While most of the 1 July changes to the National Immunisation Schedule are vaccine brand changes, the most significant move is the addition of the varicella (chickenpox) vaccine at the 15-month immunisation event. This is a total of four vaccines at the one visit, which requires a little more preparation.
As with any immunisation visit, you need to ensure that the caregiver is informed and prepared. We recommend that caregivers sit their infants sideways across their lap, allowing them to keep their child comforted and still, but allowing you access to the arm and leg on the one side.
Parents may need reassurance that four vaccines in a row is best. At the age of 15 months a child’s immune system copes easily with the four vaccines. The infant is also old enough to associate any discomfort and stress with the visit to the practice, so if the vaccines are split, coming back a week or two later for more will be much worse for them (and everyone else!).
Delaying vaccinations also increases the risk of exposure to disease but, just as importantly, could lead to a negative association with visits to the doctor or nurse. By the time the next set of vaccinations are due at four years of age, a single event at 15 months is much less likely to invoke unhappy memories than two in close succession.
Having a firm plan of injection site location and vaccine order is obviously essential (see below). Starting first with Hib in the thigh (IM in the vastus lateralis), the second injection is varicella in the arm on the same side (SC in the deltoid). The caregiver then turns the child to face the other direction giving access to the other two injection sites. Pneumococcal vaccine is next in the other leg (IM in the vastus lateralis), finishing with MMR in the arm (SC in the deltoid). MMR is likely to cause the most discomfort, which is why it is always best to finish with it.
The Immunisation Advisory Centre has developed a number of resources for health professionals to make the transitions as smooth as possible. Visit their website on immune.org.nz to find out more.
*This article was written by the Immunisation Advisory Centre’s communications manager Theo Brandt.
Preferred order of 15-month immunisations
- HIB intramuscular in first leg (vastus lateralis)
- Varicella subcutaneous in first arm (over deltoid)
- PCV intramuscular in second leg
- MMR subcutaneous in second arm