What’s new? - Changes introduced in this edition of the Handbook -  2page pdf

For those familiar with the 7th edition of this Handbook, it is important to note that the 8^th edition introduces some new vaccines, changes to the schedules and to recommendations and procedures for administering vaccines, and changes to the presentation of the Handbook. Please refer to the relevant chapters.

New vaccines now available in Australia

·         Combination vaccines, including DTPa-hepB-IPV, DTPa-IPV, DTPa-IPV-Hib, DTPa- IPV/Hib and DTPa-hepB-IPV-Hib (the latter is for boosters only). Note that additional combination vaccines are likely to become available in Australia in the near future.

·         7-valent pneumococcal conjugate vaccine (7vPCV).

·         Meningococcal C conjugate vaccine (MenCCV).

·         Adult/adolescent formulation diphtheria-tetanus-acellular pertussis (dTpa) vaccine suitable for boosting adolescents and adults against pertussis.

·         A combination hepatitis A/typhoid vaccine.

·         An additional varicella vaccine that can be stored at 2oC to 8oC or colder for up to 18 months.

Changes to vaccination schedule

The new immunisation schedule incorporates all vaccines recommended as 'best practice'. See Part 1.7, ‘The Australian Standard Vaccination Schedule’ and individual vaccine chapters.

The following recommendations have been formally endorsed by the NHMRC since publication of the 7th edition:

·         The fifth dose of oral poliomyelitis vaccine (OPV), previously scheduled at 15 to 17 years of age, is no longer recommended (level III-3 evidence).

·         A new 2-dose schedule for the hepatitis B vaccine H-B-Vax II (adult formulation) can be used as an alternative to the standard 3-dose schedule for adolescents aged 11 to 15 years of age.

·         The 7-valent pneumococcal conjugate vaccine (7vPCV) is recommended for:

                   i.            Aboriginal and Torres Strait Islander infants in a 3-dose series at 2, 4 and 6 months of age with a booster dose of the 23-valent pneumococcal polysaccharide vaccine (23vPPV) at 18 to 24 months of age (level IV evidence). Catch-up is recommended for Aboriginal children in central Australia up to the fifth birthday and for Aboriginal and Torres Strait Islander children elsewhere up to the second birthday.

                  ii.            All Australian children with underlying predisposing medical conditions at 2, 4 and 6 months of age with a booster dose (of 7vPCV) at 12 months of age and a booster dose of 23vPPV at 4 to 5 years of age (level IV evidence). Catch-up vaccination is recommended for these children up to the fifth birthday.

                iii.            All non-Indigenous children residing in central Australia at 2, 4 and 6 months of age, but no booster dose is necessary (unless there is a predisposing medical condition) (level II evidence). Catch-up vaccination is recommended for these children up to the second birthday.

                iv.            All Australian children as a 3-dose series at 2, 4 and 6 months of age (level II and IV evidence).

·         Meningococcal C conjugate vaccine (MenCCV) is recommended as a single dose at 12 months of age (level III-2 evidence).

·         The fourth dose of DTPa, which was previously given at 18 months of age, is no longer required (level IV evidence). Instead, the fourth dose of DTPa is now recommended at 4 years of age.

·         An adult/adolescent formulation pertussis-containing vaccine (dTpa) is available for boosting adolescents and adults against pertussis. It is recommended as a single dose at 15 to 17 years of age (level II evidence).

·         Oral poliomyelitis vaccine (OPV) is replaced by inactivated poliomyelitis vaccine (IPV) combination vaccines for the 3-dose primary series (2, 4 and 6 months of age) and for the booster dose at 4 years of age (level III-3 evidence).

·         Varicella-zoster (chickenpox) vaccine is now recommended for all children at 18 months of age (level II evidence), with a catch-up dose for adolescents 10 to 13 years of age without a history of either varicella or varicella vaccination (level II evidence).

Changes in recommendations and procedures

·         Having a 'medical condition affecting the brain or spinal cord' is no longer included in the pre-vaccination checklist as a contraindication to pertussis vaccine.

·         The 23-valent pneumococcal polysaccharide vaccine (23vPPV) is now recommended for tobacco smokers (level III-2 evidence). Recommendations for booster doses of 23vPPV in adults have been revised.

·         MMR is now recommended for adults born during or since 1966 (previously 1970) who do not have evidence of 2 doses of the vaccine in the past.

·         An anaphylactic sensitivity to egg is no longer considered as a cause for concern when administering MMR. In this circumstance, MMR can be safely administered in the usual manner; the vaccinee does not need to be referred for vaccination under close medical supervision.

·         The recommended interval for avoidance of pregnancy after administration of a rubellacontaining vaccine has been shortened from 2 months to 28 days (expert opinion).

·         A new 'rapid' schedule for the combined hepatitis A/B vaccine Twinrix (720/20), with 3 doses given on days 0, 7 and 21, and a (fourth) booster dose at 12 months, can be used if rapid protection is required. A 2-dose schedule of the same vaccine at 0 and 6 to 12 months can be used in 1 to 15 year olds provided that prompt protection against hepatitis B is not required.

·         The upper age limit for a single dose of varicella-zoster vaccine has been raised from the thirteenth to the fourteenth birthday. People aged 14 years and older require 2 doses with an optimal interval of 2 months between doses.

·         Varicella-zoster vaccine may now be given as soon as 3 months after the intramuscular administration of normal human immunoglobulin (not 5 months as previously recommended).

·         Guidelines for the use of varicella-zoster immunoglobulin (VZIG) include a revised definition of 'significant exposure' to varicella.

·         Some experts, including the WHO, no longer recommend withdrawing the syringe plunger before injecting a vaccine. However it is still acceptable to do so gently if preferred. If a flash of blood appears in the needle hub, the needle should be withdrawn and a new site selected for injection.2,3

·         For intramuscular injections the angle of insertion of the needle (23 gauge, 25 mm in length) should be 60o (revised from 45o to 60o) (expert opinion).

·         More comprehensive recommendations for timing of vaccination around administration of immunoglobulin are provided.

·         For preterm babies, recommendations for hepatitis B vaccination have been revised.

·         In outbreak situations, it is important to contact the local Public Health Unit, as management policies may vary between States and Territories.

·         Guidelines for the public health management of pertussis have changed.

Changes in the Handbook

·         A separate chapter on vaccination for international travel has been added (Part 2.2).

·         The chapter previously entitled 'Special risk groups' has been changed to 'Groups with special vaccination requirements' (Part 2.3). It includes recommendations for patients who have special vaccination needs, those who may experience more frequent adverse advents, and those who may have a suboptimal response to vaccination. Recommendations for immunisation of certain occupational groups are also included.

·         Injection technique has been further clarified with new photographs demonstrating intramuscular (IM ) and subcutaneous (SC) injections.

·         The pre-vaccination questionnaire and assessment table have been revised.

·         The risk/benefit table on the back cover of the Handbook has been updated.

·         Revised catch-up schedules have been provided for all vaccines in the Australian Standard Vaccination Schedule.

·         The table on “Common adverse reactions and what to do about them” (inside back cover) has been revised.

·         The information on reporting of adverse events following immunisation has been updated to reflect recent changes to the national reporting arrangements.

·         The information on the Australian Childhood Immunisation Register has been updated.

·         Table 1.10.1: 'Information on vaccines exposed to different temperatures' has been revised.

·         Levels of evidence for new recommendations have been included in the fully referenced electronic version of the Handbook. The print version of the Handbook will not be fully referenced nor include levels of evidence.