Coverage Update from Dr Pat Tuohy

Date: 31 July 2017 Pages 1 of 2 : To: Primary Care Teams, Health Professionals From: Rayoni Keith, Manager, Immunisation Subject: Coverage update, Immunisation Schedule Change, Mumps, Influenza.

Coverage update from Dr Pat Tuohy Provisional immunisation coverage at June 30th 2017 has reduced slightly to 92 percent. Timely immunisation of another 471 children was needed to meet the target. The slight drop in coverage in recent quarters has been driven mainly by a reduction in Māori coverage, and increases in both declines and missed children. I expect we will see a rebound next quarter, but it is worth considering whether your administrative systems are running well, in particular to achieve timely newborn enrolment. We know that timely six weeks vaccination is a strong predictor of completing the first year course on-time, so I recommend that you consider early referral to outreach for children whose parents have not engaged with your practice by six weeks and work closely with outreach services to re- integrate these children back into your practice. Keep working with your PHO, local iwi, Public Health Unit and paediatric services to provide reassurance to parents with questions, and showcase effective positive messages about immunisation success in your community, such as NZ Doctor’s recent article about the success of rotavirus vaccine. We are supporting immunisation at a national level through our online channels, where we know parents are seeking information about immunisation. You can repost our YouTube videos through your own online channels – find them at www.youtube.com/user/minhealthnz or www.youtube.com/playlist? list=PLWCaeydAlRF5q62kHyXJa8LtzbqCxqydc

Medtech PMS schedule – transitioning patients to the 2017 Immunisation Schedule Medtech’s transitioning rules for moving patients from the 2014 schedule to the new 2017 schedule have resulted in some conflicting messages about which vaccines patients are eligible for. The rotavirus vaccine is most affected. Any baby started on RotaTeq (rotavirus pentavalent vaccine) must have three doses of rotavirus vaccine, either RotaTeq or Rotarix. Medtech’s release notes did not cover giving RotaTeq vaccine to a six week baby. For specific instructions please refer to the document “Transitioning to the new immunisation schedule July 2017” sent to all PHOs or contact your Immunisation Coordinator. Medtech’s release notes can be found here: www.medtechglobal.com/wp- content/uploads/2017/07/Medtech32-Version-22.9-Build-5424-Release-Notes.pdf You may also wish to contact Medtech directly for clarification – the “Support Chat” tab is on the top right of the menu. Nurses are welcome to use this function too, at no cost to the practice. Varicella catch-up on the new Schedule Children born from 1 April 2016 who present late for their 15-month immunisation are still eligible. A catch up dose of varicella vaccine is funded at age 11 years for previously unvaccinated children who turn 11 years old on or after 1 July 2017 and who have not previously had a varicella infection (as determined by clinical history). In practice this means very few children will be eligible, as most will have been infected with varicella before age 11. There is no need to recall 11 year olds for this vaccine.

Immunisation Schedule Change – transition to new vaccine brands Rotarix, Synflorix, Priorix and Hiberix will begin shipping from mid-August as stocks of the previously funded vaccines run out. Please use up existing stocks before beginning vaccination with the newer vaccines. From mid-August, funded Prevenar 13 doses will only be available to order for high risk patients who meet the eligibility criteria for the vaccine. Please do not stockpile doses of this vaccine. GSK have produced a useful fridge magnet based on the Ministry’s recommendations for transitioning from RV5 (RotaTeq) to RV1 (Rotarix). The recommendations are set out below: Number of previous RotaTeq Number of Rotarix doses required doses 3 RotaTeq Fully immunised – no Rotarix required 2 RotaTeq 1 Rotarix* at least 4 weeks after the 2nd RotaTeq 1 RotaTeq 2 Rotarix* at least 4 weeks between each of the doses *All doses of Rotarix must be given prior to turning age 25 weeks (ie the latest is 24 weeks and 6 days)

Patient information resources have been amended to include information about the new scheduled vaccines. These can be ordered and downloaded at www.healthed.govt.nz.

Varilrix – changes to data sheet The updated Varilrix datasheet is at www.medsafe.govt.nz/profs/datasheet/v/Varilrixinj.pdf. It now states that pregnancy should be avoided for one month rather than the previous advice of three months after vaccination. It also contains additional information on use in immunocompromised patients, and additional efficacy data, including six-year follow-up.

Mumps The Auckland region continues to experience an outbreak of mumps and the Waikato and Wellington regions have also reported cases in recent weeks. The Auckland Regional Public Health Service has moved from attempting to contact trace and follow up all mumps cases to managing it in the community. Their experience is that mumps has established in their secondary schools amongst adolescent populations with low MMR coverage. For more information see www.arphs.govt.nz/managing-the-mumps-outbreak.

Every person born from 1 January 1969 needs to have had two recorded doses of MMR vaccine to be fully protected against measles and mumps – if in doubt, vaccinate, and record it on the NIR. A significant number of those born in the 1970s, 1980s and early 1990s will believe themselves to be fully immunised despite only having had one dose of MMR or measles vaccine. Immunity to mumps can wane over time. Those born in many Pacific countries may not have been immunised against mumps as children. Without improved MMR coverage, the adolescent population will continue to experience future outbreaks of measles, mumps or rubella – the latter becoming more important as they move into peak childbearing age.

Influenza Influenza season has arrived, and reported rates for influenza-like illness are about average for this time of year. It is not yet clear how effective the vaccine is against the circulating influenza strains, however immunisation continues to be recommended as our best available protection against influenza. Influenza vaccine effectiveness is analysed at the end of each season in order to evaluate its protection and inform future vaccine composition. Other respiratory illnesses also circulate during winter that can’t be prevented by vaccination, such as rhinovirus and respiratory syncytial virus. These viruses can also cause severe disease, especially in young children and the elderly, and can be confused with influenza. Please remind patients of ways to prevent the spread of winter illnesses by staying at home if they’re unwell, covering their nose and mouth with a tissue or inner elbow when coughing or sneezing, and washing hands regularly. Recording adult influenza vaccination on the NIR is very important – it helps us track the population’s protection in greater detail than claims data or vaccine distribution. If you have any queries about anything in this update, please email [email protected]