole-cell vaccines
• There are theoretical risks to the developing
fetus from vaccination of the mother using
live vaccines but no evidence for harm
• There are known risks from Smallpox vaccine
NZ Immunisation Handbook 2011 on
pertussis vaccination in pregnancy
- pg. 24-25
Tdap (Boostrix) vaccine
for pregnant women
• Now funded for pregnant women between 28 and
38 weeks gestation. Imms Benefit can be claimed
from 1st January 2013
• Supported by The NZ College of Midwives
• Must obtain informed consent and consider all
options- including not vaccinating, vaccinating
before, during and after pregnancy
• Main goal is to protect infants
How soon after Td can Tdap be given?
• NZ Immunisation Handbook 2006 stated 2 years6
• Canadian studies show no increase in adverse events for
those vaccinated 18-23 months after Td2-5
• The Immunisation Handbook 2011 states “when Tdap is
given to protect infants ……..from pertussis, a minimum
interval between doses does not apply” 1
• The ITF has just updated its advice to show that no
minimum interval is necessary at any age7,8
1. Ministry of Health. NZ Immunisation Handbook 2011. Available at: http://www.health.govt.nz/publication/immunisation-handbook-2011
2 Halperin SA et al. Pediatr Infect Dis J 2006; 25: 195-200. 3 ACIP. MMWR 2006: 55: RR17. 4 Talbot EA et al. Vaccine 2010; 28(50): 8001-07. 5
Canadian National Advisory Committee on Immunization (NACI). Interval between administration of vaccines against diphtheria, tetanus, and
pertussis. Can Comm Dis Rep 2005;31:16-19. Available at http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/05pdf/acs-dcc310809.pdf 6 Ministry of
Health. NZ Immunisation Handbook 2006. pg 141. Available at: http://www.health.govt.nz/publication/immunisation-handbook-2006
7 Cameron A. No need for two-year gap between Td and Tdap vaccines. NZ Doctor (7 December 2011). 7 NZ Ministry of Health. GP Fax. 19
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December 2011. Available at http://www.immune.org.nz/site_resources/GP_fax_-_19_December_2011.pdf
Influenza in pregnancy - risk to mother
• Excess hospital admissions in healthy
women
– Similar to non pregnant women with
comorbidities
• Excess hospital admissions in women with
co-morbidities
• Increases with gestation
• More vulnerable during pandemics
– 1918, 27% case fatality rate
– 1957, ½ deaths in young women were
pregnant
– 2009, 13% of all deaths from H1N1 were
pregnant
Mak TK, Mangtani P, Leese J, Watson JM, Pfeifer D. Influenza vaccination in pregnancy: current evidence and selected national policies.
The Lancet Infectious Diseases 2008;8(1):44-52.
Influenza in pregnancy - risks to fetus
1. Infection and fever
– Associated with congenital abnormalities
2. Associated with increased risk of
cancer
– Neoplasms of lymphatic and
haematopoietic tissue 1957 Asian
influenza
– Neuroblastomas
3. Increased risk of general
complications
Shiota K, Opitz JM. Neural tube defects and maternal hyperthermia in early pregnancy: Epidemiology in a human embryo population. American Journal of Medical Genetics 1982;12(3):281-8.
Griffiths PD, Ronalds CJ, Heath RB. A prospective study of influenza infections during pregnancy. Journal of Epidemiology and Community Health 1980 June 1, 1980;34(2):124-8.
Fedrick J, Alberman ED. Reported Influenza in Pregnancy and Subsequent Cancer in the Child. BMJ 1972 1972-05-27 00:00:00;2(5812):485-8.
Hakulinen T, Hovi L, Karkinen-Jääskeläinen M, Penttinen K, Saxen L. Association between Influenza during Pregnancy and Childhood Leukaemia. BMJ 1973 1973-11-03 00:00:00;4(5887):265-7.
Linos A, Kardara M, Kosmidis H, Katriou D, Hatzis C, Kontzoglou M, et al. Reported influenza in pregnancy and childhood tumour. European Journal of Epidemiology 1998 1998/07/01;14(5):4715.
Irving WL, James DK, Stephenson T, Laing P, Jameson C, Oxford JS, et al. Influenza virus infection in the second and third trimesters of pregnancy: a clinical and seroepidemiological study. BJOG:
An International Journal of Obstetrics & Gynaecology 2000;107(10):1282-9.
Protect yourself and your patients
• Annual influenza immunisation is strongly recommended for
all healthcare workers to protect vulnerable patients from the
threat of influenza illness.
• Many staff continue to work when sick, thereby exposing
influenza illness to patients and co- workers
• Annual influenza immunisation results in:
• improved patient safety
• improved employee safety and
• decreased healthcare expenditure
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Influenza vaccine and narcolepsy?
• 2010 -Association found in Finland, Sweden & UK - increased
risk narcolepsy with Pandemrix H1N1 vaccine in 4-19 yr age
group.
• China found increased narcolepsy associated with H1N1
pandemic.
• Usual onset narcolepsy during adolescence/ young adult
• Strong genetic link
• All those in Finland had this genotype.
• Narcolepsy also associated with URTIs incl strep infections
• Incr risk of narcolepsy not found with other other vaccines
including other H1N1 vaccines
See IMAC fact sheet- Association between Pandemrix and onset of narcolepsy -1/2/2013
Febrile convulsions
• In 2010 there was an increase in reports of fever and febrile
convulsions in children vaccinated with Fluvax®
• A large NZ study with over 4000 infants and children was
undertaken in 2010 and 2011. It showed the risk of fever and
febrile convulsions following Fluvax® was significantly greater
than for other seasonal flu vaccines
• The Ministry of Health recommends that children under 9
years should be vaccinated with FLUARIX®
• FLUVAX® should not be given to any children with a history
of febrile convulsions
Meningococcal Vaccines
• New Men B vaccine approved in Europe (by Euro Commision
from 2 months age) and expected in UK and US soon
(4CMenB/ Bexsero®)
– Recombinant proteins x 3 + OMP from MeNZB
– Adsorbed onto aluminium
• Recommendations re Meningococcal vaccines for hostel
dwellers (see IH 2011 pg 300)
http://www.immune.org.nz/news/new-meningococcal-b-vaccine-europe
New Resources – www.immune.org
New Resources – www.immune.org
ARPHS: www.arphs.govt.nz
ARPHS: www.arphs.govt.nz
CHOP – Vaccine Education Centre
The Panic Virus – Seth Mnookin
• "Seth Mnookin's "The Panic Virus" is a lesson how
fear hijacks reason and emotion trumps logic. . . . A
brilliant piece of reportage and science writing."
• --Michael Shermer, "The Wall Street Journal
Available at your local library
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