Download The Australian Immunisation Handbook 10th Edition 2013

NOTES
RECOGNITION AND TREATMENT OF ANAPHYLAXIS
CONTACT DETAILS FOR AUSTRALIAN, STATE AND TERRITORY GOVERNMENT
HEALTH AUTHORITIES
Signs of anaphylaxis
Anaphylaxis causes respiratory and/or cardiovascular signs or symptoms AND involves other organ systems, such as the skin or gastrointestinal
tract, with:
Australian Government health authorities
• signs of airway obstruction, such as cough, wheeze, hoarseness, stridor or signs of respiratory distress (e.g. tachypnoea, cyanosis,
rib recession)
• upper airway swelling (lip, tongue, throat, uvula or larynx)
• tachycardia, weak/absent carotid pulse
• hypotension that is sustained and with no improvement without specific treatment (Note: in infants and young children limpness and
pallor are signs of hypotension)
• loss of consciousness with no improvement once supine or in head-down position
• skin signs, such as pruritus (itchiness), generalised erythema (redness), urticaria (weals) or angioedema (localised or general swelling of
the deeper layers of the skin or subcutaneous tissue)
• abdominal cramps, diarrhoea, nausea and/or vomiting
• sense of severe anxiety and distress.
Australian Government
Department of Health and Ageing
www.health.gov.au
All information in this publication is
correct as at November 2012
<1 year (approx. 5–10 kg)
0.05–0.1 mL
7–10 years (approx. 30 kg)
0.3 mL
1–2 years (approx. 10 kg)
0.1 mL
10–12 years (approx. 40 kg)
0.4 mL
2–3 years (approx. 15 kg)
0.15 mL
>12 years and adult (over 50 kg)
0.5 mL
4–6 years (approx. 20 kg)
0.2 mL
For more detailed information, see 2.3.2 Adverse events following immunisation.
* Modified from The Brighton Collaboration Case Definition Criteria for Anaphylaxis, and an insert published in Australian Prescriber in August
2011 (available at www.australianprescriber.com/magazine/34/4/article/1210.pdf).
D0903 February 2013
Doses of 1:1000 (one in one thousand) adrenaline:
(to connect to your local Public Health Unit)
Northern Territory
08 8922 8044
Centre for Disease Control
Queensland
13 HEALTH (13 4325 84)
Contact your local Public Health Unit, details at
www.health.qld.gov.au/cdcg/contacts.asp
South Australia
1300 232 272 (8.30 am to 5.00 pm)
Email: [email protected]
O N
The following table lists the doses of 1:1000 adrenaline to be used if the exact weight of the person is not known (based on the person’s age).
1300 066 055
www.sahealth.sa.gov.au
Tasmania
03 6222 7666 or 1800 671 738
Victoria
1300 882 008
Email: [email protected]
www.health.vic.gov.au/immunisation
Western Australia
08 9388 4868
08 9328 0553 (after hours Infectious Diseases Emergency)
Email: [email protected]
i
The use of 1:1000 adrenaline is recommended because it is universally available. Adrenaline 1:1000 contains 1 mg of adrenaline per mL of
solution in a 1 mL glass vial. Use a 1 mL syringe to improve the accuracy of measurement when drawing up small doses.
10th Edition 2013
S A T
The recommended dose of 1:1000 adrenaline is 0.01 mL/kg body weight (equivalent to 0.01 mg/kg), up to a maximum of 0.5 mL or 0.5 mg,
given by deep intramuscular injection into the anterolateral thigh. Adrenaline 1:1000 must not be administered intravenously.
The Australian
Immunisation Handbook
02 6205 2300
Immunisation Enquiry Line
New South Wales
i
Adrenaline dosage
State and territory government health authorities
Australian Capital Territory
M M U N
Antihistamines and/or hydrocortisone are not recommended for the emergency management of anaphylaxis.
Freecall: 1800 671 811
www.immunise.health.gov.au
i
• If the patient is unconscious, lie him/her on the left side and position to keep the airway clear. If the patient is conscious, lie supine in
‘head-down and feet-up’ position (unless this results in breathing difficulties).
• Give adrenaline by intramuscular injection (see below for dosage) if there are any signs of anaphylaxis with respiratory and/or
cardiovascular symptoms or signs. Although adrenaline is not required for generalised non-anaphylactic reactions (such as skin rash
without other signs or symptoms), administration of intramuscular adrenaline is safe.
• Call for assistance. Never leave the patient alone.
• If oxygen is available, administer by facemask at a high flow rate.
• If there is no improvement in the patient’s condition within 5 minutes, repeat doses of adrenaline every 5 minutes, until
improvement occurs.
• Check breathing; if absent, commence basic life support or appropriate cardiopulmonary resuscitation (CPR) as per the Australian
Resuscitation Council guideline (www.resus.org.au/policy/guidelines).
• Transfer all cases to hospital for further observation and treatment.
• Complete full documentation of the event, including the time and dose(s) of adrenaline given.
Experienced practitioners may choose to use an oral airway, if the appropriate size is available, but its use is not routinely recommended,
unless the patient is unconscious.
The Australian Immunisation Handbook – 10th Edition 2013
Management of anaphylaxis
02 6289 1555
For changes introduced in the
10th edition of the Handbook,
see 1.4 What’s new
NOTES
RECOGNITION AND TREATMENT OF ANAPHYLAXIS
CONTACT DETAILS FOR AUSTRALIAN, STATE AND TERRITORY GOVERNMENT
HEALTH AUTHORITIES
Signs of anaphylaxis
Anaphylaxis causes respiratory and/or cardiovascular signs or symptoms AND involves other organ systems, such as the skin or gastrointestinal
tract, with:
Australian Government health authorities
• signs of airway obstruction, such as cough, wheeze, hoarseness, stridor or signs of respiratory distress (e.g. tachypnoea, cyanosis,
rib recession)
• upper airway swelling (lip, tongue, throat, uvula or larynx)
• tachycardia, weak/absent carotid pulse
• hypotension that is sustained and with no improvement without specific treatment (Note: in infants and young children limpness and
pallor are signs of hypotension)
• loss of consciousness with no improvement once supine or in head-down position
• skin signs, such as pruritus (itchiness), generalised erythema (redness), urticaria (weals) or angioedema (localised or general swelling of
the deeper layers of the skin or subcutaneous tissue)
• abdominal cramps, diarrhoea, nausea and/or vomiting
• sense of severe anxiety and distress.
Australian Government
Department of Health and Ageing
www.health.gov.au
All information in this publication is
correct as at November 2012
<1 year (approx. 5–10 kg)
0.05–0.1 mL
7–10 years (approx. 30 kg)
0.3 mL
1–2 years (approx. 10 kg)
0.1 mL
10–12 years (approx. 40 kg)
0.4 mL
2–3 years (approx. 15 kg)
0.15 mL
>12 years and adult (over 50 kg)
0.5 mL
4–6 years (approx. 20 kg)
0.2 mL
For more detailed information, see 2.3.2 Adverse events following immunisation.
* Modified from The Brighton Collaboration Case Definition Criteria for Anaphylaxis, and an insert published in Australian Prescriber in August
2011 (available at www.australianprescriber.com/magazine/34/4/article/1210.pdf).
D0903 February 2013
Doses of 1:1000 (one in one thousand) adrenaline:
(to connect to your local Public Health Unit)
Northern Territory
08 8922 8044
Centre for Disease Control
Queensland
13 HEALTH (13 4325 84)
Contact your local Public Health Unit, details at
www.health.qld.gov.au/cdcg/contacts.asp
South Australia
1300 232 272 (8.30 am to 5.00 pm)
Email: [email protected]
O N
The following table lists the doses of 1:1000 adrenaline to be used if the exact weight of the person is not known (based on the person’s age).
1300 066 055
www.sahealth.sa.gov.au
Tasmania
03 6222 7666 or 1800 671 738
Victoria
1300 882 008
Email: [email protected]
www.health.vic.gov.au/immunisation
Western Australia
08 9388 4868
08 9328 0553 (after hours Infectious Diseases Emergency)
Email: [email protected]
i
The use of 1:1000 adrenaline is recommended because it is universally available. Adrenaline 1:1000 contains 1 mg of adrenaline per mL of
solution in a 1 mL glass vial. Use a 1 mL syringe to improve the accuracy of measurement when drawing up small doses.
10th Edition 2013
S A T
The recommended dose of 1:1000 adrenaline is 0.01 mL/kg body weight (equivalent to 0.01 mg/kg), up to a maximum of 0.5 mL or 0.5 mg,
given by deep intramuscular injection into the anterolateral thigh. Adrenaline 1:1000 must not be administered intravenously.
The Australian
Immunisation Handbook
02 6205 2300
Immunisation Enquiry Line
New South Wales
i
Adrenaline dosage
State and territory government health authorities
Australian Capital Territory
M M U N
Antihistamines and/or hydrocortisone are not recommended for the emergency management of anaphylaxis.
Freecall: 1800 671 811
www.immunise.health.gov.au
i
• If the patient is unconscious, lie him/her on the left side and position to keep the airway clear. If the patient is conscious, lie supine in
‘head-down and feet-up’ position (unless this results in breathing difficulties).
• Give adrenaline by intramuscular injection (see below for dosage) if there are any signs of anaphylaxis with respiratory and/or
cardiovascular symptoms or signs. Although adrenaline is not required for generalised non-anaphylactic reactions (such as skin rash
without other signs or symptoms), administration of intramuscular adrenaline is safe.
• Call for assistance. Never leave the patient alone.
• If oxygen is available, administer by facemask at a high flow rate.
• If there is no improvement in the patient’s condition within 5 minutes, repeat doses of adrenaline every 5 minutes, until
improvement occurs.
• Check breathing; if absent, commence basic life support or appropriate cardiopulmonary resuscitation (CPR) as per the Australian
Resuscitation Council guideline (www.resus.org.au/policy/guidelines).
• Transfer all cases to hospital for further observation and treatment.
• Complete full documentation of the event, including the time and dose(s) of adrenaline given.
Experienced practitioners may choose to use an oral airway, if the appropriate size is available, but its use is not routinely recommended,
unless the patient is unconscious.
The Australian Immunisation Handbook – 10th Edition 2013
Management of anaphylaxis
02 6289 1555
For changes introduced in the
10th edition of the Handbook,
see 1.4 What’s new
• Localised pain, redness and
swelling at injection site
• Low-grade temperature (fever)
• Mild headache
• Mild nausea
Human papillomavirus vaccine (HPV)
• Localised pain, redness and
swelling at injection site
• Occasionally, an injection-site nodule; may
last many weeks; no treatment needed
• Low-grade temperature (fever)
In children, the following may also occur:
• Irritable, crying, unsettled and
generally unhappy
• Drowsiness or tiredness
Diphtheria-tetanus-pertussis (acellular)
DTPa-containing vaccines and dTpa
(reduced antigen) vaccines
• Drowsiness or tiredness
• Muscle aches
• Localised pain, redness and
swelling at injection site
• Occasionally, an injection-site nodule; may
last many weeks; no treatment needed
• Low-grade temperature (fever)
Influenza vaccine
• Localised pain, redness and
swelling at injection site
• Occasionally, an injection-site nodule; may
last many weeks; no treatment needed
• Low-grade temperature (fever)
Haemophilus influenzae type b vaccine (Hib)
• Occasionally, an injection-site nodule; may
last many weeks; no treatment needed
Seen 7–10 days after vaccination:
• Temperature (fever, can be >39.4˚C),
lasting 2–3 days, faint red rash (not
infectious), head cold and/or runny
nose, cough and/or puffy eyes
• Drowsiness or tiredness
• Swelling of salivary glands
Measles-mumps-rubella vaccine
(MMR, MMRV – see also varicella)
• Localised pain, redness and
swelling at injection site
• Low-grade temperature (fever)
Hepatitis A vaccine (HepA)
Varicella vaccine (VV)
• Irritable, crying, unsettled and
generally unhappy
• Loss of appetite
• Headache (usually observed
in adolescents/adults)
• Localised pain, redness and
swelling at injection site
• Occasionally, an injection-site nodule; may
last many weeks; no treatment needed
• Low-grade temperature (fever)
Meningococcal C conjugate vaccine (MenCCV)
• Localised pain, redness and swelling at
injection site
• Occasionally, an injection-site nodule; may
last many weeks; no treatment needed
• Low-grade temperature (fever)
Hepatitis B vaccine (HepB)
EFFECT OF DISEASE
Up to 1 in 7 patients die. The bacteria release a toxin, which can
produce nerve paralysis and heart failure.
At least 7 in 10 adult patients develop jaundice (yellowing of the skin and
eyes), fever, anorexia (decreased appetite), nausea, vomiting, hepatic
(liver) pain and malaise (tiredness).
About 1 in 4 chronic carriers will develop cirrhosis or liver cancer.
About 1 in 20 meningitis patients dies and about 1 in 4 survivors has
permanent brain or nerve damage. Epiglottitis is rapidly and invariably
fatal without treatment.
About 7 in 10 cervical cancers worldwide have been associated with
HPV-16 and 1 in 6 with HPV-18.
There are an estimated 3000 deaths in people older than 50 years of
age each year in Australia.
Causes increased hospitalisation in the very young (under 5 years of
age) and the elderly. Other high-risk groups include pregnant women,
people who are obese, diabetics and others with certain chronic
medical conditions.
About 1 in 15 children with measles develops pneumonia and 1 in
1000 develops encephalitis (brain inflammation). For every 10 children
who develop measles encephalitis, 1 dies and many have permanent
brain damage. About 1 in 100 000 develops SSPE (brain degeneration),
which is always fatal.
About 1 in 10 patients dies. Of those that survive, 1 to 2 in 10 have
permanent long-term problems, such as loss of limbs and brain
damage.
One in 5000 children develops encephalitis (brain inflammation).
One in 5 males (adolescent/adult) develop inflammation of the testes.
Occasionally, mumps causes infertility or permanent deafness.
About 1 in 125 babies under the age of 6 months with whooping
cough dies from pneumonia or brain damage.
About 3 in 10 people with meningitis die.
One-third of all pneumonia cases and up to half of pneumonia
hospitalisations in adults is caused by pneumococcal infection.
While many infections cause no symptoms, up to 3 in 10 patients
with paralytic polio die, and many patients who survive are
permanently paralysed.
Illness may range from mild diarrhoea to severe dehydrating diarrhoea
and fever, which can result in death.
Of children under 5 years of age, before vaccine introduction,
approximately 10 000 children were hospitalised, 115 000 needed
GP visits and 22 000 required an Emergency Department visit each
year in Australia.
Patients typically develop a rash, painful swollen glands and painful joints.
One in 3000 develops low platelet count (causing bruising or bleeding);
1 in 6000 develops encephalitis (brain inflammation).
Up to 9 in 10 babies infected during the first trimester of pregnancy
will have a major congenital abnormality (including deafness,
blindness or heart defects).
About 2 in 100 patients die. The risk is greatest for the very young or old.
One in 100 000 patients develops encephalitis (brain inflammation).
Infection during pregnancy can result in congenital malformations in
the baby. Infection in the mother around delivery time results in severe
infection in the newborn baby in up to one-third of cases.
DISEASE
Diphtheria – bacteria spread by respiratory droplets; causes
severe throat and breathing difficulties.
Hepatitis A – virus spread by contact or ingestion of faecally
contaminated water/food or through contact with the faecal
material of a person infected with hepatitis A.
Hepatitis B – virus spread mainly by blood, sexual contact
or from mother to newborn baby; causes acute hepatitis
(liver infection) or chronic infection (‘carrier’).
Hib – bacteria spread by respiratory droplets; causes
meningitis (infection of the tissues surrounding the brain),
epiglottitis (respiratory obstruction), septicaemia (infection
of the blood stream) and septic arthritis (infection in the
joints).
Human papillomavirus – virus spread mainly via sexual
contact; up to 80% of the population will be infected
with HPV at some time in their lives. Some HPV types are
associated with the development of cancer.
Influenza – virus spread by respiratory droplets; causes
fever, muscle and joint pains, pneumonia. About 1 in 10 to
1 in 5 persons will get influenza every year.
Measles – highly infectious virus spread by respiratory
droplets; causes fever, cough and rash.
Meningococcal infection – bacteria spread by respiratory
droplets; causes septicaemia (infection of the blood stream)
and meningitis (infection of the tissues surrounding the
brain).
Mumps – virus spread by saliva; causes swollen neck and
salivary glands, and fever.
Pertussis – bacteria spread by respiratory droplets; causes
‘whooping cough’, with prolonged cough lasting up to 3
months.
Pneumococcal infection – bacteria spread by respiratory
droplets; causes septicaemia (infection of the blood stream),
meningitis (infection of the tissues surrounding the brain)
and occasionally other infections.
Polio – virus spread in faeces and saliva; causes fever,
headache and vomiting and may progress to paralysis.
Rotavirus – virus spread by faecal–oral route; causes
gastroenteritis, which can be severe.
Rubella – virus spread by respiratory droplets; causes fever,
rash and swollen glands, but causes severe malformations in
babies of infected pregnant women.
Tetanus – caused by toxin of bacteria in soil; causes painful
muscle spasms, convulsions, lockjaw.
Varicella (chickenpox) – highly contagious virus; causes
low-grade fever and vesicular rash (fluid-filled spots).
Reactivation of the virus later in life causes herpes zoster
(shingles).
About 1 in 5 has a local reaction or fever. About 3 to 5 in 100 may develop
a mild varicella-like rash. Serious adverse events are very rare.
About 1 in 10 has local swelling, redness or pain at the injection site, or
fever (DTPa/dTpa vaccine). Booster doses of DTPa may occasionally be
associated with extensive swelling of the limb, but this resolves completely
within a few days. Serious adverse events are very rare.
About 1 in 10 has local swelling, redness or pain at the injection site.
About 1 in 20 has swollen glands, stiff neck or joint pains. About 1 in
20 has a rash, which is non-infectious.
Low platelet count (causing bruising or bleeding) occurs
after the1st dose of MMR vaccine, at a rate of about 1 in 20 000 to 30 000.
Serious adverse events are very rare.
Up to 3 in 100 may develop diarrhoea or vomiting in the week after
receiving the vaccine.
About 1 in 17 000 babies may develop intussusception in the
first few weeks after the 1st or 2nd vaccine doses.
Serious adverse events are very rare.
Local redness, pain and swelling at the injection site are common. Up to
1 in 10 has fever, crying and decreased appetite. Serious adverse events
are very rare.
About 1 in 5 has local swelling, redness or pain at the injection site, or
fever (conjugate vaccine).
Up to 1 in 2 has local swelling, redness or pain at the injection
site (polysaccharide vaccine).
Serious adverse events are very rare.
About 1 in 10 has local swelling, redness or pain at the injection site, or
fever (DTPa/dTpa vaccine). Booster doses of DTPa may occasionally be
associated with extensive swelling of the limb, but this resolves
completely within a few days. Serious adverse events are very rare.
About 1 in 100 may develop swelling of the salivary glands. Serious
adverse events are very rare.
About 1 in 10 has local swelling, redness or pain at the
injection site, fever, irritability, loss of appetite or headaches (conjugate
vaccines).
About 1 in 2 has a local reaction (polysaccharide vaccine).
Serious adverse events are very rare.
About 1 in 10 has local swelling, redness or pain at the
injection site, or fever. About 1 in 20 develops a rash, which is noninfectious.
Low platelet count (causing bruising or bleeding) occurs after the 1st dose
of MMR vaccine at a rate of about 1 in 20 000 to 30 000. Serious adverse
events are very rare.
About 1 in 10 has local swelling, redness or pain at the injection site.
Fever occurs in about 1 in 10 children aged 6 months to 3 years.
Guillain-Barré syndrome occurs in about 1 in 1 million. Serious adverse
events are very rare.
About 8 in 10 will have pain and 2 in 10 will have local swelling,
redness or pain at the injection site. Headache, fever, muscle aches and
tiredness may occur in up to 3 in 10 people. Serious adverse events are
very rare.
About 1 in 20 has local swelling, redness or pain at the injection site.
About 1 in 50 has fever. Serious adverse events are very rare.
About 1 in 20 will have local swelling, redness or pain at the injection site
and 2 in 100 will have fever. Anaphylaxis occurs in about 1 in 1 million.
Serious adverse events are very rare.
About 1 in 5 will have local swelling, redness or pain at the injection
site. Serious adverse events are very rare.
About 1 in 10 has local swelling, redness or pain at the injection site, or
fever (DTPa/dTpa vaccine). Booster doses of DTPa may occasionally be
associated with extensive swelling of the limb, but this resolves
completely within a few days. Serious adverse events are very rare.
SIDE EFFECT OF VACCINE
INFORMATION SHEET – COMPARISON OF THE EFFECTS OF DISEASES AND THE SIDE EFFECTS OF NIP VACCINES
From The Australian Immunisation Handbook 10th Edition (see Handbook contents for more details)
INFORMATION SHEET – ADVERSE EVENTS FOLLOWING IMMUNISATION
Side effects following immunisation for vaccines used in the National Immunisation Program (NIP) schedule
Common adverse events following immunisation are usually mild and temporary (occurring in the first few days after vaccination, unless otherwise stated). Specific treatment is not usually required (see below).
If the adverse event following immunisation is unexpected, persistent and/or severe, or if you are worried about your or your child’s condition, see your doctor or immunisation nurse as soon as possible, or go
directly to a hospital. Adverse events that occur following immunisation may be reported to the Therapeutic Goods Administration (TGA) (www.tga.gov.au) or to the Adverse Medicines Events line on 1300 134 237,
or discuss with your immunisation provider as to how reports are submitted in your state or territory.
Inactivated poliomyelitis vaccine
(IPV) and IPV-containing vaccines
Rotavirus vaccine
Pneumococcal vaccines (conjugate
13vPCV and polysaccharide 23vPPV)
• Muscle aches
• Localised pain, redness and
swelling at injection site
• Occasionally, an injection-site nodule; may
last many weeks; no treatment needed
• Low-grade temperature (fever)
• Vomiting and diarrhoea can occur up
to 7 days following vaccination
• Localised pain, redness and
swelling at injection site
• Occasionally, an injection-site nodule; may
last many weeks; no treatment needed
• Low-grade temperature (fever)
• Localised pain, redness and
swelling at injection site
• Occasionally, an injection-site nodule; may
last many weeks; no treatment needed
• Temperature (fever, can be >39˚C)
Seen 5–26 days after vaccination:
• Pustular rash (2–5 lesions), usually at
injection site, occasionally elsewhere
Key to table
meningococcal C conjugate vaccine
measles-mumps-rubella vaccine
measles-mumps-rubella-varicella vaccine
pneumococcal conjugate vaccine (13 serotypes)
pneumococcal polysaccharide vaccine (23 serotypes)
rotavirus vaccine
varicella vaccine
Concerns
MenCCV
MMR
MMRV
13vPCV
23vPPV
Rotavirus
VV
Managing fever after immunisation
diphtheria-tetanus-pertussis acellular (infant/child formulation)
diphtheria-tetanus-pertussis acellular (reduced antigen content formulation)
hepatitis A vaccine
hepatitis B vaccine
Haemophilus influenzae type b vaccine
human papillomavirus vaccine
influenza or flu vaccine
inactivated poliomyelitis vaccine
How to manage injection site discomfort
If you are worried about yourself or your child’s condition after
a vaccination, see your doctor or immunisation nurse as soon as
possible, or go directly to a hospital. It is also important to seek
medical advice if you or your child are unwell, as this may be
due to other illness rather than because of the vaccination.
DTPa
dTpa
HepA
HepB
Hib
HPV
Influenza
IPV
Many vaccine injections may result in soreness, redness,
itching, swelling or burning at the injection site for 1 to 2 days.
Paracetamol might be required to ease the discomfort.
Sometimes a small, hard lump (nodule) at the injection
site may persist for some weeks or months. This should
not be of concern and requires no treatment.
Give extra fluids to drink. Do not overdress the baby if hot.
Although routine use of paracetamol after vaccination is
not recommended, if fever is present, paracetamol can be
given. The dose of paracetamol for a child up to 12 years of
age is 15 mg/kg/dose, every 4 to 6 hours, up to four times a
day. Adults and children aged ≥12 years can receive 500 to
1000 mg every 4 to 6 hours. Paracetamol should not be given
for more than 48 hours without seeking medical advice.
i
Immunisation
Handbook
th Edition 2013
S A T
th
i
10
M M U N
The Australian
i
O N
Copyright
The Australian Immunisation Handbook 10th edition 2013
ISBN: 978-1-74241-861-2
Online ISBN: 978-1-74241-862-9
Publications approval number: D0903
Copyright statements:
Paper-based publications
© Commonwealth of Australia 2013
This work is copyright. You may reproduce the whole or part of this work in unaltered form
for your own personal use or, if you are part of an organisation, for internal use within your
organisation, but only if you or your organisation do not use the reproduction for any commercial
purpose and retain this copyright notice and all disclaimer notices as part of that reproduction.
Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright
notice, all other rights are reserved and you are not allowed to reproduce the whole or any part
of this work in any way (electronic or otherwise) without first being given the specific written
permission from the Commonwealth to do so. Requests and inquiries concerning reproduction
and rights are to be sent to the Online, Services and External Relations Branch, Department of
Health and Ageing, GPO Box 9848, Canberra ACT 2601, or via e-mail to [email protected].
Internet sites
© Commonwealth of Australia 2013
This work is copyright. You may download, display, print and reproduce the whole or
part of this work in unaltered form for your own personal use or, if you are part of an
organisation, for internal use within your organisation, but only if you or your organisation
do not use the reproduction for any commercial purpose and retain this copyright notice
and all disclaimer notices as part of that reproduction. Apart from rights to use as permitted
by the Copyright Act 1968 or allowed by this copyright notice, all other rights are reserved
and you are not allowed to reproduce the whole or any part of this work in any way
(electronic or otherwise) without first being given the specific written permission from the
Commonwealth to do so. Requests and inquiries concerning reproduction and rights are
to be sent to the Online, Services and External Relations Branch, Department of Health and
Ageing, GPO Box 9848, Canberra ACT 2601, or via e-mail to [email protected].
These guidelines were approved by the Chief Executive Officer of the National Health and
Medical Research Council (NHMRC) on 25/01/2013, under Section 14A of the National Health and
Medical Research Council Act 1992. In approving these guidelines the NHMRC considers that they
meet the NHMRC standard for clinical practice guidelines. This approval is valid for a period of
five years.
NHMRC is satisfied that they are based on the systematic identification and synthesis of the
best available scientific evidence and make clear recommendations for health professionals
practising in an Australian health care setting. The NHMRC expects that all guidelines will be
reviewed no less than once every five years.
This publication reflects the views of the authors and not necessarily the views of the
Australian Government.
ii The Australian Immunisation Handbook 10th edition
FOREWORD
Since 1932, when Government vaccination began for Australian children, illness
and death from vaccine-preventable diseases have fallen greatly. Australia still has
one of the world’s most comprehensive publicly funded immunisation programs.
As a result, tetanus, diphtheria, Haemophilus influenzae type b, poliomyelitis,
congenital rubella and newly acquired hepatitis B are no longer seen or are
extremely rare.
Immunisation is still the safest and most effective way to protect Australians from
vaccine-preventable disease. The Government is working towards increasing child
immunisation rates over time by giving parents stronger incentives to have their
children fully immunised.
The Australian Immunisation Handbook, approved by the National Health and
Medical Research Council (NHMRC), includes clinical information for Australian
immunisation providers on the safest and most effective use of vaccines, new
vaccines and vaccine-preventable diseases in Australia. It is also a valuable tool to
help immunisation providers explain the benefits of immunisation to their patients.
I’m confident that with your ongoing commitment, immunisation coverage rates
will keep on improving. We need immunisation providers to take every available
opportunity to appropriately vaccinate children and adults. We also need herd
immunity to keep on growing, so that the risk of exposure to vaccine-preventable
diseases such as pertussis and measles is minimised as far as possible.
This Handbook includes information on changes to the National Immunisation
Program. This includes, for example, the recent extension of the
Human Papillomavirus (HPV) Vaccination Program to include males aged
12–13 years. Already the HPV vaccine has had an impact, significantly reducing the
number of lesions that lead to cervical cancer amongst women in the vaccinated
age group. Providing the HPV vaccine to boys will protect them and increase the
effectiveness of the vaccination program for girls.
By building on Australia’s world-class immunisation program, we are stopping
vaccine-preventable diseases and that makes a difference to the quality of life for
Australian families.
Finally, I would like to thank the Chair, Professor Terry Nolan, and members
of the Australian Technical Advisory Group on Immunisation, its working
parties, technical writers and advisors for their work in producing this excellent
resource. It will be a great help to everyone involved in supporting and delivering
immunisation services in Australia.
The Hon Tanya Plibersek MP
Minister for Health
iii
iv The Australian Immunisation Handbook 10th edition
TABLE OF CONTENTS
PART 1 INTRODUCTION TO THE AUSTRALIAN IMMUNISATION HANDBOOK1
1.1Background
1
1.2
Development of the 10th edition of the Handbook3
1.3
How to use the 10th edition Handbook5
1.4 What’s new
1.5
Fundamentals of immunisation
PART 2 VACCINATION PROCEDURES
7
18
24
2.1Pre-vaccination
24
2.2
65
Administration of vaccines
2.3Post-vaccination
85
PART 3 VACCINATION FOR SPECIAL RISK GROUPS
104
3.1
Vaccination for Aboriginal and Torres Strait Islander people
104
3.2
Vaccination for international travel
113
3.3
Groups with special vaccination requirements
130
PART 4 VACCINE-PREVENTABLE DISEASES
176
4.1Cholera
176
4.2Diphtheria
182
4.3
Haemophilus influenzae type b
191
4.4
Hepatitis A
198
4.5
Hepatitis B
208
4.6
Human papillomavirus
231
4.7Influenza
243
4.8
259
Japanese encephalitis
4.9Measles
267
4.10
283
Meningococcal disease
4.11Mumps
295
4.12Pertussis
302
4.13
317
Pneumococcal disease
4.14Poliomyelitis
338
4.15
Q fever
345
4.16
Rabies and other lyssaviruses (including Australian bat lyssavirus)
353
v
4.17Rotavirus
372
4.18Rubella
384
4.19Tetanus
397
4.20Tuberculosis
408
4.21Typhoid
416
4.22Varicella
423
4.23
Yellow fever
439
4.24
Zoster (herpes zoster)
446
PART 5 PASSIVE IMMUNISATION
456
5.1
456
Passive immunisation using immunoglobulin preparations
APPENDICES465
APPENDIX 1: Contact details for Australian, state and territory government
health authorities and communicable disease control
465
APPENDIX 2: Literature search strategy for the 10th edition of the Handbook467
APPENDIX 3: Components of vaccines used in the National
Immunisation Program
469
APPENDIX 4: Commonly asked questions about vaccination
473
A.4.1 General questions
473
A4.2 Questions about contraindications and precautions
477
A4.3 Questions about vaccine safety
481
A4.4 Questions about vaccine content
484
A4.5 Questions about the need for immunisation
487
A4.6 Further information about vaccination
488
APPENDIX 5: Glossary of technical terms
489
APPENDIX 6: Commonly used abbreviations
495
APPENDIX 7: Overview of vaccine availability in Australia
498
INDEX500
vi The Australian Immunisation Handbook 10th edition
LIST OF TABLES
Table 2.1.1: Pre-vaccination screening checklist
30
Table 2.1.2:Responses to relevant conditions or circumstances identified
through the pre-vaccination screening checklist
31
Table 2.1.3: Live attenuated parenteral and oral vaccines
37
Table 2.1.4: False contraindications to vaccination
38
Table 2.1.5:Minimum acceptable age for the 1st dose of scheduled vaccines
in infants in special circumstances
46
Table 2.1.6: Number of vaccine doses that should have been administered
by the current age of the child
49
Table 2.1.7: Minimum acceptable dose intervals for children <10 years of age 50
Table 2.1.8: Catch-up schedule for Haemophilus influenzae type b (Hib)
vaccination for children <5 years of age
54
Table 2.1.9: Catch-up schedule for 13vPCV (Prevenar 13) for non-Indigenous
children, and Indigenous children residing in the Australian
Capital Territory, New South Wales, Tasmania and Victoria,
who do not have any medical condition(s) associated with an
increased risk of invasive pneumococcal disease (IPD), aged
<5 years
56
Table 2.1.10: Catch-up schedule for 13vPCV (Prevenar 13) for Indigenous
children residing in the Northern Territory, Queensland,
South Australia or Western Australia ONLY, who do not have
any medical condition(s) associated with an increased risk of
invasive pneumococcal disease (IPD), aged <5 years
57
Table 2.1.11: Catch-up schedule for 13vPCV (Prevenar 13) and 23vPPV
(Pneumovax 23) in children with a medical condition(s)
associated with an increased risk of invasive pneumococcal
disease (IPD), presenting at age <2 years
59
Table 2.1.12: Catch-up schedule for persons ≥10 years of age (for vaccines
recommended on a population level)
63
Table 2.2.1: Route of administration for vaccines used in Australia
68
Table 2.2.2: Recommended needle size, length and angle for administering
vaccines72
Table 2.3.1: Clinical features that may assist differentiation between a
vasovagal episode and anaphylaxis
88
Table 2.3.2: Doses of intramuscular 1:1000 (one in one thousand) adrenaline
for anaphylaxis
90
Table 2.3.3: Contact information for notification of adverse events following
immunisation96
vii
Table 3.1.1: Additional vaccines recommended for Indigenous persons,
due to their higher risk of disease
105
Table 3.2.1: Dose and routes of administration of commonly used vaccines
in adult travellers
123
Table 3.2.2: Recommended lower age limits of travel vaccines for children
127
Table 3.3.1: Recommendations for vaccination in pregnancy
135
Table 3.3.2: Recommendations for vaccinations for solid organ transplant
(SOT) recipients
151
Table 3.3.3: Recommendations for revaccination following haematopoietic
stem cell transplant (HSCT) in children and adults, irrespective
of previous immunisation history
156
Table 3.3.4: Categories of immunocompromise in HIV-infected persons, based
on age-specific CD4+ counts and percentage of total lymphocytes 158
Table 3.3.5: Recommendations for vaccination in persons with functional or
anatomical asplenia
163
Table 3.3.6: Recommended intervals between either immunoglobulins or
blood products and measles-mumps-rubella (MMR), measlesmumps-rubella-varicella (MMRV) or varicella vaccination
167
Table 3.3.7: Recommended vaccinations for persons at increased risk of
certain occupationally acquired vaccine-preventable diseases
170
Table 4.4.1: Recommended doses and schedules for use of inactivated
hepatitis A and hepatitis A combination vaccines
202
Table 4.5.1: Recommended schedules for use of monovalent hepatitis B and
hepatitis B combination vaccines
214
Table 4.5.2: Accelerated hepatitis B vaccination schedules (for persons
with imminent risk of exposure)
216
Table 4.5.3: Post-exposure prophylaxis for non-immune persons exposed
to a HBsAg-positive source
229
Table 4.7.1: Recommended doses of influenza vaccine
251
Table 4.9.1: Recommendations for measles vaccination with (a) measlesmumps-rubella (MMR) (currently available), and (b) once
measles-mumps-rubella-varicella (MMRV) vaccines are available
from July 2013
273
Table 4.9.2: Post-exposure prophylaxis ≤72 hours since exposed to measles
for non-immune individuals (adapted from Measles: national
guidelines for public health units)281
Table 4.13.1: Recommendations for pneumococcal vaccination for children
aged <5 years
viii The Australian Immunisation Handbook 10th edition
325
List 4.13.1: Conditions associated with an increased risk of invasive
pneumococcal disease (IPD) in children and adults, by severity
of risk
326
Table 4.13.2:Recommendations for pneumococcal vaccination for children
aged 2–5 years with a medical condition(s) associated with an
increased risk of invasive pneumococcal disease (IPD)
328
Table 4.13.3:Recommendations for pneumococcal vaccination using 23vPPV
for adults who do not have a condition(s) associated with an
increased risk of invasive pneumococcal disease (IPD)
332
Table 4.15.1: Interpretation and action for serological and skin test results
(with modifications from A guide to Q fever and Q fever vaccination
(CSL Biotherapies, 2009))
350
Table 4.16.1: Lyssavirus exposure categories
360
Table 4.16.2: Post-exposure prophylaxis commenced overseas and
recommended completion in Australia
365
Table 4.17.1: Upper age limits for dosing of oral rotavirus vaccines
378
Table 4.19.1: Guide to tetanus prophylaxis in wound management
404
Table 4.22.1: Recommendations for varicella vaccination with (a) monovalent
varicella vaccine (VV) (currently available), and (b) once measlesmumps-rubella-varicella (MMRV) vaccines are available from
July 2013
428
Table 4.22.2: Zoster immunoglobulin-VF (ZIG) dose based on weight
436
Table A2.1: Electronic databases searched for the 10th edition
467
Table A3.1: Components of vaccines used in the National
Immunisation Program
469
Table A7.1:Key dates when vaccines first came into widespread
use in Australia
498
ix
LIST OF FIGURES
Figure 2.1.1: Catch-up worksheet for children <10 years of age for NIP
vaccines45
Figure 2.2.1: Positioning a child <12 months of age in the cuddle position
75
Figure 2.2.2: Positioning an infant on an examination table for vaccination
76
Figure 2.2.3: Positioning an older child in the cuddle position
77
Figure 2.2.4: Positioning a child in the straddle position
78
Figure 2.2.5: Anatomical markers used to identify the vastus lateralis
injection site (X) on the anterolateral thigh
79
Figure 2.2.6: The vastus lateralis injection site (X) on the anterolateral thigh
80
Figure 2.2.7: Anatomical markers used to identify the ventrogluteal
injection site (X)
81
Figure 2.2.8: Anatomical markers used to identify the deltoid injection site
82
Figure 2.2.9: A subcutaneous injection into the deltoid area of the upper
arm using a 25 gauge, 16 mm needle, inserted at a 45° angle
82
Figure 2.2.10: Recommended technique for giving multiple vaccine injections
into the anterolateral thigh in an infant <12 months of age
83
Figure 4.7.1:Influenza notification rates 2006–2007 and hospitalisation
rates 2005–2007, Australia, by age group
245
Figure 4.15.1:Q fever notifications for Australia, New South Wales and
Queensland, 1991 to 2009
346
Figure 4.16.1:Post-exposure prophylaxis algorithm for potential exposure
to classical rabies virus from a terrestrial animal overseas
366
Figure 4.16.2:Post-exposure prophylaxis algorithm for potential exposure
to lyssaviruses from bats in Australia or overseas
367
Figure 4.16.3: Booster algorithm for persons at ongoing risk of exposure
to either rabies or other lyssaviruses, including Australian
bat lyssavirus (ABLV)
369
Figure 4.17.1: Rotavirus-coded hospitalisations per month, Australia,
2001 to 2010
373
x The Australian Immunisation Handbook 10th edition
PREFACE
The 10th edition of The Australian Immunisation Handbook was prepared by
the Australian Technical Advisory Group on Immunisation of the Australian
Government Department of Health and Ageing.
Members of the Australian Technical Advisory Group on
Immunisation
Chair
Professor Terry Nolan, Paediatrician; Epidemiologist and Head, School of
Population Health, The University of Melbourne, Victoria
Deputy Chair
Associate Professor Peter Richmond, School of Paediatrics and Child Health,
The University of Western Australia; General Paediatrician and Paediatric
Immunologist, Princess Margaret Hospital for Children, Western Australia
Voting and ex-officio members
Associate Professor Ross Andrews, Menzies School of Health Research,
Northern Territory
Associate Professor Christopher Blyth, School of Paediatrics and Child Health,
Faculty of Medicine, Dentistry and Health Sciences, The University of Western
Australia, Princess Margaret Hospital, Western Australia (member from July 2012)
Ms Sue Campbell-Lloyd, Manager, Immunisation Unit, AIDS/Infectious Diseases
Branch, NSW Health, New South Wales (member until June 2012)
Dr Grahame Dickson, Medical Officer, Drug Safety and Evaluation Branch,
Therapeutic Goods Administration, Australian Government Department of
Health and Ageing, Australian Capital Territory (member until August 2012)
Dr Nicole Gilroy, Infectious Diseases consultant, St Vincent’s Hospital, Sydney;
Blood Marrow Transplant (BMT) Network, New South Wales
Ms Madeline Hall, Public Health Nurse, Queensland Health, Queensland
(member from July 2012)
Clinical Professor David Isaacs, Senior Staff Specialist, Department of Infectious
Diseases and Microbiology, The Children’s Hospital at Westmead and Paediatric
Infectious Diseases, The University of Sydney, New South Wales
Dr Rosemary Lester, Chief Health Officer, Department of Health, Victoria
(member until December 2011)
xi
Dr Ting Lu, Medical Officer, Office of Medicines Authorisation, Market
Authorisation Group, Therapeutic Goods Administration, Australian
Government Department of Health and Ageing, Australian Capital Territory
(member from September 2012)
Professor Peter McIntyre, Professor of Paediatrics and Preventive Medicine,
The University of Sydney; Director, National Centre for Immunisation Research
and Surveillance of Vaccine Preventable Diseases, The Children’s Hospital at
Westmead, New South Wales
Associate Professor Jodie McVernon, School of Population Health, The University
of Melbourne, Victoria (member from January 2012)
Dr Joanne Molloy, General Practitioner, GP Association of Geelong, Victoria
Ms Stephanie Newell, Consumer representative (member until June 2012)
Associate Professor Michael Nissen, Director of Infectious Diseases and
Clinical Microbiologist, Unit Head of Queensland Paediatric Infectious Disease
Laboratory; Associate Professor in Biomolecular, Biomedical Science and Health,
Royal Children’s Hospital, Queensland (member until June 2012)
Dr Rod Pearce, General Practitioner, Medical Officer of Health, Eastern Health
Authority, Adelaide; GP Immunisation Advisor, Adelaide Central and Eastern
Division of General Practice, South Australia (member until June 2012)
Ms Karen Peterson, Immunisation Manager, Queensland Health, Queensland
(member from July 2012)
Ms Debra Petrys, Consumer representative (member from July 2012)
Ms Helen Pitcher, Public Health Nurse, Department of Human Services, Victoria
(member until June 2012)
Ms Julianne Quaine, Assistant Secretary, Health Protection Programs Branch,
Office of Health Protection, Australian Government Department of Health and
Ageing, Australian Capital Territory
Dr Greg Rowles, General Practitioner, Riddells Creek, Victoria (member from
July 2012)
Dr Christine Selvey, Communicable Diseases Network Australia, Queensland
Health, Queensland (member from January 2012)
Professor Steven Wesselingh, Executive Director, South Australian Health and
Medical Research Institute, South Australia (member from July 2012)
Secretary
Ms Monica Johns, Director, Immunisation Policy Section, Immunisation Branch,
Office of Health Protection, Australian Government Department of Health and
Ageing, Australian Capital Territory
xii The Australian Immunisation Handbook 10th edition
Secretariat support, Australian Technical Advisory Group on
Immunisation
Ms Sandy Anderson; Ms Jessica Hutchison
Senior technical editor
Associate Professor Kristine Macartney, Deputy Director Government Programs,
National Centre for Immunisation Research and Surveillance of Vaccine
Preventable Diseases, The Children’s Hospital at Westmead; Discipline of
Paediatrics and Child Health, The University of Sydney
Technical editor
Dr Jane Jelfs, Manager Policy Support, National Centre for Immunisation
Research and Surveillance of Vaccine Preventable Diseases
Assistant technical editor
Dr Melina Georgousakis, Research Officer, National Centre for Immunisation
Research and Surveillance of Vaccine Preventable Diseases
Senior technical writer
Dr Clayton Chiu, Public Health Physician, National Centre for Immunisation
Research and Surveillance of Vaccine Preventable Diseases
Technical writers
Mr Brett Archer; Ms Kathryn Cannings; Dr Bradley Christian; Dr Nigel
Crawford; Dr Aditi Dey; Dr Anita Heywood; Dr Sanjay Jayasinghe; Dr Robert
Menzies; Dr Helen Quinn; Dr Tom Snelling; Ms Kirsten Ward; Dr Nicholas Wood
Editorial support
Ms Donna Armstrong, Editing and Publications Officer, National Centre for
Immunisation Research and Surveillance of Vaccine Preventable Diseases
Library support
Ms Catherine King, Information Manager, National Centre for Immunisation
Research and Surveillance of Vaccine Preventable Diseases
Mr Edward Jacyna, Assistant Librarian, National Centre for Immunisation
Research and Surveillance of Vaccine Preventable Diseases
Administration support
Ms Lyn Benfield, Senior Administration Project Officer, National Centre for
Immunisation Research and Surveillance of Vaccine Preventable Diseases
xiii
Acknowledgments
Dr Frank Beard
Dr Vicki Krause
Professor Julie Bines
Associate Professor Stephen Lambert
Dr Julia Brotherton
Associate Professor Amanda Leach
Associate Professor Tony Brown
Professor Raina MacIntyre
Professor Margaret Burgess
Professor John Mackenzie
Dr Dave Burgner
Associate Professor Guy Marks
Dr Jim Buttery
Dr Jeremy McAnulty
Professor Jonathan Carapetis
Dr Brad McCall
Dr Ben Cowie
Dr Elizabeth McCarthy
Dr Andrew Daley
Dr Neil Parker
Professor Basil Donovan
Professor Bill Rawlinson
Dr Mark Douglas
Associate Professor Tilman Ruff
Professor David Durrheim
Dr Rosalie Schultz
Professor Dominic Dwyer
Dr Vicky Sheppeard
Professor Joan Faoagali
Associate Professor Vitali Sintchenko
Dr Tony Gherardin
Associate Professor Monica Slavin
Dr Heather Gidding
Associate Professor David Smith
Professor Lyn Gilbert
Dr Bruce Thorley
Dr Robert Hall
Dr Joe Torressi
Dr Alan Hampson
Dr Siranda Torvaldsen
Dr Penny Hutchinson
Ms Maureen Watson
Dr Heath Kelly
Dr Rosalind Webby
Professor Michael Kidd
Dr Melanie Wong
Dr Anne Koehler
Professor Nick Zwar
xiv The Australian Immunisation Handbook 10th edition