In this issue: Special Influenza edition ISSUE Winter is coming...

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1 ISSUE In this issue: Seasonal Influenza Vaccine Program Commencement 2015 Influenza vaccine composition Free Vaccine Children and influenza vaccination A look at influenza in the ACT Influenza testing Reminders Special Influenza edition Winter is coming... Influenza or the flu is a highly contagious viral illness that can affect people of all ages. Influenza is spread from person to person by coughing, sneezing, or contact with contaminated surfaces. Influenza is a notifiable disease both in the ACT and nationally. In Australia, there were two predominant influenza A strains, H3N2 in NSW and the ACT, and H1N1(pdm09) in the other states and territories. Laboratory-confirmed cases are notified to ACT Health s Health Protection Service (HPS). HPS monitors the incidence of influenza via these notifications. In 2014, HPS received 1254 notifications of influenza. This is the highest number of notifications since the 2009 H1N1 pandemic (n=1266). When someone has the flu, the symptoms come on suddenly and can be severe. Symptoms usually appear within one to three days of coming into contact with the virus. Those symptoms include fever, chills, muscle and joint aches and extreme tiredness, along with a sore throat and runny nose. Severe complications, such as pneumonia, are more common in children, pregnant women, the elderly and other vulnerable groups (e.g. people with chronic diseases). The common cold (usually caused by a rhinovirus) typically has different symptoms to influenza, a slower onset and is less likely to cause complications. Colds tend to cause a sore throat, blocked or runny nose, and a cough. Help patients avoid getting and spreading the flu by teaching them these basic infection control measures: Stay away from work, school, childcare and other public places when you are unwell; Cover your nose and mouth with disposable tissues when you cough or sneeze, throw the tissues straight into the bin and wash your hands afterwards; Wash your hands frequently with soap and water, or alcohol-based products; If you don't have a tissue, cough or sneeze into your upper sleeve or elbow, not your hands Contact us: Immunisation Unit Communicable Disease Control Phone: Phone: Fax: Fax: immunisation@act.gov.au cdc@act.gov.au

2 IMPORTANT Delay of Seasonal Influenza Immunisation Program Due to a double-strain change in this year s influenza vaccine it is unlikely that vaccines will be available for the usual 15 March commencement date. There are manufacturing delays due to the time it takes to develop, test and distribute the reagents needed to make the vaccine (Department of Health, 2015). The program will be delayed until at least two suppliers have sufficient supplies to reduce the risk of biocsl s Fluvax being administered to children under five years of age. This will not affect supply volumes. We will update you on the commencement date of the 2015 Program as soon as information becomes available. Reference: Department of Health. Seasonal Influenza Vaccination Program Australian Government 2015 (accessed on from: Vaccine composition for 2015 Each year, the flu vaccine provides protection against the three strains of flu virus which are most likely to circulate over the winter period. Vaccination is recommended in autumn to allow time for immunity to develop before the flu season starts. The Australian Influenza Vaccine Committee and World Health Organization have agreed that the influenza vaccine for the Australian 2015 influenza season contains the following three virus strains: an A/California/7/2009 (H1N1)-like virus; an A/Switzerland/ /2013 (H3N2)-like virus a ; a B/Phuket/3073/2013-like virus. a A/South Australia/55/2014, A/Norway/466/2014 and A/Stockholm/6/2014 are A/ Switzerland/ /2013-like viruses Strain changes from } the 2014 vaccine GP Staff Flu Program 2015 The GP staff influenza program is continuing this year. More information coming to your practice soon. 2

3 Free Influenza Vaccine Influenza vaccine is provided free under the National Immunisation Program for: Anyone over 65 years; Aboriginal and Torres Strait Islanders 6 months to 5 years and, 15 years and over; Pregnant women (see following section) and; Anyone over 6 months old with risk factors (including heart conditions, asthma and other lung conditions, diabetes, kidney problems or impaired immunity). Influenza vaccine is recommended, but not funded, for health care workers, workers at aged care facilities, household contacts of high risk individuals and anyone who wishes to have it. Healthcare workers and those who work in aged care facilities are exposed to the influenza virus more than others in the community. For this reason, they are more at risk of exposure and also transmission of influenza. To reduce the spread of influenza in these settings, it is highly recommended that annual influenza vaccine is received (Seale & MacIntyre, 2011). Reference: Seale, H., MacIntyre, C.R.; Seasonal influenza vaccination in Australian hospital healthcare workers: a review. Medical Journal of Australia: 2011; 195 (6): Influenza vaccination for pregnant women The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) have recommended that influenza vaccination during pregnancy should be routine. Safety of the vaccine is well established and both maternal and infant benefit is proven. (RANZCOG, Influenza vaccination during pregnancy statement. 2011). Vaccination early in the season, regardless of gestational age is optimal. Unvaccinated pregnant women should be immunised at any time during influenza season. No study to date has shown an adverse consequence of inactivated influenza vaccine in pregnant women or their offspring. Active placental transfer of maternal antibodies makes influenza vaccine during pregnancy a highly effective measure to protect infants from influenza during the first 6 months of life. 3

4 Children and influenza vaccination Current Australian immunisation guidelines recommend annual influenza vaccination for anyone who wishes to protect themselves, which includes children aged over six months. It is critical that children at particular risk of severe complications from influenza are vaccinated, including those with heart conditions, asthma and other lung conditions, diabetes, kidney problems and impaired immunity. Influenza vaccine is funded for all Aboriginal and Torres Strait Islander children aged 6 months to 5 years and any child over 6 months of age who has an underlying medical condition. Fluvax (biocsl Ltd) must not be given to children 5 years of age and is not recommended for use in children <10 years of age (The Australian Immunisation Handbook, 10 th Edition; 2013). Recommended doses of influenza vaccine for children Age Dose Number of doses first year of vaccination Number of doses subsequent years Formulation 6-35 mths 0.25ml (7.5µg) 2 doses at least 4 weeks apart mL from 0.5mL syringe. Vaxigrip & Fluarix only 3 <5 yrs 0.5ml (15µg) 2 doses at least 4 weeks apart 1 0.5mL prefilled syringe. Vaxigrip & Fluarix only 5 - <10 yrs 0.5ml (15µg) 2 doses at least 4 weeks apart 1 0.5mL prefilled syringe Vaxigrip & Fluarix preferred 10 years and over 0.5ml (15µg) 1 dose annually 1 0.5mL prefilled syringe Any brand Cut this out and keep it as a quick reference 4

5 A look at influenza in the ACT in 2014 Influenza notifications Between 1 January and 31 December 2014, there were 1,254 notifications of influenza reported in the Australian Capital Territory (Figure 1). This represents a 128% increase compared with the 550 notifications received in Ninety-two percent (n=1,158) of notifications were influenza A. Of the 415 influenza A notifications with subtype information available, 301 (72%) were H3 (presumed to be H3N2) and 118 (28%) were H1N1. Of the notifications received to 31 December 2014, 51% (n=645) were females, and most notifications were in 30 to 39 year olds (n=226, 18%). Sixty percent (n=135) of cases aged years were female. Surveillance of influenza in the community is important to identify an increase in disease incidence and outbreaks, and to inform and target disease prevention and control strategies. It is also necessary to determine circulating strains of the virus to inform the composition of the seasonal vaccine, and to detect changes in the influenza virus which may contribute to the development of a pandemic. Not all cases of influenza seek medical care or get tested. As a result, the true number of cases is thought to be underestimated by surveillance data. However, the data collected provides a good indication of general disease trends in the broader community. Figure 1: Number of ACT influenza notifications for Includes all subtypes of influenza. 5

6 INFLUENZA TESTING Routine laboratory testing of all potential cases of influenza is unnecessary for management of community-acquired cases. Confirmation of influenza infection is a greater priority for your patients who are at higher risk of complications of influenza, including those: Who are hospitalised or who are critically ill; At an increased risk for severe disease including pregnant women and those with underlying chronic medical conditions; Who may be part of an influenza-like illness outbreak, particularly individuals living or working in a residential care setting; Health care workers in high-risk settings. Asymptomatic cases should not be tested. If testing is required, PCR is the preferred and most reliable method of diagnosis for influenza. Serology is of little benefit in diagnosing acute influenza. Request a PCR test on a nasopharyngeal or throat swab and include relevant clinical notes on the pathology request form (e.g. symptoms, travel history, onset date). For more information, please call the Communicable Disease Control section on Fridge servicing REMINDERS: All fridges that store vaccine need to be regularly serviced. Please consult your fridge manufacturer to find out how often your fridge needs to be serviced. Servicing your fridge may help reduce unnecessary wastage of vaccines due to fridge malfunction. Vaccine order forms Please order your vaccines on the Vaccine Order Form dated January Catch up vaccines Any student requiring catch up vaccinations from the 2014 School Program should have received a letter from the School Health team outlining which vaccine/s they missed. This letter is not essential for ordering vaccines, however, it assists in ensuring minimum intervals between doses of HPV are kept. Students in Year 8 this year can receive funded HPV, Boostrix and Varicella catch up vaccination. Students in Year 9 and Year 10 at school this year are entitled to funded Boostrix catch up vaccination. Boys in Year 10 are also eligible to receive funded HPV catch up vaccination. Catch up vaccines are delivered with your normal delivery date. VMU is unable to deliver it as an urgent delivery. When you place an order, please include the year that the student is in this year. Incomplete catch up orders may not be approved. Contact us: Immunisation Unit Communicable Disease Control Phone: Phone: Fax: Fax: immunisation@act.gov.au cdc@act.gov.au

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