ISSUE 89 — JUNE 2016 Immunisation Handbook 2014 Online HPV Module Our new online module is designed for health professionals who 2nd edition provide advice to parents/caregivers or general public about the The second edition of the online Immunisation Handbook Human Papillomavirus (HPV) Immunisation Programme. 2014 is now available on the Ministry of Health website 2nd edition The module consists of one hour of self-directed study covering: now at http://www.health.govt.nz/publication/immunisation- available handbook-2014-2nd-edn. This update includes corrections, »» HPV viruses and the of and disease additions, and the 2015 PHARMAC eligibility changes. globally. There are no hard copies of the Handbook available. A decision »» Pathogenesis and diagnosis of genital HPV . about printing hard copy Handbooks will be made as part of the 2017 »» Prevention strategies for genital HPV infection. Immunisation Schedule change process. All immunisation providers are advised to refer to the online Handbook. Providers can also download the »» Effective communication of the HPV Immunisation Programme complete Handbook or individual Handbook chapters in PDF format. benefits. A set of brief assessment questions after completion of the study New Zealand influenza Symposium help to consolidate learning. Links to additional material and 2nd November 2016 information provide optional study, in addition to the one hour credited to the module. Save the date and book your flights for this year’s influenza Symposium at the University of Otago in Access the module through our Education and Training webpage Newtown, Wellington. and scroll all the way to the bottom of the page, or click on this HPV Vaccination Module link. Speakers from across the country and around the world will provide us with a stimulating programme that includes the latest science around new Eligibility for pneumococcal — influenza vaccines, the use of antiviral medicines to treat influenza, and influenza pandemics. An update notice PHARMAC have recently confirmed that the only individuals Along with our own local stories and research, we will hear from Dr Paul eligible to receive funded pneumococcal vaccines are those who Van Buynder, a public health physician with the Gold Coast Health Service, meet the criteria specified in the Pharmaceutical Schedule. Queensland, Australia; Associate Professor Aeron C. Hurt, the Deputy Director (Acting) of the WHO Collaborating Centre for Reference and Childhood Immunisation Schedule Research on Influenza, and Head of the Antiviral Susceptibility Analysis Prevenar 13® is funded for all children at the 6 weeks, 3 months, Surveillance Unit and Research group at the Doherty Institute, Melbourne, 5 months and 15 months of age immunisation visits, and for age- Australia; and Dr Richard Pebody (presenting via video), Head (Acting) of appropriate catch-up immunisation for children aged under 5 the Respiratory Diseases Department at Public Health England, and the years. Head of the Influenza and Other Respiratory Virus Surveillance Section at Special groups the National Infections Service in the United Kingdom. The “high risk” conditions listed in the Pharmaceutical Schedule Vaccinator Training Course — Flexible learning eligible are: post-haematopoietic stem cell transplantation; post- chemotherapy; pre- or post-splenectomy; pre- or post-solid organ The aim of this course is to provide participants with the knowledge transplantation; functional asplenia; cochlear implant; acquired or and skills required to provide high quality, safe and effective delivery of inherited complement deficiency, primary immunodeficiency; on vaccines on the National Immunisation Schedule, and to meet the minimum renal dialysis or HIV-positive. requirements when applying to the Medical Officer of Health to become an authorised vaccinator. Children aged under 5 years with a “high risk” condition listed in Table 15.3 in the Immunisation Handbook 2014 are now This course covers the vaccines on the New Zealand National Immunisation only eligible for additional funded pneumococcal if Schedule and consists of: the condition is also listed in the Pharmaceutical Schedule as »» Theory: Self-directed online study. A minimum of 16 hours is required described above. prior to a four hour face to face tutorial. Pneumococcal vaccines for children, adolescents and adults with » Tutorial: Key concepts from the theory will be highlighted during this four » an eligible condition listed above are: hour face to face session. Completion of the self-directed study prior to ® the tutorial is essential. The tutorial complements the knowledge the Prevenar 13 student has gained through the self-directed study, it does not replace »» One dose if aged 18 months to under 18 years and have the self-directed study requirement. previously received four doses of Synflorix®, OR »» Assessment: A take home written assessment, taking a minimum of one »» Up to an additional four doses for (re-)immunisation, the hour, consisting of a combination of multiple choice and short answers. number of doses are determined by age at first presentation for The test is ‘open book’ and a score of 80% or higher is required to pass the (re-)immunisation. course. The flexible learning option is excellent for people who enjoy setting Pneumovax®23 their own learning pace, need flexibility with their schedule, and who are »» Up to two doses if aged 2 years to under 18 years, OR disciplined enough to complete the minimum hours of theory before they attend a short classroom based tutorial. »» Up to three doses if aged 18 years or older, the number of doses are determined by age at first presentation for immunisation. People who prefer to learn in a classroom environment, use discussion to enhance their understanding, or prefer to receive some external guidance Non-funded recommendations as they complete the required theory, will gain more from enrolling in one Doctors may recommend either or both pneumococcal of our Vaccinator Training Course — Two day courses. vaccines for people with a medical condition not listed on the Pharmaceutical Schedule, Information for all our courses is available on our Education and Training but the vaccines will not be webpage. free.

Visit the Immunisation Advisory Centre website at www.immune.org.nz ImmNuZ JUNE 2016 •••from the phones Cold chain Addressing some of the questions we receive on the 0800 IMMUNE phone line Matters … Funding/Eligibility for MMR vaccine Vaccine stock management Everyone born from 1 January 1969 needs to have had two doses We have recently heard of a ‘near miss’ administration of a 2014 of measles, mumps, rubella (MMR) vaccine, given at least a month and several cases of administration of 2015 apart to be protected. The vaccine is free for anyone who needs influenza vaccines. Expired vaccines were being stored in the it: refrigerator with current vaccines. Each vaccinator is responsible for ensuring that the vaccines they • A maximum of two MMR vaccine doses for any patient meeting 1 the following criteria: administer have been correctly stored. Each vaccinator also needs to be sure that their practice: • Primary vaccination in children; or »» Has enough vaccine stock for the population they vaccinate, but • Revaccination following immunosuppression; or »» Isn’t overstocked. • Any individual susceptible to measles, mumps or rubella. ◊ You can order Schedule vaccines twice a month for free, and influenza vaccine is usually delivered within 3 days of ordering. • A maximum of three doses for children who had their first MMR »» Use vaccines with the shortest expiry date first, and dose prior to 12 months. »» Dispose of expired vaccines correctly. Immunisation records Sounds simple, doesn’t it? Who, at your practice, checks the stock Children, adolescents and adults born before 2005 will not have and ensures that expired or discontinued vaccines are returned to immunisation records on the NIR, except MeNZB™, ®, ProPharma for destruction? How often do they do it? ® and more recently influenza and Boostrix vaccines if they To err is human2, but do you want to be the person advising your patient received them. The National Immunisation Register (NIR) was that you gave them an expired vaccine? not rolled out across New Zealand until mid-2005. Prior to this, 3 there was no central register and records would only have been In addition to the five rights of medication administration, please in the person’s Well Child Book and held by the doctor they check that your practice has an effective process in place for vaccine went to as a baby or subsequent doctors if their old notes were stock management so that expired stock is separated from normal transferred to them. stock, clearly marked “vaccines for destruction”, and doesn’t accidently get used. It is appropriate to vaccinate when immunisation records cannot be easily located. Vaccination is a safer option than possibly Right and stock management. leaving a person susceptible to measles whilst they are searching Right vaccine and that it has not expired. for records. Right dose. Right person. Influenza Immunisation Programme end date Right time. The publicly funded Influenza Immunisation Programme ends on Right route. 31 July 2016. References • Funded vaccines eligible for payment must be administered within 1. Ministry of Health. National guidelines for vaccine storage and distribution the subsidised period. 2012 [Internet]. Wellington: Ministry of Health [cited 9 May 2016]. Available from: http://www.health.govt.nz/coldchain. • Funded vaccines eligible for payment need to be submitted within 2. Alexander Pope, An essay on criticism (325). eight months from the date the patient received the influenza 3. Adapted from New Zealand Nurses Organisation. Guidelines for nurses on vaccine. the administration of medicines [Internet]. Wellington: New Zealand Nurses Organisation; 2014 [cited 9 May 2016]. Available from: http://www.nzno.org. Note: The second influenza vaccine dose for eligible children nz/resources/nzno_publications. aged under 9 years must have been given within one month after the end of the subsidised period to be able to be claimed and only M-M-R® II diluent storage when prior approval has been given by your DHB. The data sheet for M-M-R® II advises that the vaccine diluent may be stored “at room temperature”, but does not define what “room temperature” actually is. Thanks to the Immunisation Co-ordinators at Canterbury Immunisation, we can advise that the manufacturer (MSD) consider the acceptable room temperature for storage of M-M-R® II diluent is Subscribe and keep up-to-date up to 25°C. Our ImmNuZ and immunisation updates are emailed Pharmacists regularly monitor room temperature for their medicines directly into the inbox of just over 1400 subscribers. storage areas but general practices do not. Room temperatures of 25 C or higher may occur in some practices, especially during the If you would like to join them, from our ° Subscribe summer months. homepage www.immune.org.nz or use this link http://eepurl.com/w3qQX. If there is any concern that the temperature of the room where your practice’s M-M-R® II diluent is stored may reach 25°C, or higher, Our Well Child/Tamariki Ora newsletter for providers is please store the diluent in the vaccine refrigerator with the lyophilised emailed to subscribers quarterly. Subscribe from our vaccine vials. website www.wellchild.org.nz or use this link Lyophilised vaccine and diluent storage guidelines adapted from the http://eepurl.com/Kp0RP. M-M-R® II data sheet:1 Before reconstitution, store the lyophilised vaccine at 2°C to 8°C. The IMAC hits the waves diluent may be stored in the refrigerator with the lyophilised vaccine or The social media surf is up and we’re starting to make waves! Like separately at room temperature [up to 25°C]. Do not freeze the diluent. us on Facebook or follow us on Twitter and get a great selection of Reference immunisation-related news and vaccine preventable disease stories. 1. Medsafe. Datasheet: M-M-R II [Internet]. Wellington: New Zealand Medicines and Medical Devices Safety Authority; 2015 [cited 9 May 2016]. Contact the editorial team: Available from: http://www.medsafe.govt. Fax: 09 373 7030 nz/profs/Datasheet/m/MMRIIinj.pdf. Facebook: ImmunisationAdvisoryCentre Twitter: immunenz Email: [email protected]

For evidence based information from the Immunisation Advisory Centre visit our website at www.immune.org.nz