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Human Papillomavirus and other immunisation updates Measles

7 cases of infectious measles

Check everyone has had 2 MMR if born after 1966. Human Papillomavirus

HPV is responsible for: • almost all cases of genital and cervical cancer • 90% of anal cancers • 65% of vaginal cancers • 50% of vulvar cancers • 35% of penile cancers • 60% of oropharyngeal cancers (cancers of the back of the throat, including the base of the tongue and tonsils). HPV related cancer by number and type and potential impact of vaccines HPV vaccine-components

• The HPV vaccine (Gardasil 9) vaccine is made from tiny proteins that look like the outside of the real human papillomavirus (HPV). • It also contains Aluminium, Sodium Chloride (salt), water, L-histidine, Polysorbate 80 and Borax, to stimulate the immune system and keep the vaccine stable and suitable for . • The vaccine does not contain any live , or even killed virus or DNA from the virus, so it cannot cause cancer or other HPV-related illnesses. • The vaccine is very effective- 99% Gardasil 9® HPV new vaccine

Licensed for: Gardasil® 9vHPV Serotypes •females aged 9 through 45 years for 6,11,16,18,31,33,45,52,58 the prevention of cervical, vulvar, vaginal and anal cancer, precancerous or dysplastic lesions, genital warts caused by HPV •males 9 through 26 years of age for Serotypes 16,18 Serotypes 6,11 Serotypes 70% cervical cancer 90% genital warts 31,33,45,52,58 the prevention of anal cancer, cases cases 20% cervical cancer precancerous or dysplastic lesions, external genital lesions and infection caused by HPV infection. Gardasil® 4vHPV Serotypes 6,11,16,18 Gardasil®9 vaccine

School program •Offered at age 11-12 years (Year 7)

• 2 dose program at 0,6-12 months for those who receive their dose when 9-14 years.

•Immuno-compromisedǂ people and people 15 years and above will require 3 doses at 0,2,6 months

•catch up program until <20 years

ǂImmuno-compromised conditions include B lymphocyte antibody and T lymphocyte complete and partial deficiencies, HIV infection, malignancy, , autoimmune disease or significant immunosuppressive therapy ( but does not include asplenia or hyposplenia). Impact of HPV vaccine-cervical abnormalities and genital warts

• Reduction in high grade cervical abnormalities in young women

• Reduction in genital warts in all socioeconomic areas

Trends in prevalence rates of high-grade cervical abnormalities in Victorian women, by age group, 2000-2014. Aboriginal females high grade cervical abnormalities 2000-2017 NT 25 vaccine program - women commenced 20

15

10

Rate per Rate 1000 population 5

0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Age Group

<20 years 20-24 25-29 30-34 Non Aboriginal females high grade cervical abnormalities 2000-2017 NT

14

12

10

8

6

4 Rate per Rate 1000 population 2

0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Age Group

<20 years 20-24 25-29 30-34 Impact of the HPV vaccine

However, the incidence of HPV-positive oropharyngeal cancer and anal cancer has been increasing while the incidence of cervical cancer has declined, due mainly to highly effective cervical cancer screening programs.

There are no formal screening programs for the non-cervical cancers, so universal could have an important public health benefit.

For example, researchers estimate that Gardasil 9 could reduce the number of new anal cancers by 90% (9). Who should not have HPV vaccine

People who should not have the HPV vaccine are: • people with a yeast allergy

• pregnant women: however research has shown no significant effect on you or your baby if you have the vaccine and later find out you are pregnant

• people with previous anaphylaxis (serious allergy) to a previous dose of the vaccine or any of the vaccine ingredients. Vaccine safety- HPV vaccine •9vHPV vaccine more likely to have injection site reactions (90.7% vs. 84.9% compared to 4 valent HPV), with the most common events being pain, swelling, , and pruritus. •These side effects show that the vaccine is working •The most common systemic adverse events are headache, pyrexia, nausea, dizziness, and fatigue.

•Reassure as mild and self limited •Anaphylaxis very rare 3 in 1 million

•Chronic and autoimmune diseases are not related to administration of HPV vaccine •Over 200 million doses of the quadrivalent HPV vaccine have been administered worldwide, and there is no scientific or epidemiological evidence to suggest that the vaccine has caused these illnesses. HPV vaccine course completion rate- Aboriginal and non-Aboriginal females and males

Females Males Courses Aboriginal Non Aboriginal Non completed in Aboriginal Aboriginal year

2016 66.6% 81.3% 55.5% 78% What can you do to improve HPV vaccine

• Increase awareness and knowledge about the importance of vaccination- posters /information • Have a recall list for those who have not commenced but are 11-12 years • Recall for those who have not finished the course HPV awareness-video https://www.betterhealth.vic.gov.au/health/healthyliving/human-papillomavirus- hpv-immunisation HPV vaccines to prevent cancer

• 9vHPV is safe and effective vaccine • Important to get high coverage in young people prior to infection • Reassure about safety Australian Immunisation Register

HPV immunisations are included in immunisation history recorded on the Australian Immunisation Register (AIR).

All staff can have access to AIR- CDC need to counter sign applications forms for people who do not have provider numbers

Queensland Health have good resources about how to use Aust Immunisation Register https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/diseases- infection/immunisation/service-providers/instructional-videos-australian- immunisation-register 2019

New cohort: all 6 months and over Aboriginal people

Same vaccines Influenza vaccine 2019 Influenza notifications June -December 2018 Influenza notifications January -December 2018 by serotype

Influenza notification rate by age group and Aboriginal status 2018

2500

2000

1500 Aboriginal non Aboriginal

1000

500

0 Notification rate per 100 000 100 per rate Notification <5 year 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70 years years years years years years years years years years years years years years and over Age group Influenza vaccines for children

• Previously healthy children can be severely ill and suffer from influenza-associated such as and . • Vaccination is the most effective way to prevent flu. The risk of flu is reduced, on average, by 50-60% in children receiving the vaccine. • Childhood flu vaccination programs have been shown to also protect others in the household and the community by 22- 60%. This is called “herd” or “community” . Cold Chain

Data loggers-mandatory Vaccine fridges-mandatory New cold chain monitors- June 2019 Cooler – min/max thermometer rather than cold chain monitors