|Title:||Adult Influenza and Pneumococcal Immunisation Program Ė 2005|
|Document ID:||Operational Circular OP 1921/05|
|Date of issue:||Thursday, 24 February 2005|
|Status:||NO LONGER APPLICABLE|
|Description:||DoH guidelines for influenza and pneumococcal vaccination of hospital staff and patients.|
|Period of effect:||from 24 February 2005|
|Authorised by:||Dr Shirley Bowen, Director, Communicable Disease Control Directorate, 21-Feb-2005|
|Print version:||View print version|
Adult Influenza and Pneumococcal Immunisation Program Ė 2005
This Operational Circular is designed to advise Department of Health staff on Department of Health policies and procedures and may contain advice that is not appropriate in other circumstances.
Since 1998, the Australian Government has funded "free" influenza vaccine for persons 65 years of age or older. In addition, the Australian Government has funded "free" influenza and pneumococcal vaccines for the immunisation of indigenous persons 50 years of age or older and indigenous persons between 15 and 49 years of age with a predisposing medical condition (see Table 1). In 2005, the Australian Government has also funded "free" pneumococcal vaccine for persons 65 years of age or older.
High risk patients ineligible for free influenza or pneumococcal vaccines
High risk patients who are not eligible for free influenza or pneumococcal vaccine should be prescribed these vaccines via the Pharmaceutical Benefits Scheme or purchase these vaccines directly from their General Practitioner. To prevent heat damage to prescribed vaccines, patients should be advised how to transport and store the vaccines appropriately and to pick up their vaccines from the pharmacist immediately before their vaccination appointment.
The strains for the Australian influenza vaccine in 2005 are:
The strains for the Australian influenza vaccine in 2004 were:
Influenza vaccine efficacy varies according to the similarity of the vaccine strain to the circulating influenza strain, and the age and health of the vaccinee. Although the vaccine is about 30-40% effective in preventing clinical illness among the elderly, it is about 50-60% effective in preventing hospitalisation and about 80% effective in preventing death.
Persons with moderate to severe acute febrile illnesses should not be vaccinated until their symptoms have resolved. Persons with a severe allergic reaction to a previous dose of influenza vaccine, or to a vaccine component (e.g. eggs), should not receive influenza vaccine.
Adverse events following vaccination
Local reactions, including soreness, erythema, and induration at the site of injection, are the most common adverse events (reported in 15-20% of vaccinees). These events generally last 1 to 2 days. Non-specific systemic symptoms, including fever, chills, malaise and myalgia are reported in less than 1% of vaccine recipients. These symptoms usually occur within 6-12 hours and, presumably, in vaccinees with no previous exposure to the viruses in the vaccine. Rarely, immediate hypersensitivity reactions (such as hives, angioedema, allergic asthma, or systemic anaphylaxis) occur in persons with a history of severe egg allergy. Persons who have developed hives, or swelling of the lips or tongue, or who have experienced acute respiratory distress or collapse after eating eggs, or who have documented immunoglobulin E (IgE)-mediated hypersensitivity to eggs (including those who have had occupational asthma or other allergic responses from exposure to egg protein) may be at increased risk for allergic reactions from influenza vaccine and should be referred to an immunologist.
Guillain-Barre Syndrome (GBS) surveillance in the USA has suggested that some cases of GBS may be attributable to influenza vaccination (Lasky T, Terracciano G, Magder L, et al. The Guillain-Barre Syndrome and the 1992-1993 and 1993-1994 Influenza Vaccines. NEJM 1998; 339:25). The risk is approximately 1 case per 1 million vaccinees. The evidence is not conclusive, and should not deter routine influenza immunisation since the risk of death or hospitalisation from influenza is thousands of times greater than the risk of GBS.
The 23 valent polysaccharide vaccine (Pneumovax23TM) is about 60% effective in preventing invasive pneumococcal disease in immunocompetent persons.
Persons with moderate to severe acute febrile illness should not be vaccinated until their symptoms have resolved. A serious allergic reaction to a dose of pneumococcal vaccine or a vaccine component is a contraindication to further doses of the vaccine. The safety of pneumococcal vaccine for pregnant women has not been demonstrated and, therefore, it should not be given to healthy pregnant women.
Adverse events following vaccination
Local reactions, including pain, swelling, or erythema at the site of injection, are the most common adverse events (reported in 30-50% of vaccinees). These reactions usually persist for less than 48 hours. Moderate systemic reactions (such as fever and myalgias) are uncommon (<1% of vaccinees), and more severe systemic adverse events are rare. Adverse events following the second dose occur no more frequently than following the first dose.
Vaccine supplies are available from CSL (Phone: 9328 7322) in the metropolitan area and from Regional Pharmacies or other depots in rural areas.
AUTHORITY TO VACCINATE
Department of Health (DOH) nurses with a current DOH Certificate of Immunisation Competency may administer any of the vaccines listed in the current Australian Standard Vaccination Schedule (ASVS), including influenza and pneumococcal vaccines. DOH nurses may administer vaccines not included in the current ASVS under the authority of a Regional Population Health Physician or other registered medical practitioner. Non-DOH nurses may administer any vaccines under the authority of a registered medical practitioner.
HOSPITAL PATIENTS AND STAFF
Hospital staff should make arrangements to ensure that high risk patients (see Table 1) are either offered influenza and/or pneumococcal vaccination as in-patients or as out-patients, or that high risk patients are advised to obtain influenza and/or pneumococcal vaccination from their general practitioner. In addition, hospitals and Residential Care Facilities should have staff influenza vaccination programs to reduce the transmission of influenza between staff and patients (see Appendix 1). For more information about staff immunisation recommendations, see OP 1873/04 - Health Care Worker Immunisation Protocol.
REGIONAL INDIGENOUS INFLUENZA AND PNEUMOCOCCAL VACCINATION REPORTS
Influenza and pneumococcal vaccine coverage data for Population Health Regions for indigenous persons aged 15 to 49 years and 50 years or older must be provided to the Medical Coordinator, Communicable Disease Control Directorate, by the Regional Immunisation Coordinator for the Population Health Region before 1 November each year.
Dr Shirley Bowen
This circular last updated: Thursday, 24 February 2005 at 12:00am