In the last outbreak from August 2011 to December 2013 about 11,000 cases were notified; there were three deaths of babies and young children and hundreds needed hospital treatment.
Apart from encouraging the immunisation of pregnant women and babies the Ministry of Health is also promoting the vaccination of health staff – particularly amongst those who regularly work with babies, children and pregnant women – because immunity (whether acquired by natural infection or vaccination) wanes over time.
Dr Nikki Turner, the Director of the Immunisation Advisory Centre (IMAC), said at present the Ministry of Health’s Immunisation Handbook recommends that midwives, doctors and nurses who regularly work with infants to get a pertussis (whooping cough) booster every 10 years, and this is what IMAC recommends.
Immunity wanes – boosters needed
But she said it also recognised that vaccine immunity wanes earlier than 10 years so some people advise shorter booster intervals for those in contact with very high-risk babies or women; for example, those in neonatal units.
“There is no hard and fast rule, but in high-risk contact situations maybe every five years would be our suggestion, but there is no national or international guidance on what would be the appropriate intervals,” said Turner.
She also pointed out that even when immunity is present an individual can still carry and spread pertussis. “So standard hygiene precautions remain important (such as hand hygiene and covering your cough) and staying away from vulnerable people when unwell.”
The Ministry of Health’s director of Public Health Dr Caroline McElnay said the best way to protect babies from whooping cough is for pregnant women to get their free immunisation between 28 and 38 weeks of pregnancy and to take their baby for free immunisations when they’re six weeks, three months and five months old.
She said any siblings should also be up to date with their immunisations – older children receive free boosters at four and 11 years of age. If people are unsure whether they or their children have been immunised, they can talk to their health practitioner, doctor or nurse.
“On time immunisation is vitally important,” says Dr McElnay. “If immunisation is delayed, babies are vulnerable for longer.”
Turner said pregnant woman are advised to get immunised for each pregnancy because the main purpose of vaccinating in pregnancy was to pass on protective antibodies to the newborn infant. “Antibody levels need to be boosted with every pregnancy to ensure the infant gets adequate protection,” she said.
Turner said that a local reaction (e.g. a sore arm) can be experienced after the vaccine; this is more likely to occur after receiving more doses of toxoid vaccine. Hence, the usual advice is to have the pertussis vaccine 10-yearly unless the health professional or other person was likely to be in contact with high-risk infants, who are at greatest risk of severe pertussis, or was a pregnant woman.
For more information on whooping cough, including videos and interviews with parents whose babies have caught whooping cough, click here.
]]>Pharmac announced last week that it will fully fund the shingles vaccine Zostavax for 65-year-olds from April 1 next year and also fund a catch-up programme for people aged 66-80 years until March 2020.
It is envisaged that people will receive their Zostavax vaccine the same time they receive their annual influenza vaccine but it will only be available at general practices and not pharmacies at this point.
Pharmac said some concerns were raised during the consultation process about the extra workload the shingles vaccine could bring in an already busy time for general practice, but it believed the net overall impact would be positive as it would reduce the incidence of shingles and the more serious complications that can arise for older adults.
Pharmac director of operations, Sarah Fitt, said the vaccine would make a big difference to the one in three New Zealanders who would have at least one attack of shingles in their lifetime.
“Shingles can occur in people at any age but older people are the most affected and complications can be more serious and require admission to hospital,” Fitt said.
“While most cases of shingles can be managed at home, these attacks can sometimes lead to other serious health complications. Some people may continue to experience pain for months to years after an initial shingles attack.”
Shingles is caused by the same virus as chickenpox, varicella-zoster. Anyone who has had chickenpox is at risk of developing shingles later in life, although the most significant risk factor for developing shingles is age.
During the consultation some respondents had called for the vaccine to be available for people younger and older than the selected 65-80 years age range. Pharmac said its Pharmacology and Therapeutics Advisory Committee considered the costs and benefits of different age bands and opted for age 65, plus catch-up vaccinations to the age of 80 years, as the clinical evidence showed that vaccine efficacy dropped to 18 per cent in people aged over 80 years at time of vaccination. In addition, the vaccine’s efficacy waned over time and if people were vaccinated when younger than 65 they might not remain protected when they were older when the incidence of the herpes zoster virus was higher and the risk of complications also higher.
Fitt said the shingles vaccine would help to reduce the number of serious cases, and provide many flow-on benefits to families and whānau, as well as the wider health system.
Zostavax will be available from general practices from 1 April 2018.
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The World Health Organization (WHO) has just verified that New Zealand has successfully eliminated endemic measles and rubella for the first time.
This means no measles or rubella cases have originated here for the past three years, the Ministry of Health’s director of public health Dr Caroline McElnay said.
The MMR vaccine protects against measles, mumps and rubella, all which can be serious in young adults. Measles is extremely contagious and more than 95 per cent of people need to be fully vaccinated to prevent sustained outbreaks, McElnay said.
“About 90 percent of young children have received both doses of MMR by age five in New Zealand, but only about 80 percent of teenagers and young adults have had both doses, which leaves them at risk.
“In New Zealand, people aged 12 to 32 years have lower vaccination rates than young children so are less likely to be protected against these diseases. That’s why teens and young adults have been most affected in the recent mumps outbreaks.”
Professor of public health at the University of Otago Michael Baker said it was the culmination of decades of work to achieve high coverage of vaccinations.
“It’s just a great success story for New Zealand… In the end it means a high level of safety and protection for our children.”
Baker explained that the term “elimination” did not mean that no one would ever get a case of the measles, but that there had been no occurrences of a transmission of measles lasting more than 12 months in the last three years and no case of congenital rubella in 20 years.
“It essentially fizzles out. That means you don’t get a sustained epidemic.”
]]>This winter was the second in three years in which the DHB required unvaccinated frontline staff to wear masks when caring for patients during the declared flu season (low influenza rates last year meant a flu season was never declared).
This winter the DHB also asked for visitors who hadn’t had the season’s flu vaccine to wear masks when with patients from July 3 until September 19, when the Medical Officer of Health Dr Felicity Dumble declared the flu season officially over.
The NZNO at the start of the flu season expressed ‘significant concerns’ about the DHB’s ‘vaccinate or mask’ policy, particularly because of the suspension of two unvaccinated nurses who declined to wear masks in the first winter the policy was in force.
Director of nursing Sue Hayward told Nursing Review that no issues involving staff unable to wear masks when working clinically had been brought to her attention this winter.
In late June, 71 per cent of nurses had had the seasonal flu vaccine but Hayward said by the end of the flu season 81.6 per cent of nurses had taken up the option of vaccination, which was slightly higher than the 80 per cent who had received the vaccine by the end of winter last year.
]]>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.