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- Pneumococcal vaccine (Pneumovax 23 and Prevenar 13) - There are changes to the timing and type of pneumococcal vaccine for some at risk groups, adults and Aboriginal people.
- Meningococcal B vaccine (Bexsero) - This vaccine is now funded for Aboriginal children and some at risk people.
- Meningococcal ACWY (Nimerix) - This vaccine is now funded for some additional at risk people.
- Haemophilus influenzae type b (ACT-Hib) - This vaccine is now funded for some additional at risk people.
Pneumococcal: Prevenar 13 and Pneumovax 23
What are the changes relating to pneumococcal vaccination?
There have been a number of changes in relation to pneumococcal vaccines. These include:
- The list of conditions associated with an increased risk of invasive pneumococcal disease have been consolidated into one list i.e there are no longer a category A and category B list.
- The number of doses of Pneumovax 23 that people receive in a lifetime is now limited to two doses.
- Non-Aboriginal adults with no risk factors now receive a single dose of Prevenar 13 ≥ 70 years of age (the single dose of Pneumovax 23 at 65 years is no longer recommended or funded). This vaccine is not needed every year. It is a one-off dose.
- Aboriginal people aged 50 years and over now receive:
- At 50 years or over – a dose of Prevenar 13
- 2-12 months later – a dose of Pneumovax 23
- At least 5 years later – another dose of Pneumovax 23.
- Children and adults diagnosed with an at risk condition after 12 months of age now receive:
- At diagnosis – a dose of Prevenar 13
- 2-12 months later or at 4 years of age (whichever is later) – a dose of Pneumovax 23
- At least 5 years later – another dose of Pneumovax 23.
- In addition to the routine childhood schedule (6 weeks, 4 months and 12 months) children 12 months old or younger who are diagnosed with an at risk condition are recommended to receive:
- 6 Months – an additional dose of Prevenar 13
- 4 years – a dose of Pneumovax 23
- At least 5 years later – another dose of Pneumovax 23.
Immunisation providers should check the online Australian Immunisation Handbook for changes.
Have the lists of at risk conditions for invasive pneumococcal disease (IPD) changed?
The list of at risk conditions for IPD have been consolidated into one list i.e. there are no longer category A and category B lists. A previous history of IPD in adults as well as children has also been included.
Where can I find a list of the at risk conditions that are recommended to receive pneumococcal vaccination?
A list of conditions that pneumococcal vaccination is recommended for is available in the online Australian Immunisation Handbook.
Where can I find a list of at risk conditions that people are eligible to receive funded pneumococcal vaccines for?
Not all at risk conditions are eligible for funded pneumococcal vaccination. A list of people eligible to receive pneumococcal vaccine that is funded under the National Immunisation Program (NIP) is available from the Australian Department of Health.
Why are the pneumococcal vaccines not funded for all at risk group?
The pneumococcal vaccines recommended for many of those with at risk conditions are now funded under the National Immunisation Program (NIP) for children and adults. However, for other risk conditions, where the rate of disease is not sufficiently high enough to be cost-effective, people will not be eligible to receive the recommended pneumococcal vaccines under the NIP.
Has the number of lifetime doses of Pneumovax 23 changed?
Yes. The number of lifetime doses of Pneumovax 23 that any individual should receive has been reduced from three to two doses with doses already received counted towards the lifetime doses.
A review of literature demonstrated that there did not appear to be a substantial benefit in additional doses beyond two. Additional doses are also associated with higher rates of adverse events particularly injection site reactions. It was also unclear whether additional doses of Pneumovax 23 may lead to immune hyporesponsiveness. Additional information is available from the Australian Department of Health.
My patient who is ≥70 years, non-Aboriginal without at risk conditions received a pneumovax 23 previously. Should they now have Prevenar 13?
Yes. Anyone who is 70 years or over who has not previously received a Prevenar 13 should receive a dose of Prevenar 13 ≥70 years of age. If it is less than 12 months since they received Pneumovax 23, wait until it has been at least 12 months before administering Prevenar 13.
Those who are already 70 years of age or older on 1 July 2020 are also eligible for a single NIP-funded dose of Prevenar 13, which can be given opportunistically at a suitable clinical encounter. This vaccine is not needed every year. It is a one-off dose.
How often should my patient receive pneumococcal vaccine if they are ≥70 years, non-Aboriginal and without at risk conditions?
Your patient is recommended and funded to receive a one-off dose of Prevenar 13 ≥70 years of age. Additional boosters are not required.
Why has the dose of Pneumovax 23 for 65 year old’s been changed to Prevenar 13 and moved to ≥70?
In pooled notification data for 2016 and 2017, the incidence of IPD due to 13vPCV serotypes was almost 2-fold higher among non-Indigenous adults aged ≥70 years (6.2 per 100,000) than in those aged 65–69 years (3.4 per 100,000).
This substantially greater burden in adults from age 70 years and expected waning of pneumococcal protection with increasing age supports the recommendation of 13vPCV for all adults aged 70 years and above.
Of all IPD notifications in non-Indigenous adults ≥65 years of age, around 4% occurred in those without risk conditions as identified in notification data. Of those cases, only 20% were due to 23v-non-13v serotypes. Additional information is available from the Australian Department of Health.
My patient who is ≥50 years, Aboriginal and does not have any at risk conditions, has previously received dose/s of Pneumovax 23 vaccine. Do they require further vaccination for pneumococcal?
Yes. Aboriginal people aged ≥50 should receive 1 dose of Prevenar 13 and 2 lifetime doses of Pneumovax 23.
They should receive a dose Prevenar 13 ≥50. If they have received Pneumovax 23 in the last 12 months wait until it has been at least 12 months before administering Prevenar 13.
They should then receive an additional dose of Pneumovax 23, 12 months after Prevenar 13 or 5 years after their previous Pneumovax 23, whichever is later.
If they have already received 2 doses of Pneumovax 23 no further doses are required.
Why has Prevenar 13 been added to the schedule for Aboriginal people ≥50 years?
The incidence of IPD among Aboriginal and Torres Strait Islander people is higher than that among non-Indigenous Australians for all age groups. The incidence of IPD has continued to increase in Aboriginal and Torres Strait Islander adults, despite the high coverage of 13vPCV vaccination in infants and children. This is in contrast to the incidence of IPD in non-Indigenous adults, which has decreased. Along with this higher disease burden, 26% of IPD cases in Aboriginal and Torres Strait Islander adults aged ≥50 years are due to 23v-non-13v types. Additional information is available from the Australian Department of Health.
My patient is ≤12 months of age and has been diagnosed with an at risk condition for IPV. What schedule of pneumococcal vaccines should they receive?
They should receive the routine childhood vaccination schedule of Prevenar 13 which is 6 weeks, 4 months and 12 months. They should also receive an additional dose of Prevenar 13 at 6 months (or at diagnosis if they are diagnosed between 6 and 11 months). Allow at least 4 weeks between doses.
Your patient will then require a dose of Pneumovax 23 at 4 years and then another Pneumovax 23 at least 5 years later.
Meningococcal B: Bexsero
What are the changes in relation to Meningococcal B vaccination?
- Now routinely recommended and funded for Aboriginal children on the National Immunisation Program at 6 weeks, 4 months and 12 months of age.
- An additional dose may be required ≥ 6 months for Aboriginal children with asplenia, hyposplenia, complement deficiency, treatment with eculizumab, HIV and haematopoietic stem cell transplant. This additional dose is funded for Aboriginal children ˂ 2 years of age.
- Now funded for all people with asplenia, hyposplenia, complement deficiency and those receiving treatment with eculizumab.
How many doses of meningococcal B vaccine are required?
Aboriginal children should routinely receive a dose of Bexsero at the 6 weeks, 4 and 12 month schedule points. For people with at risk conditions or for catch up, the number of Bexsero doses required depends on the age of the infovidual and the presence of any medical conditions that increase the risk of IMD. See the online Australian Immunisation Handbook for further information.
Are booster doses of Bexsero recommended?
No. Booster doses of meningococcal B vaccine (Bexsero) are not currently recommended.
Is there a catch-up for Bexsero for Aboriginal children?
Yes. Aboriginal children ˂2 years are funded for catch-up of Bexsero until 30 June 2023. The number of doses required is dependent on age at commencement of the for additional information.course and the presence of at risk medical conditions. Refer to the Australian Immunisation Handbook for additional information.
If my patient is an Aboriginal child and they did not complete their Meningococcal B vaccination course before they turned 2 are they still eligible for the additional dose of Bexsero free?
Yes. Provided that they commenced the Bexsero vaccination course before turning 2 years of age they are eligible to complete the course for free under the National Immunisation Program.
Why isn’t Bexsero (meningococcal B vaccine) free for all at risk groups?
The cost-effectiveness of the Bexsero (meningococcal B vaccine) has not been demonstrated in all groups. The incidence of invasive meningococcal disease (IMD) caused by serogroup B is highest in young children compared with other age groups and it is about 4 times higher in Aboriginal and Torres Strait Islander children aged <2 years than in non-Indigenous children.
Meningococcal B vaccines are however available for purchase from the private market for anyone from 6 weeks of age who wants to protect themselves from Meningococcal B.
Is the meningococcal B vaccine included under the Australian Government’s ‘No Jab, No Pay’ and the NSW 'No Jab, No Play' immunisation requirements policy for Aboriginal children?
No, the meningococcal B vaccine is not assessed as part of the eligibility requirements for family assistance payments under the Australian Government’s No Jab, No Pay policy and therefore does not affcet the NSW 'No Jab, No Play' requirements.
What should I do if a parent is concerned about the number of vaccines being administered to their child in one session?
Parents should be reassured that the aim of immunisation is to provide protection against harmful diseases at the very earliest opportunity. Studies have demonstrated that there are no harmful effects from administering multiple vaccines in one session and there is no evidence to support arguments that vaccines may ‘overwhelm’ the child’s immune system.
Is paracetamol recommended before administration of Bexsero?
Yes. Children <2 years of age are recommended to receive prophylactic paracetamol with every dose of Bexsero. This is because of the increased risk of fever, including high fever, after receiving Bexsero. This is an exception to the general recommendation to not routinely give paracetamol at the time of vaccination.
- Give first dose (15 mg/kg/dose) of paracetamol within 30 minutes before, or as soon as practicable after, receiving the vaccine, regardless of whether the child has a fever.
- This can be followed by 2 more doses of paracetamol given 6 hours apart.
Meningococcal ACWY: Nimenrix
What are the changes in relation to meningococcal ACWY vaccination?
People with asplenia, hyposplenia, complement deficiency and treatment with eculizumab are now recommended and funded to receive Nimenrix. Doses are age dependent. See the online Australian Immunisation Handbook for more information.
How many doses of meningococcal ACWY vaccine (Nimenrix) are required?
For people with at risk conditions, the number of Nimenrix doses required depends on the age of the individual and the presence of any medical conditions that increase the risk of IMD. See the online Australian Immunisation Handbook for further information.
Why isn’t Nimenrix (meningococcal ACWY vaccine) free for everyone?
For a few medical conditions that are associated with an increased risk of invasive meningococcal disease e.g. human immunodeficiency virus infection and haematopoietic stem cell transplant, cost-effectiveness thresholds for a nationally-funded population program have not been met to-date. People with these medical conditions are still recommended to receive these vaccines, but are not eligible to receive funded Meningococcal ACWY vaccine.
Is my patient eligible for booster doses?
People with asplenia, hyposplenia, complement deficiency and treatment with Eculizumab who have an ongoing risk of invasive meningococcal disease are recommended and funded to receive booster doses of the meningococcal ACWY vaccine. Refer to the online Australian Immunisation Handbook for further information.
Haemophilus influenzae type b (Hib): Act- HIB
What are the changes in relation to Haemophilus influenzae type b vaccination?
A dose of Haemophilus influenzae type b vaccine (Act-HIB) is now funded for people >5 years of age with asplenia or hyposplenia if they were not vaccinated in childhood or were incompletely vaccinated.
How many doses of Haemophilus influenzae type b vaccine (Act-HIB) are required?
People ˃5 years of age with asplenia or hyposplenia who were not vaccinated in infancy or incompletely vaccinated should receive a single dose of Hib. Booster doses are not required.