NSW School Vaccination Program

Overview  School Immunisation program  ‘Catch ups’  Year 7 vaccination at Practices

 HPV National evaluation study  HPV studies  Cold chain

Benefits of the School Immunisation Programme  Convenient for families  Cost effective  ‘captive’ audience, hence high immunisation rate  Vaccination requirements for school camp,

work experience, travel etc  Excellent immune response at this age

Brief History 1971-1994

Rubella Year 7 girls

1994-1998

MMR primary/Year 7

2003-2004

Men C (local records kept from 2003)

2004

Boostrix all years high school

2004

Hepatitis B Year 7

2006

Varicella Year 7

2007

HPV Years 10, 11, 12 girls

Brief History continued…. 2008

HPV Years 7,8,9 & 10 girls

2009

Boostrix Years 10 & 7

2012

‘Catch up’ of any vaccine; any visit

2013

HPV Years 7 & 9 boys. Last year of Hep B

2014

MMR ‘catch up’ all high school years (ISLHD)

2015

MMR Years 11 & 12

2016

HPV, dTpa & Varicella Year 7 & Year 8 HPV cu

2016 School Immunisation Program  3 carefully timed visits to 46 mainstream schools from Helensburgh to Ulladulla  ‘Catch up’ Gardasil doses Year 8 ONLY IF started course in Year 7

 Boostrix, Varicella & Gardasil to be offered to all Year 7  No MMR in 2016

2016 School Immunisation Programme Visit 1

Visit 2

Visit 3

HPV dose 1

HPV dose 2

HPV dose 3

dTpa

Varicella

Year 8 HPV ‘catch up’

Year 8 HPV ‘catch up’

Year 7 HPV & dTpa ‘catch up’

Year 8 HPV ‘catch up’

Year 7 HPV, dTpa & Varicella ‘catch up’

Importance of Timing  Human Papillomavirus (HPV) vaccine  3-dose schedule at 0, 2 and 6 months apart

The NH&MRC recommended spacing between doses is  56 days between dose 1 and 2,  112 days between dose 2 and 3,  168 days between dose 1 and 3.  All three HPV doses should ideally be administered within 12 months

Intensive English Centre Vaccination Program  The Intensive English Centre (IEC) Vaccination Program enables new immigrants to be vaccinated in line with the National Immunisation Program. Students in IECs are offered :

 hepatitis B  dTpa  HPV  MMR  Varicella

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Year 8 students can receive ‘catch up’ HPV at any of the 3 scheduled visits

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Year 7 students can be ‘caught up’ at visits 2 & 3 if an earlier visit missed.

ISLHD stats & project  In 2015, we had the highest rate in the state of Year 8 ‘catch ups’ in the school program.

Why is this???  Initiative 2015: phone call to consenting parent/guardian for any missed vaccination to advise their child will be ‘caught up’ next visit and give the date of the anticipated visit  Does this intervention keep Year 7 in the school based immunisation program & enhance vaccination completion rates??

ISLHD stats and project  This initiative will be assessed in 2016 by: – Continuing the follow up phone calls

– Clarifying if the consenting parent/guardian knew of the ‘catch up’ at school option – Determining if our phone call has contributed towards keeping the child in the school immunisation program – Will be evaluated

School Immunisation at GP Practices  Vaccines free for Year 7 students within NSW either in school based programme or at practices

 Preference for NSW Health is the School based programme as cost effective, increased vaccine course completion and recording of vaccination  If parents/guardians prefer vaccination in a GP setting, please do the following:

School Immunisation at GP Practices

 Be aware that Year 7 vaccines can be ‘caught up’ at visits 2&3  If a HPV dose is given at a Practice, then the rest of the course needs to be completed at the Practice.

 If the Parent/Guardian wish vaccination to take place at the Practice, the consenting Parent/Guardian needs to withdraw consent (if consented to previously) from the program

Report HPV vaccine doses administered  To the National HPV Vaccination Program Register (HPV Register)

- Via web site www.hpvregister.org.au Contact HPV register on 1800 478 734 (1800 HPV REG)

Withdrawing Consent  Consenting parent/guardian in writing to the school or  Phone call to school  Phone call to PHU

proforma completed by school or

School Vaccination Records  ISLHD PHU school vaccination records from 2003  RecFind NSW school vaccination records since 2010  HPV Register  Record of vaccination card given to student at each occasion of service  Will become of part of the ‘Life Register”

Behind the scenes  Preparations for School Program- booking of schools with correct intervals  Letters sent to Principles informing of program also given letters for newsletters  Schools receive Annual School Coverage Rates

 Audits of School Program  Transfer of card for students changing school  Letters sent to parents keeping them informed

The First 5 Years of HPV vaccination in Australia – A National Evaluation  Approved by the Australian Department of Health and Aging in January, 2013

 Instigated by the NCIRS  Finalised in December, 2014 Involved - National HPV Vaccination Program Register (NHVPR) - Therapeutic Goods Administration (TGA)

Evaluation Process  Aim was to look at the strengths and weakness of the program

Looking at different areas :  Implementation  Coverage by dose number and by Aboriginal status and socio-economic status  Completion rates

 Adverse effects following Immunisation (AEFI)  Impact of the program

Successes and Lessons from the first 5 years of the Australian HPV vaccine program  High coverage achieved by rolling the vaccine out by school-based delivery which is ongoing

 There was a strong collaboration in service delivery and research across multiple disciplines  Learnings in vaccine safety monitoring, communication and optimum delivery in school setting are providing leadership regionally and internationally

Continue…  Good evidence of impact against cervical disease and anogenital warts  This is equivalent in Indigenous women + herd impact in males for anogenital warts  Lessons learnt were put into place for the implementation of boys program  Being prepared for increase in AEFI following initiation

Two Studies Regarding HPV Study 1 A 9-valent HPV vaccine infection and intraepithelial neoplasia in women (New England Journal of Medicine 2015)  Results from a study of 14,215 women aged 16-26yrs  Received either 9vHPV or 4vHPV vaccines  Gardasil is a quadrivalent 4vHPV vaccine  Countries with established HPV vaccination programs indicate a beneficial effect at the population level  Decreases in the incidence of high-grade cervical abnormalities and the incidence of genital warts.

Study 2 Assessment of herd immunity and cross-protection after a human papillomavirus vaccination programme in Australia :a repeat cross-sectional study (Lancet Infectious Diseases 2014)  Prevalence of vaccine targeted HPV types were significantly lower than pre-vaccine samples

 No significant declines observed for non-vaccines HPV types  Lower prevalence of vaccine-targeted HPV types were seen in unvaccinated women- suggesting herd immunity

Implications for us  The HPV disease chapter has been updated to include information on next generation HPV vaccination strategies under development including formulation and changes in schedule (fewer doses may be required)  Any changes to this recommendation will require careful review and assessment of evidence available on the use of different vaccine schedules.

Cold Chain

 Strive for 5 provides information and advice for vaccine storage management.

 It has been written to assist all Australian immunisation service providers, from medical practices to large hospitals, clinics and outreach providers.  The publication’s title refers to Strive for 5 degrees Celsius (°C) – that is, the point midway between +2°C and +8°C which is the temperature range recommended for vaccine storage. Many vaccines are damaged or destroyed at temperatures outside this range.

How long can vaccines be out of 2 to 8 degree C range and still be safe to give?

WHAT IS THE COLD CHAIN? The ‘cold chain’ is the system of transporting and storing vaccines within the safe temperature range of +2°C to +8°C. The cold chain begins from the time the vaccine is manufactured, continues through to the state or territory vaccine distribution centres and ends when the vaccine is administered.

WHAT IS A COLD CHAIN BREACH? A ‘cold chain breach’ has occurred if vaccine storage temperatures have been outside the recommended range of +2°C to +8°C. It excludes fluctuations up to +12°C, lasting no longer than 15 minutes, as may occur when stock taking or restocking refrigerators.

Vaccine Management Protocol  Important to have a protocol in all facilities also important to become familiar with the protocol

 Strive for 5 - Appendix 1 : Vaccine Management Protocol- Self audit  All practices should have a copy of Strive for 5 available

MONITOR AND RECORD REFRIGERATOR TEMPERATURES  Ensure procedures are in place to provide written records of these activities every day  Check and record the vaccine refrigerator temperature (minimum and maximum) twice daily: before the refrigerator is used for the first time and at the end of each day

Documentation  Document temperature twice daily  Reset every time you record the temperature  If stock taking, keep an eye on temperature, door left open  Document actions taken  Check and record when vaccines arrive

What is a data logger?  Temperature data loggers are small electronic devices that measure temperatures at pre-set time intervals and record the results over a period of time.  Data loggers should be set to record temperatures at 10– 15 minute intervals.  It is recommended that the data is downloaded weekly as a permanent record.

Benefits of using a Data Logger  Confirms cold chain has been maintained  Provides accurate knowledge of the vaccine fridge temperature  Identify the temperature fluctuations within shelves  It is strongly encouraged that all practices purchase a data logger

Changes to Management of Breaches  Increased requires for new applicants  New checklist for PHU when looking at approval for a Vaccine Account Number

 If a breach occurs and there is no data logger- the practice will need to purchase one and log for a 24 hour period

Reporting to PHU  Cold chain breach protocol to report to the PHU ph. 4221 6700

 Assist with collecting information that is needed to advise you with management of the breach  Will help with making decisions regarding the breach

 Not a reflection on the practice/facility

Resources:

Strive for Five Vaccine Fridge Temperature Chart

Acknowledgments to……  Ellen Moran – School Program Co-ordinator  NCIRS  Health Protection NSW, Immunisation Unit  Strive for 5 - 2nd edition

 One Flew Over the Cuckoos Nest 