Immunisation Update Changes to the immunisation schedule Contraindications

Immunisation Update

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

§ Three significant changes to the immunisation schedule in 2008: – New pneumococcal vaccine for infants – Me. NZB vaccine programme – HPV vaccine programme

New pneumococcal vaccine for infants § PCV 7 (Prevenar®) vaccine has been added § Effective in children < 2 years § Previous vaccine 23 PPV (Pneumovax 23) not effective in infants § Given at 6 weeks, 5 and 15 months § Children at high risk still have PCV 7 + 23 PPV

Me. NZB vaccine programme § in cases group B meningococcus § Me. NZB now removed from National immunisation schedule

Contraindications and precautions to vaccination

Vaccine Contraindications All Vaccines Anaphylactic 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, • Immunosuppressed individuals Rubella, MMR, Varicella, • If blood, plasma or immunoglobulin were Yellow Fever, Oral Polio given in the last 11 months • Pregnancy Influenza, Yellow Fever Anaphylactic reaction to chickens, including eggs, egg protein, feathers etc

Precautions There 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

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)

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)

Epidemic update § Pertussis § Measles

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

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