Adult Influenza and Pneumococcal Immunisation Program

This Operational Directive 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.

VACCINE RECOMMENDATIONS AND FUNDING

The Australian Government funds influenza and pneumococcal vaccine for defined at risk groups as outlined in table 1. 

Influenza vaccine is also recommended but unfunded for the following groups:

• Non-Indigenous people less than 65 years of age with chronic medical conditions that predispose them to complications of influenza.  These vaccines must be prescribed and are subsidised through the Pharmaceutical Benefits Scheme (PBS). 
• High risk children (≥6 months of age) with chronic cardiac conditions, chronic suppurative lung disease and chronic illnesses requiring regular hospitalisation and intervention.  Caregivers and household contacts of high risk children should also be vaccinated against influenza each year.  Two doses of influenza vaccine, at least one month apart, are recommended for children aged less than 9 years of age who are receiving influenza vaccine for the first time.  These vaccines must be prescribed and are subsidised through the Pharmaceutical Benefits Scheme (PBS). 
• Health care providers and staff of nursing homes and long term care facilities.  Check with your employer as organisations usually provide this free for health care workers. 

Pneumococcal vaccine (Pneumovax23®) is recommended but unfunded for non-Indigenous people less than 65 years of age with a predisposing medical condition.  These vaccines must be prescribed and are subsidised through the Pharmaceutical Benefits Scheme (PBS). 

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.

Influenza vaccine

Influenza vaccine contains two type A strains and one type B strain, representing the influenza viruses most likely to circulate each winter.  Product information leaflets should be consulted for each vaccine to determine its exact composition.  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.

There are two influenza vaccines available through the Commonwealth Government funded program for 2007.  These are:

CSL  - Fluvax®

Sanofi Pasteur - VAXIGRIP®

Pneumococcal vaccine

The only available pneumococcal 23 valent polysaccharide vaccine is Pneumovax23^TM. 

ORDERING VACCINES

Vaccine supplies are available from CSL in the metropolitan area and from Regional Pharmacies or other depots in rural areas.  Fax vaccine order forms to CSL on 9227 6196.  For vaccine order enquiries, phone CSL on 9328 7322.

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.

GUIDELINES

All information regarding administration of an immunisation program and the information regarding individual vaccines and the diseases they protect against can be found in the Australian Immunisation Handbook, 8th Edition, 2003 at www.immunise.health.gov.au (9th Edition 2007 will be released shortly). The National Vaccine Storage Guidelines - Strive for Five provides further information on storage of vaccines and can be found at

http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/provider-store

PATIENTS AND STAFF OF HOSPITALS AND RESIDENTIAL CARE FACILITIES

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 provide staff influenza vaccination programs to reduce the transmission of influenza between staff and patients.  For more information about staff immunisation recommendations, see OD0049/07 Health Care Worker Immunisation Protocol at http://intranet.health.wa.gov.au/circularsnew/pdfs/12275.pdf

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.

PATIENT INFLUENZA AND PNEUMOCOCAL IMMUNISATION PROGRAMS

• A number of strategies can be adopted within hospitals to ensure that as many high-risk patients as possible are vaccinated against influenza or pneumococcal disease:
• Patients hospitalised with influenza have a significant risk of readmission during subsequent influenza seasons.  High-risk patients should be vaccinated against influenza and pneumococcal disease, as appropriate, preferably before they are discharged from hospital.
• If it is not feasible to vaccinate high-risk patients before they are discharged from hospital, then they should be vaccinated during Outpatient or General Practitioner discharge follow-up appointments.  Vaccination recommendations should be included in the patient’s notes and discharge letters.
• High-risk patients should be routinely assessed in Outpatients for influenza and pneumococcal vaccination and either vaccinated on site or referred to their General Practitioner for vaccination.
• Hospitals that have the capacity to do so should write to the General Practitioners of previously admitted influenza high-risk patients each year reminding them to recall the identified patients for influenza and pneumococcal vaccination, as appropriate.

STAFF INFLUENZA IMMUNISATION PROGRAMS

Many hospitals and residential care facilities have established staff influenza vaccination programs to reduce nosocomial infections and staff sick leave.  Staff influenza vaccination programs are best managed by designated infection control and/or occupational health staff.  These programs require consistent administrative and collegiate support to maximise vaccine coverage.  The objectives of these programs include:

1.   Promoting staff influenza vaccination,
2.   Offering free influenza vaccination to staff, and
3.   Measuring the effectiveness and costs of the program

1. Promoting staff influenza vaccination

Successful staff influenza vaccination programs require routine promotion activities including emails, letters, pamphlets, posters, vaccination stickers, broadcasts and direct support from team leaders.  Some influenza vaccine companies routinely provide hospitals with staff influenza vaccination promotion materials.

2. Offering free influenza vaccination to staff

The most successful staff influenza vaccination programs include the provision of free vaccine and a free, convenient, vaccination service.  The most successful staff vaccination services usually utilise a mobile vaccination team visiting each ward or site, or an on-site staff vaccination clinic, to maximise convenience.  Some influenza vaccine companies subsidise the cost of influenza vaccine or vaccination services for staff vaccination programs.

3. Measuring the effectiveness and costs of the program

Influenza vaccination programs should be evaluated each year with data including staff vaccine coverage, staff sick leave and costs, and vaccine and vaccination costs.

4. Advice

Expert advice on implementing and evaluating staff vaccination programs is available from staff immunisation coordinators in WA hospitals or from vaccine consultants with the pharmaceutical companies providing the influenza vaccine.  Contact numbers are: Sanofi Pasteur 0404 467 807 and CSL 0422 000 322.

Dr Neale Fong
DIRECTOR GENERAL
DEPARTMENT OF HEALTH