The Royal Children's Hospital COVID-19 follow-up clinic

In July 2020, the Royal Children’s Hospital (RCH) COVID-19 follow-up clinic was initiated to support COVID-19 positive​ children and their families. The clinic provides acute care and long-term follow-up via telehealth services. Face-to-face appointments are also available (after being cleared from isolation or quarantine).

The clinic aims:

  • To provide clinical support/advice to COVID-19 positive children/families soon after diagnosis with long term follow-up care
  • To provide links to long-term primary health care networks and GP’s
  • To support vulnerable children and families
  • To provide investigations as needed
  • To offer children and families the opportunity to participate in research projects (e.g. SARS-CoV-2 antibody testing)

Clinic details:

  • Time: Wednesdays 1.30pm - 4.30pm

 Referral by a GP or specialist:

  • External referrals can be made here
  • Specialty: General Medicine
  • Provider: Dr Shidan Tosif
  • Department: COVID Clinic
  • Diagnosis: COVID follow-up​

Authors: Daniela Say (MVEC Immunisation Fellow, Murdoch Children's Research Institute)

Date: October 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.


Recommended additional vaccines for purchase up to 20 years of age (unfunded)

Did you know there are additional vaccines recommended by vaccine experts that are available for private purchase? They are not free as they are not listed on the National Immunisation Program (NIP) or funded by the government. Most councils will offer some additional vaccines for purchase or alternatively all these vaccines are available for purchase with a prescription from your GP.

Influenza vaccine

Influenza vaccine is recommended annually for everyone from the age of 6-months.

Who is eligible for the free vaccine?

  • Influenza vaccine is routinely funded for all children aged 6-months to less than 5-years of age, all Aboriginal & Torres Strait Islander people ≥ 6-months of age, pregnant women and for people with specific medical risk factors who are at risk of complications from influenza, regardless of age.

Recommended but not funded:

  • For children (> 5-years), adolescents and adults. Influenza vaccines can be purchased and administered at most council community immunisation sessions or alternatively with a prescription from your GP or from pharmacist immunisers for people aged 10-years and over.
  • Children less than 9-years of age require 2 doses, 1 month apart, in the first year they receive the vaccine.

Resources:

Meningococcal vaccines

Meningococcal ACWY

Meningococcal ACWY (MenACWY) vaccine is recommended for any person who wants to protect themselves against invasive meningococcal disease (IMD) and can be administered from as early as 6-weeks of age. MenACWY provides protection against four strains of meningococcal disease, A, C, W and Y.

Who is eligible for the free vaccine?

  • A single dose of Nimenrix® is currently provided at 12-months of age on the National Immunisation Program (NIP)
  • Catch-up dose for any person aged under 20 years who did not receive a meningococcal C containing vaccine at 12-months of age
  • Young people aged 15 to 16-years or in Year 10 of secondary school as a school based vaccine program
  • All young people aged 15-19 years of age who have not received the vaccine at secondary school
  • People of all ages with some specified medical conditions that increase the risk of IMD (complement deficiency, current or future treatment with eculizumab, asplenia) [see resources].

Recommended but not funded:

Some local councils offer Nimenrix® (Meningococcal ACWY) as a fee for service if patients wish to be protected but do not meet the criteria on the NIP. Alternatively, this vaccine is available at the GP on private prescription.

Meningococcal B 

Meningococcal B (MenB) vaccine provides protection against B strain meningococcal disease and can be administered from as early as 6-weeks of age.

Who is eligible for the free vaccine?

  • People of all ages with some specified medical conditions that increase the risk of IMD (complement deficiency, current or future treatment with eculizumab, asplenia) [see resources]
  • Aboriginal and Torres Strait Islander infants from 2-months of age [see resources]

There are currently 2 vaccines available on the private market for the protection of meningococcal B disease.

  • Bexsero® is for use from 6-weeks of age
  • Trumenba® is licensed for use in ≥ 10-years of age

Meningococcal B vaccines brands are not interchangeable.

Some local councils offer Bexsero® as a fee for service if patients wish to be protected but do not meet the criteria on the NIP. Alternatively, this vaccine is available at the GP on private prescription.

Resources:

Chickenpox (varicella) vaccine

2 doses of varicella-containing vaccine provide 15-20% more protection against (mild) breakthrough varicella (chickenpox) in children <14 years of age, however a 2nd dose is not included on the National Immunisation Program schedule.

Who is eligible for the free vaccine?

  • A single dose of the live-attenuated varicella vaccine is currently funded on the NIP for children at age 18 months of age in a combined measles-mumps-rubella-chickenpox (MMRV) vaccine.
  • For those ≥ 14 years of age, 2 doses (administered 4 weeks apart) are required for the protection of non-immune individuals.
  • MMRV combination vaccine is not recommended for use in people from >14 years of age.

Recommended but not funded

  • If parents or carers wish to minimise the risk of breakthrough varicella in children <14 years of age, a 2nd dose of varicella-containing vaccine is recommended and can be purchased at some council community immunisation sessions or purchased by prescription from the GP.
  • Children can receive a chickenpox vaccine from as young as 12 months of age. This can provide earlier protection against varicella, which may be appropriate in the context of childcare, travel or a varicella outbreak. There is no safety concern if the child still receives the dose scheduled at 18 months of age.
  • The minimum interval between doses of varicella-containing vaccine is 4 weeks.

Resources:                           

Special risk groups

Individuals that are at higher risk of vaccine preventable diseases (VPD) are classified as ‘special risk’ groups in the Australian Immunisation Handbook.

This includes populations at special risk (e.g. Aboriginal and Torres Straight Islanders) and those with additional vaccine requirements (e.g. maternal vaccination; preterm infants). It also has detailed sections on those at special risk because of immune suppression (disease and/or therapy) e.g. Asplenia, cancer/chemotherapy.

Resources:

Additional resources

Further information about childhood vaccination can be found at:

Authors: Georgina Lewis (SAEFVIC Clinical Manager, Murdoch Children’s Research Institute), Francesca Machingaifa (SAEFVIC Research Nurse, Murdoch Children's Research Institute) and DHHS Immunisation Nurses (Immunisation Section, Health Protection Branch, Department of Health and Human Services). 

Reviewed by: Francesca Machingaifa (SAEFVIC Research Nurse, Murdoch Children's Research Institute) and Georgina Lewis (SAEFVIC Clinical Manager, 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.


Rituximab and immunisation recommendations

Rituximab is becoming a frequently used treatment option for many patients with complex medical needs. It is an immune suppressive medication which greatly impacts the production and functionality of immune cells, including the near complete depletion of B-cells. Once treatment with Rituximab has been completed, recovery of immune cell function can take 3-12 months, and even longer in some cases. It may be used as a once-only dose or as a long term therapy.

Due to the effects on lymphocytes, patients on Rituximab therapy are considered immune suppressed and are at a greater risk of vaccine preventable diseases. However, recommendations for immunisation of these patients is complicated by the inability to produce an immune response to vaccines without functioning B- and T-cells.

Many patients on Rituximab are also receiving concomitant immunoglobulin therapy. As this is a blood product, it further complicates the immunisation recommendations involving live vaccines.

Prior to commencing treatment

Where possible please ensure patient is up to date for their age with the current immunisation schedule. Ideally inactivated vaccines should be completed at least 1 week prior, and any live-attenuated vaccines should be completed a minimum of 4 weeks prior to commencing treatment.

During treatment

Due to lack of immune cell function, all future immunisations should be withheld whilst on Rituximab. An immunisation medical exemption form should be completed where appropriate to ensure that the patient is not considered overdue [see resources].

The only exception to this, is Influenza vaccines. Some studies have indicated that an immune response to the influenza vaccine in patients receiving Rituximab therapy may occur. For this reason MVEC recommends that patients continue to be immunised against influenza whilst on therapy and receive 2 doses of the age-appropriate vaccine annually, minimum of 4 weeks apart (regardless of age or vaccine history).

Immunisation of household contacts

All close contacts should ensure that they are up to date with the routine immunisation schedule, including MMR, varicella and pertussis vaccines. Annual Influenza vaccination is strongly recommended.

Serology

There is no need to check serology pre- or post-Rituximab therapy.

Patients should be aware of their immune suppression and avoid potential exposures to vaccine preventable diseases. Medical advice should be sought if exposure does occur [see resources for post-exposure immunoglobulin recommendations].

Post treatment

Post the completion of Rituximab therapy, immunoglobulin and B-cell levels should be checked every 3 months. Once both levels have returned to normal AND ≥ 6-months post treatment has lapsed (whichever is later), immunisation with both inactivated and live-attenuated vaccines can recommence. For patients who have received immunoglobulin alongside their Rituximab, specific intervals are recommended between the administration of live-attenuated vaccines and blood products/immunoglobulin [refer to MVEC: Live-attenuated vaccines and immunoglobulins or blood products]. Any previous vaccine history should be disregarded due to the loss of immune memory.

Please refer to MVEC: Post Rituximab therapy immunisation guideline for re-immunisation recommendations.

Resources

Authors: Rachael McGuire (SAEFVIC Research Nurse, Murdoch Children’s Research Institute), Daryl Cheng (Senior Research Fellow, Murdoch Children's Research Institute) and Theresa Cole (Consultant, Allergy and Immunology, The Royal Children's Hospital)

Date: March 2019

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.

 


Rotavirus

What is it?

Rotavirus is a common cause of viral gastroenteritis in children less than 5 years of age.

What to look for

Symptoms of disease include vomiting, diarrhea, fever, dehydration and drowsiness.

How is it transmitted?

Rotavirus is transmitted via the faecal-oral route.

Prevention

Prior to the introduction of Rotavirus vaccine on the National Immunisation Program in 2007, about 4% of children were hospitalised with rotavirus gastroenteritis by the age of 5 years, with on average one death per year. These rates have dropped dramatically since its introduction. Rotarix® is administered in a 2-dose schedule at approximately 2 months (from 6 weeks) and 4 months of age. The 1st dose must be administered prior to 15 weeks of age and the 2nd dose prior to 25 weeks of age .

Infants living in household with persons who have an immunodeficiency disorder or impaired immune status can still be vaccinated.

Contraindications

Rotavirus vaccine should not be given to any infant with a previous history of intussusception (a rare form of bowel blockage) or a congenital abnormality, which pre-disposes them to intussusception. Infants with severe combined immunodeficiency disorder (SCID) are also excluded from vaccination. The vaccine should also not be administered to an infant with anaphylaxis to a previous dose of Rotavirus vaccine.

Intussusception

There is evidence from Australian and international research that there is a small increase in intussusception cases in infants who receive the oral rotavirus vaccine. Intussusception is a rare condition where the bowel slides or telescopes inside itself causing a blockage. Infants may cry, pull up their legs and later have vomiting and sometimes blood in the stools. In most cases the cause of intussusception is not known. It has been estimated that the increased risk with rotavirus vaccines means an additional six cases per 100,000 infants vaccinated.

Resources

Authors: Georgie Lewis (SAEFVIC Clinical Manager, Murdoch Children’s Research Institute) and Rachael McGuire (SAEFVIC Research Nurse, 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.


Rabies

What is it?

Rabies is a disease caused by exposure to saliva or nerve tissue of an animal infected with the rabies virus or other lyssavirus.

The majority of exposures occur in travellers visiting places where disease is endemic (e.g Asia, Africa)

What to look for

Initial symptoms are usually non-specific and can include cough, fever, headache, myalgia, tiredness and vomiting. Disorientation, anxiety, bizarre behaviour, agitation, hypersalivation (increase in saliva) and hyperactivity can then occur before sudden death.

How is it transmitted?

Disease can occur after a scratch or bite that has broken the skin, or via direct contact with a person’s mucosa (nose, eye or mouth)

Prevention

Rabies is a vaccine preventable disease. Pre-exposure prophylaxis is often recommended for those travelling to Rabies prone areas, as well as for those who work in an at-risk occupation such as bat-handlers and veterinarians.

Post-exposure treatment should be commenced as soon as possible. In cases of rabies exposure when prior immunisations have not been administered, treatment with Human Rabies Immunoglobulin (HRIG) and immunisation is recommended.

Resources

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

Date: September 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.


The Royal Children's Hospital Immunisation Service Drop-in Centre

What is it?

The RCH Immunisation Service drop-in centre was established in March 2001.

The drop-in centre provides opportunistic vaccines for patients and parents at the hospital, and, where available, non-patients (appointments are required for catch-up immunisation plans). Led by a specialist nursing team (and run by Nurse Practitioner and Manager Sonja Elia), it also provides specialist immunisation advice. The team supports outpatient clinics such as the Immunisation Clinic (Tuesday am), Immigrant Health clinic (Monday pm) and dedicated BCG clinics (for infants aged less then 12 months). The drop-in centre provides seasonal vaccines, such as influenza; and delivers Palivizumab (RSV prophylaxis) for at risk infants. Additional vaccines such as varicella, meningococcal B and meningococcal ACWY are also available for purchase.

The staff at the drop-in centre employ a range of distraction techniques to reduce pain and anxiety and when these techniques are unsuccessful, an “immunisation under sedation” service can be offered. Please telephone the service for more information regarding this, bookings are essential.

Please note that the RCH has implemented additional precautions to ensure the safety of all patients, families and staff at this time. Access to medical care remains an essential service during the COVID-19 pandemic and staying up to date with scheduled immunisations is encouraged.

Referrals

Immunisation clinic – referrals can be sent directly to fax number (03) 9345 4163.

BCG clinic – referrals can be sent directly to fax number (03) 9345 5034.

Inpatients and Outpatients – can be seen by one of the Immunisation Nurse Specialists at RCH, no referral is required.

Contact

Telephone: Immunisation hotline 1300 882 924 (option 2) or direct (03) 9345 6599 / 9345 6399.

Pager: 4330 via hospital switchboard (03) 9345 5522.

Email: immunisation.centre@rch.org.au

Facsimile: (03) 9345 4100.

Resources

Author: Sonja Elia (Nurse Practitioner and Manager Immunisation Service, RCH)

Reviewed by: Sonja Elia (Nurse Practitioner and Manager Immunisation Service, RCH) and 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.