Monkeypox (MPX)

What is it?

Monkeypox is a viral zoonosis (an infection spread from animals to humans). It is caused by a virus that belongs to the Orthopoxvirus genus (which also causes the variola virus responsible for smallpox disease and the vaccinia virus, which is used in smallpox vaccines). Monkeypox was first discovered in 1958 and there have been small outbreaks since, predominantly in Western and Central Africa. Since the eradication of smallpox in 1980, monkeypox has become the most important orthopoxvirus affecting humans, however, causes less severe disease than smallpox.

What to look for

The incubation period of monkeypox is usually 7-14 days, but can be as short as 5 days or as long as 21 days. The initial symptoms of monkeypox include fever, headache, backache and muscle aches, fatigue and lymphadenopathy. Lymphadenopathy in this early phase is a key feature of monkeypox.

1-3 days following the beginning of fever, a rash may develop, often beginning on the mouth and face, and then spreading to other areas of the body. The face is involved in 95% infections, followed by the palms of the hands and soles of the feed (75%). Oral mucous membranes are involved in 70% of cases, and involvement of the genitalia is also common (30%).

The rash is initially characterised as being erythematous (reddened) and macular (flat), which then develops papular features (raised areas) and turns into well-demarcated pustules and vesicles. These then dry into crusts and fall off. The number of lesions is highly variable, ranging from a couple to over a thousand.

The infection is usually self-limiting with symptoms lasting from 2-4 weeks. Complications can include secondary infection such as cellulitis, sepsis, infection of the cornea (which can be threaten vision), bronchopneumonia and encephalitis. The case fatality ratio is between 3-6%. More severe illness can occur in immunocompromised people.

How is it transmitted?

Monkeypox is spread via either animal-to-human transmission (zoonotic) or human-to-human transmission.

Zoonotic transmission involves direct contact with the bodily fluids, blood, or lesions (cutaneous or mucosal) of infected animals. This is most common for people living near or within forest areas with exposure to infected animals.

Human-to-human transmission involves close contact with respiratory secretions, the skin lesions of an infected person, or a contaminated objects such as linen or clothing. Droplet particle transmission requires prolonged face-to-face exposure, placing household contacts at highest risk. This can be minimised by isolating away from other members of the household.

Healthcare workers caring for individuals with monkeypox must undertake infection control precautions and handling of laboratory specimens should be by suitably trained staff.

Epidemiology

Monkeypox is very common in West and Central Africa, often in areas with tropical rainforests. However, there is currently outbreaks in many other countries across the globe including Australia and parts of Europe and the United Kingdom.

Vaccines

The vaccinia virus is a poxvirus related to smallpox and monkeypox and is contained in smallpox vaccines. Historically, smallpox vaccines have been used in the prevention of smallpox infection, however, they are also likely to be effective against monkeypox.

There are two types of smallpox vaccines available for use in Australia for the prevention of monkeypox:

  • ACAM2000™ – 2nd generation, live-attenuated vaccine
  • JYNNEOS® – 3rd generation, non-replicating vaccine

Recommendations

Either vaccine can be administered as either pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP) based on an individual risk-benefit assessment. For PEP, vaccination within 4 days is recommended to provide optimal protection against the development of monkeypox infection. Vaccination between 4-14 days following exposure may lessen the severity of disease.

ATAGI preferentially recommends JYNNEOS® vaccine due to the ease of administration and decreased likelihood of side effects. Vaccination is currently recommended for the following groups:

  • Gay, bisexual, and other men, non-binary individuals assigned male at birth, trans men who have sex with men (including cis and trans men) who are the highest risk of infection with monkeypox. Markers indicating increased risk of infection include:
    • those living with HIV
    • recent history of multiple sexual partners, including group sex or sex on licensed premises
    • other markers including recent sexually transmitted disease or on HIV PrEP due to number of partners
    • recommendations from sexual health clinics
    • those who are homeless, are significant drug users or have psychiatric illness
  • sex workers, particularly those with clients who belong to high-risk groups
  • anyone in the above categories planning to travel to a country experiencing a monkeypox outbreak (immunisation is recommended 4-6 weeks prior to travelling)
  • anyone at greater risk of poorer outcomes due to monkeypox infection, such as those with severe immunocompromise
  • immunisation providers who are administering ACAM2000™
  • laboratory workers who have contact with monkeypox specimens.

Individuals who have a history of confirmed monkeypox infection should defer vaccination in the short-medium term after recovery due to the immunity gained from natural infection.

Precautions

Vaccination with JYNNEOS® can be considered in children aged < 18 years where the benefits of vaccination outweigh the risks of disease. Despite no formal studies, there are no theoretical safety concerns surrounding the administration of JYNNEOS® in pregnant or breastfeeding women.

Individuals receiving ACAM2000™ as PrEP should consider an interval of 4 weeks between vaccination and administration of COVID-19 vaccines due to the rare risk of myocarditis/pericarditis.

Contraindications

Anyone with a history of anaphylaxis to a previous dose of the vaccine to be administered or anaphylaxis to a component of the vaccine to be administered should not be vaccinated.  Due to the risk of vaccine associated disease, ACAM2000™ is contraindicated for those with immunocompromise or those who are pregnant.

Individuals with active eczema, atopic dermatitis or other exfoliative skin conditions should not receive ACAM2000™ due to the risk of developing eczema vaccinatum (a reaction to smallpox vaccination experienced by people with eczema/atopic dermatitis resulting in a severe rash and systemic illness).

§ Using alternate routes of vaccine delivering to complete a primary course is acceptable (eg, intradermal for dose 1 and subcutaneous for dose 2)
€ Intradermal administration is an alternate route of vaccination for pre-exposure prophylaxis. It is not preferred for the first dose of post-exposure prophylaxis and is NOT recommended in people with severe immunocompromise
£ Vaccination providers administering intradermally should ensure that they are appropriately trained in intradermal technique. Where a dose of intradermal vaccine is inadvertently administered subcutaneously, a repeat dose of 0.5ml should be administered subcutaneously as soon as possible to ensure that the vaccinee receives an appropriate level of protection
^ Percutaneous administration involves using a bifurcated needle and scarification technique requiring specialised training and accreditation
# for full aftercare instructions, refer the product information
¥ ACAM2000 is a live-attenuated vaccine and therefore as outlined above, it’s use is contraindicated in some patient groups. For a full list of contraindications and precautions refer to the ATAGI clinical guidance on vaccination against Monkeypox.

Following vaccination

Individuals receiving ACAM2000™ should be advised that 2-5 days after vaccination a papule will form at the injection site. This will progress to a vesicle (blister) then pustule (blister with pus) before scabbing and forming a permanent pitted scar. Individuals are recommended to cover the injection site with a gauze bandage secured with adhesive tape until scabbing occurs, noting that the wound is infectious until the wound dries up.

Common systemic side effects following vaccination with either vaccine include muscle aches, headache, fatigue and nausea. Localised side effects can include injection site itch, pain redness and swelling (and permanent scarring following ACAM2000™.

ACAM2000™ is also associated with a risk of myocarditis and pericarditis as well as other serious side effects noted here.

Resources

Authors: Rachael Purcell (RCH Immunisation Fellow), Francesca Machingaifa (MVEC Education Nurse Coordinator) and Rachael McGuire (MVEC Education Nurse Coordinator)

Reviewed by: Francesca Machingaifa (MVEC Education Nurse Coordinator) and Rachael McGuire (MVEC Education Nurse Coordinator)

Date: November 10, 2022

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.


Mandatory vaccine directions in Victoria

Background

A vaccine mandate means that proof of vaccination, or an authorised medical exemption, is required in certain settings. Mandating is generally considered a late step in optimising vaccine uptake, as it is important to ensure vaccine access is available in an equitable way, before progressing to a mandate. Vaccine mandates may vary depending on the jurisdiction and there may be some variations around Australia. The following information is specific to Victoria, and refers to COVID-19 and influenza vaccine directions, as well as the ‘no jab, no play’ and ‘no jab, no pay’ policies.

Vaccine specific directions

  • COVID-19

    Vaccination against COVID-19 protects against developing severe disease that may lead to hospital admission, intensive care or even death. Due to the occupational risk for disease exposure and transmission as well as having increased contact with vulnerable groups, workers in the following settings must be fully vaccinated against COVID-19 (regardless of whether they have patient contact or not):

    • public, private and denominational hospitals
    • public health services
    • private day procedure centres
    • ambulance services
    • patient transport services engaged by a health service or Ambulance Victoria
    • residential aged care services that are operated by public health services.

    To be considered fully vaccinated, individuals ≥ 18 years must have completed a primary schedule of COVID-19 vaccination plus a booster dose and those aged < 18 years must have completed a primary schedule.

    For further information refer to DH: Vaccination for healthcare workers.

  • Influenza

    Influenza vaccination is recommended for all individuals aged 6 months and over. Due to an increased risk of exposure to, and transmission of influenza disease it is mandatory that workers in the following settings are vaccinated against influenza annually (regardless of whether they have patient contact or not):

    • public, private and denominational hospitals
    • public health services
    • private day procedure centres
    • ambulance services
    • patient transport services engaged by a health service or Ambulance Victoria
    • residential aged care services that are operated by public health services
    • Forensicare.

    For further information, refer to DH: Vaccination for healthcare workers.

Policy specific vaccine directions

  • No jab, no play

    “No jab, no play” legislation was introduced by the Victorian State Government on January 1st, 2016, in an effort to improve vaccination rates and reduce the spread of vaccine preventable diseases, This legislation requires confirmation of up to date vaccination status according to the National Immunisation Program (NIP) when enrolling in all early childhood education and care services including childcare and kindergarten. This legislation does not apply to enrolment into school.

    A current Immunisation History Statement (IHS) provided by the Australian Immunisation Register (AIR) is the only accepted proof of immunisation when enrolling in early childhood education and care services.

  • No jab, no pay

    “No jab, no pay” legislation was introduced by the Federal Government on July 1, 2018, altering Family Tax Benefit (FTB) Part A payments and childcare subsidies if a child is not up to date for age with their scheduled immunisations as per the NIP. Recipients of FTB part A or child-care fee assistance will need to meet these immunisation requirements to ensure that payments are not reduced.

Responsibilities of the employer/service provider and the employee/vaccinee

Employers and service providers are responsible for ensuring that employees/enrolees in early childhood education and care services comply with relevant orders. The employer or service provider is required to sight and store evidence of mandated vaccination status or medical exemption, if applicable.

It is the responsibility of the employee to be vaccinated against mandated vaccines for their profession or have a valid medical exemption.

It is the responsibility of individual receiving Family Tax Benefits and childcare subsidies to ensure that children are up to date with the NIP.

Medical exemptions

Exemption to vaccination can be granted to individuals following assessment by an authorised practitioner who deems deferral of vaccination to be warranted. Exemptions may be permanent or temporary.

All medical exemptions to vaccination will be recorded on the individuals Immunisation History Statement on the Australian Immunisation Register which can be accessed via myGOV.

Individuals who have previously experienced or who are at higher risk of experiencing a serious adverse event following vaccination should be referred to a specialist immunisation service. Individuals who have experienced a previous adverse event following vaccination should also be reported to SAEFVIC.

  • Permanent medical exemptions

    Anaphylaxis to a previous dose of the same vaccine or anaphylaxis to a component of the same vaccine are the only two absolute contraindications to vaccination and warrant permanent medical exemption. Permanent exemptions to some routine vaccines can also be provided when an individual has documented evidence of natural immunity against that vaccine preventable disease (eg. varicella, measles-mumps-rubella or hepatitis B).

    In addition, there are a small group of specific medical conditions precluding some individuals from receiving certain COVID-19 vaccine brands. For more information refer to MVEC: VicSIS.

  • Temporary medical exemptions

    Temporary exemptions to vaccination can also be granted in circumstances such as acute major medical illness, significant immunocompromise of short duration (for live-attenuated vaccines only), the individual is pregnant (live-attenuated vaccines only). Individuals with a confirmed history of COVID-19 infection can have their COVID-19 vaccination deferred for up to 4 months).

    Children on an approved catch-up schedule will be automatically granted a grace period of 6 months to complete their outstanding vaccines and be up to date with the NIP.

  • Authorising providers

    General practitioners defined by the Health Insurance Act 1973 as:

    • fellows of the Royal Australian College of General Practitioners
    • fellows of the Australian College of Rural and Remote Medicine
    • on Medicare’s Vocation Register of General Practitioners

    or:

    • a practice registrar on an approved 3GA training placement
    • a paediatrician
    • a public health physician
    • an infectious diseases physician
    • a clinical immunologist.

Authors: Rachael McGuire (MVEC Education Nurse Coordinator) and Francesca Machingaifa (MVEC Education Nurse Coordinator)

Reviewed by: Rachael McGuire (MVEC Education Nurse Coordinator) and Francesca Machingaifa (MVEC Education Nurse Coordinator)

Date: October 18, 2022

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.


Meningococcal

What is it?

Meningococcal disease constitutes any illness caused by the bacteria Neisseria meningitidis. There are 13 known sub-types (serogroups) and of these, 5 are currently vaccine preventable (B and A, C, W, Y).

Invasive meningococcal disease (IMD) can cause meningitis (inflammation of the membrane covering the brain and spinal cord), septicaemia (infection in the blood) as well as other infections like pneumonia (lung infection), arthritis (inflammation of the joints) and conjunctivitis (eye infection). Mortality (death) can be as high as 5-10% and can occur very quickly. Permanent lifelong complications can occur in 10-20% of those who survive.

What to look for

The incubation period of meningococcal is 1-7 days, more commonly 3-4 days. People with meningococcal disease can become extremely unwell very quickly. Symptoms can include fever, headache, neck stiffness, nausea, vomiting and photophobia (sensitivity to light). Cool, mottled extremities and leg pain can also occur. Babies can appear irritable or unsettled, have a high-pitched moaning cry, refuse or not wake for feeds and be lethargic (sleepy) or floppy. A petechial or purpuric rash can appear late in the disease progression (within 13-22 hours) or not at all.

How is it transmitted?

Disease can be transmitted from person to person via respiratory droplets (eg. sneezing and coughing). Meningococcal bacteria can also live harmlessly at the back of the nose or throat, resulting in individuals being asymptomatic carriers.

Epidemiology

Children < 2 years of age have the highest incidence of meningococcal disease in Australia, with another peak of disease among adolescents and young adults (15-24 years). Aboriginal and Torres Strait Islander people have a much greater burden of disease than non-Indigenous people.

There are also certain medical conditions and medications that can increase an individual’s risk of IMD. These include (but are not limited to) those with functional asplenia and hyposplenia, complement deficiency and those receiving treatment with eculizamab [refer to Recommendations for those at increased risk of IMD below for more information on risk groups].

Prevention

MVEC strongly recommends everyone wishing to be protected against ACWY and B strains of meningococcal disease be immunised. Some individuals are eligible for funded vaccines via the National Immunisation Program (NIP). Those aged ≥ 6 weeks of age who do not meet the funding criteria can purchase vaccines privately through some councils, GPs and pharmacies.

The number of vaccine doses recommended depends on a person’s age and risk factors.

Meningococcal ACWY vaccines

MVEC recommends 2 conjugate meningococcal ACWY vaccines:

  • Nimenrix®
  • Menveo®

A single dose of Nimenrix® is currently provided for free at 12 months of age and for all adolescents in Year 10 (or age equivalent) with catch up available for those aged 15-19 years. It is also funded for certain individuals of any age with immunocompromising conditions.

  • Meningococcal ACWY recommendations for healthy individuals

    ¥completing the course with the same vaccine brand is preferred but may not always be practical. The NIP funded 12 month dose of Nimenrix® may be used as the booster dose for those who have commenced the course at < 12 months of age.
    †there is no registered upper age limit for the use of Menveo® or Nimenrix®.
    ^booster doses are given at ≥ 12 months of age/8 weeks since the previous dose (whichever is later).
    #a single dose of Nimenrix® is funded on the NIP at 12 months and for year 10 students and adolescents aged 15-19 years who missed receiving the vaccine at school.

  • Meningococcal ACWY recommendations for those at increased risk of IMD

    Individuals with specified medical conditions that increase the risk of IMD are recommended and funded to receive additional vaccines. These groups include:

    • those with complement deficiency (including factor H, factor D or properdin deficiency), those receiving treatment with eculizumab or those who are planning to receive treatment with eculizumab in the future,
    • functional or anatomical asplenia,
    • sickle cell disease or haemoglobinopathies
    • HIV
    • previous haemopoietic stem cell transplant (HSCT).

    Refer to ATAGI clinical advice on changes to recommendations for meningococcal vaccines from 1 July 2020 for a full list of immunocompromising conditions.

    ^booster doses are given at ≥ 12 months of age/8 weeks since the previous dose (whichever is later).
    ¥completing the course with the same vaccine brand is preferred but may not always be practical. The NIP funded 12 month dose of Nimenrix® may be used as the booster dose for those who have commenced the course at < 12 months of age.
    †there is no registered upper age limit for the use of Menveo® or Nimenrix®.
    ^booster doses are given at ≥ 12 months of age/8 weeks since the previous dose (whichever is later).
    #a single dose of Nimenrix® is funded on the NIP at 12 months and for year 10 students and adolescents aged 15-19 years who missed receiving the vaccine at school.

Meningococcal B vaccines

There are currently 2 vaccines available for protection against meningococcal B disease.

  • Bexsero®
  • Trumenba®

Meningococcal B vaccines brands are not interchangeable.

A primary course of Bexsero® is available on the NIP for Aboriginal and Torres Strait Islander children < 2 years of age only, as well as some individuals of any age with immunocompromising conditions.

Paracetamol advice

It is widely recognised that children receiving Bexsero® are more likely to experience fever following vaccination. It is for this reason that children < 4 years of age are recommended to receive prophylactic paracetamol (15mg/kg per dose) 30 minutes prior to vaccination (or as soon as possible after), as well as 2 subsequent doses (4-6 hours apart) to reduce the likelihood and severity of fever. This should be administered regardless of whether the child is experiencing a fever or not.

  • Meningococcal B recommendations for healthy individuals

    †Bexsero® is registered for use in those 6 weeks of age and older. Trumenba® is registered for use in those 10 years of age or older.
    ¥meningococcal B vaccines brands are not interchangeable.
    #paracetamol recommended to those < 4 years of age (refer to advice above).
    ^booster dose at ≥ 12-months of age/8 weeks since previous dose (whichever is later).
    N/R- not recommended in this age group.
    £Funded on the NIP for Aboriginal and Torres Strait Islander children < 2 years of age and those identified as medically at risk (see recommendations below for further information).

  • Meningococcal B recommendations for those with increased risk of IMD

    Individuals with specified medical conditions that increase the risk of IMD are recommended and funded to receive additional vaccines. These groups include:

    • those with complement deficiency (including factor H, factor D or properdin deficiency), those receiving treatment with eculizumab or those who are planning to receive treatment with eculizumab in the future,
    • functional or anatomical asplenia,
    • sickle cell disease or haemoglobinopathies,
    • HIV,
    • previous haemopoietic stem cell transplant (HSCT).

    Refer to ATAGI clinical advice on changes to recommendations for meningococcal vaccines from 1 July 2020 for a full list of immunocompromising conditions.

    †Bexsero® is registered for use in those 6 weeks of age and older. Trumenba® is registered for use in those 10 years of age or older.
    ¥Meningococcal B vaccines are not equivalent or interchangeable – MVEC preferentially recommends Bexsero® brand.
    #paracetamol recommended to those < 4 years of age (refer to advice above).
    ^booster dose at ≥ 12-months of age/8 weeks since previous dose (whichever is later).
    N/R- not recommended in this age group.

Authors: Rachael McGuire (MVEC Education Nurse Coordinator), Georgina Lewis (Clinical Nurse Manager, SAEFVIC, Murdoch Children’s Research Institute) and Nigel Crawford (Director SAEFVIC, Murdoch Children’s Research Institute)

Reviewed by: Rachael McGuire (MVEC Education Nurse Coordinator) and Francesca Machingaifa (MVEC Education Nurse Coordinator)

Date: November 29, 2022

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.


Myocarditis and pericarditis following COVID-19 vaccines

Myocarditis is an inflammatory disease of the heart muscle, whilst pericarditis is an inflammatory disease of the lining of the heart muscle. They are rare conditions, most commonly associated with viral infections (including SARS-CoV-2) but can also be triggered by other factors such as medications and autoimmune conditions.

Globally, an increased number of cases above an expected population rate of myocarditis and pericarditis have been reported in individuals who have received COVID-19 vaccines, with the highest rates occurring following administration of COVID-19 mRNA vaccines (eg. Comirnaty (Pfizer) and Spikevax (Moderna)).

Information specific to myocarditis and pericarditis can be found via the below buttons. In addition, frequently asked questions relating to vaccination are also addressed.

Myocarditis

  • How is myocarditis following COVID-19 vaccination triggered?

    The exact mechanism behind cardiac inflammation temporally associated with COVID-19 vaccines is currently being investigated. Clinical causes from international and local surveillance data suggest an immune-mediated or hypersensitivity trigger. There are ongoing studies examining the role of the SARS-CoV-2 spike protein, impact of certain cardiac biomarkers and genetic predispositions to this adverse event of special interest (AESI).

  • Who is at risk of myocarditis?

    Myocarditis from any cause, occurs more commonly in males than females. It is also more likely to affect younger adults.

    Reported rates of myocarditis occurring following administration of COVID-19 vaccines vary; however, they are above expected background rates for both sexes. The peak risk group for COVID-19 vaccine related myocarditis is young adult males aged 16-17 years, with a smaller increased risk for males aged between 12-24 years.

    International and local vaccine safety surveillance data have found that it is more commonly associated with administration of a second dose of COVID-19 mRNA vaccine. Myocarditis following other COVID-19 vaccines, third doses or booster doses have also been identified, although reported cases have occurred at lower rates than those identified following either dose of a primary course.

    Although myocarditis AESI has been associated with all of the COVID-19 vaccines used in Australia, there is a higher risk of myocarditis following administration of COVID-19 mRNA vaccines compared to non-mRNA vaccines. Surveillance data from multiple countries have also demonstrated a greater risk with Spikevax (Moderna) compared to Comirnaty (Pfizer).

  • Are children more likely to experience myocarditis following COVID-19 vaccination?

    Available safety data from local and international sources suggest there is a significantly lower risk of children developing myocarditis following vaccination. Thus far, data shows that the risk of COVID-19 vaccine myocarditis decreases as age decreases.

    ATAGI recommends an interval of 8 weeks between vaccine doses in a primary course for age-eligible children (≤ 11 years) for maximum efficacy and safety. This extended interval is based on international data suggesting a longer time interval between dose 1 and 2 may reduce the risk of myocarditis. This extended interval also allows more time to observe international vaccine safety data and identify any signals for rare adverse events.

    Very few cases of myocarditis in children <6 years of age have been reported in available worldwide surveillance data to date.

    For more information on COVID-19 vaccination in individuals < 18 years please refer to COVID-19 vaccination in children and adolescents.

  • Pre-existing cardiac conditions and COVID-19 vaccination

    Individuals with the following cardiac conditions can safely receive COVID-19 vaccines without the need for additional monitoring or precautions:

    • coronary artery disease
    • myocardial infarction
    • stable heart failure
    • arrhythmias
    • rheumatic fever
    • rheumatic heart disease
    • kawasaki disease
    • most congenital heart disease
    • those with implanted cardiac devices
    • congenital heart disease
    • cardiac transplant
    • cardiomyopathy.

    Those with a history of the following conditions can also receive COVID-19 vaccines; however should consult their treating specialist to determine the appropriate timing for vaccination:

    • recent (within 3 months) or current inflammatory cardiac conditions (including myocarditis, pericarditis and endocarditis)
    • acute rheumatic fever or acute rheumatic heart disease
    • acute decompensated heart failure.

    Patients with ongoing cardiac inflammation should have vaccination deferred. In some instances, vaccination with Vaxzevria (AstraZeneca) or Nuvaxovid (Novavax) may be considered due to the lower associated risk of developing myocarditis.

  • What are the symptoms of myocarditis?

    Myocarditis presents similarly to pericarditis, with a range of symptoms including:

    • chest pain, pressure or discomfort
    • pain with breathing (pleuritic chest pain)
    • shortness of breath
    • palpitations
    • syncope (faint)
    • other non-specific symptoms such as fatigue, dizziness, abdominal pain.

    In individuals who have received COVID-19  vaccines, symptoms of myocarditis have most commonly been reported within 2-7 days of second dose vaccination.

  • How is myocarditis after COVID-19 vaccination diagnosed and investigated?

    If there is suspicion of myocarditis, particularly in the first week following vaccination, timely medical review is important. Those who appear unwell should be referred to an emergency department for examination and the following primary investigations:

    • blood tests for cardiac biomarkers, such as troponin
    • electrocardiogram (ECG).

    Other tests should be considered if the patient is unwell or the tests above are abnormal:

    • chest X-ray (CXR)
    • other tests related to investigating differential diagnoses such as inflammatory markers (C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)
    • bedside or formal ultrasound/echo
    • cardiac MRI.

    Consistent findings of myocarditis may include elevated troponin, ECG changes (ST or T-wave abnormalities, premature atrial or ventricular complexes) as well as abnormal echocardiogram or cardiac MRI.

    Individuals who are investigated for myocarditis following vaccination should avoid high-intensity exercise until symptoms have resolved is recommended.

    Cardiologist advice and followup is strongly recommended.

  • How is myocarditis after COVID-19 vaccination treated?

    Current data shows that most cases of myocarditis following COVID-19 vaccination have mild symptoms and recover well. Information on long term sequelae is not yet available.

    Treatment of these conditions is managed by a cardiologist and include in-patient supportive therapies. In the rare severe or complicated cases, specific management for arrythmias, decreased cardiac function or congestive cardiac failure with pharmacological agents such as ACE-inhibitors and beta-blockers or mechanical support may be necessary.

  • I have specific questions around my risk of myocarditis following COVID-19 vaccination. Help!

    Although uncommon, myocarditis is most often seen after COVID-19 mRNA vaccines. Please refer to our specific FAQs on COVID-19 mRNA vaccines for further information. This includes answers on:

    • impact of dose intervals between 1st and 2nd doses of vaccine
    • risk of developing myocarditis from COVID-19 disease vs the vaccine
    • exercise after COVID-19 vaccination
    • impacts of medications and drugs such as clozapine, stimulants, amphetamines on developing myocarditis.

  • What are the implications for future doses (including third and booster doses)?

    For individuals where the cause of inflammation is attributed to COVID-19 vaccination, a report to SAEFVIC is indicated and a referral to a cardiologist and/or specialist immunisation service (eg. VicSIS) is recommended.

    Please refer to the below algorithm for recommendations relating to further doses of COVID-19 vaccines in patients who have been diagnosed with myocarditis following vaccination.

    *Brighton Level refers to Brighton Collaboration criteria for classifying myocarditis
    PDF version of the above diagram available here.

    ATAGI currently recommends that individuals diagnosed with myocarditis following vaccination defer any further doses and are referred to a specialist immunisation clinic.

  • What is the risk/benefit ratio for vaccination for the young adult age group?

    It is important to discuss your individual circumstances with a health care provider in order to make an informed decision.

    The level of COVID-19 community transmission in Australia can change quickly. Factors to consider include age, potential for exposure to the virus (including in the workplace), high rates of global transmission, the emergence of new variants of the virus, as well as the potential for future changes to Australia’s border controls.

    Whilst COVID-19 infection can sometimes result in myocarditis, its incidence following COVID-19 vaccination is comparatively extremely rare. Most individuals diagnosed with myocarditis following COVID-19 vaccination have responded well to treatment.

Pericarditis

  • How is pericarditis following COVID-19 vaccination triggered?

    The exact mechanism behind cardiac sac inflammation temporally associated with COVID-19 vaccination is currently being investigated. Clinical causes from international surveillance data suggest an immune-mediated or hypersensitivity trigger.

  • Who is at risk of pericarditis?

    Pericarditis from any cause occurs in similar rates amongst males and females. It is also more likely to affect younger adults.

    Reported rates of pericarditis occurring following administration of a COVID-19 vaccine vary; however, they are above expected background population rates. Available surveillance data suggests the risks for pericarditis after a mRNA vaccine are higher than non-mRNA vaccines.

    International and local data indicate that pericarditis following COVID-19 vaccines is more common in the 18-39 year old age group for both males and females. Pericarditis following third doses or booster doses have also been identified in a small number of individuals. Reported cases have occurred at significantly lower rates than those identified following either dose of a primary course.

  • Are children more likely to experience pericarditis following COVID-19 vaccination?

    Available safety data from local and international sources suggest there is a significantly lower risk of children developing pericarditis following COVID-19 vaccination.

    ATAGI recommends an interval of 8 weeks between vaccine doses in a primary course for age-eligible children (≤ 11 years) for maximum efficacy and safety. This extended interval is based on international data suggesting a longer time interval between dose 1 and 2 may reduce the risk of myocarditis – which in principle may also extend to pericarditis. This extended interval also allows more time to observe international vaccine safety data and identify any signals for rare adverse events.

    For more information on COVID-19 vaccination in individuals < 18 years please refer to COVID-19 vaccination in children and adolescents.

  • Pre-existing cardiac conditions and COVID-19 vaccination

    Individuals with the following cardiac conditions can safely receive COVID-19 vaccines without the need for additional monitoring or precautions:

    • coronary artery disease
    • myocardial infarction
    • stable heart failure
    • arrhythmias
    • rheumatic fever
    • rheumatic heart disease
    • kawasaki disease
    • most congenital heart disease
    • those with implanted cardiac devices
    • congenital heart disease
    • cardiac transplant
    • cardiomyopathy.

    Those with a history of the following conditions can also receive COVID-19 vaccines; however should consult their treating specialist to determine the appropriate timing for vaccination:

    • recent (within 3 months) or current inflammatory cardiac conditions (including myocarditis, pericarditis and endocarditis)
    • acute rheumatic fever or acute rheumatic heart disease
    • acute decompensated heart failure.

    Patients with ongoing cardiac inflammation should have vaccination deferred. In some instances, vaccination with Vaxzevria (AstraZeneca) or Nuvaxovid (Novavax) may be considered due to the lower associated risk of pericarditis.

  • What are the symptoms of pericarditis?

    Pericarditis presents similarly to myocarditis, with a range of symptoms including:

    • chest pain, pressure or discomfort
    • pain with breathing (pleuritic chest pain)
    • shortness of breath
    • palpitations
    • syncope (faint)
    • other non-specific symptoms such as fatigue, dizziness, abdominal pain.

  • How is pericarditis after COVID-19 vaccination diagnosed and investigated?

    If there is suspicion of either of these conditions, particularly in the first 2-3 weeks following vaccination, timely medical review is important. Those who appear unwell should be referred to an emergency department for the following investigations:

    • blood tests for cardiac biomarkers, such as troponin
    • electrocardiogram (ECG)

    Other tests should be considered if the patient unwell or the tests above are abnormal:

    • chest X-ray (CXR)
    • other tests related to investigating differential diagnoses such as inflammatory markers (C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)).

    Consistent findings of pericarditis include a pericardial rub on auscultation, widespread ST-elevation or PR depression on ECG, as well as pericardial effusion on imaging.

    Individuals who are investigated for pericarditis following vaccination should avoid high-intensity exercise until symptoms have resolved is recommended. Those experiencing ongoing symptoms should return for review in 1-2 days time. Cardiologist advice is recommended if clinical suspicion is high, regardless of normal investigations.

  • How is pericarditis after COVID-19 vaccination treated?

    Current data shows that most cases of pericarditis following COVID-19 vaccination have mild symptoms and recover well.

    In some scenarios, there have been reports of pericarditis causing prolonged and recurrent symptoms but with functionally normal investigations including cardiac imaging. Information on long term sequelae is still being collected.

    Treatment of these conditions is managed by a cardiologist and include in-patient supportive therapies, often with anti-inflammatory medications or colchicine. In the rare severe or complicated cases, specific management for arrhythmias, decreased cardiac function or congestive cardiac failure with pharmacological agents such as ACE-inhibitors and beta-blockers or mechanical support may be necessary.

  • What are the implications for future doses (including third and booster doses)?

    For individuals where the cause of inflammation is attributed to COVID-19 vaccination, a report to SAEFVIC is indicated and a referral to a cardiologist and/or specialist immunisation service (eg. VicSIS) is recommended.

    Please refer to the below algorithm for recommendations relating to further doses of COVID-19 vaccines in patients who have been diagnosed with pericarditis following vaccination.

    *Brighton Level refers to Brighton Collaboration criteria for classifying pericarditis
    Access a pdf version of this guide here.

    In particular, the groups which are at lower risk (green in algorithm), could proceed with further doses of COVID-19 vaccination as per above suggested instructions.

  • What is the risk/benefit ratio for vaccination for the young adult age group?

    It is important to discuss your individual circumstances with a health care provider in order to make an informed decision.

    The level of COVID-19 community transmission in Australia can change quickly. Factors to consider include age, potential for exposure to the virus (including in the workplace), high rates of global transmission, the emergence of new variants of the virus, as well as the potential for future changes to Australia’s border controls.

    Whilst COVID-19 infection can sometimes result in pericarditis, its incidence following COVID-19 vaccination is comparatively extremely rare. Most individuals diagnosed with pericarditis following COVID-19 vaccination have responded well to treatment.

Frequently asked questions

  • I am taking certain medications that have myocarditis listed as an uncommon side effect. Am I at greater risk of developing myocarditis/pericarditis after COVID-19 vaccination?

    Taking medications that have myocarditis listed as an uncommon side effect (e.g. antipsychotic drugs and biological chemotherapeutic agents) is not a contraindication to COVID-19 vaccination. Individuals taking these medications can be safely vaccinated in the community with no need for additional precautions or monitoring.

  • Are there impacts of other substances on the development of myocarditis/pericarditis after COVID-19 vaccines?

    The use of recreational stimulants (particularly amphetamines) is discouraged especially in the week following vaccination to limit the potential for developing myocarditis/pericarditis.

  • Should exercise be limited after receiving COVID-19 vaccines to reduce the chance of myocarditis/pericarditis?

    Exercise is not thought to increase the risk of developing myocarditis/pericarditis following COVID-19 vaccination. It is therefore not necessary to reduce or avoid exercise in the post-vacccination period.

    However, if patients develop myocarditis/pericarditis post vaccination there is a concern that exercise may be pro-arrhythmic (eg. will exacerbate) the condition.

  • As myocarditis/pericarditis following COVID-19 vaccination is thought to be immune mediated, would those with pre-existing autoimmune diseases be at an increased risk compared to the general public?

    Myocarditis/pericarditis following COVID-19 vaccination appears to be idiosyncratic at this stage, with no clear risk factors. Thus, there is no indication of increased risk in those with underlying autoimmune disease.

Authors: Rachael McGuire (MVEC Education Nurse Coordinator), Francesca Machingaifa (MVEC Education Nurse Coordinator), Daryl Cheng (MVEC Medical Lead) and Nigel Crawford (Director SAEFVIC, Murdoch Children’s Research Institute)

Reviewed by: Daryl Cheng (MVEC Medical Lead) and Julia Smith (Immunisation Fellow, Royal Children’s Hospital)

Date: October 27, 2022

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.


Moderna (Spikevax) COVID-19 vaccine

Immunogenicity

Pre-clinical trials were conducted in mice which showed that two doses of the vaccine protected the mice from infection with the SARS-CoV-2 virus with no virus detected in the lower respiratory tract and nose following a challenge with the SARS-CoV-2 virus. These results indicated the vaccine may reduce both infection and transmission in humans.

The US phase 1 trial included participants aged 18-55 years old who received two injections of Spikevax 28 days apart at doses of 25 μg, 100 μg or 250 μg. The vaccine elicited a strong immune response without any severe adverse events and the trial supported the selection of the 100 μg  dose for advancement to Phase 2/3 trials.

Safety profile

During clinical trials, symptoms following immunisation were generally mild to moderate and short-term. Local and systemic reactions were more common after the second dose and in the younger age group (18-64 years).

Local reactions included pain (86-90%) and redness (3-9%) at the injection site and axillary (armpit) swelling/tenderness (11-16%). The average onset of local reactions was 1 day after either dose, with an average duration of 2-3 days.

Systemic reactions (including fatigue, headache,  muscle ache, joint pain, chills, nausea and vomiting) were more common after the second dose (82%) compared to the first dose (57%).  Fever was more common following the second dose (17%). The average onset of local reactions was 1-2 days after either dose, with an average duration of 2 days. The incidence of serious adverse events was very low (1%) and similar in both the vaccine and placebo groups.

Vaccine efficacy

phase 3 trial enrolling 30,420 volunteers aged ≥18 years, assigned participants to receive either the vaccine or placebo as two intramuscular injections 28 days apart. Spikevax showed overall efficacy of 94.1% for preventing COVID-19 illness, and 100% efficacy for preventing severe disease. Vaccine efficacy was consistent across subgroups stratified by age group (18 to < 65 years of age, ≥ 65 years, presence of risk for severe COVID-19 disease, sex, race and ethnic groups).

Paediatric clinical trials

3732 adolescents (12-15 years) participated in a phase 3 trial in the US investigating the safety and efficacy of Spikevax (Moderna) in children. Results from this trial have demonstrated an efficacy against confirmed symptomatic COVID-19 disease of 93.3% (commencing 14 days after dose 2 of vaccine. 1 case in vaccine group, 7 cases in placebo group). There were no cases of severe COVID-19 or deaths in the study cohort.

Up to 4000 children (6-11 years) were recruited to the KidCOVE clinical trial across Canada and the United States. The immunogenicity, safety and efficacy of 2 doses of 50µ of Spikevax (Moderna) was assessed. Immunogenicity was comparable to that seen in individuals aged 18-25, with a good protection seen against COVID-19 disease.

2024 children aged 6 to 23 months and 3452 children aged 2-5 years participated in the phase 2-3 P205 clinical trial assessing the immunogenicity, efficacy and safety of a two-dose primary course of 25µ of Spikevax (Moderna). The immune response of the infants and children was comparable to that seen in adults aged 18-25 years in earlier trials. Results (>14 days after dose 2) demonstrated that in those without history of prior COVID-19 infection, vaccination was 50.6% effective in preventing disease in participants aged 6-23 months of age, and 36.8% in those aged 2-5 years. In those with a history of previous COVID-19 infection, vaccine efficacy against symptomatic COVID-19 disease was 52.1% for the 6-23 month group, and 34.5% in the 2-5 years group. There were no cases of severe COVID-19 disease reported in the study.

For further information, refer to MVEC: COVID-19 vaccination in children.

Post-licensure surveillance

Allergies

A true vaccine allergy (anaphylaxis) is a rare side effect occurring for all vaccines at a rate of approximately 1 case per million vaccine doses administered. Post-licensure surveillance of Spikevax in the US has shown that it has a slightly higher rate of anaphylaxis with approximately 2.5 cases per million. Most cases (89%) occurred within 30 minutes of vaccination and 26% had a history of prior anaphylaxis.

Myocarditis/pericarditis

A small number of cases of myocarditis and pericarditis have been reported in individuals vaccinated with COVID-19 mRNA vaccines (eg. Comirnaty and Spikevax). Reports have predominantly involved adolescents and young adults, more commonly males, after the second dose of vaccine. Symptom onset has typically been seen within 4 days of vaccination.

Resources

Authors: MVEC Education Team

Reviewed by: Rachael McGuire, (MVEC Education Nurse Coordinator) and Francesca Machingaifa (MVEC Education Nurse Coordinator)

Date: September 15, 2022

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.


Multi-dose vials

What are they?

Multi-dose vials contain more than one dose of a medicine/vaccine in a single vial. Whilst all vaccines on the National Immunisation Program are single-use preparations, BCG vaccines and COVID-19 vaccines are available in multi-dose vials in Australia. Multi-dose vials are more economical, take less time to manufacture and require less storage space than single-use preparations, however, there is an increased risk of infection control breaches associated with their use.

Infection control principles

There is an increased risk of blood-borne viruses or bacterial contamination with the use of multi-dose vials due to an increased risk of cross contamination. These risks can be mitigated by:

  • Maintaining standard principles of infection control and strict aseptic technique when accessing multi-dose vials
  • Preparing doses of vaccines from multi-dose vials in a clean, designated medication preparation area
  • Cleaning the stopper with an alcohol swab and allowing to dry every time the vial is accessed
  • Using a new, sterile syringe and needle each time the vial is accessed. Needles should never be left inside the vial
  • Discarding a multi-dose vial if the vaccine’s integrity or sterility is compromised

Storage and usage

  • Follow the manufacturer’s recommendations for refrigeration, storage, usage timeframes and expiry dates. Protect from sunlight and freezing where required.
  • Always label a multi-dose vial with the date and time of first access or reconstitution
  • The expiry date is the date after which an unused multi-dose vial should be discarded
  • The use by date is the date after which a multi-dose vial that has been accessed should no longer be used. A use by date supercedes the expiry date
  • Check reconstituted vaccines for signs of deterioration, such as a change in colour or clarity. If there are signs of deterioration, refer to the vaccine product information. Do not use the vaccine

Multi-dose vials that require reconstitution

  • Only the recommended diluent should be used to reconstitute a multi-dose vial
  • Introduce the diluent down the side of the vial to avoid foaming or potentially denaturing the vaccine. Mix gently with a careful swirling motion. Do not shake
  • Give reconstituted vaccines as soon as practicable after reconstituting. This is because reconstituted vaccines may deteriorate rapidly
  • Once accessed, label the multi-dose vial with the date and time of reconstitution

Pre-filling syringes

Pre-preparing syringes with vaccines is not recommended for several reasons:

  • The uncertainty of vaccine stability
  • The risk of contamination
  • Increased risk of potential errors in administration
  • Potential vaccine wastage

If you are in a setting where pre-preparing multiple doses is required, then only draw up the number of doses necessary to keep the immunisation session running efficiently. These doses must be labelled with the date and time the vial was accessed and should be used as soon as possible, ensuring that the cold chain is maintained.

Principles of administration

  • Attach a new, sterile, disposable injecting needle of appropriate size and length to administer the vaccine
  • Be careful not to prime the needle with any of the vaccine as this can increase the risk of injection site reactions
  • Administer the vaccine as soon as practicable after drawing it up
  • Discard multi-dose vials at the end of an Immunisation session/6 hours after accessing (whichever is sooner) or according to manufacturer’s guidelines
  • Refer to the product information to determine the specified timeframe the vaccine must be used by once the vial has been accessed

Resources

Authors: Francesca Machingaifa (MVEC Education Nurse Coordinator) and Rachael McGuire (MVEC Education Nurse Coordinator)

Reviewed by: Francesca Machingaifa (MVEC Education Nurse Coordinator)

Date: March 2022

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.


MTHFR Gene

  • A number of families and consumers and healthcare professionals have been asking MVEC staff about the MTHFR gene and possible adverse events following immunisation [AEFI]
  • MTHFR stands for methylenetetrahydrofolate reductase, which is the name of an enzyme involved in folate metabolism

MTHFR gene polymorphisms, or harmless changes in the gene, are very common. MTHFR gene mutations are different to gene polymorphisms and are very rare and present differently [see below Resources: MTHFR VCGS].

Research and clinical reports have shown that multiple MTHFR gene polymorphisms have been linked to thromboembolism (or blood clots), but there has been no proven, or conclusive link regarding other health conditions. This includes adverse events [AEFI] following vaccines administered on the Australian National Immunisation Program.

We have sought advice from our expert colleagues at the Victorian Clinical Genetic Services, who have provided an excellent, clearly written document regarding the indications for and usefulness of the MHFTR test [see below Resources: MTHFR VCGS].

What to do?

  • At MVEC, we believe that there is no clinical indication for MTHFR polymorphism testing before vaccination, as there is no proven increased risk of an AEFI
  • If a family member has already had the test, we do not recommend any testing of relatives and feel it is safe to proceed with all immunisations

Resources

Authors: Nigel Crawford (Director SAEFVIC, Murdoch Children’s Research Institute) and Margie Danchin (Senior Research Fellow, Murdoch Children’s Research Institute)

Date: February 2018

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.


Maternal vaccination during pregnancy

Immunisation assessment is an extremely important aspect of healthcare during pregnancy. When planning a pregnancy, talk to your health care provider about any vaccines you might need beforehand. Live-attenuated vaccines should be given at least a month before conception.

Recommended vaccines

Influenza, pertussis and COVID-19 vaccines are the only vaccines routinely recommended for pregnant women. They are provided for free via the National Immunisation Program (NIP).

Some other vaccines can be administered in special circumstances but are not routinely recommended. Refer to the Australian Immunisation Handbook for further information.

Influenza

Influenza vaccination is safe and strongly recommended for pregnant women to avoid complications from influenza disease. It can be administered at any stage of pregnancy and not only aims to protect the expectant mother from disease, but also to provide passive protection to the infant.

Pregnant women are at greater risk of morbidity and mortality from influenza disease than non-pregnant women. They are more than twice as likely to be hospitalised with influenza disease as other people with influenza.

Babies less than 6-months of age are at greatest risk of disease and death from influenza and maternal vaccination will provide protection to babies for the first few months of life until they can be immunised against influenza from 6-months of age.

Pertussis

Pertussis (whooping cough) immunisation during pregnancy is a safe and effective way to protect the mother and prevent disease of the newborn. It is recommended that a single dose of the vaccine be administered between 20 and 32 weeks of pregnancy, in every pregnancy, including pregnancies that are closely spaced.

Maternal antibodies against pertussis provide protection for babies until they have at least received 2 doses of their own pertussis containing vaccine (given at 6-weeks and 4-months of age). Babies less than 6-months of age are at greatest risk of severe disease and death from pertussis.

COVID-19 vaccines

Due to an increased risk of severe outcomes for pregnant women and their unborn babies it is recommended that pregnant women are routinely offered COVID-19 vaccines. Vaccines can be given at any stage of pregnancy.

Surveillance of international data on administration of mRNA COVID-19 vaccines (Comirnaty (Pfizer) or Spikevax (Moderna)) to pregnant women has shown no significant safety concerns for either the mother or the baby. Evidence demonstrates antibodies can pass into breastmilk and cord blood which may provide protection to infants via passive immunity.

Nuvaxovid (Novavax) may be administered to pregnant and breastfeeding women however there is no immunogenicity or safety data on it’s use in this patient group.

Pregnant women have been shown to have an increased risk of needing admission to the intensive care unit and requiring mechanical ventilation if they contract COVID-19 compared with non-pregnant women of the same age.

Women who are planning pregnancy or who are breastfeeding can safely receive a COVID-19 vaccine. You do not need to stop breastfeeding before or after vaccination.

For more information refer to the following:

Contraindicated vaccines

All live-attenuated vaccines are contraindicated during pregnancy due to the potential risk to the unborn baby [see Table 1 below]. In most circumstances the risk is hypothetical however, there is insufficient evidence to support vaccination in this patient group. The limited safety data from inadvertent administration of live-attenuated viral vaccines such as the MMR and Varicella vaccines is reassuring.

Table 1: Live-attenuated vaccines contraindicated in pregnancy

Disease Brand name
Rotavirus Rotarix®, Rotateq®
MMR (measles-mumps-rubella) Priorix®, MMR II®
MMRV (measles-mumps-rubella-varicella) Priorix-tetra®, ProQuad®
Varicella (chickenpox) Varilrix®, Varivax®
Zoster (shingles) Zostavax®
Tuberculosis BCG (varying brands)
Yellow fever Stamaril®
Typhoid^ Vivotif®
Japanese encephalitis Imojev®

^Oral vaccine

Resources

Monash Health immunisation resources

MVEC resources

Authors: Michelle Giles (Infectious Diseases Consultant, Monash Health) and Rachael McGuire (MVEC Education Nurse Coordinator)

Reviewed by: Rachael McGuire (MVEC Education Nurse Coordinator) and Francesca Machingaifa (MVEC Education Nurse Coordinator)

Date: November 30, 2022

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.


Measles

What is it?

Measles is a highly contagious viral illness.

What to look for

Infection usually begins with 2-4 days of fever, malaise, cough, runny nose and conjunctivivits.

A macropapular rash then develops, often beginning on the face before becoming more generalised.

Complications of disease include pneumonia, encephalitis, brain damage, subacute sclerosing panencephalitis (SSPE) and death.

Measles infections during pregnancy can result in miscarriage and prematurity.

How is it transmitted?

It is highly infective and spread by coughing and sneezing.

Prevention

Measles containing vaccines (measles-mumps-rubella or measles-mumps-rubella-varicella) can protect against disease. Currently on the National Immunisation Program, these are given at 12 months of age (MMR) and 18 months of age (MMRV).

For those born after 1966, 2 doses are required for lifelong protection. One or two doses of free MMR vaccine is available for all adults born during or since 1966 without evidence of receiving two documented doses of valid MMR vaccine or without serological evidence of immunity.

Travel

Infants aged from 6 months to less than 11 months can receive a free dose of MMR vaccine prior to overseas travel to highly endemic areas and during outbreaks. This dose is in addition to the scheduled MMR vaccine doses usually administered at ages 12 months (MMR) and 18 months (MMRV). Please discuss with your Doctor or travel specialist.

Post-exposure prophylaxis

If a non-immune individual is exposed to measles, immunisation with MMR or MMRV is recommended to occur within 72 hours of exposure in order to reduce the likelihood of infection (provided immunisation is not a contraindication).

In some instances, administration of Normal Human Immunoglobulin (NHIG) may be indicated [refer to resources].

Resources

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

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

Date: August 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.


MMR vaccine and autism

Some families have concerns around the measles-mumps-rubella (MMR) vaccine and the diagnosis of autism. At MVEC we encourage parents to find the best available evidence to help them make a decision around vaccinating their child. The MMR live-attenuated vaccine is recommended on the National Immunisation Program at 12-months of age and combined with the varicella vaccine (MMRV) at 18-months of age.

A great resource for addressing MMR concerns is a decision aid developed by the National Centre for Immunisation Research and Surveillance (NCIRS) in Sydney. It is targeted at:

  • Parents or caregivers of a child approaching their due date for MMR vaccination.
  • Anyone who would like more information about MMR vaccination

Note: this guide provides general information only, and is not intended as a substitute for consultations with qualified health professionals. For specific queries talk with your local doctor or immunisation provider, or contact us at info.mvec@mcri.edu.au or Telephone: 1300 882 924

Resource

Authors: Nigel Crawford (Director, SAEFVIC, Murdoch Children’s Research Institute) 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.