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Open Access
Immunisation update

Keeping up with vaccinations. What's new, what's available and who to ask for help

ARCHANA KOIRALA, LUCY DENG, Nicholas Wood
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Despite the efficacy and safety data, influenza vaccine uptake is still not universal, and data from Australian states and territories estimate a minimum of 25%, and up to 60%, of pregnant women may not receive the vaccine.56-58 GPs play a significant role in increasing vaccine uptake as women are more likely to receive the influenza vaccine if recommended by their healthcare provider.59-61

Pneumococcal disease

Pneumococcal disease is an infection caused by the Gram-positive encapsulated bacterium Streptococcus pneumoniae. Invasive pneumococcal disease (IPD) refers to severe infection usually causing sepsis, bacteraemic pneumonia or meningitis. Young children, older people, people of Aboriginal or Torres Strait Islander descent, patients who have or are at risk of cerebrospinal fluid leak or people who are immunocompromised have the highest increased risk of IPD.62 Protection against pneumococcal disease is serotype specific. Two vaccines exist in Australia: a 13-valent pneumococcal conjugate vaccine (13vPCV) and a 23-valent pneumococcal polysaccharide vaccine (23vPPV).4,63 The 13vPCV is funded in the NIP infant vaccination schedule as it induces long-lasting immune responses, even in children under 2 years of age.64 The 23vPPV offers protection, albeit shorter lasting, to more pneumococcal serotypes and is currently recommended for Indigenous people at 50 years of age and non-Indigenous people at 65 years of age.62 This recommendation is likely to change in the next 12 months as the Pharmaceutical Benefits Advisory Committee has proposed, based on cost-effective analysis, that the 13vPCV replace the first dose of 23vPPV for Aboriginal and Torres Strait Islander adults at 50 years of age and for all other healthy adults at 70 years of age.65

Recommendations on the infant pneumococcal immunisation schedule were updated in July 2018. The current recommendation for children with no risk factors is to receive 13vPCV at age 2 months (or 6 weeks), 4 months and a booster at 12 months of age (2+1 schedule) to generate longer lasting immunity and improved herd immunity in children compared with the original 3+0 schedule (2, 4, 6 months of age).4 Children of Indigenous background or with risk factors for IPD are funded through the NIP to receive four doses (3+1) of the 13vPCV at 2, 4, 6 and 12 months of age and 23vPPV at 5 years of age.4 Additional pneumococcal vaccines, as detailed in the Australian Immunisation Handbook, continue to be recommended for adults and children aged 5 years and over, with risk factors for IPD, depending on the severity of risk and history of previous pneumococcal vaccination.4,62 

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The PneumoSmart vaccination tool

The PneumoSmart vaccination tool was developed by the Immunisation Coalition to help immunisation providers correctly provide pneumococcal vaccination for people aged 5 years or over, based on the recommendations from the Australian Immunisation Handbook. The algorithm incorporates a person’s age, Indigenous status, comorbidities and previous pneumococcal vaccinations to develop a table recommending the type of vaccine, intervals between doses and whether the vaccine is funded through the NIP (https://immunisationcoalition.org.au/pvt).66

Q fever

Q fever is a zoonotic disease caused by the intracellular bacterium Coxiella burnetii. Although the disease can be asymptomatic, it can often present with severe flu-like symptoms and be complicated by pneumonia and hepatitis. Some people go on to develop chronic Q fever, which may manifest as endocarditis. Ruminants such as cattle, sheep and goats are the main reservoir for human infection but a wide variety of animals including birds, ticks and marsupials can be infected. The environmental form of C. burnetii is resistant to heat and desiccation. The bacteria can persist for long periods in the environment and be transported long distances by wind and dust. Humans are infected via direct contact with animals or inhalation of contaminated aerosols.67,68

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Early diagnosis and vaccination

Q fever, despite being undernotified, remains a highly vaccine-preventable disease, especially for rural residents. A large serosurvey reported a seropositivity of 3.6% among blood donors in NSW and Queensland, with higher seroprevalence among those living in rural areas. However, 0.9% of urban dwellers with no risk factors also had evidence of exposure.69

People who are at high risk of contracting Q fever and for whom the vaccine is recommeded include those who work on farms, in veterinary practice or in abattoirs, manage or breed animals or handle veterinary specimens. The Q fever vaccine is licensed for use in people from 15 years of age but studies are underway to assess its safety and efficacy in children as young as 10 years of age.70

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Candidates require prevaccination testing with serum antibody and skin testing to ensure there has been no past exposure to C. burnetii and to minimise adverse effects following vaccination.4 Test results can be uploaded onto the Australian Q fever register (https://qfever.org/findvaccinator), and authorised users (usually meat processors and medical practitioners) are able to check a person’s Q fever immune status.71 The register also provides a list of medical practitioners who are experienced in testing and vaccinating against Q fever. 

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Dr Koirala is an Immunisation Fellow at the National Centre for Immunisation Research and Surveillance (NCIRS), Sydney; Paediatric Infectious Diseases Specialist at Nepean Hospital, Kingswood; and Clinical Associate Lecturer at The University of Sydney Children’s Hospital Westmead Clinical School, Sydney. Dr Deng is a Staff Specialist at NCIRS, Sydney; Paediatrician at The Children’s Hospital at Westmead, Sydney; and Clinical Associate Lecturer at The University of Sydney Children’s Hospital Westmead Clinical School, Sydney. Dr Wood is a Senior Staff Specialist at NCIRS, Sydney; Paediatrician at The Children’s Hospital at Westmead, Sydney; and Associate Professor at The University of Sydney Children’s Hospital Westmead Clinical School, Sydney, NSW.