Immunisation Handbook 2020

Description

Disclaimer Feedback Foreword The Immunisation Handbook Advisory Group Acknowledgements Main sources Books New Zealand epidemiology data Commonly used abbreviations Glossary of vaccine brand names and abbreviations Introduction Changes to the Handbook in 2020 The National Immunisation Schedule Changes to the National Immunisation Schedule in 2020 2020 changes to extended immunisation programme for special groups Eligibility for publicly funded vaccines Notifiable diseases 1 General immunisation principles 1.1 Immunity and immunisation 1.1.1 Immune recognition 1.1.2 Induction of the adaptive immune response 1.1.3 Development of immune memory and the secondary response Innate immunity 1.1.4 Acquisition of adaptive immunity Naturally acquired immunity Artificially acquired immunity 1.1.5 Maternally derived immunity 1.1.6 Summary 1.2 From personal protection to community (herd) immunity 1.2.1 Reproduction number and herd immunity threshold 1.2.2 Summary 1.3 The importance of immunisation coverage 1.4 Classification of vaccines 1.4.1 Live attenuated vaccines 1.4.2 Killed and inactivated vaccines 1.4.3 Subunit vaccines Toxoid vaccines Recombinant vaccines Polysaccharide and conjugate vaccines Principles and implications for using polysaccharide and conjugate vaccines 1.4.4 Summary 1.5 Vaccine ingredients 1.5.1 Adjuvants 1.5.2 Preservatives 1.5.3 Stabilisers 1.5.4 Surfactants/emulsifiers 1.5.5 Residuals 1.6 Safety monitoring of vaccines in New Zealand 1.6.1 The approval of vaccines for use in New Zealand 1.6.2 The New Zealand spontaneous reporting scheme 1.6.3 AEFI reporting process – notifying CARM How to report to CARM What should be reported? Seriousness of AEFIs CARM assessment of causality 1.6.4 What does Medsafe do with this information? 1.6.5 Advantages and limitations of spontaneous reports Understanding vaccine safety and spontaneous reporting References 2 Processes for safe immunisation 2.1 Pre-vaccination 2.1.1 Cold chain management 2.1.2 Informed consent What is informed consent? The informed consent process Privacy and control over personal information Immunisation consent in primary care Vaccine hesitancy Information for parents, guardians and health care providers Ministry of Health information Other information sources Immunisation consent in other settings (eg, schools) Consent and children 2.1.3 Pre-vaccination screening 2.1.4 Contraindications Conditions that are not contraindications to immunisation 2.1.5 Spacing of doses Principles for spacing of doses of the same vaccine Spacing of different vaccines Concurrent administration of vaccines 2.1.6 Catch-up programmes for unimmunised or partially immunised children Vaccination of children with inadequate vaccination records 2.1.7 Adult vaccination (aged 18 years and older) 2.2 Vaccine administration 2.2.1 Minimising pain and distress at the time of vaccination 2.2.2 Preparing for vaccine administration Removal of air bubbles Skin preparation Special considerations for COVID-19 outbreak 2.2.3 Route of administration Needle angle, gauge and length Intramuscular injection sites Subcutaneous injection sites Intramuscular versus subcutaneous administration Thrombocytopenia, anticoagulant therapy and bleeding disorders Intradermal injections Oral vaccine administration 2.2.4 Infant vaccination Vastus lateralis BCG vaccine (administered by authorised vaccinators with BCG endorsement) 2.2.5 Young child vaccination (vastus lateralis or deltoid) 2.2.6 Older child, adolescent and adult vaccination (deltoid) 2.2.7 Multiple injections at the same visit The 12-month and 15-month immunisation events Multiple injections in the same muscle 2.3 Post-vaccination 2.3.1 Post-vaccination advice 2.3.2 Recommendations for fever and pain management Fever Pain management and soothing measures 2.3.3 Anaphylaxis and emergency management Signs of anaphylaxis Immunisation stress-related response Distinguishing a hypotonic-hyporesponsive episode from anaphylaxis Avoidance of anaphylaxis Emergency equipment Emergency management Ongoing management in hospital or by a medical practitioner 2.3.4 Documentation and insurance Indemnity insurance 2.3.5 The National Immunisation Register 2.3.6 Managing the information on the National Immunisation Register The SBVS References 3 Vaccination questions and addressing concerns 3.1 Some commonly asked questions 3.1.1 Vaccine scheduling Which vaccines can be administered at the same visit? What steps are required if the Schedule is interrupted or varied? How should the rest of the Schedule be handled when an adverse event has occurred following immunisation? 3.1.2 Babies and children What if a baby had a difficult birth or was premature? What special vaccines are offered to newborn babies? What are the special requirements of immigrant children? Is it possible to boost a child’s immune system by other means? 3.1.3 Allergies and illnesses What if the child is unwell on the day of immunisation? What if the child is due to have an operation (elective surgery)? Can immunisations be given during an operation? What if the child has a chronic disease? What if the child has had seizures? What if the child is allergic? Can children be immunised if they are known to develop a rash with antibiotics? Can all children receive all the vaccines? 3.1.4 Parents, guardians and contacts What if the child’s mother or guardian is pregnant or breastfeeding? Are the viruses in live vaccines, such as MMR and varicella, transmissible? 3.2 Addressing myths and concerns about immunisation 3.2.1 Background 3.2.2 Understanding anti-immunisation 3.2.3 Addressing concerns 3.2.4 Debunking a myth 1. Try not to repeat the myth. Focus on the core facts. 2. Precede a myth with a warning. 3. Include an alternative explanation that accounts for how the myth misleads. Facts and myths about immunisation 3.3 Addressing immunisation issues in a constantly changing environment References 4 Immunisation of special groups 4.1 Pregnancy and lactation 4.1.1 Women planning pregnancy Measles, mumps and rubella vaccine Varicella vaccine 4.1.2 During pregnancy Influenza vaccine Pertussis vaccine (Tdap) Close contacts 4.1.3 Breastfeeding and post-partum Measles, mumps and rubella vaccine Pertussis vaccine (Tdap) Varicella vaccine 4.2 Infants with special immunisation considerations from birth 4.2.1 Infants born to mothers with positive or unknown hepatitis B (HBsAg) status 4.2.2 Preterm and/or low birthweight infants Hepatitis B vaccine Rotavirus vaccine Pneumococcal vaccines Influenza vaccine Pertussis vaccine (Tdap) 4.2.3 Infants with congenital heart disease Vaccination of infants with congenital heart disease Live vaccines – caution Pneumococcal vaccine Influenza vaccine Pertussis vaccination Varicella vaccine 4.2.4 Infants with immunocompromise, including primary immunodeficiencies from birth 4.3 Immunocompromised individuals 4.3.1 Vaccination of close contacts of immunocompromised individuals Rotavirus vaccine Measles, mumps and rubella vaccine Varicella vaccine and zoster vaccine Influenza vaccine 4.3.2 Immune checkpoint inhibitor (immunostimulant) therapy 4.3.3 Primary immunodeficiency Vaccines for individuals with a primary immunodeficiency Live vaccines – caution Influenza vaccine Pneumococcal vaccines Infants and children aged under 5 years Children aged 5 years or older and adults Children with Down syndrome aged 5 years to under 18 years Meningococcal conjugate vaccines Infants aged under 9 months Infants and children aged 9–23 months Children aged 2 years to under 8 years Children aged 9 years or older and adults Group B meningococcal recombinant vaccine (4CMenB) Vaccines used to test for a primary immunodeficiency Vaccination advice, by primary immunodeficiency B lymphocyte deficiencies (humoral) X-linked agammaglobulinaemia and common variable immune deficiency Selective IgA deficiency, IgG subclass deficiency and hypogammaglobulinaemia Combined lymphocyte deficiencies (T and B cell) Complete defects (eg, SCID or athymia) Partial defects (eg, most patients with DiGeorge syndrome, Wiskott Aldrich syndrome, ataxia telangiectasia) Complement deficiencies Deficiency of C1–9, mannose-binding lectin, properdin, factor B Phagocytic function deficiencies Chronic granulomatous disease and cyclic neutropenia Leukocyte adhesion defect, myeloperoxidase deficiency 4.3.4 Secondary (acquired) immunodeficiency Vaccines for individuals with acquired immunodeficiency Live vaccines – caution Influenza vaccine Haemophilus influenzae type b (Hib-PRP) vaccines Infants and children aged under 5 years Children aged 5 years or older and adults Children and adults post-haematopoietic stem cell transplantation Pneumococcal vaccines Infants and children aged under 5 years Children aged 5 years to under 18 years Children aged 5 years or older and adults Meningococcal conjugate vaccines Infants aged under 9 months Infants and children aged 9–23 months Children aged 2 years to under 8 years Children aged 9 years or older and adults Group B meningococcal vaccine (4CMenB) Measles or chickenpox exposure post-transplantation 4.3.5 Individuals receiving corticosteroids 4.3.6 Individuals receiving non-corticosteroid immunomodulatory agents Non-biologic agents Biologic agents Infants of mothers who received immunosuppressive biologic agents during pregnancy Rotavirus vaccine BCG, MMR and VV 4.3.7 (Re)vaccination following immunosuppression 4.3.8 Oncology Vaccination during cancer chemotherapy Vaccination after cancer chemotherapy Vaccination and radiotherapy 4.3.9 Haematopoietic stem cell transplantation Vaccination of individuals post-HSCT 4.3.10 Solid organ transplantation Vaccination of individuals pre-/post solid organ transplantation Live vaccines – caution 4.3.11 Functional asplenia, hyposplenia and pre-/post-splenectomy Vaccination of individuals with asplenia or hyposplenia or pre-/post-splenectomy 4.3.12 HIV infection Vaccination of individuals with HIV infection Live vaccines – caution 4.4 Chronic kidney disease Vaccination of individuals with chronic kidney disease Live vaccines – caution 4.5 Chronic liver disease 4.5.1 Vaccination of individuals with chronic liver disease 4.6 Other special groups 4.7 Immigrants and refugees Tuberculosis Hepatitis B Varicella 4.8 Occupation-related vaccination 4.9 Travel References 5 Diphtheria Key information 5.1 Bacteriology 5.2 Clinical features 5.3 Epidemiology 5.3.1 Global burden of disease 5.3.2 New Zealand epidemiology 5.3.3 Transport, storage and handling 5.4 Vaccines 5.4.1 Available vaccines Funded diphtheria vaccines Other vaccines 5.4.2 Efficacy and effectiveness Herd immunity Duration of immunity 5.4.3 Dosage and administration Co-administration with other vaccines 5.5 Recommended immunisation schedule 5.5.1 Usual childhood schedule 5.5.2 Catch-ups for individuals aged 10 years and older 5.5.3 Booster doses for adolescents and adults Booster doses before travel 5.5.4 Pregnancy and breastfeeding 5.5.5 (Re)vaccination DTaP-IPV-HepB/Hib (Infanrix-hexa) and DTaP-IPV (Infanrix-IPV) Tdap (Boostrix) 5.6 Contraindications and precautions 5.6.1 Contraindications 5.6.2 Precautions 5.7 Potential responses and AEFIs 5.8 Public health measures 5.8.1 Antimicrobial prophylaxis 5.8.2 Vaccination of contacts 5.8.3 Exclusion of contacts 5.9 Variations from the vaccine data sheets References 6 Haemophilus influenzae type b (Hib) disease Key information 6.1 Bacteriology 6.2 Clinical features 6.3 Epidemiology 6.3.1 Global burden of disease 6.3.2 New Zealand epidemiology 6.4 Vaccines 6.4.1 Available vaccines Funded vaccines Other vaccines 6.4.2 Efficacy and effectiveness Duration of immunity 6.4.3 Transport, storage and handling 6.4.4 Dosage and administration Co-administration 6.5 Recommended immunisation schedule 6.5.1 Usual childhood schedule 6.5.2 Special groups Children Recommendations for Hib vaccine for older children and adults with asplenia 6.5.3 Children who have recovered from invasive Hib disease 6.5.4 (Re)vaccination DTaP-IPV-HepB/Hib (Infanrix-hexa) Hib-PRP-T (Hiberix) 6.5.5 Pregnancy and breastfeeding 6.6 Contraindications and precautions 6.7 Potential responses and AEFIs 6.7.1 Potential responses 6.7.2 AEFIs 6.8 Public health measures 6.8.1 Management of contacts Rifampicin chemoprophylaxis Rifampicin recommendations 6.9 Variations from the vaccine data sheets References 7 Hepatitis A Key information 7.1 Virology 7.2 Clinical features 7.3 Epidemiology 7.3.1 Global burden of disease 7.3.2 New Zealand epidemiology 7.4 Vaccines 7.4.1 Available vaccines Funded vaccine Other vaccines Inactivated HAV vaccine Combined HAV and HBV vaccine Combined HAV and typhoid vaccines 7.4.2 Efficacy and effectiveness Duration of immunity 7.4.3 Transport, storage and handling 7.4.4 Dosage and administration Co-administration with other vaccines Interchangeability of hepatitis A vaccines 7.5 Recommended immunisation schedule 7.5.1 Recommendations Individuals with chronic liver disease Chronic hepatitis B or C infection Other chronic liver disease Travellers Certain occupational groups Others at higher risk Routine immunisation for children 7.5.2 Immunisation schedule 7.5.3 Pregnancy and breastfeeding 7.6 Contraindications and precautions 7.6.1 Contraindications 7.6.2 Precautions 7.7 Potential responses and AEFIs 7.7.1 Potential responses 7.7.2 AEFIs 7.8 Public health measures 7.8.1 Post-exposure prophylaxis and outbreak control Vaccination Immunoglobulin Early childhood services and other institutional outbreaks Community-wide outbreaks of hepatitis A infection 7.9 Variations from the vaccine data sheets References 8 Hepatitis B Key information 8.1 Virology 8.2 Clinical features 8.2.1 Serological markers of infection 8.2.2 Acute hepatitis 8.2.3 Chronic HBV infection 8.2.4 Routes of transmission Perinatal (vertical) transmission Person-to-person (horizontal) transmission 8.3 Epidemiology 8.3.1 Global burden of disease 8.3.2 New Zealand epidemiology Acute HBV infection Chronic HBV infection Strategy for prevention 8.4 Vaccines 8.4.1 Available vaccines Funded vaccines Other vaccines 8.4.2 Efficacy and effectiveness Immunogenicity Effectiveness of birth dose given to babies born to HBsAg-positive mothers Duration of immunity Impact on chronic HBV infection 8.4.3 Transport, storage and handling 8.4.4 Dosage and administration DTaP-IPV-HepB/Hib HepB Co-administration with other vaccines 8.5 Recommended immunisation schedule 8.5.1 Usual childhood schedule Preterm infants of HBsAg-negative women Infants with liver or renal disease 8.5.2 Infants born to HBsAg-positive mothers Preterm and low birthweight infants of HBsAg-positive women 8.5.3 Catch-ups for children and adolescents Children and adolescents with liver or kidney disease 8.5.4 Eligible adults aged 18 years and older Adult dialysis or adult liver or kidney transplant patients Adult HIV patients Other eligible adults 8.5.5 Pregnancy and breastfeeding 8.5.6 (Re)vaccination DTaP-IPV-HepB/Hib (Infanrix-hexa) Monovalent HepB 8.5.7 Serological testing Screening for chronic infection Serological testing for high-risk groups The non-responder protocol 8.6 Contraindications and precautions 8.7 Potential responses and AEFIs 8.7.1 Potential responses 8.7.2 AEFIs 8.8 Public health measures 8.8.1 Passive immunisation 8.9 Variations from the vaccine data sheet References 9 Human papillomavirus Key information 9.1 Virology and the causal link to cancer 9.2 Clinical features 9.2.1 Infection Acquisition of HPV 9.2.2 Cervical cancer 9.2.3 Oropharyngeal and other cancers 9.2.4 Genital warts and recurrent respiratory papillomatosis 9.3 Epidemiology 9.3.1 Global burden of disease Onset of sexual activity Cervical cancer Other HPV-related cancers Anal cancers Oropharyngeal cancers Vulval and vaginal cancer Genital warts 9.3.2 New Zealand epidemiology Onset of sexual activity Cervical cancer HPV prevalence in precancerous lesions and invasive cervical cancer Cervical cancer registrations and deaths Other HPV-related cancers Anal cancers Oropharyngeal cancers Genital warts 9.4 Vaccines 9.4.1 Available vaccines Funded HPV vaccine Other vaccine 9.4.2 Efficacy and effectiveness Immunogenicity HPV4 HPV9 Efficacy HPV-related cancers Effectiveness Duration of protection Herd immunity and population impact Previous exposure to HPV 9.4.3 Transport, storage and handling 9.4.4 Dosage and administration Co-administration with other vaccines Interchangeability 9.5 Recommended immunisation schedule 9.5.1 Recommended and funded Note 9.5.2 Recommended but not funded Individuals aged 27 years and older 9.5.3 Pregnancy and breastfeeding 9.6 Contraindications and precautions 9.6.1 Contraindications 9.6.2 Precautions 9.7 Potential responses and AEFIs 9.8 Cancer prevention measures 9.8.1 HPV immunisation 9.8.2 Regular cervical screening for women 9.8.3 Safer sex approaches 9.9 Variations from the vaccine data sheets References 10 Influenza Key information 10.1 Virology 10.1.1 Antigenic drift 10.1.2 Antigenic shift 10.2 Clinical features Asymptomatic influenza 10.3 Epidemiology 10.3.1 Global epidemiology 10.3.2 New Zealand epidemiology Influenza surveillance Influenza immunisation uptake 10.3.3 Pandemic influenza 10.4 Vaccines 10.4.1 Available vaccines Funded vaccines Vaccine preparations and potential future options Split virion influenza vaccines Live attenuated influenza vaccines Adjuvanted and high-dose vaccines 10.4.2 Efficacy and effectiveness International data Vaccine effectiveness in New Zealand Pregnant women, the fetus and neonates Children Healthy adults Adults aged over 65 years Co-morbid conditions in adults and children Herd immunity Duration of immunity 10.4.3 Transport, storage and handling 10.4.4 Dosage and administration Individuals aged 9 years and older Children aged under 9 years Immunocompromised individuals Co-administration with other vaccines 10.5 Recommended immunisation schedule 10.5.1 Pregnancy and breastfeeding 10.5.2 Children at increased risk 10.5.3 Adults at increased risk Adults aged 65 years and older Adults with underlying medical conditions 10.5.4 Recommended but not funded Healthy individuals of any age from 6 months and older Health care workers Travellers 10.6 Contraindications and precautions 10.6.1 Contraindications 10.6.2 Precautions Immune checkpoint inhibitors History of Guillain–Barré syndrome Co-administration with PCV13 10.6.3 Egg allergy 10.7 Potential responses and AEFIs 10.8 Public health measures 10.8.1 Improving vaccine uptake 10.8.2 Antiviral drugs 10.8.3 Pandemics 10.9 Variations from the vaccine data sheet References 11 Measles Key information 11.1 Virology 11.2 Clinical features 11.3 Epidemiology 11.3.1 Global burden of disease Mortality and morbidity Measles elimination 11.3.2 New Zealand epidemiology 11.4 Vaccines 11.4.1 Available vaccines Funded vaccine Other vaccines 11.4.2 Efficacy and effectiveness Duration of immunity 11.4.3 Transport, storage and handling 11.4.4 Dosage and administration Co-administration with other vaccines Interchangeability 11.5 Recommended immunisation schedule 11.5.1 Usual childhood schedule MMR vaccination when aged under 12 months 11.5.2 Catch-up Adults born from 1 January 1969 Occupational risk groups 11.5.3 Immunocompromise Contacts of immunocompromised individuals (Re)vaccination before or following immunosuppression HIV infection 11.5.4 Pregnancy and breastfeeding After delivery 11.5.5 Travel 11.6 Contraindications and precautions 11.6.1 Contraindications 11.6.2 Precautions 11.6.3 Egg allergy 11.7 Potential responses and AEFIs 11.7.1 Potential responses 11.7.2 AEFIs Vaccine virus transmission Idiopathic thrombocytopenic purpura 11.7.3 Adverse outcomes not linked to MMR 11.8 Public health measures 11.8.1 Diagnosis 11.8.2 Post-exposure prophylaxis MMR vaccination Human normal immunoglobulin prophylaxis for contacts Prophylaxis with intravenous immunoglobulin 11.8.3 Exclusion 11.9 Variations from the vaccine data sheet References 12 Meningococcal disease Key information 12.1 Bacteriology 12.2 Clinical features 12.3 Epidemiology 12.3.1 Global burden of disease Incidence and serotypes Risk groups 12.3.2 New Zealand epidemiology Incidence and mortality Strain types 12.4 Vaccines 12.4.1 Introduction Funded vaccines Other vaccines Quadrivalent meningococcal conjugate vaccines Group B meningococcal vaccines Historic MeNZB vaccine 12.4.2 Efficacy and effectiveness Meningococcal conjugate vaccines Quadrivalent meningococcal conjugate vaccines Meningococcal group C conjugate vaccines Meningococcal group B recombinant vaccine 12.4.3 Transport, storage and handling Reconstitution 12.4.4 Dosage and administration Quadrivalent meningococcal conjugate vaccines (MenACWY) Menactra (MenACWY-D) Nimenrix (MenACWY-T) Meningococcal group C conjugate vaccine (MenC) Meningococcal group B recombinant vaccine (4CMenB) 12.5 Recommended immunisation schedule 12.5.1 Individuals at increased risk Before travel Before moving into communal living situations 12.5.2 Recommendations for children and adolescents 12.5.3 Pregnancy and breastfeeding 12.5.4 (Re)vaccination 12.6 Contraindications and precautions 12.7 Potential responses and AEFIs 12.7.1 Quadrivalent meningococcal conjugate vaccine Guillain–Barré syndrome 12.7.2 Meningococcal group C conjugate vaccine 12.7.3 Meningococcal B recombinant vaccine 12.8 Public health measures 12.8.1 Contacts 12.8.2 Chemoprophylaxis for contacts Recommended antibiotics Rifampicin Ceftriaxone Ciprofloxacin Use of meningococcal vaccines for close contacts 12.8.3 Outbreak control 12.9 Variations from the vaccine data sheets References 13 Mumps Key information 13.1 Virology 13.2 Clinical features 13.3 Epidemiology 13.3.1 Global burden of disease 13.3.2 New Zealand epidemiology 13.4 Vaccines 13.4.1 Available vaccines Funded vaccine Other vaccines 13.4.2 Efficacy and effectiveness 13.4.3 Transport, storage and handling 13.4.4 Dosage and administration Co-administration with other vaccines Interchangeability 13.5 Recommended immunisation schedule 13.5.1 Usual childhood schedule 13.5.2 Catch-up 13.5.3 Immunocompromise Contacts of immunocompromised individuals (Re)vaccination following immunosuppression HIV infection 13.5.4 Pregnancy and breastfeeding After delivery 13.6 Contraindications and precautions 13.6.1 Contraindications 13.6.2 Precautions 13.7 Potential responses and AEFIs 13.8 Public health measures 13.8.1 Diagnosis 13.8.2 Susceptible contacts 13.8.3 Exclusion and post-exposure prophylaxis Cases Susceptible contacts Health care settings or working or living with immunocompromised people Other settings Post-exposure prophylaxis 13.9 Variations from the vaccine data sheet References 14 Pertussis (whooping cough) Key information 14.1 Bacteriology 14.2 Clinical features 14.3 Epidemiology 14.3.1 Global burden of disease 14.3.2 New Zealand epidemiology Pertussis mortality in New Zealand Pertussis morbidity in New Zealand Pertussis morbidity in New Zealand as described by notification data Pertussis morbidity in New Zealand, as described by hospital discharge data 14.4 Vaccines 14.4.1 Available vaccines Funded pertussis vaccines Other vaccines 14.4.2 Efficacy and effectiveness Immunogenicity Efficacy and effectiveness Vaccination in pregnancy Direct protection Duration of protection 14.4.3 Transport, storage and handling 14.4.4 Dosage and administration Co-administration with other vaccines 14.5 Recommended immunisation schedule 14.5.1 Children Catch-up immunisation 14.5.2 Pregnancy and breastfeeding 14.5.3 (Re)vaccination DTaP-IPV-HepB/Hib (Infanrix-hexa) and DTaP-IPV (Infanrix-IPV) Tdap (Boostrix) 14.5.4 Recommended but not funded 14.6 Contraindications and precautions 14.6.1 Contraindications 14.6.2 Precautions 14.7 Potential responses and AEFIs 14.7.1 DTaP-containing vaccines 14.7.2 Tdap vaccine 14.7.3 Major adverse events associated with pertussis-containing vaccines 14.8 Public health measures 14.8.1 Improving pertussis control 14.8.2 Notification 14.8.3 Laboratory diagnosis of Bordetella pertussis infection 14.8.4 Antimicrobial treatment of case Exclusion 14.8.5 Management of contacts Restriction 14.9 Variations from the vaccine data sheets References 15 Pneumococcal disease Key information 15.1 Bacteriology 15.2 Clinical features 15.3 Epidemiology 15.3.1 Global burden of disease 15.3.2 Global epidemiology since the introduction of pneumococcal conjugate vaccines Direct impact of PCV programmes on IPD in children Direct impact of vaccination on non-invasive pneumococcal disease Herd immunity 15.3.3 New Zealand epidemiology Incidence and mortality New Zealand epidemiology since the introduction of PCV IPD incidence Pneumococcal serotypes Herd immunity Impact of vaccination on non-invasive pneumococcal disease Antimicrobial resistance 15.4 Vaccines 15.4.1 Available vaccines Funded vaccines 15.4.2 Efficacy and effectiveness 10-valent pneumococcal conjugate vaccine IPD Non-IPD pneumonia Otitis media 13-valent pneumococcal conjugate vaccine Individuals at increased risk of IPD Use of pneumococcal conjugate vaccines in adults 23-valent vaccine pneumococcal polysaccharide 15.4.3 Transport, storage and handling 15.4.4 Dosage and administration Co-administration with other vaccines 15.5 Recommended immunisation schedule 15.5.1 Usual childhood schedule (PCV10) PCV10 for children aged under 5 years 15.5.2 Extended pneumococcal immunisation for high-risk groups PCV13 23PPV 15.5.3 (Re)vaccination 15.5.4 Recommended but not funded Risk stacking Recommendations Adults aged 65 years and older with no other risk factors 15.5.5 Pregnancy and breastfeeding 15.6 Contraindications and precautions 15.6.1 Contraindications 15.6.2 Precautions 15.7 Potential responses and AEFIs 15.7.1 Pneumococcal conjugate vaccines PCV10 PCV13 15.7.2 Pneumococcal polysaccharide vaccine 15.8 Public health measures 15.9 Variations from the vaccine data sheets References 16 Poliomyelitis Key information 16.1 Virology 16.2 Clinical features 16.3 Epidemiology 16.3.1 Global burden of disease 16.3.2 New Zealand epidemiology 16.4 Vaccines 16.4.1 Available vaccines Funded polio vaccines Other vaccine 16.4.2 Efficacy and effectiveness Immunogenicity and efficacy 16.4.3 Transport, storage and handling 16.4.4 Dosage and administration Co-administration with other vaccines 16.5 Recommended immunisation schedule 16.5.1 Usual childhood schedule 16.5.2 Unimmunised adults and children 16.5.3 Pregnancy and breastfeeding 16.5.4 (Re)vaccination DTaP-IPV-HepB/Hib (Infanrix-hexa) and DTaP-IPV (Infanrix-IPV) IPV (IPOL) 16.5.5 Recommendations for other groups 16.6 Contraindications and precautions 16.6.1 Contraindications 16.6.2 Precautions 16.7 Potential responses and AEFIs 16.7.1 Potential responses 16.7.2 AEFIs 16.8 Public health measures 16.9 Variations from the vaccine data sheets References 17 Rotavirus Key information 17.1 Virology 17.2 Clinical features 17.3 Epidemiology 17.3.1 Global burden of disease 17.3.2 New Zealand epidemiology Pre-vaccine epidemiology Post-vaccine epidemiology 17.4 Vaccines 17.4.1 Available vaccines Funded vaccine 17.4.2 Efficacy and effectiveness Prevention of disease Effectiveness Herd immunity in the post-licensure period Duration of protection Partial vaccination Cross-protection 17.4.3 Transport, storage and handling 17.4.4 Dosage and administration Co-administration with other vaccines If the dose is regurgitated or vomited 17.5 Recommended immunisation schedule 17.5.1 Routine schedule 17.5.2 Catch-up schedules 17.5.3 Preterm infants 17.5.4 Hospitalised infants 17.5.5 Pregnancy and breastfeeding 17.6 Contraindications and precautions 17.6.1 Contraindications 17.6.2 Precautions Infants born to mothers on immunosuppressive therapies Shedding 17.7 Potential responses and AEFIs 17.7.1 Intussusception 17.8 Public health measures 17.9 Variations from the vaccine data sheet References 18 Rubella Key information 18.1 Virology 18.2 Clinical features 18.3 Epidemiology 18.3.1 Global burden of disease 18.3.2 New Zealand epidemiology 18.4 Vaccines 18.4.1 Available vaccines Funded vaccine Other vaccines 18.4.2 Efficacy and effectiveness 18.4.3 Transport, storage and handling 18.4.4 Dosage and administration Co-administration with other vaccines Interchangeability 18.5 Recommended immunisation schedule 18.5.1 Usual childhood schedule 18.5.2 Catch-up Immigrants to New Zealand Occupational risk 18.5.3 Pregnancy and breastfeeding Women planning pregnancy Pregnant women After delivery Breastfeeding 18.5.4 Immunocompromise HIV infection 18.6 Contraindications and precautions 18.6.1 Contraindications 18.6.2 Precautions 18.7 Potential responses and AEFIs 18.7.1 Potential responses 18.7.2 AEFIs 18.8 Public health measures 18.8.1 Exclusion of cases of rubella infection 18.8.2 Management of non-pregnant contacts 18.8.3 Management of pregnant contacts Coordinated care and management 18.9 Variations from the vaccine data sheet References 19 Tetanus Key information 19.1 Bacteriology 19.2 Clinical features 19.3 Epidemiology 19.3.1 Global burden of disease 19.3.2 New Zealand epidemiology 19.4 Vaccines 19.4.1 Available vaccines Funded vaccines Other vaccines 19.4.2 Efficacy and effectiveness Efficacy and effectiveness Duration of protection 19.4.3 Transport, storage and handling 19.4.4 Dosage and administration Co-administration with other vaccines 19.5 Recommended immunisation schedule 19.5.1 Usual childhood schedule 19.5.2 Catch-up immunisation for individuals aged 10 years and older Dose intervals between Td and Tdap 19.5.3 Booster doses for adolescents and adults 19.5.4 Pregnancy and breastfeeding 19.5.5 (Re)vaccination DTaP-IPV-HepB/Hib (Infanrix-hexa) and DTaP-IPV (Infanrix-IPV) Tdap (Boostrix) 19.5.6 Prevention of tetanus following injury General measures for the treatment of tetanus-prone wounds Tetanus immunoglobulin availability and storage TIG dose 19.6 Contraindications and precautions 19.6.1 Contraindications 19.6.2 Precautions 19.7 Potential responses and AEFIs 19.7.1 Potential responses 19.7.2 AEFIs 19.8 Public health measures 19.9 Variations from the vaccine data sheets References 20 Tuberculosis Key information 20.1 Bacteriology 20.2 Clinical features 20.3 Epidemiology 20.3.1 Global epidemiology 20.3.2 New Zealand epidemiology Notification rates and risk factors Multidrug-resistant TB 20.4 Vaccine 20.4.1 Licensed vaccine 20.4.2 Efficacy and effectiveness 20.4.3 Transport, storage and handling 20.4.4 Dosage and administration BCG immunisation given in other countries Co-administration with other vaccines 20.5 Recommended immunisation schedule 20.5.1 Tuberculin skin testing (Mantoux) before BCG vaccination 20.5.2 BCG eligibility criteria BCG vaccine information for parents 20.5.3 Other high-risk individuals or groups 20.5.4 Pregnancy and breastfeeding 20.6 Contraindications and precautions 20.6.1 Contraindications 20.6.2 Precautions 20.7 Potential responses and AEFIs 20.7.1 Potential responses 20.7.2 AEFIs 20.8 Public health measures 20.9 Variations from the vaccine data sheet References 21 Varicella (chickenpox) Key information 21.1 Virology 21.2 Clinical features 21.3 Epidemiology 21.3.1 Global burden of disease 21.3.2 New Zealand epidemiology 21.4 Vaccines 21.4.1 Available vaccines Funded vaccine Other vaccines Monovalent VV Quadrivalent MMRV – not currently available in New Zealand 21.4.2 Efficacy and effectiveness Herd immunity Duration of immunity 21.4.3 Transport, storage and handling 21.4.4 Dosage and administration Co-administration with other vaccines 21.5 Recommended immunisation schedule 21.5.1 Usual childhood schedule 21.5.2 Special groups Immunocompromised (including immunosuppressed) individuals Household contacts of immunocompromised individuals 21.5.3 Recommended but not funded Health care workers 21.5.4 Pregnancy and breastfeeding 21.6 Contraindications and precautions 21.6.1 Contraindications 21.6.2 Precautions 21.7 Potential responses and AEFIs 21.7.1 Potential responses Post-VV rash Transmission of vaccine virus to contacts of vaccinated individuals 21.7.2 AEFIs Vaccine virus shingles Febrile seizures with MMRV vaccine 21.8 Public health measures 21.8.1 Susceptibility 21.8.2 Post-exposure prophylaxis with zoster immunoglobulin Dosage of ZIG 21.8.3 Post-exposure vaccination and outbreak control 21.8.4 In-hospital exposure 21.8.5 Exclusion from school or early childhood education services 21.8.6 Care of pregnant women after exposure 21.9 Variations from the vaccine data sheet References 22 Zoster (herpes zoster/shingles) Key information 22.1 Virology 22.2 Clinical features 22.3 Epidemiology 22.3.1 Global burden of disease 22.3.2 New Zealand epidemiology 22.4 Vaccine 22.4.1 Available vaccine Funded vaccine Other vaccine 22.4.2 Efficacy and effectiveness Duration of protection 22.4.3 Transport, storage and handling 22.4.4 Dosage and administration Co-administration with other vaccines 22.5 Recommended immunisation schedule 22.5.1 Recommended and funded 22.5.2 Other considerations Vaccination of individuals aged 50–64 years (unfunded) Individuals with a history of zoster (shingles) Household contacts of immunocompromised individuals Serological testing 22.6 Contraindications and precautions 22.6.1 Contraindications 22.6.2 Precautions HIV Immunocompromised individuals 22.7 Potential responses and AEFIs 22.7.1 Potential responses 22.7.2 AEFIs 22.8 Variations from the vaccine data sheet References Appendix 1 : The history of immunisation in New Zealand A1.1 History of the Schedule – summary tables A1.2 Previous national immunisation schedules A1.3 History of the Schedule: background information A1.3.1 Diphtheria-containing vaccines A1.3.2 Hib-containing vaccines A1.3.3 Hepatitis B-containing vaccines A1.3.4 HPV vaccines A1.3.5 Influenza vaccines A1.3.6 Measles-containing vaccines A1.3.7 Mumps-containing vaccines A1.3.8 Pertussis-containing vaccines A1.3.9 Pneumococcal vaccines A1.3.10 Poliomyelitis-containing vaccines A1.3.11 Rotavirus vaccines A1.3.12 Rubella-containing vaccines A1.3.13 Tetanus-containing vaccines A1.3.14 BCG vaccines A1.3.15 Varicella vaccines A1.3.16 Herpes zoster vaccines References Appendix 2 : Planning immunisation catch-ups A2.1 Eligibility for publicly funded vaccines A2.2 Planning catch-ups for infants, children and adolescents aged under 18 years A2.2.1 Principles of catch-up for infants and children aged under 10 years A2.2.2 Principles of catch-up for children and adolescents aged 10 to under 18 years A2.2.3 National Immunisation Schedule catch-up guides for infants, children and adolescents aged under 18 years A2.3 Immunisation catch-up for eligible adults aged 18 years and older Appendix 3 : Immunisation standards for vaccinators and guidelines for organisations offering immunisation services A3.1 Purpose A3.2 Health and Disability Commissioner (Code of Health and Disability Services Consumers’ Rights) Regulations 1996 A3.3 Immunisation standards for vaccinators Standard 1: The vaccinator is competent in all aspects of the immunisation technique and has the appropriate knowledge and skills for the task Required characteristics of the vaccinator Standard 2: The vaccinator obtains informed consent to immunise Required characteristics of the vaccinator Standard 3: The vaccinator provides safe immunisation Required characteristics of the vaccinator and immunisation setting Standard 4: The vaccinator documents information on the vaccine(s) administered, and maintains patient confidentiality Required characteristics of the vaccinator Standard 5: The vaccinator administers all vaccine doses for which the vaccine recipient is due at each visit and only follows true contraindications Required characteristics of the vaccinator Standard 6: The vaccinator reports AEFIs promptly, accurately and completely Required characteristics of the vaccinator A3.4 Guidelines for organisations storing vaccines and/or offering immunisation services The organisation that employs vaccinators to offer immunisation services has links to primary health care and to Well Child Tamariki Ora providers Required characteristics The organisation achieves high immunisation coverage of its population Required characteristics The organisation supports vaccinators and NIR administrators Required characteristics The service is readily available, with no barriers to access Required characteristics A3.5 Recommended resources Ministry of Health (www.health.govt.nz/our-work/preventative-health-wellness/immunisation/national-immunisation-programme-cold-chain-management) Immunisation Advisory Centre (www.immune.org.nz) Other A3.6 Relevant legislation and regulations Appendix 4 : Authorisation of vaccinators and criteria for pharmacist vaccinators A4.1 Protocol for authorisation of vaccinators and pharmacist vaccinators A4.1.1 Authority Authorised vaccinators Pharmacist vaccinators A4.1.2 Process for all vaccinators Authorised vaccinators Pharmacist vaccinators A4.1.3 Additional endorsement process for BCG vaccinators New BCG vaccinators and gazetted BCG vaccinators seeking regional BCG endorsement Process for two-yearly renewal of BCG vaccinator status A4.1.4 Process for provisional authorised vaccinators A4.1.5 Process for two-yearly renewal of vaccinator status for all vaccinators Authorised vaccinators Pharmacist vaccinators A4.1.6 Process when vaccinator status has not been maintained or has not been achieved If it is less than five years since the vaccinator attended and completed an approved vaccinator training course If it is five or more years since the applicant completed an approved vaccinator training and they have not achieved or maintained their vaccinator status A4.1.7 Process when a vaccinator is new to the health district in which they intend to practise A4.2 Resuscitation requirements for all authorised vaccinators and pharmacist vaccinators A4.3 Local immunisation programmes A4.4 Minimum staff and equipment requirements for vaccination services Appendix 5 : Immunisation certificate A5.1 Introduction A5.2 Parent/guardian responsibilities A5.3 Vaccinator responsibilities A5.4 Early childhood services and school responsibilities Appendix 6 : Passive immunisation A6.1 Introduction A6.2 Preparations available in New Zealand A6.2.1 Human normal immunoglobulin for intramuscular use A6.2.2 Specific immunoglobulin for intramuscular use A6.2.3 Human normal immunoglobulin for intravenous use A6.2.4 Human normal immunoglobulin for subcutaneous use A6.2.5 Accessing immunoglobulin or contacting NZBS for advice A6.3 Indications for use A6.3.1 Passive immunisation A6.3.2 Management of primary and acquired immune deficiency A6.4 Storage and administration A6.4.1 Interactions with other drugs A6.4.2 Passive transfer of antibodies and interference with serological testing A6.5 Duration of effect A6.6 Contraindications and precautions A6.6.1 Contraindications A6.6.2 Precautions A6.7 Potential responses and adverse events following passive immunisation References Appendix 7 : Vaccine presentation, preparation, disposal, and needle-stick recommendations A7.1 Presentation of vaccines A7.2 Preparation and administration of vaccines A7.2.1 Preparing vaccines supplied as a liquid preparation A7.2.2 Preparing vaccines supplied as powder/pellet vaccines Reconstituting vaccines where the diluent is in a vial Reconstituting vaccines where the vaccine or diluent is in a prefilled syringe A7.2.3 Preparing vaccines supplied as prefilled syringes A7.2.4 Preparing the rotavirus vaccine A7.2.5 Preparing vaccines supplied as multi-dose vials A7.3 Disposal of needles, syringes and vaccine vials A7.3.1 Sharps containers A7.3.2 Spillages A7.3.3 Recommendations following a needle-stick injury Appendix 8 : High-incidence TB countries Appendix 9 : Websites and other online resources A9.1 New Zealand-based websites Ministry of Health Immunisation Pregnancy and kids Pharmaceutical Management Agency (PHARMAC) Medsafe – New Zealand Medicines and Medical Devices Safety Authority Institute of Environmental Science and Research Ltd (ESR) HealthEd Immunisation Advisory Centre (IMAC) KidsHealth Health Promotion Agency (HPA) A9.2 International websites World Health Organization (WHO) Centers for Disease Control and Prevention (CDC) Immunization Action Coalition Healthychildren.org – American Academy of Pediatrics Institute for Vaccine Safety The Vaccine Page National Centre for Immunisation Research & Surveillance (NCIRS) Sharing Knowledge About Immunisation (SKAI) A9.3 Influenza-related websites National Influenza Strategy Group Ministry of Health – Pandemic planning and response FluTracking Institute of Environmental Science and Research Ltd Virological surveillance WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, Australia WHO – Global Influenza Programme WHO – FluNet CDC – Influenza (Flu) A9.4 Travel-related websites Ministry of Health – Travelling Ministry of Foreign Affairs and Trade – Safe Travel WHO – International travel and health CDC – Travellers’ health Fit for travel Funded vaccines for special groups Anaphylaxis response/management National Immunisation Schedule