Immunisation Handbook 2006

Immunisation Handbook 2006
Date of publication: April 2006

ISBN 0-478-29925-7 (book)
ISBN 0-478-29926-5 (web)
HP 4224

Citation: Ministry of Health. 2006. Immunisation Handbook 2006. Wellington: Ministry of Health.

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Summary

Immunisation is a highly effective strategy for the prevention of infectious disease throughout life. The results of the 2005 National Coverage Survey (as summarised in the Introduction) have shown we have made progress in improving immunisation coverage in New Zealand since the previous survey in 1991. The implementation of the National Immunisation Register and the Meningococcal B Immunisation Programme have focused health professionals and the public on the beneﬁts of immunisation. We will be able to build on these successes to use the National Immunisation Register to improve immunisation coverage so that children whose parents wish to immunise their children receive their age appropriate immunisations.

The Immunisation Handbook 2006 provides information for health professionals on vaccine preventable diseases, the vaccines available, and the updated National Immunisation Schedule, as well as practical advice and strategies for health professionals immunising children and adults in New Zealand. A new chapter identiﬁes new vaccines likely to be available in New Zealand during the time this edition of the handbook is current.

The 2006 National Immunisation Schedule introduces a pertussis containing vaccine to be offered at the age of 11 years to protect adolescents and young adults against pertussis. This new vaccine provides an opportunity to decrease the impact of pertussis in young people and reduce the size of pertussis epidemics. The meningococcal B vaccine will continue to be offered to infants and children under the age of ﬁve years until it is no longer necessary to control the disease.

I would like to thank the members of the Immunisation Technical Working Group who have contributed to rewriting the Immunisation Handbook 2006, and to thank all those who acted as peer reviewers. I trust this edition, like its predecessors, will prove a valuable resource for health professionals.

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This publication is also available in hard copy. You can order a copy by emailing moh@wickliffe.co.nz or calling 04 496 2277 quoting HP number 4224. Please let us know your name, both your physical and postal address and how many copies you would like.

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Contents
Immunisation Handbook 2006 - Contents (PDF, 484 kB)

Introduction
Immunisation Handbook 2006 - Introduction (PDF, 102 kB)

The new National Immunisation Schedule (Schedule) will commence on 1 February 2006. This edition of the Handbook provides information on the new Schedule, vaccines available and the epidemiology of the vaccine preventable diseases in New Zealand.

To assist immunisation coverage and disease prevention in New Zealand the Schedule will be reviewed every two years and may change as new, safer and more effective vaccines and combinations become available.

Key points
Immunisation Handbook 2006 - Key points (PDF, 159 kB)

or read Key Points online

Following are the key points from each of the chapters that focus on a particular disease (chapters 3–17). See page xvi for an explanation of the abbreviations. For catch up schedules for unimmunised or partially immunised children see Appendix 2.

General Considerations
Immunisation Handbook 2006 - General Considerations (PDF, 192 kB)

Chapter 2 - Processes for Safe Immunisation
Immunisation Handbook 2006 - Processes for Safe Immunisation (PDF, 585 kB)

Chapter 3 - Hepatitis B
Immunisation Handbook 2006 - Hepatitis B (PDF, 328 kB)

Hippocrates described episodes of jaundice, likely to have been viral hepatitis caused by various viruses. In 1883 hepatitis transmitted through blood or blood products was ﬁrst documented in Germany during a smallpox immunisation campaign. McCallum proposed the term hepatitis B for ‘serum’ hepatitis in 1947. The Australia antigen, now called the hepatitis B surface antigen (HBsAg), was ﬁrst identiﬁed in 1967 and is the basis of the vaccine.

Chapter 4 - Diphtheria
Immunisation Handbook 2006 - Diphtheria (PDF, 101 kB)

Diphtheria has been known since ancient times, although in the pre-microbiological age it was not clearly distinguished from streptococcal infections. The ﬁrst accurate description of the disease was by Bretonneau in 1826. Epidemics of diphtheria occurred in France, Norway and Denmark during the early part of the 19th century. In 1858 there was a sudden widespread appearance of severe diphtheria, and within a year it had spread all over the world, including New Zealand. Very young children were most at risk, with few cases being reported in individuals over 10 years of age. Klebs described the morphological appearance of the organism in a diphtheritic membrane in 1883, and a year later Loefﬂer isolated the organism.

Chapter 5 - Tetanus
Immunisation Handbook 2006 - Tetanus (PDF, 85 kB)

Tetanus has long been known as the scourge of parturient women, newborn babies and wounded soldiers. In the 18th century one out of every six infants born at the Rotunda Hospital in Dublin died from neonatal tetanus. Hippocrates described tetanus, but the cause was not recognised until 1884 and the toxin not puriﬁed until 1890. The toxoid (chemically inactivated toxin) was ﬁrst prepared in 1924.

Chapter 6 - Pertussis (Whooping Cough)
Immunisation Handbook 2006 - Pertussis (Whooping Cough) (PDF, 156 kB)

Descriptions of pertussis appeared relatively recently (in the 16th century) in comparison with other common infectious illnesses, such as mumps and measles. As the disease became widely known it was given different names. The Italians spoke of the ‘dog bark’, while in England it became known as the ‘chin cough’ or ‘kin cough’, later to be called whooping cough. The Chinese called it the ‘100 day cough’ because of the protracted course of the disease. Thomas Sydenham ﬁrst used the term ‘infantum pertussis’ in 1670, ‘pertussis’ meaning a violent cough of any kind.

Chapter 7 - Haemophilus inﬂuenzae type b (Hib)
Immunisation Handbook 2006 - Haemophilus inﬂuenzae type b (Hib) (PDF, 96 kB)

Haemophilus inﬂuenzae, ﬁrst described by Pfeiffer in 1889, is a gram negative coccobacillus, which occurs in encapsulated (typeable) and non-encapsulated (untypeable) forms. There are six antigenically distinct capsular types (a–f), type b being the most important.

Chapter 8 - Poliomyelitis
Immunisation Handbook 2006 - Poliomyelitis (PDF, 87 kB)

Although a 3500-year-old Egyptian stele depicts a man with the characteristic features of poliomyelitis (polio), the ﬁrst written description of polio as a distinct disease was by Michael Underwood in 1789. The epidemiology of polio changed from endemic to periodic epidemics, starting in Sweden and Norway in the late 19th century and then affecting other industrialised countries. These changes were presumably due to improvements in hygiene increasing the average age of infection, which is more likely to be symptomatic in older children and adults.

Chapter 9 - Measles
Immunisation Handbook 2006 - Measles (PDF, 133 kB)

The earliest written description of measles is classically attributed to the Persian born physician Abu Becr (Rhazes) in the 10th century. Rhazes was the ﬁrst to differentiate measles from smallpox and considered the former to be more dreaded. Although he recognised both the cyclical and seasonal nature of the disease, it was not until the 17th century that Thomas Sydenham of London identiﬁed the infectious nature of measles. The studies of Peter Panum in the Faroe Islands in 1846 showed that the disease was acquired solely by direct transmission. Outbreaks of measles occurred for the ﬁrst time in the South Paciﬁc during the mid- and late 19th century, with devastating results among the Fijians and New Zealand Maori. In 1954 Enders and Peebles in the United States (US) reported the ﬁrst successful isolation and propagation of the measles virus in human and monkey kidney cells. This led to the production of a live attenuated measles vaccine, which was ﬁrst licensed for use in the US in 1963.

Chapter 10 - Mumps
Immunisation Handbook 2006 - Mumps (PDF, 56 kB)

Mumps has been recognised as an acute disease since antiquity. In the ﬁfth century BC Hippocrates described mumps as an illness accompanied by swelling of the ear and painful enlargement of the testes, either unilaterally or bilaterally. The infectious nature of the disease was recognised in the 19th century. By the early 20th century it was noted that mumps was particularly likely to occur in institutions and the armed forces. Large outbreaks occurred among the United States (US) armed forces in France during the First World War. In 1934 Johnson and Goodpasture demonstrated that a virus in human saliva could transmit the disease. The ﬁrst safe and immunogenic attenuated mumps virus vaccine became available in 1967.

Chapter 11 - Rubella
Immunisation Handbook 2006 - Rubella (PDF, 80 kB)

Rubella has probably afﬂicted humans for centuries, but its often mild symptoms and the similarity of its rash to many other infections prevented recognition of the disease as a separate entity until the late 18th century. George Maton gave a clear description of the disease in 1814. Henry Veale named the illness ‘rubella’ half a century after he observed an outbreak in India. The viral nature of the infection was demonstrated by Hess in 1914 and conﬁrmed by Hiro and Tasaka in 1938, when they inoculated children with the ﬁltered nasal washings of infectious cases. In 1941 Gregg published his classic account of Congenital Cataract Following German Measles in the Mother. The virus was not isolated in tissue culture until 20 years later in 1962. The ﬁrst effective live attenuated virus vaccine, based on the Cendehill strain, was released for use in 1969 following a major outbreak of rubella, starting in Europe in 1962/63 and spreading to the United States (US) in 1964/65, with many cases of the congenital rubella syndrome. A triple vaccine containing attenuated measles, mumps and rubella viruses has been in use in the US since the early 1970s. The RA27/3 strain has been used since 1979 because of its superior immunogenicity and lower rate of reactions.

Chapter 12 - Tuberculosis
Immunisation Handbook 2006 - Tuberculosis (PDF, 104 kB)

The history of tuberculosis (TB) in New Zealand has been well documented. The present control programme took shape with the introduction of the Tuberculosis Act 1948. Under this Act the medical ofﬁcer of health is given wide powers to investigate and control all TB cases and their contacts, while district health boards are required to make provision for the treatment and supervision of patients and their contacts. The TB control programme, including some aspects of Bacille Calmette-Guérin (BCG) immunisation, are outlined in the Ministry of Health publication Guidelines for Tuberculosis Control in New Zealand, 2003. The local medical ofﬁcer of health can advise on local TB control programmes, including BCG immunisation. Under the Tuberculosis Regulations 1951, BCG immunisation in New Zealand may legally be performed only by gazetted BCG vaccinators. A detailed technical description for the administration of the BCG vaccine is provided in the Ministry of Health publication Technical Guidelines for Tuberculin Testing and BCG Vaccination, 1996.

Chapter 13 - Inﬂuenza
Immunisation Handbook 2006 - Inﬂuenza (PDF, 196 kB)

Inﬂuenza continues to be a major threat to public health world wide because of its ability to spread rapidly through populations. Epidemics of inﬂuenza typically occur during the winter months in New Zealand, affecting all age groups. The greatest burden is among children, but people at increased risk of complications and death from inﬂuenza are those 65 years of age or older, and those aged under 65 who have certain medical conditions. Inﬂuenza viruses can also cause pandemics, during which the rates of illness and mortality can rise dramatically.

Inﬂuenza vaccination is the primary method for preventing inﬂuenza and its severe complications.

Chapter 14 - Hepatitis A
Immunisation Handbook 2006 - Hepatitis A (PDF, 83 kB)

Hepatitis A virus (HAV) is an RNA virus belonging to the Picornavirus group. Denhart and his colleagues ﬁrst demonstrated the viral nature of the disease in the 1960s when they transmitted the infection to marmosets. Subsequently, HAV was adapted to grow in a clonal line of fetal rhesus monkey kidney cells, a development that opened the way for the preparation of vaccine strains.

Chapter 15 - Meningococcal Invasive Disease
Immunisation Handbook 2006 - Meningococcal Invasive Disease (PDF, 172 kB)

Meningococcal disease is caused by Neisseria meningitidis, a gram-negative intracellular diplococcus typically seen within leucocytes. It causes both endemic and epidemic disease. The ﬁrst epidemic was probably reported by Willin in 1661, but Weiselbaum did not identify the organism until 1887. Vieusseux published the ﬁrst deﬁnitive description of meningococcal meningitis in 1905.

At least 13 serogroups of meningococci can be differentiated based on the chemical and immunological properties of the capsular polysaccharides. Most human disease is caused by serogroups A, B, C, W135 and Y, and these strains are responsible for nearly all outbreaks of disease. Meningococci can be further subdivided on the basis of the class 2 or 3 outer membrane protein (serotype) and class 1 outer membrane protein subtype and lipopolysaccharide (immunotype). Standard nomenclature lists serogroup, serotype, serosubtype and immunotype (eg, B:4:P1.7-2,4). Meningococci have the capacity to exchange genes and switch serogroups.

Chapter 16 - Pneumococcal Disease
Immunisation Handbook 2006 - Pneumococcal Disease (PDF, 150 kB)

Streptococcus pneumoniae (pneumococcus) is a lance shaped gram-positive diplococcus. It is ubiquitous, with many asymptomatic individuals carrying the organism in the upper respiratory tract. There are some 90 identiﬁable serotypes of S. pneumoniae. Some more commonly affect children, while others are of greater signiﬁcance in adults.

Chapter 17 - Varicella (Chickenpox and Shingles)
Immunisation Handbook 2006 - Varicella (Chickenpox and Shingles) (PDF, 108 kB)

Varicella was at ﬁrst confused with smallpox, and the ﬁrst clinical differentiation was by Heberden in 1767. The varicella zoster virus (VZV) was ﬁrst isolated in cell culture in 1952. Varicella (chickenpox) is a highly infectious disease caused by human herpes virus type 3 (varicella-zoster virus). It is usually, but not invariably, a mild, self limited disease in otherwise healthy children, but the severity of disease and risk of complications are usually greater in adolescents and adults. Varicella can also cause severe and even fatal disease in immune suppressed individuals (eg, children with acute leukaemia), in whom the mortality may be as high as 7–10 percent. Mortality in normal children is less than 2 per 100,000 cases, increasing up to 15-fold in adults. Reactivation of latent VZV results in herpes zoster (shingles), a disease with considerable morbidity.

Chapter 18 - Passive Immunisation
Immunisation Handbook 2006 - Passive Immunisation (PDf, 63 kB)

Passive immunisation involves administering pre-formed antibody as human immune globulin to a recipient who is thought to have either no natural immunity to one or more infections, or has impaired antibody production. Human immune globulin preparations are prepared by fractionating large pools of plasma collected from blood donors to the New Zealand Blood Service. In New Zealand, blood donations are only collected from voluntary, unpaid donors who are in good health and who do not have any conditions identiﬁable by the standard questionnaire that all blood donors complete, and/or by the mandatory serological testing for HIV/AIDS, hepatitis B, hepatitis C and syphilis on each donation. Blood donations are only used if the tests show no evidence that these infections are present. CSL Bioplasma of Australia manufacture the immune globulins (immunoglobulins) for the New Zealand Blood Service.

Chapter 19 - New Vaccines
Immunisation Handbook 2006 - New Vaccines (PDF, 61 kB)

Human papilloma virus (HPV) vaccines are now in stage III clinical trials. The pharmaceutical companies expect to apply soon for licensure overseas, and to submit in Australia and New Zealand in the next year.

Rotavirus gastroenteritis is a signiﬁcant cause of infant diarrhoea worldwide, both in developed and in less developed countries. In less developed countries rotavirus is a common cause of mortality, and in developed countries is a cause of hospitalisations.

Chapter 20 - Vaccination Questions and Concerns
Immunisation Handbook 2006 - Vaccination Questions and Concerns (PDF, 162 kB)

This chapter provides information that can be used when responding to concerns from the public and health professionals about how vaccines work and the safety of vaccines. In particular, it addresses some recent concerns about vaccines and the National Immunisation Schedule.

Appendices
Immunisation Handbook 2006 - Appendices (PDF, 479 kB)

1 The History of Immunisation in New Zealand
2 Immunisation Catch Up Schedules
3 Immunisation Standards 2006
4 Authorisation as an Independent Vaccinator
5 Immunisation Certiﬁcate
6 Vaccine Presentation, Preparation and Disposal
7 Medicines Act 1981, Section 47
8 Hepatitis B Antibody Levels in Infants
9 Meningococcal Invasive Disease
10 Management of Exposure to Varicella During Pregnancy and Care of the Newborn
11 Websites