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Free meningococcal vaccine to the public |
This has been a hot topic for many months and there is more to come. A letter has been sent to all practitioners concerning the introduction of the meningococcal program. To recap:
In November the Federal Government announced further funding for an expanded national meningococcal conjugate C vaccine program. This expanded program aims to immunise all children and adolescents under 19 years of age.
In NSW the first phase of the program will target 1 - 5 year olds only and will start on February 3. The meningococcal C conjugate vaccine (MenCCV) has been added to the national immunisation program as at 1 January 2003. The rest of the program will be rolled out over the next four years with each state and territory still discussing the coordination of their start dates for each phase of the roll out. NSW Health will advise all providers about the availability of vaccine for older age groups.
Supply
NSW Health will buy all of the currently licensed brands of MenCCV to ensure that sufficient supplies are available for the program. This includes Meningitec (Wyeth), Menjugate (CSL Vaccines/Chiron) and NeisVac-C (Baxter Healthcare).
Ordering stock
An order form has been sent to all practices. If you require another one contact the division. When ordering, please keep in mind the amount of refrigerator storage space available. In the interests of maintaining the cold chain, leave sufficient room for the cold air in the refrigerator to flow around the vaccines and saline bottles (p.55 the Australian Immunisation Handbook 7th Edition).
As we come close to influenza vaccination time (around April) and the introduction of new vaccines for the change in schedule (proposed middle of this year), some may like to consider a bigger refrigerator or more frequent ordering to overcome impending space problems. NB. There will be a limit as to how frequently vaccines can be ordered, but it is proposed that a period of grace be granted while unusual circumstances, ie. introduction of a new vaccine and initial demand, are rationalised.
Service provision
Phase one of the program is being channelled through the regular vaccine providers such as general practices and immunisation clinics. Victoria has chosen to administer MenCCV through its public schools for the school aged recipients. NSW has postulated a plan to do the same but at this time no definite statements have been made.
Reporting the encounter
As MenCCV is now part of the national immunisation program, ACIR recording is required. After giving any of the meningococcal vaccines, record them by brand name in the ‘other’ box at the bottom of the purple encounter forms. New forms will be printed mid year that will add MenCCV to the selection of scheduled vaccines on the encounter form or on the website. A multiple recording form is available if you are running an immunisation clinic at your practice. You may consider conducting a clinic to facilitate the initial high demand. Please contact the division for a copy of the multiple encounter form or assistance in running a clinic.
Recording this information at ACIR is important for two reasons. As with all vaccines, it is essential to monitor the coverage rates of immunisation in different cohorts. Also, as the vaccine budget is capped, checks need to be in place so ‘leakage’ does not occur into age groups not eligible.
ACIR’s position
The ACIR reporting payment for the 12 month immunisation encounter (three vaccines) will not initially be directly linked to the administration of the meningococcal conjugate C vaccine. There will be a grace period of 12 months before the ACIR payment will be affected by the incompletion of the scheduled 12 month immunisations because of the omission of the meningococcal C vaccine that is to be given at this time. MenCCV should be given at 12 months with the administration of MMR and Hib.
Administration
During the start of the new program of meningococcal C vaccine, some children will be due for several vaccines at the same time (12 and 18 months and 4 years). The Australian Advisory Group on Immunisation (ATAGI) advise that it is safe and effective to administer multiple vaccines at the same time and that there is no evidence that multiple doses ‘overload’ a child’s immune system. Studies in the United Kingdom have shown that meningococcal C vaccine can be safely given with routine childhood vaccines and does not affect the seroconversion rate of other vaccines administered at the same time.
The vaccine should be given as an intra muscular single dose into the deltoid muscle (for children over 12 months old). Where three doses need to be given, both deltoids are to be used and then the anteriolateral thigh can be used or the provider may judge that there is enough muscle mass to insert two injections into a deltoid. These deltoid injections must be spaced at least 2.5cm apart. The vaccine given into the thigh must be one that has the lowest risk of local reaction (not DTPa).
There is no time frame given between the administration of childhood vaccines and the new meningococcal C vaccine. Meningococcal C vaccine is an inactivated (dead) vaccine so no waiting period is required.
If a parent does not consent to the third injection at the time of the visit, the provider must document this refusal and encourage the parent to make another appointment for the third injection.
Meningococcal vaccines and other childhood vaccines must not be mixed in the same syringe.
Vaccine side effects
Pain, redness and swelling at the injection site, fever, irritability, anorexia and headaches are the common adverse events (>10%). Serious general adverse events are rare. See product information for details.
Meningococcal vaccines (two types)
During the last 12 months, many parents have requested that their children be given meningococcal vaccines. As you would be aware, there are two types of vaccines: conjugate C that only covers type C but lasts about 20 years (Meningitec, Menjugate and NeisVac-C) and polysaccharide vaccines (Menomune and Mencevax) that cover type A, C, W and Y but last a shorter time and are mostly viewed as a travel vaccine. With the lack of supply of the conjugate vaccines, many parents opted for the polysaccharide.
The National Health and Medical Research Council recommend that if the polysaccharide vaccine has been given; wait six months before administering the conjugate vaccine.
For more information on the meningococcal C conjugate vaccine, see the references below or the product information supplied with the vaccine.
References
Immunisation Program Newsletter, Issue 3 December 2002
Department of Human Services, Victorian State Government
Letter to Immunisation Service Providers, January 2003
Dr Greg Stewart, Deputy director-General, Public Health and Chief Health Officer
Meningococcal C Conjugate Vaccine: Guidelines for Providers about the administration of the Vaccine, December 2002
"Immunise Australia Program", NCIRS and Commonwealth Dept. Health and Ageing
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