With the influenza season fast approaching, it is time to consider who needs to be protected against influenza.
The composition of influenza vaccines for Australia this year is the same as last year, with the components being:
- A (H1N1): an A/California/7/2009 (H1N1) - like strain
- A (H3N2): an A/Perth/16/2009 (H3N2) - like strain
- B: a B/Brisbane/60/2008 - like strain
It is important to impress on patients the need to get the vaccine every year, because virus strains change frequently and immunological evidence indicates that immunity following vaccination does not provide long-term protection.
Recommended groups for immunisation
Under the National Immunisation Program (external site) (NIP) influenza vaccination is provided free for:
- older Australians (external site) (>65 years)
- Aboriginal and Torres Strait Islander people over 15 years of age (external site)
- pregnant women (external site)
- individuals aged 6 months and over with medical conditions that predispose them to severe influenza (external site) namely:
- cardiac disease
- chronic respiratory conditions
- chronic illnesses requiring regular medical follow-up or hospitalisation in the preceding year
- chronic neurological conditions
- people with impaired immunity
- children aged 6 months to 10 years receiving long-term aspirin therapy.
The WA paediatric influenza vaccination program
The WA Paediatric Influenza Vaccination Program will continue in 2012.
Children from 6 months up to their fifth birthday (not already eligible to receive influenza vaccine under the NIP) are eligible for State-procured influenza vaccine. The Communicable Disease Control Directorate strongly encourages providers to discuss the benefits and risks of influenza vaccination with parents of young children.
Please note that in 2012 Fluvax is not approved by the TGA for use in children under the age of 5 years and should only be used in children aged 5 to 9 years based on a careful consideration of the potential benefits and risks in the individual child. See further safety information (external site).
Vaccination for pregnant women
This year, greater emphasis is being given to protecting pregnant women against influenza. The Royal Australian and New Zealand College of Obstetricians and Gynecologists and the National Health and Medical Research Council has recommended that all women be offered influenza vaccination during pregnancy.
Experience with prior annual seasonal influenza epidemics and the pandemic in 2009 has clearly demonstrated that pregnant women are at increased risk of morbidity and mortality from influenza.
It is important that pregnant women are vaccinated against influenza because:
- influenza vaccination of pregnant women reduces maternal hospitalisations.
- influenza vaccination of pregnant women reduces illness in the newborn. Pregnant women who are vaccinated against influenza make antibodies which cross the placenta and help protect the baby for the first 6 months of life (when they are too young to receive the vaccine themselves).
Vaccinating new mothers reduces the risk of influenza virus transmission from her to the newborn after delivery.
The influenza vaccine is safe for pregnant women. The influenza vaccine is an inactivated vaccine so does not cross the placenta. There is no evidence of congenital defects or adverse effects on the foetus of women who are vaccinated against influenza in pregnancy.
Influenza vaccine can be given in any trimester of pregnancy.
The 2012 influenza campaign will be launched in late March and will be similar to last year’s campaign including the “Fluey” logo.
Communications material will be provided by the Department of Health and Ageing through a direct mail out to health professionals including general and specialist practitioners, key primary and tertiary care organisations and other immunisation providers.
Pneumococcal (23vPPV) Vaccine Update
The Therapeutic Goods Administration (TGA) has completed a review on the increase in adverse events notification following revaccination with pneumovax 23vPPV. The Australian Technical Advisory Group on Immunisation (ATAGI) has also reviewed the role of 23vPPV within the National Immunisation Program (NIP).
The TGA has determined that the adverse events were not due to a batch-related problem. It found the increased number of reports were likely due to known high rates of injection site reactions after a repeat dose of 23vPPV, increased rates of revaccination following the introduction of free 23vPPV through the NIP in 2005 and an increase in reporting following publicity of the batch recall.
ATAGI has concluded that the benefits of a first dose of 23vPPV outweigh the risks of severe adverse reactions. For second doses, the greatest benefit in comparison to risk appears to be for older adults with a higher risk of invasive pneumococcal disease (IPD), who are revaccinated with 23vPPV more than 5 years after their first dose.
The findings of both of these reviews have led to new recommendations relating to the revaccination of adults with 23vPPV. These are, that:
- adults aged 65 years and over are at higher risk of contracting pneumococcal disease than the rest of the population, with the majority of deaths from this disease occurring in this age group.
- a dose of 23vPPV should be given to adults at 65 years of age. Every effort should be made to provide a dose to anyone over 65 years old who has not previously received a dose of 23vPPV.
- a repeat dose (a single revaccination) of 23vPPV is no longer routinely recommended for this population group.
A repeat dose of 23vPPV is recommended only for those adults aged 65 years and over who have a condition that predisposes them to a higher risk of IPD than other adults in this cohort. This repeat dose is to be given 5 years or more after the first dose to smokers and those with the following predisposing conditions:
- asplenia, either functional (including sickle-cell disease) or anatomical
- conditions associated with increased risk of IPD due to impaired immunity
- chronic illness associated with increased risk of IPD
- CSF leak.