Cystic Fibrosis immunisation recommendations

Background

Cystic Fibrosis (CF) is a genetic disorder, primarily affecting the lungs as well as the pancreas, liver, kidneys and intestines.  In patients with CF, the cells that are responsible for producing mucous, sweat and other fluids are impaired. As a result of this, secretions become thick and sticky, impacting the function of certain organs in the body. 1 in 2500 babies in Australia are born with CF each year.

Symptoms of CF include frequent chest infections, poor weight gain and growth, intestinal obstructions, infertility (commonly in males) and diabetes. Treatment includes intensive daily physiotherapy, enzyme replacement medication, salt and vitamin supplements, exercise and a high calorie diet. Insulin and blood glucose monitoring is required for patients that develop diabetes. Many patients progress to requiring a lung transplant. CF patients are at high risk of infections, including some that are vaccine preventable diseases.

Immunisation recommendations

Patients with CF are recommended to complete the routine immunisation schedule as per the National Immunisation Program (NIP) as well as some additional funded immunisations.

Secondary school vaccines are available on the NIP and should be administered to all children with CF including Year 7 (12-13 years of age): Boostrix® (diphtheria-tetanus-pertussis) and Gardasil 9® (human papillomavirus) and in Year 10 (14-19 years) Nimenrix® (meningococcal ACWY).

Influenza

Patients with CF are funded to receive influenza vaccines annually from 6 months of age. 2 doses of the age-specific vaccine are required in the first year of receiving the vaccine [refer to MVEC: Influenza vaccine recommendations].

Pneumococcal

Prevenar 13® (pneumococcal conjugate) should be given 6-weeks, 4-months, 6-months (additional dose) and 12-months.

A dose of Pneumovax 23® (pneumococcal polysaccharide) should be should be given at 4-years of age. A second dose should then be given at least 5 years later.

Further booster vaccines are required if being worked up for a lung transplant [refer to MVEC: Solid organ transplant recipient]

Other vaccines to consider

Varicella

Currently a single dose of varicella vaccine is funded on the NIP. The combination MMRV (ProQuad®/Priorix tetra®) is scheduled for 18-months of age, however giving 2 doses of the varicella vaccine can enhance protection. A second varicella vaccine dose can be obtained with a private script. As the varicella vaccine is a live-attenuated vaccine, doses should be separated by a minimum of 4 weeks.

Hepatitis A

CF patients are at risk of associated liver disease, so at The Royal Children’s Hospital they are funded to receive Hepatitis A vaccines via approval from our Drug Usage Committee (DUC). Two doses of age appropriate Hepatitis A are required, given 6-months apart. Administration can be commenced from 12 months of age.

Resources

Authors: Rachael McGuire (SAEFVIC Research Nurse, Murdoch Children’s Research Institute) Nigel Crawford (Director SAEFVIC, Murdoch Children’s Research Institute) and Nadine Henare (Nurse Coordinator- Immunisation, The Royal Children's Hospital)

Reviewed by: Rachael McGuire (SAEFVIC Research Nurse, Murdoch Children’s Research Institute)

Date: July 2020

Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.

You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.

 

 

 

 


Catch-up immunisations

Where a person’s immunisations are not up to date with the National Immunisation Program (NIP), it is important to arrange a catch up schedule for immunisations to be completed in the shortest and most effective time frame to ensure protection against vaccine preventable diseases.

Prior to commencing a catch up schedule, written documentation of any previous immunisations should be obtained where possible. Documentation could include the Immunisation History Statement (AIH) from AIR, personal immunisation records (ie: green book) or medical records. Overseas records may need translating.

Serology is not routinely recommended prior to catch up immunisation.

All refugee and humanitarian entrants including asylum seekers are eligible for free catch up immunisations [see resources].

Please be aware that some individuals may be recommended to receive additional immunisations due to predisposing conditions or at risk circumstances. For further queries please contact: info.mvec@mcri.edu.au

For individuals <10 years of age

Australian Immunisation Handbook: catch up calculator

For individuals aged 10 years to 19 years

Victorian immunisation catch-up tool

Refugee and asylum seekers

The Victorian DHHS and Health Translations has an excellent resource for catch up mmunisations in refugees and asylum seekers. It has been translated into more than 10 languages (see Catch up immunisation in other languages).

Resources

Authors: Nigel Crawford (Paediatrician, The Royal Children’s Hospital, Melbourne) and Rachael McGuire (SAEFVIC Research Nurse, Murdoch Children's Research Institute)

Reviewed by: Rachael McGuire (SAEFVIC Research Nurse, Murdoch Children's Research Institute)

Date: July 2020

Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.

You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.


Children with Cardiac Disease

Background

Children with underlying cardiac disease are at increased risk of vaccine preventable diseases when compared to children with no cardiac disease. This includes influenza and invasive pneumococcal disease (IPD). IPD includes pneumonia, meningitis and bacteraemia, with those at highest risk being children with cyanotic heart disease or cardiac failure.

Vaccine recommendations

  • Routine childhood vaccines as per Victorian immunisation schedule
  • If children with cardiac disease are immunocompromised, live vaccines may be contraindicated 
  • If children with cardiac disease have received blood products and/or immunoglobulin, live vaccines may need to be delayed [see resources]
  • If children are also asplenic or have hyposplenism, some additional vaccines are recommended [see resources]
  • Vaccines should be given within recommended timeframes unless contraindicated due to medical treatment, including surgery (discuss with your treating doctor)
  • Recommended time intervals for vaccination before and after surgery
  • Before surgery – 1 week for inactive vaccines; 3 weeks for live vaccines (e.g. MMR, Varicella)
  • After surgery – delay vaccination for 1 week
  • Additional vaccines –
    • Influenza vaccine: all cardiology patients are recommended to receive influenza vaccine annually from 6-months of age. Two doses are required in the first year of vaccination for children < 9-years
    • Pneumococcal vaccine: children with chronic cardiac disease are recommended to have an additional pneumococcal conjugate vaccine (Prevenar 13®) at 6-months of age (or at diagnosis) and pneumococcal polysaccharide vaccine (Pneumovax 23®) at 4-years of age and another dose at least 5 years later
  • If a child with cardiac disease is travelling overseas, particularly to high risk areas for vaccine preventable diseases, they should seek specialist travel advice [see resources]

Any immunisation queries should be directed to the treating doctor and/or contact the Victorian Immunisation services Hotline 1300 882 924.

Resources

Author: Kirsten Mitchell (SAEFVIC Research Nurse, Murdoch Children's Research Institute)

Reviewed by: Georgina Lewis (Clinical Manager SAEFVIC, Murdoch Children's Research Institute)

Date: July 2020

Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy. You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.


Cancer immunisation guideline: chemotherapy and post haematopoietic stem cell transplant

MVEC special risk guidelines

These guidelines have been prepared by immunisation staff from the Royal Children’s Hospital and Monash Health and endorsed at a monthly immunisation meeting. Attendees at this meeting include paediatricians, infectious disease physicians, nurse immunisation specialists, infection control team members and a representative from the Immunisation Section of the Victorian Department of Health.

These guidelines are based on the latest available evidence and aim to align with recommendations in the Australian Immunisation Handbook.

Vaccine funding

Some of the recommendations in these guidelines are outside the scope of the National Immunisation Program (NIP). Different jurisdictions and individual hospitals have varying approaches to non-NIP vaccines, which should be clarified with the local health service.

We welcome any feedback on the guidelines, please email: info.mvec@mcri.edu.au

Resources

Authors: Nigel Crawford (Director SAEFVIC, Murdoch Children’s Research Institute), Rachael McGuire (SAEFVIC Research Nurse, Murdoch Children’s Research Institute) and Nadine Harare (Immunisation Nurse, Royal Children’s Hospital)

Reviewed by: Rachael McGuire (SAEFVIC Research Nurse, Murdoch Children’s Research Institute) 

Date: July 2020

Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.

You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family's personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.