Immunisation Toolkit for General Practices - August 2020 - Murrumbidgee ...

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Immunisation Toolkit for General Practices - August 2020 - Murrumbidgee ...
Immunisation
Toolkit for General
Practices

                August 2020
NSW Ministry of Health
1 Reserve Road
ST LEONARDS NSW 2065
Tel. (02) 9391 9000
Fax. (02) 9391 9101
TTY. (02) 9391 9900
www.health.nsw.gov.au

Produced by: NSW Ministry of Health

This work is copyright. It may be reproduced in whole
or in part for study or training purposes subject to
the inclusion of an acknowledgement of the source.
It may not be reproduced for commercial usage or sale.
Reproduction for purposes other than those indicated
above requires written permission from the NSW
Ministry of Health.

© NSW Ministry of Health 2020

SHPN (HP NSW) 200177
ISBN 978-1-76081-387-1

Further copies of this document can be downloaded
from the NSW Health website
www.health.nsw.gov.au

August 2020
Contents
What the kit contains                                   4    7    Other vaccines                            27
                                                                   7.1    Q Fever                            27
1   The NSW Immunisation Program                         5        7.2    Yellow Fever                       28
    1.1   Roles and responsibilities                     5
    1.2   Staying up to date                             6   8    Pharmacist Vaccinations                   29
                                                                   8.1    Vaccinations provided by
2   The NSW Immunisation Schedule                        9               pharmacists                        29
    2.1   Recent changes to the
          immunisation schedule                         10   9    NSW Occupational Assessment,
                                                                   Screening & Vaccination Policy
3   Recording Vaccinations                              13        (Health Care Worker Policy)               30
    3.1   The Blue Book                                 13
                                                              10 Vaccine Storage and Cold Chain
    3.2 The Australian Immunisation Register  13
                                                                 Management                                  31

4   Vaccination Programs                                17        10.1 National Vaccine Storage Guidelines
                                                                        ‘Strive for 5’                       31
    4.1   Childhood Vaccines                            17
                                                                   10.2 NSW Health Cold Chain Toolkit        31
    4.2 Adolescent Vaccines                             17
                                                                   10.3 Safe Vaccine Storage Requirements  32
    4.3 Catch-up Program for Individuals
        10–19 years                                     17        10.4 Private Vaccine Scripts              32

    4.4 Catch up vaccines for refugees                             10.5 Managing cold chain breaches         32
        and humanitarian entrants aged
        20 years and over                               18   11   NSW State Vaccine Centre                  34

    4.5 Influenza Vaccination Program                   20        11.1   Applying for a Vaccine Account     34
                                                                   11.2 Routine Vaccine Orders               34
5   Vaccines for Specific Groups                        21        11.3 Authorised Provider Declaration      35
    5.1   Aboriginal and Torres Strait Islander                    11.4 Vaccine Deliveries                   35
          Populations                                   21        11.5 Change of address                    36
    5.2 Asplenic Patients                               22        11.6 Ordering rabies vaccine for post-
    5.3 Preterm Infants                                 22             exposure prophylaxis                 36
    5.4 Women Who Are Planning
        Pregnancy and Pregnant Women                    23   12 Vaccine Safety                              37
    5.5 Individuals with Medical                                   12.1 Talking to patients about vaccine
        Risk Factors and/or                                             safety                               37
        Immunocompromised                               23        12.2 Vaccine safety surveillance          37
    5.6 People at occupational risk                     23        12.3 What is an Adverse Event Following
                                                                        Immunisation (AEFI)?                 38
6   Specific Vaccines                                   24        12.4 How to minimise the risk of an AEFI  39
    6.1   Diphtheria, Tetanus and Pertussis                        12.5 Reporting an AEFI                    39
          Vaccine (DTPa/dTpa)                           24
                                                                   12.6 Specialist Immunisation
    6.2 Pneumococcal vaccine (Prevenar 13                               Services NSW                         39
        and Pneumovax 23)                               24
                                                                   12.7 Vaccination Administration Errors    40
    6.3 Measles, Mumps Rubella (MMR)                    25
                                                                   12.8 Vaccine Safety Resources             40
    6.4 Zoster (shingles) vaccine                       25
    6.5 Hepatitis B                                     26   13 Other resources                             41

NSW Health Immunisation Toolkit for General Practices                                                         3
What the kit contains
This Toolkit has been developed to support      Over 90% of all childhood vaccinations in
general practices to implement the NSW          NSW are given in general practices. Primary
Immunisation Program. The Toolkit includes      health care professionals should take
information about:                              every opportunity to vaccinate children,
                                                adolescents and adults on time and at the
•    the NSW Immunisation Program
                                                recommended intervals to ensure they
•    the NSW Immunisation schedule and          are protected against serious vaccine
     recent changes                             preventable diseases. Health workers
•    reporting to the Australian Immunisation   play a critical role in shaping attitudes
     Register(AIR)                              towards immunisation and maintaining high
                                                vaccination coverage. It is essential that
•    vaccine recommendations
                                                immunisation providers stay up to date with
•    cold chain management                      current issues in immunisation to provide
•    vaccine safety and adverse                 accurate information to patients, and discuss
     event reporting                            the risks and benefits of vaccination during
                                                the consent process.
•    vaccine ordering and management.

4                                                   NSW Health Immunisation Toolkit for General Practices
1       The NSW Immunisation Program
The NSW Immunisation Program provides the community with protection
against vaccine preventable diseases through initiatives targeting
infants, adolescents, adults and at risk persons in line with the National
Immunisation Program.

1.1     Roles and responsibilities

 Organisation/s              Responsibilities

 NSW Ministry                Manages the NSW Immunisation Program, develops strategy and policy
 of Health                   and provides surveillance and analysis of vaccine preventable diseases.
                             Website: www.health.nsw.gov.au/immunisation

 Public Health Units Assists with state and National Immunisation Program (NIP) funded
                     vaccine management queries including breaches in cold chain, adverse
                     events following immunisation, the school-based vaccination program,
                     and requests for immunisation related information and advice.
                             Phone: 1300 066 055
                             Website: www.health.nsw.gov.au/Infectious/Pages/phus.aspx

 National Centre             Provides policy and planning advice, supports initiatives including
 for Immunisation            disease surveillance, vaccine coverage and immunisation adverse
 Research and                events. NCIRS also conducts an extensive program of clinical trials and
 Surveillance                epidemiologic research funded by diverse sources.
 (NCIRS)                     Website: www.ncirs.org.au

 State Vaccine               Stores and distributes vaccines available under the National
 Centre                      Immunisation Program (NIP) to immunisation providers in NSW.
                             Phone: 1300 656 132
                             Website: https://nsw.tollhealthcare.com

 Primary Health              Not for profit organisation funded by the Australian Government that
 Networks (NSW)              provides direct support to general practices and allied health providers
                             in NSW across a range of issues including to support the quality of
                             vaccination services in general practice.
                             If you are not sure which Primary Health Network you belong to:
                             Email: phn@health.gov.au
                             Website: www1.health.gov.au/internet/main/publishing.nsf/Content/
                             phn-maps-nsw

NSW Health Immunisation Toolkit for General Practices                                                  5
1.2   Staying up to date

1.2.1 Key Immunisation Resources

 Resource              Description

 NSW Health            Up to date immunisation information and resources, alerts and advice
 Immunisation          about the NSW Immunisation Program.
 webpage               Website: www.health.nsw.gov.au/immunisation

 The Australian        A comprehensive guide developed by the Australian Technical Advisory
 Immunisation          Group on Immunisation (ATAGI) providing clinical advice for health
 Handbook              professionals on the safest and most effective use of vaccines in their
 (digital version or   practice.
 phone app)            Website: https://immunisationhandbook.health.gov.au
                       Handbook App: The mobile application is known as the Australian
                       Immunisation Handbook App (or the Handbook App for short) and can
                       be downloaded from the Apple App Store or Google Play Store.

 National              Outlines the basic principles for safe and effective vaccine management
 Vaccine Storage       within cold chain (+2°-+8° C).
 Guidelines            Website: www.health.gov.au/resources/publications/national-vaccine-
 ‘Strive for 5’        storage-guidelines-strive-for-5
 (3rd edition)

 NSW Cold Chain        Practical guidance on mandatory vaccine storage and cold chain
 Toolkit               requirements in NSW.
                       Website: www.health.nsw.gov.au/immunisation/Documents/cold-chain-
                       toolkit.pdf

 Save the Date         The Save the Date to Vaccinate app allows parents to stay up to date with
 to Vaccinate—         their child’s vaccinations. Once the app is downloaded, the app will create
 immunisation app      the recommended immunisation schedules, along with reminders for
                       when vaccines are due.
                       Website: www.health.nsw.gov.au/immunisation/app/pages/default.aspx

6                                                        NSW Health Immunisation Toolkit for General Practices
1.2.2 Useful Links

 Resource                    Contact Details

 Australian                  Phone: 1800 653 809
 Immunisation                Website: https://www.servicesaustralia.gov.au/individuals/services/
 Register (AIR)              medicare/australian-immunisation-register

 Better Health               Immunisation resources including the NSW Health cold chain labels
 Centre (for                 can be ordered from the Better Health Centre (BHC) via email. A list
 ordering                    of resources that can be ordered from the BHC can be found at the
 publications)               website below.
                             Phone: (02) 9816 0452
                             Website: www.health.nsw.gov.au/immunisation/Documents/
                             immunisation-order-form.pdf
                             Email: nslhd-bhc@health.nsw.gov.au

 National                    The National Immunisation Catch‑up Calculator (NICC V1.0) developed
 Immunisation                by the Australian Government Department of Health assists in the
 Catch-up                    development of a vaccination catch up schedule when vaccine doses are
 Calculator (NICC)           delayed or missed.
                             Website: https://immunisationhandbook.health.gov.au/catch-up-
                             calculator/calculator

 Document                    Free document translation service from the Department of Home Affairs
 translation                 Phone: 1800 962 100
 Services                    Website: https://translating.homeaffairs.gov.au/en

 National Adverse            All serious AEFI must be reported and any event felt to be significant
 Events Following            following immunisation should be reported to your local public health
 Immunisation                unit using the national AEFI reporting form
 (AEFI) reporting            Website: the form is available at the following link,
 form                        www.health.nsw.gov.au/immunisation/Pages/aefi.aspx

 National Centre             Website: http://ncirs.org.au/measles-vaccination-catch-up-guide
 for Immunisation
 Research and
 Surveillance
 (NCIRS) MMR
 Catch Up Decision
 tool

 NSW Immunisation Website: www.health.nsw.gov.au/immunisation/Publications/nsw-
 Schedule         immunisation-schedule.pdf

NSW Health Immunisation Toolkit for General Practices                                                7
Resource            Contact Details

 NSW Immunisation This service provides specialised immunisation advice to clinician and
 Specialist Service families which includes a 1800 telephone advice service, a drop-in
 (NSWISS)           immunisation clinic at Westmead Children’s Hospital, an immunisation
                    specialist clinic and telehealth consultations.
                     Phone: 1800 679 477

 NSW Vaccine         Phone: 1300 656 132
 Centre              Fax: 1800 041 528
                     Website: https://nsw.tollhealthcare.com

 PHN Immunisation    Website: www.phnimmunise.org.au
 Support Program

 Pneumococcal        Website: www.immunisationcoalition.org.au/resources/pneumococcal-
 Vaccination         vaccination-tool
 Decision Tool

 Sharing             Credible resources for parents and providers about immunisations.
 Knowledge About     Website: www.ncirs.org.au/health-professionals/skai-supporting-
 Immunisation        health-professionals
 (SKAI)

 SKAI Online         Provides information and resources to assist healthcare professionals
 Education Module    in responding to parents/carers concerns and questions about
                     immunisation.
                     Website: www.ncirs.org.au/health-professionals/skai-supporting-
                     health-professionals

 Spleen Australia    Website: https://spleen.org.au/wp-content/uploads/2020/03/
 Vaccine Decision    RECOMMENDATIONS_Spleen_Registry.pdf
 Tool

8                                                     NSW Health Immunisation Toolkit for General Practices
2 The NSW Immunisation Schedule
The National Immunisation Program1 (NIP), underpinned by the National
Immunisation Strategy (2019–2024), 2 is funded by the Australian Government
and implemented by state and territory departments of health. The National
Immunisation Program funds many of the vaccines recommended in childhood
and throughout the life course for medically at risk groups. State and territory
health departments also fund some additional vaccines.

The National Immunisation Program (NIP)                  Other vaccines are also recommended but
Schedule is a series of recommended                      they are not funded through the national,
vaccines by age group and/or medical risk.               state or territory immunisation programs.
The schedule is developed by the Australian              For example, vaccines for people who have
Government Department of Health in                       an occupational risk of a disease, travellers
consultation with the Australian Technical               or people with medical conditions that
Advisory Group on Immunisation (ATAGI).                  put them at increased risk of contracting a
                                                         vaccine preventable disease. These vaccines
The NIP was established in 1997 and
                                                         are available for purchase privately on
provided vaccines against nine childhood
                                                         prescription if required.
diseases. The NIP Schedule now covers 17
diseases for infants, children, young adults,            Immunisation providers should refer to the
vulnerable adults (such as Aboriginal and                Australian Immunisation Handbook4 (digital
Torres Strait Islander people, and pregnant              version or phone app) for comprehensive
women) and older people. Vaccines on the                 information about all vaccines approved for
NIP schedule are made available free of                  use in Australia, including routine vaccination
charge to Australians in those age groups                of infants, young children, adolescents and
and risk groups.                                         older people; vaccination for special-risk
                                                         groups (e.g. Aboriginal and Torres Strait
The NSW Immunisation Schedule3 is a
                                                         Islander people); vaccination for international
schedule of vaccines that are provided
                                                         travelers; and groups with special vaccination
under the National Immunisation Program.
                                                         requirements (e.g. pregnant women, people
Providers in NSW should refer to the NSW
                                                         who are immunocompromised).
Immunisation Schedule to ensure any
additional vaccines funded in NSW are
administered to eligible patients.

NSW Health Immunisation Toolkit for General Practices                                                   9
2.1   Recent changes to the immunisation schedule
Immunisation providers are encouraged to refer to the Australian Immunisation Handbook
(digital version or phone app) for the most up to date vaccine recommendation particularly
for medically at risk groups. For further information refer to the immunisation history tables at
www.ncirs.org.au/health-professionals/history-immunisation-australia

 Vaccine          Group                      When      What’s changed

 Pneumococcal: All ages                      1 July    The list of conditions associated with an
 Prevenar 13                                 2020      increased risk of invasive pneumococcal
 (13vPCV) and                                          disease have been consolidated into
 Pneumovax 23                                          one list i.e. there are no longer category
 (23vPPV)                                              A and category B lists. The list of
                                                       conditions vaccination is recommended
                                                       for is available in the online Australian
                                                       Immunisation Handbook.
                                                       A list of at risk groups that the vaccines
                                                       are funded for is available from the
                                                       Australian Department of Health 5
                                                       webpage.
                                                       The number of lifetime doses of 23vPPV is
                                                       now limited to 2 doses.

                  Children diagnosed        1 July     In addition to the standard childhood
                  with an at risk condition 2020       schedule, children with an at risk condition
                  at ≤ 12 months of age                are recommended to receive additional
                                                       pneumococcal vaccines:
                                                       •   6 Months: an additional dose of
                                                           13vPCV (or at diagnosis if diagnosed
                                                           6–11 months)
                                                       •   4 years: A dose of 23vPPV
                                                       •   At least 5 years later: A dose 23vPPV

                  Children and adults        1 July    People diagnosed with an at risk condition
                  diagnosed with an          2020      are recommended to receive:
                  at risk condition > 12               •   13vPCV: at diagnosis
                  months of age
                                                       •   23vPPV: 2–12 months later or ≥ 4 years
                                                           whichever is later
                                                       •   23vPPV: at least 5 years later

10                                                        NSW Health Immunisation Toolkit for General Practices
Vaccine                Group                            When     What’s changed

                        Aboriginal people aged           1 July   Now recommended and funded
                        ≥ 50 years without an            2020     to receive:
                        at risk condition                         •   A dose of 13vPCV: ≥ 50 years of age
                                                                  •   2-12 months later: a dose of 23vPPV
                                                                  •   At least 5 years later: a dose of 23vPPV
                                                                  If someone has previously received a dose
                                                                  of 23vPPV, wait 12 months before giving
                                                                  13vPCV.
                                                                  Give an additional dose of 23vPPV:
                                                                  12 months after Prevenar 13 or 5 years
                                                                  after the previous dose of 23vPPV—
                                                                  whichever is later.
                                                                  The number of doses of 23vPPV required
                                                                  should be calculated with consideration
                                                                  that 23vPPV is now limited to 2
                                                                  lifetime doses.

                        Non-Aboriginal adults            1 July   Now recommended and funded to receive
                        aged ≥ 70 years                  2020     a single dose of 13vPCV ≥ 70 years of age
                        without an at risk                        (the single dose of 23vPPV at 65 years
                        condition                                 is no longer recommended or funded).
                                                                  This is an ongoing program with no time
                                                                  limited catch up.
                                                                  Those already 70 years of age or older
                                                                  on 1 July 2020 are eligible for a single
                                                                  funded dose of Prevenar 13 which can
                                                                  be given opportunistically at a suitable
                                                                  clinical encounter.
                                                                  If someone has received a 23vPPV in the
                                                                  last 12 months allow 12 months before
                                                                  13vPCV is administered.

NSW Health Immunisation Toolkit for General Practices                                                       11
Vaccine         Group                     When     What’s changed

 Meningococcal   All Aboriginal children   1 July   Recommended and funded to receive
 B: Bexsero      < 2 years of age          2020     three doses of Bexsero at 6 weeks,
                                                    4 months and 12 months of age.
                                                    Catch up is available for Aboriginal
                                                    children less than 2 years of age until
                                                    30 June 2023—The number of doses
                                                    required is based on age. Refer to the
                                                    online Australian Immunisation Handbook.
                                                    An additional dose for Aboriginal
                                                    children < 2 years of age with certain
                                                    at risk conditions may be required.
                                                    These conditions include asplenia and
                                                    hyposplenia, complement deficiency,
                                                    treatment with Eculizumab, HIV and
                                                    Haematopoietic stem cell transplant—see
                                                    online Australian Immunisation handbook.

                 People with specified     1 July   Recommended and funded to receive
                 risk conditions           2020     Bexsero. The number of doses required
                 including:                         are based on age. Refer to the online
                 •   Asplenia and                   Australian Immunisation Handbook.
                     hyposplenia
                 •   Complement
                     deficiency
                 •   Treatment with
                     Eculizumab

 Meningococcal   People with specified     1 July   Recommended and funded to receive
 ACWY:           risk conditions           2020     Nimenrix. The number of doses required
 Nimenrix        including:                         are based on age. Refer to the online
                 •   Asplenia and                   Australian Immunisation Handbook.
                     hyposplenia                    Booster doses are also available for
                 •   Complement                     people with these conditions with
                     deficiency                     ongoing risk.
                 •   Treatment with                 Refer to the online Australian
                     Eculizumab                     Immunisation Handbook for dosing
                                                    requirements.

 Haemophilus     All people > 5 years of   1 July   All people greater than 5 years with
 influenzae      age with asplenia or      2020     asplenia or hyposplenia that were
 type b (Hib):   hyposplenia                        incompletely vaccinated or not vaccinated
 Act-HIB                                            during childhood are recommended and
                                                    funded to receive one dose of Act-HIB.

12                                                   NSW Health Immunisation Toolkit for General Practices
3 Recording Vaccinations

3.1     The Blue Book                                    An eLearning module on using AIR is
                                                         available for vaccination providers at: www.
NSW Health provides the parents of each                  servicesaustralia.gov.au/organisations/
newborn with a Personal Health Record                    health-professionals/services/medicare/
(“The Blue Book”) that includes background               australian-immunisation-register-health-
information on immunisation and a table to               professionals/resources/education-modules
record the vaccinations given to the child.

The Blue Book is a useful reference                      3.2.1 Accessing the AIR
for immunisation providers to confirm
                                                         Medical practitioners, midwives and nurse
that children are up to date with their
                                                         practitioners with a Medicare provider
vaccinations or to arrange a catch-up
                                                         number are automatically recognised as
vaccination schedule, if needed. The person’s
                                                         an immunisation provider and authorised
immunisation history should also be checked
                                                         to record or access immunisation data on
on the Australian Immunisation Register
                                                         the AIR.
(AIR) to ensure all vaccinations have been
provided to AIR.                                         You can find further information on obtaining
                                                         access to AIR at www.servicesaustralia.
Additional copies of The Blue Book are
                                                         gov.au/organisations/health-professionals/
available from the Better Health Centre on
                                                         services/medicare/australian-immunisation-
9887 5450 or nslhd-bhc@health.nsw.gov.au
                                                         register-health-professionals

                                                         Providers must obtain electronic access to
3.2 The Australian                                       AIR to review their patient’s immunisation
    Immunisation Register                                histories, record immunisations given
                                                         overseas and record immunisation
The Australian Immunisation Register                     encounters for immunisations provided
(AIR) is a national register for recording               in Australia.
vaccines given to people of all ages who
live in Australia. The AIR commenced on 1
                                                         3.2.2 Registering Patients on the AIR
January 1996 under its previous name of
Australian Childhood Immunisation Register               People who are enrolled in Medicare are
(ACIR). It was expanded to a whole-of-                   automatically registered on the AIR. People
life register in 2016 and is administered by             who are not eligible to enroll in Medicare are
Services Australia. The AIR provides detailed            registered on the AIR when a recognised
reports on immunisation coverage, overdue                vaccination provider records immunisation
immunisations and personal immunisation                  details for them.
history statements.
                                                         To learn how to record overseas
The AIR can be used as a tool to track                   immunisations on the AIR refer to the
immunisation uptake levels and identify low              following education module www.
coverage areas. The accuracy of the register             servicesaustralia.gov.au/organisations/
is dependent upon immunisation providers                 health-professionals/subjects/air-
reporting data to the AIR in a timely manner.            education-vaccination-providers

NSW Health Immunisation Toolkit for General Practices                                                13
3.2.3 Reporting Immunisation Encounters           2. Use the AIR site to manually record
      to the AIR                                     immunisation encounters by using
                                                     the Identify Individual and Record
AIR relies on immunisation providers to
                                                     Encounter functions.
submit accurate and timely data to monitor
vaccine coverage in Australia and inform              –    Refer to the Australian Immunisation
public health management and research of                   Register (AIR) education resources
vaccine preventable diseases. Patients also                to help you access and record
rely on immunisation providers to report                   information on the AIR at:
accurate and timely data to the AIR to                     www.servicesaustralia.gov.au/
access personal immunisation records, enroll               organisations/health-professionals/
in child care and school and receive family                subjects/air-education-vaccination-
assistance payments on time.                               providers

                                                  The PHN Support Program has developed
                                                  a resource ‘Enhancing data quality of
      Did you know?                               vaccination encounters recorded in practice
                                                  software and on AIR – tips and tricks’ to
      In 2018, the number of influenza
                                                  help immunisation providers minimise and
      vaccine doses recorded in AIR for
                                                  identify errors in vaccination recording to
      people 65 years and over was 44%,
                                                  ensure the information held on patient’s
      lower than the total doses distributed
                                                  records and on the Australian Immunisation
      under the NIP. True adult vaccination
                                                  Register (AIR) is accurate.
      coverage is underreported. Make sure
      you report all vaccination encounters
      to the AIR.                                 3.2.4 AIR History Statements

                                                  An immunisation history statement issued by
                                                  the AIR is required by child care services and
                                                  schools as evidence of immunisation status
There are two ways to record information on       for enrolment under the NSW Public Health
the AIR:                                          Act 2010.

1.    Use your practice management software       Parents can obtain an Immunisation History
      (PMS). The details you enter will be        Statement for children aged less than 14
      transferred from your PMS to the AIR.       years by:
      –   Make sure you are using the latest      •   using their Medicare online account
          version of your PMS so you have             through myGov6
          up to date vaccine codes (contact
                                                  •   using the Medicare Express Plus App7
          your software vendor for further
          information or your primary health      •   by asking their vaccination provider
          network for advice).                        to print it (including non-Medicare
                                                      eligible patients with an immunisation
      –   Ensure you select the correct vaccine
                                                      history in AIR)
          and dose number that has been given
          to the patient.                         •   by calling the AIR General Enquiries Line
                                                      on 1800 653 809
                                                  •   For non‑Medicare eligible patients,
                                                      visiting a Medicare office

14                                                       NSW Health Immunisation Toolkit for General Practices
For privacy reasons, anyone aged over 14                 Please note that children unvaccinated
years can access their own immunisation                  due to parental conscientious objection to
history statement. Parents with children over            vaccination cannot be enrolled in childcare.
14 years, must obtain consent from the child
                                                         More information regarding the requirements
before the Immunisation History Statement
                                                         for enrolment in childcare can be found at
can be released to the parent. Consent must
                                                         www.health.nsw.gov.au/immunisation/
be obtained each time a request for an
                                                         Pages/childcare_qa.aspx
Immunisation History Statement is made.

                                                         3.2.7 Primary and Secondary
3.2.5 AIR Coverage Rates
                                                               School enrolment
Australian Immunisation Register (AIR)
                                                         Since April 2018 immunisation requirements11
coverage rates are provided to the
                                                         for enrolment have been extended to
NSW Ministry of Health quarterly.
                                                         primary and secondary schools and require
The data (by Local Health District)
                                                         that school principals:
are available on the NSW Health website:
www.health.nsw.gov.au/immunisation                       •   request an immunisation history
                                                             statement at enrolment
                                                         •   record each child’s immunisation status in
    Did you know?                                            a register and retain copies of approved
    In 2019, vaccination coverage in NSW                     immunisation certificates for a period of 3
    was higher in Aboriginal children                        years after the child has ceased to attend
    (97.9%) compared to non-Aboriginal                       the school
    children (94.5%) aged 5 years.                       •   provide a copy of a child’s immunisation
                                                             certificate to another school that the
                                                             child has transferred to (upon request)
                                                         •   notify the public health unit if an enrolled
                                                             child has a vaccine preventable disease,
3.2.6 Childcare Enrolment
                                                             or if they reasonably believe that an
All children presenting for enrolment with a                 unimmunised enrolled child has come
childcare provider are required to provide                   into contact with someone who has a
proof of vaccination status on enrolment.                    vaccine preventable disease
Documentation that can be provided by the                •   exclude unimmunised children at risk
parents/carers are:                                          of contracting a disease from attending
                                                             school on the direction of a public
•   AIR Immunisation History Statement8
                                                             health officer.
    demonstrating that they are
    fully immunised
•   AIR Immunisation Medical Exemption
    Form 9 noting that the child has a medical
    reason not to be vaccinated including
    natural immunity
•   AIR Immunisation History Form10
    noting that the child is on a recognised
    catch-up schedule

NSW Health Immunisation Toolkit for General Practices                                                  15
3.2.8 Recording Immunisation Encounters        Vaccination Record Card for Health Care
                                               Workers and Students and a Vaccine
Immunisation encounters will be recorded
                                               Administration Record Card for Adults—
in the patient’s medical record and then
                                               available from the Better Health Centre
the information is transferred to AIR (refer
                                               publications warehouse (refer to Section
to Section 3.2.3 Reporting Immunisation
                                               1.2.2 Useful Links).
Encounters to the AIR).
                                               Parents of children from overseas should
For children the encounter is also recorded
                                               consult their local doctor to have their child’s
in the child’s blue book including vaccine
                                               immunisation status reviewed. The doctor
brand name, batch number, dose number,
                                               can also administer any vaccinations that
date and time of vaccination, site of
                                               are required and transfer the information to
administration, name of the person who
                                               the AIR (refer to Section 3.2.2 Registering
provided the vaccination and the date the
                                               Patients on the AIR).
next vaccination is due.

Health care worker immunisations should
be recorded on AIR and additionally on the
Vaccination Record Card for Health Care
Workers and Students (if requested).

16                                                 NSW Health Immunisation Toolkit for General Practices
4 Vaccination Programs

4.1     Childhood Vaccines                               If the vaccination is not on the AIR contact
                                                         your local public health unit on 1300 066
Childhood vaccines are administered as                   055. The public health unit has a record of
per the schedule of vaccines recommended                 all vaccinations administered in the school
by the NSW Immunisation Schedule.12                      based vaccination program that may still be
                                                         uploading to the AIR.

4.2 Adolescent Vaccines
NSW Health works in partnership with                        TIP
education authorities to offer the vaccines
                                                            Check the AIR before giving any
recommended and funded for adolescents
                                                            vaccines offered in the school based
under the National Immunisation Program
                                                            program to avoid double dosing. If
in a school-based vaccination program.
                                                            it is not on AIR and you suspect the
The program is implemented in two settings:
                                                            dose is missing contact your local
•   in secondary schools,13 students are                    public health unit on 1300 066 055.
    offered diphtheria-tetanus-pertussis (dTpa)
    and human papillomavirus (HPV) in Year 7
    and Meningococcal ACWY in Year 10,
•   In Intensive English Centres,14 where                GPs are encouraged to opportunistically
    catch-up vaccination is offered to                   check the vaccination status of adolescents
    newly-arrived migrants transitioning to              as part of routine clinical practice.
    mainstream schooling, including human                Information on the vaccines offered is
    papillomavirus, hepatitis B, varicella,              available on the NSW Health website at
    polio, diphtheria-tetanus-pertussis,                 www.health.nsw.gov.au/immunisation/
    meningococcal ACWY and measles-                      Pages/schoolvaccination.aspx
    mumps-rubella.

Students who miss vaccine doses in the
school-based vaccination program are                     4.3 Catch-up Program for
offered these vaccines as catch up doses                     Individuals 10–19 years
at subsequent visits or are referred to their
                                                         The National Immunisation Program provides
local doctor if they miss the school cinics.
                                                         free catch-up vaccines for individuals aged
Students who are home schooled or attend
                                                         10 to 19 years. Catch‑up vaccines are free as
distance education should complete their
                                                         long as the catch up schedule is commenced
immunisations with their doctor or other
                                                         before the age of 20 years. The Australian
immunisation provider.
                                                         Government Department of Health has
Records for vaccines given in schools are                prepared a table with detailed information
progressively uploaded to the AIR and                    about the funded vaccines, doses required,
linked to existing childhood records to                  minimum intervals and any additional
provide a complete vaccination history.                  considerations that immunisation providers
Before administering any school based                    should be aware of (refer to Figure 1 on
vaccinations to adolescents presenting to                page 19).
your practice check their AIR record.

NSW Health Immunisation Toolkit for General Practices                                                  17
4.4 Catch up vaccines for refugees and humanitarian entrants aged
    20 years and over
The Australian Government provides free catch-up vaccines for refugees and humanitarian
entrants aged 20 years or over through the National Immunisation Program. Detailed
information is available on the Australian Government Department of Health Vaccination
Provider Factsheet (refugee catch up)​15

Table 1: Nationally funded catch-up vaccines for refugees
and other humanitarian entrants aged 20 years and over

                                  Total doses         Minimal interval
              Antigen                                                                           Notes
                                    needed            between doses

                                                                              People should receive 1 of the doses as
                                                   Between doses 1 and 2:     dTpa-containing vaccine to provide the
                                                   4 weeks                    catch-up dose for pertussis. The course
      Diphtheria, tetanus   3 doses                                           can be completed with dT.
                                                   Between doses 2 and 3:
                                                   4 weeks                    If dT is not available, use dTpa or
                                                                              dTpa-IPV for all 3 primary doses.

                                                                              People ≥10 years of age who did not
                                                                              receive all the pertussis vaccine doses
                                                                              recommended before the age of 10
      Pertussis             1 dose                 Not required               years only need 1 dose to be considered
                                                                              up to date. This is regardless of the
                                                                              number of previous doses they received
                                                                              before the age of 10 years.

                                                   Between doses 1 and 2:
                                                   4 weeks
      Poliomyelitis         3 doses                                           None
                                                   Between doses 2 and 3:
                                                   4 weeks

      Measles, mumps
                            2 doses                4 weeks                    None
      and rubella

                                                   Between doses 1 and 2:
      Hepatitis B                                  1 month                    Minimum interval between dose 1 and
                            3 adult doses
      Aged ≥20 years                               Between doses 2 and 3:     dose 3 is 4 months.
                                                   2 months

                                                                              MMRV is not recommended for use in
      Varicella             2 doses                4 weeks
                                                                              people ≥14 years of age.

Source: Department of Health, National Immunisation Program https://www.health.gov.au/resources/publications/
free-catch-up-vaccines-for-refugees-and-humanitarian-entrants-aged-20-years-and-over-fact-sheet

18                                                               NSW Health Immunisation Toolkit for General Practices
Figure 1—Catch up vaccines for children 10–19 years

Table 1: Nationally funded catch-up vaccines for children aged 10–19 years

                                                                 Minimal interval
        Antigen             Total doses needed                                                                      Notes
                                                                 between doses

                                                             Between doses 1 and 2:   People should receive 1 of the doses as dTpa-containing
  Diphtheria,                                                4 weeks                  vaccine and complete the course with dT. This dose would
                            3 doses                                                   also provide the catch-up dose for pertussis.
  tetanus                                                    Between doses 2 and 3:
                                                             4 weeks                  If dT is not available, use dTpa or dTpa-IPV for all 3 primary doses.

                                                                                      People ≥10 years of age who did not receive all the pertussis
                                                                                      vaccine doses recommended before the age of 10 years only
                                                                                      need 1 dose to be considered up to date. This is regardless of
                                                                                      the number of previous doses they received before the age of
  Pertussis                 1 dose                           Not required             10 years.
                                                                                      A booster dose of pertussis-containing vaccine is routinely
                                                                                      recommended for all adolescents aged 11–13 years. Take this
                                                                                      into account when planning catch-up for pertussis.

                                                             Between doses 1 and 2:
                                                             4 weeks
  Poliomyelitis             3 doses                                                   None
                                                             Between doses 2 and 3:
                                                             4 weeks

  Measles, mumps
                            2 doses                          4 weeks                  None
  and rubella

                                                             Between doses 1 and 2:
                            3 paediatric doses               1 month
  Hepatitis B                                                                         Minimum interval between dose 1 and dose 3 is 4 months.
                            aged 10–19 years                 Between doses 2 and 3:
  Note the age groups                                        2 months
  overlap and this is an
  either/or, not both
                            2 adult doses aged
                                                             4 months                 None
                            11–15 years only

                            1 dose of meningococcal
                            C vaccine aged                   Not required             None
                            10-14 years
  Meningococcal
                            1 dose of meningococcal
                            ACWY vaccine aged                Not required             None
                            15-19 years

                                                                                      Recommended for all non-immune people. People aged
                                                             Between doses 1 and 2:
4.5 Influenza Vaccination Program
Annual seasonal influenza vaccination is            –    other chronic illnesses requiring
recommended for any person aged 6 months                 regular medical follow up or
and over who wishes to reduce the likelihood             hospitalisation in the previous year,
of becoming ill with influenza.                          including diabetes mellitus, chronic
                                                         metabolic diseases, chronic renal
The annual influenza vaccine is available free
                                                         failure, and haemoglobinopathies
of charge under the National Immunisation
Program from April/May each year to:                –    chronic neurological conditions
                                                         that impact on respiratory function,
•     All children aged 6 months to less than            including multiple sclerosis, spinal
      5 years                                            cord injuries, and seizure disorders
•     pregnant women: can be given at any           –    impaired immunity, including HIV,
      stage of pregnancy                                 malignancy and chronic steroid use
•     people aged 65 years and over: should         –    children aged 6 months to 10 years on
      receive the enhanced vaccine specially             long term aspirin therapy.
      formulated to produce a higher immune
      response in this group                     A number of resources are available on the
                                                 NSW Health website—including the Influenza
•     Aboriginal people 6 months and older
                                                 Vaccination Provider Toolkit.16 This kit is
•     Persons who have identified medical        updated each influenza season with advice
      risk conditions:                           to assist immunisation providers to manage
      –   cardiac disease, including cyanotic    roll-out and implementation of their flu
          congenital heart disease, coronary     vaccination program. The toolkit contains
          artery disease and congestive          advice about influenza vaccine composition,
          heart failure                          vaccine ordering and delivery timeframes
                                                 to assist in program planning. Refer to
      –   chronic respiratory conditions,
                                                 www.health.nsw.gov.au/immunisation/
          including suppurative lung disease,
                                                 Publications/flu-provider-toolkit.pdf
          chronic obstructive pulmonary
          disease and severe asthma

20                                                     NSW Health Immunisation Toolkit for General Practices
5 Vaccines for Specific Groups
The Australian Government funds free                     The impacts of these gaps in vaccine uptake
vaccines for a range of specific groups at               and timeliness are seen in notifiable diseases
high risk from vaccine preventable diseases,             data where Aboriginal children have higher
including Aboriginal and Torres Strait                   rates of vaccine preventable conditions
Islander populations, children, adolescents,             such as Haemophilus influenzae type b,
young adults and older Australians in order              invasive meningococcal disease, whooping
to protect the most vulnerable from vaccine              cough, invasive pneumococcal disease and
preventable diseases.                                    rotavirus infection.

                                                         NSW Health has implemented a number of
                                                         strategies to improve immunisation coverage
5.1     Aboriginal and Torres Strait
                                                         for Aboriginal and Torres Strait Islander
        Islander Populations                             people following the introduction of the
Aboriginal and Torres Strait Islander                    NSW Aboriginal Immunisation Health Care
populations have a higher burden of disease              Worker (AIHCW) Program.
overall compared to non-Aboriginal and
                                                         GPs are encouraged to ask all patients ‘‘Are
Torres Strait Islander populations including
                                                         you of Aboriginal or Torres Strait Islander
vaccine preventable diseases. Data from
                                                         origin?’ as part of routine clinical practice
the Australian Immunisation Register
                                                         to ensure they receive appropriate primary
(AIR) indicate that Aboriginal children
                                                         health care services. The RACGP has a range
have historically been vaccinated at lower
                                                         of resources (refer to useful links below) to
rates, and experienced greater delays in
                                                         ensure your practice provides culturally safe
vaccination, than non-Aboriginal children. As
                                                         primary health care.
a result, Aboriginal children are at increased
risk of morbidity and mortality associated               Please refer to the digital version of the
with vaccine preventable diseases.                       Australian Immunisation Handbook17 for
                                                         specific requirements for patients in these
                                                         at-risk groups.

    Did you know?                                        Useful links:
    Due to the success of the AIHCW
                                                         •   RACGP Guidelines: Identification of
    program in NSW, vaccination
                                                             Aboriginal and Torres Strait Islander
    coverage at 5 years of age in 2019 was
                                                             people in Australian general practice
    higher in Aboriginal children (97.9%)
                                                             www.racgp.org.au/FSDEDEV/
    compared to non-Aboriginal children
                                                             media/documents/Faculties/ATSI/
    (94.5% ). Let’s keep working together
                                                             Identification-of-Aboriginal-and-Torres-
    to ensure the gap remains closed.
                                                             Strait-Islander-people-in-Australian-
                                                             general-practice.pdf
                                                         •   RACGP webinar series:
                                                             Providing effective, culturally safe
                                                             primary health care
                                                             www.racgp.org.au/cultural-safety

NSW Health Immunisation Toolkit for General Practices                                                 21
5.2 Asplenic Patients                            5.3 Preterm Infants
Patients who have been identified as being       Preterm (premature) infants (according to
asplenic or who may be scheduled to have         The Australian Immunisation Handbook)
a splenectomy have specific requirements         are those babies born at less than 37 weeks
for vaccination. People with functional or       gestation. Extremely preterm infants are
anatomical asplenia should be up to date         those born at less than 28 weeks gestation.
with all routinely recommended vaccines
                                                 Prematurity can increase the child’s risk
and are also recommended to receive the
                                                 of vaccine-preventable diseases. Infants
following vaccines which are funded under
                                                 identified as preterm should receive vaccines
the National Immunisation Program:
                                                 according to the recommended schedule at
•     Hib vaccine                                their chronological age, without correction
•     influenza vaccine                          for prematurity. Consideration should
•     meningococcal vaccine                      be given to the child’s birth weight, the
•     pneumococcal vaccine                       precise gestational age and the presence
                                                 of any chronic medical condition(s) before
Specific vaccine recommendations                 giving vaccines.
for people with elective or unplanned
asplenia are available in the Australian         Specific requirements for Hepatitis B and
Immunisation Handbook18 (digital version).       pneumococcal vaccine may be necessary.
Spleen Australia19 has also developed            Please refer to the Australian Immunisation
‘medical recommendations for vaccines            Handbook 20 (digital version).
recommended for adults and children with         https://immunisationhandbook.health.gov.
asplenia’ that take into consideration an        au/vaccination-for-special-risk-groups/
individual’s previous vaccination history. The   vaccination-for-preterm-infants
recommendations can be accessed at the
spleen Australia webpage.

Vaccines recommended for people with
asplenia in the Australian Immunisation
Handbook are funded under the National
Immunisation Program.

Useful links:

•     Australian Immunisation Handbook
      https://immunisationhandbook.health.
      gov.au/vaccination-for-special-risk-
      groups/vaccination-for-people-who-are-
      immunocompromised
•     Spleen Australia
      https://spleen.org.au/wp-content/
      uploads/2020/03/RECOMMENDATIONS_
      Spleen_Registry.pdf

22                                                   NSW Health Immunisation Toolkit for General Practices
5.4 Women Who Are                                        5.5 Individuals with Medical
    Planning Pregnancy and                                   Risk Factors and/or
    Pregnant Women                                           Immunocompromised
Women planning pregnancy should have                     Individuals with certain medical conditions
their vaccination needs assessed as part                 and/or immunocompromising conditions that
of any pre-conception health check. In                   place them at increased risk of contracting
particular, consider vaccines for:                       disease or who are more likely to experience
                                                         severe morbidity or mortality may have
•   hepatitis B
                                                         additional immunisation requirements.
•   measles, mumps, rubella
•   varicella                                            Refer to the digital version of the Australian
                                                         Immunisation Handbook for specific advice:
It is also important to ask women of child-              https://immunisationhandbook.health.gov.
bearing age who present for vaccination                  au/vaccination-for-special-risk-groups/
about the possibility of pregnancy as part               vaccination-for-people-at-occupational-risk
of routine pre-vaccination screening. This is
so that they are not given any vaccines that
are not recommended in pregnancy. Advise                 5.6 People at occupational risk
women who receive live vaccines to avoid
pregnancy within 28 days of vaccination.                 Certain occupations place individuals
                                                         at greater risk of exposure to vaccine
Pregnant women are routinely                             preventable diseases. You should consider
recommended to receive free (government                  the work activities, rather than the job title,
funded):                                                 for each person to ensure that they are
                                                         appropriately protected. You should consider
•   influenza vaccine: can be administered at
                                                         the occupational needs of people employed
    any time during pregnancy
                                                         in the following roles:
•   Pertussis-containing vaccine: usually
    given to pregnant women at 28 weeks                  •   Healthcare workers
    but can be given anytime between 20–32               •   People who work in childhood education
    weeks of each pregnancy. The vaccine                     and care
    should be given as early as possible (from           •   Carers
    20 weeks) to women who are identified                •   Emergency and essential
    as being at high risk of preterm birth, or               services workers
    who are unlikely to attend a 28 week visit           •   Laboratory workers
    for any reason.
                                                         •   People who work with animals
Refer to the digital version of the Australian           •   Other people exposed to human tissue,
Immunisation Handbook for specific advice:                   blood, body fluids or sewage
https://immunisationhandbook.health.gov.
au/vaccination-for-special-risk-groups/
vaccination-for-women-who-are-planning-
pregnancy-pregnant-or

NSW Health Immunisation Toolkit for General Practices                                                23
6 Specific Vaccines

6.1   Diphtheria, Tetanus and                     6.2 Pneumococcal
      Pertussis Vaccine (DTPa/                        vaccine (Prevenar 13 and
      dTpa)                                           Pneumovax 23)
The routine schedule for pertussis                Information related to those people with
vaccination is 6 weeks, 4 months, 6 months,       at risk conditions which require additional
18 months and 4 years of age. Booster             pneumococcal vaccinations can be found
doses are offered in Year 7 (12 years of age)     in the Australian Immunisation Handbook
and then at 50 years of age (not funded at        (digital version).
50 years).
                                                  https://immunisationhandbook.health.gov.
Pregnant women are advised to receive a           au/vaccination-for-special-risk-groups
free booster dose of pertussis containing
                                                  A useful pneumococcal vaccination tool
vaccine. This is usually given to pregnant
                                                  is also available on the Immunisation
women at 28 weeks but can be given
                                                  Coalition webpage:
anytime between 20–32 weeks of each
pregnancy. The vaccine should be given as         www.immunisationcoalition.org.au/
early as possible (from 20 weeks) to women        resources/pneumococcal-vaccination-tool
who are identified as being at high risk of
preterm birth, or who are unlikely to attend a    From 1 July 2020 the National Immunisation
28 week visit for any reason.                     Program schedule has been updated to
                                                  reflect changes to pneumococcal vaccine
Pertussis containing vaccine is also              recommendations . For more information
recommended (but not funded) for all              refer to:
people who will care for, or have close
contact with a baby in the first weeks of life.   •   Section 2.1 for a summary of changes
                                                  •   the Australian Immunisation Handbook
For more information and resources refer              (digital or app version) and
to the NSW Health webpage Protect Your
                                                  •   FAQs on the NSW Health webpage.
Newborn From Whooping Cough and
Section 5.4 of the toolkit.

www.health.nsw.gov.au/immunisation/
pages/wc-newborns.aspx

24                                                    NSW Health Immunisation Toolkit for General Practices
6.3 Measles, Mumps                                       6.4 Zoster (shingles) vaccine
    Rubella (MMR)                                        A single dose of zoster (Zostavax®) vaccine
The measles, mumps rubella vaccine (MMR)                 is recommended and funded for adults at
is routinely provided to children at 12 months           70 years of age.
and Measles, Mumps, Rubella and Varicella
                                                         Adults 71–79 years of age are also eligible
(MMRV) at 18 months.
                                                         under a five-year catch up program until
•   Children as young as 6 months of age                 31 October 2021.
    can receive MMR vaccine in certain
    circumstances, including travel to highly            6.4.1 Contraindications
    endemic areas and during outbreaks.
                                                         Zostavax® is contraindicated in people who
    If an infant receives MMR vaccine at
                                                         are immunocompromised. The Australian
6.4.2 Adverse events                             6.5 Hepatitis B
The most common adverse event following          Hepatitis B vaccine is routinely funded for
Zostavax® immunisation are injection             children under the childhood vaccination
site reactions. Serious reactions, such          program at birth, 6 weeks, 4 and 6 months.
as disseminated varicella zoster virus           Post vaccination serology should be
(Oka strain) infection are rare however          performed on babies born to mothers with
patients should be advised of the risk and       a high viral load >200,000IU/ml. It is also
to seek immediate medical attention if           funded by NSW Health for additional groups
they develop:                                    who are at increased risk of contracting
                                                 this disease. A course of the vaccination is
•     Chickenpox-like rash within 3 to 4 weeks
                                                 available for:
      after vaccine administration
•     feeling unwell                             •   Aboriginal people
•     fever                                      •   Household and sexual contacts of acute
                                                     and chronic hepatitis B cases
If a patient presents with these symptoms
                                                 •   Immunosuppressed people
following Zostavax® vaccination,
                                                 •   People with HIV or hepatitis C
disseminated varicella zoster virus (Oka
strain) infection should be considered in the    •   Men who have sex with men
differential diagnosis. Immunisation providers   •   Injecting drug users
should initiate early and appropriate testing,   •   Sex workers
treatment and management.                        •   Clients of sexual health clinics

26                                                    NSW Health Immunisation Toolkit for General Practices
7 Other vaccines

7.1      Q Fever                                         The Australian Q Fever Register holds
                                                         information on the Q Fever immune status
Q fever vaccination is contraindicated in                of individuals, accessible to registered
people who have been previously infected                 organisations (primarily meat processors and
with the Q fever organism. People who                    medical practitioners). The register holds
have previously been infected with Q fever               details of Q Fever vaccination providers in a
are likely to have adverse reactions to the              number of Australian states.
vaccine and should not be vaccinated.
Immunisation providers are responsible for               Further information about the management
conducting appropriate pre-vaccination                   of persons with Q fever and their contacts is
screening to identify patients who may not               available in the Q fever control guidelines or
be aware that they have been previously                  by contacting your local public health unit on
infected with Q fever. Authorised nurse                  1300 066 055.
immunisers are not authorised to administer
                                                         Useful links:
Q Fever vaccine without a doctors order.
                                                         •   Seqirus Q fever facts website—
The manufacturer (Seqirus) and the
                                                             www.qfeverfacts.com.au
Australian College of Rural and Remote
Medicine (ACCRM) both provide online                     •   ACCRM Q fever module—
education on Q fever vaccination and                         https://mycollege.acrrm.org.
skin testing.                                                au/search/find-online-learning/
                                                             details?id=11347&title=Q+Fever+-+Early+
•     Seqirus has developed the                              Diagnosis+and+Vaccination
      www.qfeverfacts.com.au website.
                                                         •   Australian Q Fever Register—
      Health professionals can log in to access
                                                             www.qfever.org
      educational resources. Please contact
      Seqirus Pty Ltd on 1800 008 275 for                •   NSW Health Q fever control guidelines
      log‑in details to access these resources.              www.health.nsw.gov.au/Infectious/
                                                             controlguideline/Pages/qfever.aspx
•     ACRRM has developed an accredited
      ‘Q fever—early diagnosis and
      vaccination’22 education module (worth 2
      CPD points, link below). The module is a
      two hour course that includes advice on
      testing, diagnosis and management of Q
      fever and guidance on vaccination and
      pre-vaccination skin testing. It is available
      for free for ACRRM members. NSW GPs
      can access the course at no cost using
      the code NSWGP18 (places are limited).

NSW Health Immunisation Toolkit for General Practices                                               27
7.2 Yellow Fever
The yellow fever vaccine can only be
administered by accredited providers at an
approved Yellow Fever Vaccination Centre.
Immunisation providers seeking to become
an approved yellow fever vaccination clinic
must complete the Yellow Fever Vaccination
Centre application package23 and contact
their local Public Health Unit on 1300
066 055.

Further information regarding Yellow Fever
vaccination including a list of accredited
yellow fever vaccination centres in NSW
is available on the NSW Health website
www.health.nsw.gov.au/immunisation/
Pages/yellow_fever.aspx

28                                           NSW Health Immunisation Toolkit for General Practices
8 Pharmacist Vaccinations

8.1     Vaccinations provided by                         Appropriately trained pharmacists
                                                         must comply with the NSW Pharmacist
        pharmacists
                                                         Vaccination Standards24 including:
Appropriately trained NSW pharmacists
                                                         •   advising all individuals who are eligible
can provide the following privately funded
                                                             for funded vaccines of their eligibility,
vaccines to the following age ranges:
                                                             and of how to access funded vaccines e.g
•   Influenza—10 years and over                              people over 65 years of age requesting
•   diphtheria, tetanus and pertussis (dTpa)—                influenza vaccine.
    16 years and over                                    •   checking an individual’s vaccination
•   measles, mumps, and rubella (MMR)—                       status on AIR prior to administering a
    16 years and over                                        vaccine and subsequently recording any
                                                             vaccines they administer.
Appropriately trained pharmacists can
administer authorised vaccines in the                    Information regarding pharmacist
following settings:                                      vaccination including the process
                                                         for pharmacists to register as a
•   Retail pharmacy                                      vaccination provider with the AIR can
•   General Practice                                     be found on the NSW Health website
                                                         www.health.nsw.gov.au/immunisation/
•   Aboriginal Medical Services
                                                         Pages/immunisation-providers.aspx
•   Local Council Clinics
•   Private Hospitals
•   Public Hospitals and health services
•   Community Health Centres
•   Aged Care Facilities
•   Staff Occupational Health Clinics

NSW Health Immunisation Toolkit for General Practices                                              29
9 NSW Occupational Assessment,
  Screening & Vaccination Policy
  (Health Care Worker Policy)
NSW Health Policy Directive (PD)                For more information and Frequently
Occupational Assessment Screening and           Asked Questions (FAQs) please visit the
Vaccination against Specified Infectious        NSW Health Immunisation website at
Diseases (PD2020_017), 25 provides a            www.health.nsw.gov.au/immunisation/
framework for the assessment, screening and     Pages/default.aspx and go to the Health
vaccination of health care workers employed     care worker vaccination section
in NSW Health facilities.
                                                A learning module that provides training on
Health care workers, including students, are    the requirements of this policy is available
required to provide evidence of protection      from: https://www.health.nsw.gov.au/
against the specified diseases listed in the    immunisation/OASV/index.html
policy. The Vaccination Record Card for
Health Care Workers and Students can be
used to record these vaccinations in addition
to the AIR history statement and is available
from the Better Health Centre on 9887 5450
or nslhd-bhc@health.nsw.gov.au

30                                                  NSW Health Immunisation Toolkit for General Practices
10 Vaccine Storage and Cold
   Chain Management
Vaccines are sensitive to temperature                    Website: https://www.health.gov.au/
and light and must be stored in their                    resources/collections/national-vaccine-
original cardboard packaging between the                 storage-guidelines-resource-collection
recommended temperature range of +2°C
to +8°C. This section provides an overview
of resources available to support vaccine                10.2 NSW Health Cold
storage and cold chain management and                         Chain Toolkit
outlines mandatory requirements for NSW
immunisation providers. More detailed                    NSW Health has also developed a Cold
information is available in the NSW Cold                 Chain Toolkit for Immunisation Providers
Chain Toolkit for Immunisation Providers                 (link below) and Safe Vaccine Storage
(Refer to Section 10.2)                                  Checklist (link below) to support
                                                         immunisation providers in general practice.
                                                         The Cold Chain Toolkit includes additional
10.1 National Vaccine Storage                            information about vaccine storage and
                                                         cold chain requirements in NSW including
     Guidelines ‘Strive for 5’
                                                         mandatory training requirements and
All immunisation providers should have                   random audits conducted by NSW Health.
access to the updated National Vaccine
Storage Guidelines ‘Strive for 5’ (3rd
edition), 26 released in June 2019. These
guidelines provide best practice guidelines
                                                            COLD CHAIN TOOLKIT   Immunisation Provider Cold Chain Toolkit

for storing vaccines and managing the cold                   FOR IMMUNISATION                Appendix 1: Safe Vaccine Storage Checklist
                                                                                   Remember to follow the principles of safe vaccine storage management to ensure
                                                                                  safe and effective vaccines are given to your patients. Strive for 5°C and report ALL

                                                                PROVIDERS                cold chain breaches to your local public health unit on 1300 066 055.

chain. The guidelines include additional cold                                      Vaccine
                                                                                   refrigerators
                                                                                                           Purpose-built vaccine refrigerators (PBVR) are the
                                                                                                           only suitable option for vaccine storage.
                                                                                  •If your practice does not have a PBVR you will be required to order a new PBVR.

chain resources such as:
                                                                                  •Domestic fridges and bar fridges are not built to store vaccines and must not be used for
                                                                                   vaccine storage.

                                                                                   Vaccine                 Vaccines MUST be stored in their original
                                                                                   Storage                 packaging
                                                                                  •Store vaccines in their original cardboard packaging as they are sensitive to UV light and
                                                                                   temperature fluctuations.
                                                                                  •Vaccines must not touch the sides of the fridge
                                                                                  •Vaccines must not be stored on the floor of the fridge

•   minimum/maximum vaccine refrigerator
                                                                                  •Annual vaccine storage self-audit completed and up to date.

                                                                                   Temperature             Vaccine fridge temperatures MUST be
                                                                                   monitoring              continuously monitored using a data logger

    temperature chart
                                                                                  •Data loggers MUST be set at 5 minute intervals with a report downloaded weekly and when a
                                                                                   potential cold chain breach has been identified.
                                                                                  •Current, minimum and maximum temperatures MUST be manually recorded twice daily,
                                                                                   every day the practice is open. Thermometer to be reset after temperatures are recorded.
                                                                                  •Review temperature of fridge before removing vaccines for administration.

                                                                                   Vaccine                 Rotate stock and discard expired
                                                                                   expiry

•   posters e.g. cold chain breach protocol
                                                                   NSW Health
                                                                                                           vaccines
                                                                                  •Check the vaccine expiry before administering vaccines.
                                                                   JULY 2019
                                                                                  •Regularly review stock and bring vaccines with the shortest dates to the front of the
                                                                                   refrigerator so they are used first.

    and stickers
                                                                                   Staff                   Ensure ALL staff are trained in vaccine
                                                                                   education               management
                                                                                  •Provide regular vaccine management orientation and education training sessions for all staff.
                                                                                  •Ensure one member of staff is responsible for vaccine management and a back up person.
                                                                                  •The NSW Health Vaccine Storage and Cold Chain Management online training module
                                                                                   may be used to train all staff that are responsible for vaccine storage and monitoring,

•   self audit tool
                                                                                   visit
                                                                                   https://nswhealth.seertechsolutions.com.au/public_content/HETICP/HETI/CCMWebv3/s
                                                                                   tory_flash.html.

                                                                                                                                                                               11
                                                                                 July 2019

Copies and additional resources are available
to be downloaded from the Australian                     Useful links:
Government’s Department of Health
                                                         NSW Health Cold Chain Toolkit
webpage. These resources include the
                                                         for Immunisation Providers—
ordering ID required to order hard copies.
                                                         www.health.nsw.gov.au/immunisation/
Hardcopies can be ordered by contacting
                                                         Documents/cold-chain-toolkit.pdf
National Mailing and Marketing by.
                                                         Safe Vaccine Storage Checklist—
•   Email—health@nationalmailing.com.au
                                                         www.health.nsw.gov.au/immunisation/
•   Phone—02 6269 1080                                   Documents/safe-vaccine-storage-checklist.
                                                         pdf

NSW Health Immunisation Toolkit for General Practices                                                                                                                              31
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