|Title:||Childhood Pneumococcal Vaccination Schedule 2003|
|Document ID:||Operational Circular OP 1734/04|
|Date of issue:||Thursday, 8 January 2004|
|Status:||NO LONGER APPLICABLE|
|Applicable to:||All health services|
|Period of effect:||from 1 January 2004 to 31 December 2004|
|Authorised by:||Dr Gary Dowse, Acting Director, Communicable Disease Control Directorate, 20-Dec-2003|
|Print version:||View print version|
Childhood Pneumococcal Vaccination Schedule 2003
NOTE: This Operational Circular is designed to advise Department of Health staff on Department of Health immunisation policies and procedures and may contain advice that does not apply to others.
In June 2001, the Australian Government introduced a national high-risk childhood pneumococcal vaccination program (Program) that provided funded (free) pneumococcal vaccines (7vPCV or Prevenar™, 23vPPV or Pneumovax™) for the immunisation of children at high-risk of invasive pneumococcal disease.
In September 2003, the Australian Government expanded the list of children at high-risk of invasive pneumococcal disease to include children less than 5 years of age who were born at less than 28 weeks gestation or who have chronic lung disease associated with prematurity, insulin-dependent diabetes mellitus, Down Syndrome, cystic fibrosis, a cochlear implant, or an intracranial shunt.
The following recommendations, based on recommendations in the NHMRC Australian Immunisation Handbook 8th Edition 2003 (http://immunise.health.gov.au/handbook.htm), pp146-150, are effective immediately.
GROUPS ELIGIBLE FOR FREE PNEUMOCOCCAL VACCINES
Group 1: Pneumococcal vaccination schedule for indigenous children from 2 months of age to 5 years of age living in the Ngaanyatjarra Region
Group 2: Pneumococcal vaccination schedule for:
Group 3: Pneumococcal vaccination schedule for children from 2 months of age to 5 years of age with a predisposing medical condition
Note: Indigenous children up to 59 months of age who also have predisposing medical condition should receive a Pneumovax™ dose ≧ 18 months (instead of ≧ 4 years) and at least 2 months after their last dose of Prevenar™.
For more information (e.g. "catch-up" pneumococcal vaccination schedules) see the NHMRC Australian Immunisation Handbook 8th Edition, 2003 (http://immunise.health.gov.au/handbook.htm), pp146-150.
Prevenar is a 7-valent pneumococcal conjugate vaccine. It is a sterile solution of saccharides of the capsular antigens of Streptococcus pneumoniae serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F individually conjugated to diphtheria CRM197 protein. The vaccine also contains aluminium phosphate as an adjuvant and forms an homogenous white suspension after shaking.
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 conjugate vaccine or vaccine component (e.g. diptheria toxoid) is a contraindication to this vaccine. Unlike the 23-valent pneumococcal polysaccharide vaccine, this vaccine is not recommended for use in adults.
Adverse events following vaccination
Local reactions, including pain, swelling, or erythema at the site of injection, are the most common adverse events (reported in 20-30% of vacinees). These reactions usually persist for less than 48 hours. Moderate systemic reactions (e.g. fever, irritability) are uncommon (< 5% of vaccinees), and more severe systemic adverse events are rare. As with other aluminium-containing vaccines, a nodule may be palpable at the injection site for several weeks.
Pneumovax™ is a 23-valent pneumococcal polysaccharide vaccine. It is a saline solution of saccharides of the capsular antigens of Streptococcus pneumoniae serotypes 1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19F, 19A, 20, 22F, 23F, 33F. The vaccine also contains phenol as a preservative.
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 polysaccharide vaccine or vaccine component is a contraindication to this vaccine. The safety of pneumococcal vaccine for pregnant women has not been demonstrated and, therefore, it should not be given to pregnant women unless the risk is warranted. Unlike the pneumococcal conjugate vaccine, this vaccine is not recommended for use in children less than 18 months of age. Patient's with Hodgkin's disease or who are being treated for Hodgkin's disease should not routinely be vaccinated with pneumococcal vaccine because their antibody response may be suppressed.
Adverse events following vaccination
Local reactions, including pain, swelling, or erythema at the site of injection, are the most common adverse events (reported in 70% of adult vacinees). These reactions usually persist for less than 48 hours. Moderate systemic reactions (e.g. fever) are uncommon (< 5% of vaccinees), and more severe systemic adverse events are rare. Rarely, patients with otherwise stabilised idiopathic thrombocytopenic purpura have experienced a relapse occuring 2-14 days after vaccination and lasting up to 2 weeks.
The addition of the pneumococcal vaccines to the childhood vaccination schedule means that some children will receive three vaccine injections at the same encounter. This can be achieved by giving two injections in the same thigh (separated by 25 mm or more), or by using the deltoid region for one of the injections (e.g. Hib-hepB) if there is sufficient muscle mass.
Dr Gary Dowse
This circular last updated: Thursday, 8 January 2004 at 12:00am