To: / Primary Care Teams, Health Professionals
From: / Jane Chambers, Acting Manager, Immunisation
Subject: / Coverage update, Influenza, Zoster, HBVaxPro, Whooping Cough, Mumps.
Coverage update from Dr Pat Tuohy
National immunisation coverage at age 8 months was essentially unchanged at 92.2 percent for the quarter ending 31 December compared with the previous quarter, but results remain one percent lower than at the same time last year. There was an increase in Māori infant immunisation rates to 88.7 percent; it is great to see an upward trend but rates are still two percent lower than this time last year.
Influenza Immunisation Programme - funded quadrivalent influenza vaccines for 2018
Two quadrivalent influenza vaccines will be funded for the 2018 influenza immunisation programme:
· Influvac Tetra – for adults and children 3 years and over (available in March)
· Fluarix Tetra – for children under 3 years ie 6 to 35 months (available mid-April). Limited quantities of Fluarix Tetra are available – please reserve this for funded 6 to 35 month olds.
The funded vaccines will protect against the following strains of influenza:
· A(H1N1): an A/Michigan/45/2015 (H1N1)pdm09-like virus
· A(H3N2): an A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus (new)
· B/Phuket/3073/2013-like virus (belonging to B/Yamagata lineage) (new)
· B/Brisbane/60/2008-like virus (belonging to B/Victoria lineage)
A/Singapore/INFIMH-16-0019/2016 is broadly matched to the strain referred to in the media as “Australian flu”, which circulated in the Southern Hemisphere last winter and more recently severely affected the Northern Hemisphere in their current season. Regardless of whether the coming influenza season is severe, moderate or mild, immunisation is the most effective tool available to reduce the impact of the disease.
The introduction of funded quadrivalent vaccines has slightly delayed the production of the usual resources supporting the programme. The Influenza Kit will be available online at www.influenza.org.nz in mid-February. This and other printed resources are expected to be mailed to providers by the end of February.
Influvac Tetra vaccine for adults and children aged 3 years and over is expected to be distributed from March. Please do not plan clinics until your supplies have arrived. The introduction of free zoster vaccination from 1 April 2018 may place pressure on your capacity. In particular, be mindful of your cold chain capacity and vaccine ordering volumes during this time. Immunity may wane earlier with elderly, so vaccinating younger patients earlier and delaying older groups until April is a reasonable strategy and aligns with the introduction of the zoster vaccine. Therefore, during March, you may wish to prioritise eligible patients aged 3 years to under 65 years for influenza vaccination.
During 2017, Māori, Pacific and Asian immunisation rates were notably lower than those of New Zealand Europeans. Please record all influenza vaccinations on the NIR, particularly those aged 65 and older, and pregnant women.
Zoster (shingles) vaccine to be funded
From 1 April 2018, Zostavax will be funded at age 65, with a catch up programme over two years for those aged 66 to 80 years. A fact sheet and resources for patients to support the introduction of free zoster vaccine are being developed. An updated Immunisation Schedule Card will be available from HealthEd from mid-March, as will a new resource “Immunisation for Older People”. Additional zoster vaccine information will be included with your Flu Kit.
Zostavax can be administered on the same day as influenza vaccine from 1 April onwards. As with childhood immunisations, one immunisation benefit will be paid per visit, regardless of the number of vaccines administered.
Adults who have previously purchased a Zostavax are eligible to receive one funded Zostavax. The benefit from receiving a second Zostavax is not known. However, we do not anticipate any increased risk associated with receipt of a second dose. Zostavax is a live, attenuated varicella-zoster vaccine and administration to individuals who are immunosuppressed or immunodeficient may result in disseminated varicella-zoster virus disease, including fatal outcomes. Complete information on the contraindications can be found in the updated Immunisation Handbook (available online by the end of February).
HBvaxPRO 5mcg and 10mcg are out of stock until 2019
Engerix-B 20mcg/1mL temporarily replaces HBvaxPRO 5mcg and 10mcg until HBvaxPRO is available again. Recombivax HB 10mcg, which was distributed towards the end of 2017, is no longer available. HBvaxPRO 40mcg continues to be available for adults aged 18 years or older who are on renal dialysis or who are liver or kidney transplant patients. Funded Engerix-B vaccine is distributed by ProPharma.
Engerix-B can be used in the same manner as HBvaxPro 5mcg and 10mcg. Engerix-B is supplied in a prefilled syringe. There are no concerns about increased vaccine responses following administration of a full 20mcg/mL vaccine dose. Neonates and infants can safely receive the full 1mL intramuscular injection into the vastus lateralis. It is not recommended to decant the contents of the prefilled syringe and administer half or a quarter of the volume.
Based on safety and immunogenicity data supporting the interchangeability of vaccine brands, a two-dose course of Engerix-B 20mcg can be considered for adolescents aged 11-15 years, with the second dose given 4-6 months after the first. As this is off-label use for Engerix-B, the two-dose adolescent schedule needs to be prescribed by a doctor or nurse practitioner with prescribing rights. IMAC have developed a fact sheet on the use of Engerix-B which is available on their website www.immune.org.nz/vaccines/available-vaccines/engerix-b
Pertussis
With whooping cough cases continuing to be reported, please continue to reinforce the importance of maternal immunisation and timely infant immunisation as crucial ways to protect babies and children against whooping cough.
Pertussis tends to develop in three stages. During the first stage symptoms include a runny nose, sneezing, a slight fever, a mild irritating cough and generally feeling unwell. In the second stage, coughing fits (paroxysms) are the main symptom. A paroxysm is a spasm of coughing followed by a big breath in or a high-pitched whoop in children. Babies and adults generally do not have the high-pitched whoop. During the final stage, the cough gradually gets better and will disappear after several weeks.
Mumps cases and the importance of MMR vaccine in teenagers and young adults
Mumps cases continue to be reported across New Zealand, with the majority of cases among young people in the Auckland region. Please continue to help raise public awareness about mumps and remind patients that the best protection is the MMR vaccine.
Adults born in New Zealand before 1969 are considered to be immune to measles. While adults born from 1969 to 1980 are considered to be immune to mumps, two documented doses of MMR vaccine are still recommended to protect against measles. There is a known immunity gap among teenagers and young adults who did not receive both doses as young children – this cohort remains vulnerable to outbreaks of measles, mumps and rubella.
If you have any queries about anything in this update, please email