Immunisation Update May 2018

133 Molesworth St P.O Box 5013 Wellington Date:

25 May 2018

Pages: 1 of 2

To:

Primary Care Teams, Health Professionals

From:

Jane Chambers, Acting Manager, Immunisation

Subject:

Gardasil 9 supplies, Shingles vaccine, Rotavirus intussusception, Influenza surveillance, Outbreaks.

Gardasil 9 supplies postponed to General Practices PHARMAC advises that there will be limited supply of Gardasil 9 (HPV) vaccine until September 2018, due to ongoing global supply constraints. Until the release of new stock in September, distribution of the remaining stock will be limited to school based programmes and, via hospitals, the high risk groups identified in the National Immunisation Schedule criteria – that is, people aged 9 to 26 inclusive with HIV infection, transplant patients (including stem cells) or post chemotherapy.

These patients will generally be under the care of DHB hospital specialist services so will access the vaccine via a DHB Hospital. Hospital-based vaccinators ordering for high risk patients will need an order code, which can be obtained from PHARMAC (contact details below).

General Practices and other vaccinators will not be able to order stock. Please refer any high risk patients to the specialist services caring for those patients to arrange vaccination.

Vaccinators with patients who need to complete their final (second or third) vaccination in accordance with the recommended vaccination administration period should delay these doses until September – December 2018. Clinical advice received by PHARMAC is that delaying the second and third vaccination doses by several months will not impact the efficacy of the vaccine.

Vaccinators who have patients currently aged 26 can delay their first dose of the vaccine due to the shortage and submit a manual claim for the administration of their vaccine when new stock is available. The final date for such manual claims will be advised in future communication once normal supply has resumed. If you have any questions regarding Gardasil 9 vaccine supply please contact PHARMAC on 0800 660 050 or email enquiry@pharmac.govt.nz.

Shingles vaccine PHARMAC advise that a brief shortage of Zostavax shingles vaccine stock is expected in late May until early June. This follows the uptake of the vaccine exceeding expectations and forecasts. New supply is on track for delivery into New Zealand in early June. We apologise for any inconvenience that this brief shortage may cause.

Practices needing to manage Zostavax stocks during this time may wish to prioritise patients aged 80 before they age out of the eligibility criteria. This would also be an appropriate way to manage any workload pressures arising from demand for influenza and shingles vaccine - we recognise these pressures can be significant during April and May. Influenza is our priority this time of year, as a seasonal illness with a short space of time in which to provide annual immunisation, whereas the risk of shingles is constant throughout the year, and patients aged 66 to 80 will have until 31 March 2020, or until they age out, to be vaccinated.

The 0800 IMMUNE line has received queries about inappropriately administered zoster vaccine.

These include administration to immunocompromised patients, patients outside of the recommended or funded age range, and intramuscular administration rather than subcutaneous.

Please report any vaccine administration errors to CARM at carmnz@otago.ac.nz or 08004Monitor (0800 466 678). The Immunisation Advisory Centre has produced further resources for health professionals and patients to assist with shingles pre-vaccination screening, available from their website at www.immune.org.nz/node/548/

Rotavirus intussusception A case of intussusception in a three month old baby following his first dose of rotavirus vaccination has been reported on social and mainstream media. While intussusception is rare, it needs urgent treatment in hospital, and the Ministry would like to remind vaccinators to discuss the risks and benefits of vaccines with parents. Parents may have additional concerns about the vaccine in light of this discussion, but can be reassured that the risk of serious illness following rotavirus infection is far higher than the risk of harm from vaccination. The number of children needing hospital treatment for rotavirus each year has fallen by hundreds since the vaccine was introduced, compared with a predicted three additional cases of intussusception per year.

IMAC has updated their website with additional information about intussusception at www.immune.org.nz/sites/default/files/Rotavirus%20update%20May%202018.pdf Influenza surveillance New Zealand has joined the Flutracking initiative – a voluntary participatory online system developed in Australia in 2006 to monitor flu-like symptoms in the community. Flutracking will provide a more complete picture of influenza-like illness in New Zealand, identifying influenza trends and hotspots around the country. The more people who sign up, the more useful it will be, so we would like to invite readers to sign up at www.flutracking.net/join, and to share information about Flutracking with their networks.

Flutracking uses a brief weekly survey by email to find out whether participants have had a cough or a fever in the past week and whether they’ve had the annual influenza vaccine. All information provided is kept confidential and only aggregated data (by regions) will be published in the weekly reports.

Outbreaks Meningococcal disease Since 2014 there has been a gradual increase in meningococcal disease cases in New Zealand.

There have been 30 cases of meningococcal disease up to 4 May in 2018, compared with 18 in the same period last year. The increase this year has been due largely to Meningococcal W cases.

The Meningococcal W sequence type is the same as that circulating in Australia and the UK. International studies of cases caused by this sequence type have reported more severe clinical illness and an increased rate of atypical, including gastrointestinal, presentations, potentially leading to delayed diagnoses.

The increasing trend and change in sequence type, coupled with the known capacity for Meningococcal W to cause severe disease, present atypically and cause outbreaks, requires that clinicians remain alert to ensure early diagnosis. Two meningococcal vaccines, Menactra and Nimenrix, are available in New Zealand and protect against the W strain, however they are not publicly funded for most people – see the Immunisation Handbook for details.

Measles and mumps

Mumps cases continue to be reported across New Zealand and over the past month, there have also been measles cases reported in Canterbury, the Southern District Health Board region, Nelson-Marlborough, Hamilton and Auckland. Please continue to check your patient’s immunisation records and encourage those who do not have easily accessible clear records of two MMRs to be vaccinated. Those born from 1 January 1969 are eligible for free MMR vaccinations.

The MMR vaccine can be given at the same time as other vaccines. There are no safety concerns with giving extra MMR when vaccination history is unclear.

Pertussis While we continue to be in the middle of a large pertussis outbreak, please continue to reinforce the importance of maternal immunisation and timely infant immunisation as crucial ways to protect babies and children against whooping cough.

If you have any queries about anything in this update, please email immunisation@moh.govt.nz