M Letter

इन्फ्लुएंजा क्या है?

Mpox (previously known as monkeypox) is a viral zoonosis (an infection spread from animals to humans). It is caused by a virus that belongs to the ऑर्थोपॉक्सवायरस genus (which also causes the variola virus responsible for smallpox disease). Since the eradication of smallpox in 1980, mpox has become the most important orthopoxvirus affecting humans.

किन लक्षणों पर नज़र रखने की आवश्यकता है?

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

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 feet (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 (blisters). 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 threaten vision), bronchopneumonia and encephalitis. The case fatality ratio is between 3-6%. More severe illness can occur in immunocompromised people.

यह कैसे संचारित होता है?

Mpox 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 (often through bites or scratches). 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 (through activities such as kissing), the skin lesions of an infected person (by touching or sexual contact), or through contact with 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. Infections during pregnancy can be transmitted to the baby.

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

एपिडेमियोलॉजी (महामारी विज्ञान)

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

टीके

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

• ACAM2000 – 2nd generation, live-attenuated vaccine
• JYNNEOS (MVA-BN) – 3rd generation, non-replicating vaccine.

Both vaccines are formulated using the vaccinia virus, a poxvirus related to smallpox and mpox.

JYNNEOS (MVA-BN) can be administered either subcutaneously (preferred) or intradermally. ACAM2000 must be administered via a percutaneous route which can only be performed by a provider who is trained in this complex technique. ATAGI preferentially recommends JYNNEOS (MVA-BN) vaccine due to the ease of administration and decreased likelihood of side effects.

Recommendations

Vaccines can be administered as either primary preventative vaccination (PPV) or post-exposure preventative vaccination (PEPV). For PEPV, vaccination within 4 days is recommended to provide optimal protection against the development of mpox infection. Vaccination between 4-14 days following exposure may lessen the severity of disease.

Vaccination is currently recommended for the following groups:

• sexually active gay, bisexual or other men who have sex with men (GBMSM), including transgender and gender diverse people
• sex workers
• people living with HIV or other immune suppressive conditions if at risk of mpox exposure
• laboratory personnel working with orthopoxviruses
• high-risk contacts of a confirmed case of mpox.

Vaccination may also be considered for:

• healthcare workers at risk of exposure to patients with mpox
• regular sexual partners of GBMSM, sex workers and people living with HIV.

Contraindications

Anyone with a history of तीव्रग्राहिता 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 गर्भवती.

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).

एहतियात

Subcutaneous vaccination is preferred over intradermal in individuals with a history of keloid scarring.

Individuals receiving ACAM2000 as PPV should consider an interval of 4 weeks between vaccination and administration of COVID-19 vaccines due to the rare risk of मायोकार्डिटिस / पेरिकार्डिटिस.

Table 1: Vaccine brands, dose and route 

* subcutaneous and intradermal routes are considered interchangeable to complete a primary course; when vaccinating post-exposure (PEPV) using a subcutaneous route is preferred for the first dose
^ only immunisation providers with appropriate training and experience should administer vaccines via an intradermal route
# percutaneous administration involves using a bifurcated needle and scarification technique which requires specialised training and accreditation
Ω for full aftercare instructions, refer the product information

संसाधन

विक्टोरियन कार्यक्रम की जानकारी

• Victorian Department of Health: Mpox [includes information on where to access vaccines]

अन्य संसाधन

• Australian Government Department of Health and Aged Care: Mpox resources
• Mpox virus infection: CDNA National Guidelines for Public Health Units
• Better Health Channel: Mpox

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

संसाधन

• MVEC: Use of Multi-dose Vials eLearning package
• ATAGI guidance on the use of multi-dose vials for COVID-19 vaccination
• ACIPC: Aseptic Technique Clinician Cheat Sheet
• Canadian Immunization Guide: Vaccine administration practices
• Center for Disease Control Injection Safety: Questions about multi-dose vials
• Medical Journal of Australia: Vaccination, consent and multi-dose vials
• WHO policy statement: Multi-dose Vial Policy (MDVP)

पृष्ठभूमि

एमethylenetetrahydrofolate reductase (MTHFR) is an enzyme that helps the body to break down folate. The MTHFR enzyme is made by the MTHFR gene. Harmless changes in the MTHFR gene, polymorphisms, are very common. Importantly, MTHFR polymorphisms do नहीं cause any significant health problems. MTHFR gene variants or mutations are different to gene polymorphisms और are very rare. For more information about the MTHFR gene, refer to the resource below [Resources: VCGS MTHFR].

MTHFR gene polymorphisms and vaccines

People who have MTHFR gene polymorphisms can safely receive vaccines. There is no increased risk of adverse events following immunisation (AEFI).

MTHFR gene polymorphism testing

There is no clinical indication for MTHFR polymorphism testing before vaccination.

संसाधन

• VCGS: MTHFR testing fact sheet

पृष्ठभूमि

Administering vaccines during a pregnancy है an important way to provide much needed protection at a time when a person is more vulnerable to गंभीर disease and complications. Vaccination during pregnancy also haएस the added benefit of allowing the transfer of maternal antibodies across the placenta to the unborn baby which will provide short-term protection (passive immunity) in the first few months of life.

During pregnancy, many anatomical and physical changes occur to support the growth of ए baby. Some of these changes include एक increase in blood volume, increased demand on the heart and lungs, increased physical pressure placed on अन्य organs due to an enlarged uterus, and changes को the immune system to ensure that the developing baby is not recognised as “foreign”. With these changes comes an increaseडी risk का experiencing severe symptoms and complications if exposed to infections, in particular respiratory infections.

The administration of

during pregnancy was historically avoided. However, as technologies have advanced, the benefits that some vaccines can offer when admमैंnistered during pregnancy now far outweigh any theoretical concerns for safety. This has been parटीicularly evident during pandemics such as H1N1 और COVID-19 where pregnant people were more likely to experience severe disease, hospitalisation and intensive care, affecting maternal and infant outcomes.

Recommendations

A thorough assessment of a person’s immunisation history and administration of any outstanding vaccines prior to pregnancy is an important part of preconception care. Administration of livइ

एttenuated vaccines (e.g. MMR/वी) during pregnancy is contraindicated due to the theoretical risks associated with vaccine-related disease and its impact on a developing infant (see ‘Contraindicated vaccines’ below for more information). Live

attenuated vaccines should be given a minimum of 28 days prior to conception, या must be withheld until after delivery.

During pregnancy, there are multiple inactivated vaccines recommended and funded on the राष्ट्रीय टीकाकरण कार्यक्रम (NIP). Other inactivated vaccines can be administered in special circumstances (e.g. medical risk factors, travel) but are not routinely recommended. Refer to the Australian Immunisation Handbook: Vaccines that are not routinely recommended in pregnancy अधिक जानकारी के लिए।

Correctly timing the administration of vaccines during a pregnancy is important and varies with each vaccine. Guidance on timing is based on whether the resulting immune response is intended to protect the mother, the infant, or both.

इन्फ्लुएंजा

इन्फ्लुएंजा vaccination during pregnancy is safe and strongly recommended to protect the mother from infection and avoid complications of disease. During pregnancy there is an increased effort required by the lungs. Influenza viruses affect lung tissue meaning infection adds further strain. As a result, pregnant people with influenza infection have a higher likelihood of requiring hospitalisation and intensive care than non

pregnant people with influenza infection. Influenza infections during pregnancy also increase the risk of preterm birth, babies being born at low birthweight and stillbirths. 

Antibodies derived from maternal vaccination can also cross the placenta providing some protection to the infant. It is estimated that vaccination during pregnancy can reduce the risk of influenza infection by half in infants less than 6 months of age. This is important because influenza vaccines cannot be administered to infants until they are 6 months of age. 

Influenza vaccines are recommended annually and can be given at any time during a pregnancy. If a person is vaccinated before becoming pregnant, they should receive another dose when they are pregnant (minimum 4 weeks between doses). When a pregnancy crosses over influenza seasons, pregnant people are recommended to receive two vaccines, one for each season.  

को देखें एमवीईसी: इन्फ्लुएंजा for up

को

date information on current influenza vaccines.

काली खांसी

काली खांसी vaccination during pregnancy is safe and effective and is recommended to protect both the pregnant person and, most importantly, the infant.

Infants under 6 months of age infected with pertussis have the highest rates of hospitalisation and death compared with people infected in other age groups. Symptoms include periods of intense coughing (paroxysmal coughing) with apnoea where infants stop breathing for a short period. There can be vomiting and difficulty feeding due to prolonged paroxysmal coughing episodes. Complications of pertussis in infants include pneumonia (lung infection), seizures and encephalitis (brain inflammation) which can be fatal. 

Infants require a 3

dose course of pertussis vaccines (doses given at 6 weeks, 4 months and 6 months) to be considered fully protected. Vaccination during pregnancy can reduce the likelihood of infections occurring in infants who are too young to have completed this course by 90%. 

A single dose of vaccine (which is provided in combination with डिप्थीरिया और धनुस्तंभ) should be administered between 20 and 32 weeks of gestation, in every pregnancy (including pregnancies that are closely spaced). If the pregnant person was vaccinated prior to pregnancy, they should still receive another vaccine within the pregnancy to ensure the infant will be passively protected. If an infant is born within 2 weeks of their mother’s vaccine, the passive immunity passed onto the infant may be suboptimal. 

को देखें एमवीईसी: Pertussis अधिक जानकारी के लिए।

रेस्पिरेटरी सिंकाइटियल वायरस (आरएसवी)

Vaccination against RSV during pregnancy is recommended to provide passive immunity to infants. From 2025, vaccination during pregnancy will be funded on the NIP. 

Current data shows that almost all children will be infected with RSV by the time they turn 2 years old. Whilst most infections are mild, bronchiolitis (inflammation of the small airways) and pneumonia (lung infection) can occur and may lead to hospitalisation for supportive measures such as oxygen therapy and rehydration. Infants with specified risk factors such as preterm birth, cardiac conditions and chronic lung disease are more likely to experience severe disease. Clinical trials demonstrate that when vaccines are administered during pregnancy the risks of hospitalisation due to severe RSV infection is reduced by 57% in infants less than 6 months of age.  

A single dose of Abrysvo should be administered between 28 and 36 weeks’ gestation (NB: Arexvy is नहीं registered for use in pregnancy). There is currently no recommendation for further doses in subsequent pregnancies; however, this may change as more data becomes available. When a pregnant person is vaccinated within 2 weeks of delivery, infant protection is likely to be reduced (many jurisdictions are funding infant RSV prevention programs for infants with medical risk factors and those with suboptimal passive protection). 

अधिक जानकारी के लिए देखें MVEC: RSV.

प्रतिबंधित टीके

The RSV vaccine Arexvy must नहीं be administered to pregnant women due to a lack of safety and efficacy data. Should inadvertent administration occur, it should be reported to the adverse event reporting service in your jurisdiction and the patient should be informed using the open disclosure process.

सभी जीवित-क्षीण टीके हैं contraindicated during pregnancy due to the potential risk to the unborn baby. In most circumstances the risk is hypothetical; however, there is insufficient evidence to support vaccination in this patient group.

If a live

attenuated vaccine is inadvertently administered को a pregnant person, the person should be informed of the administration error and reassured using the open disclosure framework. The limited safety data from inadvertent administration of MMR and varicella vaccines is reassuring. The administration error should be reported to tवह adverse event reporting service in your jurisdiction.

Table 1: Live

attenuated vaccines contraindicated in pregnancy

* oral vaccine
^ Pregnant people should be advised not to go to पीला बुखार endemic areas. However, if travel cannot be avoided a specialist consultation is advised.

Access

All vaccines recommended during pregnancy are funded on the NIP.

These vaccines are available via GP services, परिषदों, hospital immunisation services, some pharmacies and other health services.

आमतौर पर पूछे जाने वाले प्रश्न

संसाधन

• Australian Government Department of Health and Aged Care: How vaccines work for pregnancy and newborns (VIDEO)
• Australian Government Department of Health and Aged Care: Shared decision making guide for women who are pregnant ,breastfeeding or planning pregnancy
• ऑस्ट्रेलियाई टीकाकरण पुस्तिका: गर्भावस्था, गर्भवती या स्तनपान कराने वाली महिलाओं के लिए टीकाकरण
• बच्चों का नेटवर्क बढ़ाना: COVID-19 टीकाकरण: गर्भावस्था और स्तनपान
• एमवीईसी: काली खांसी
• एमवीईसी: इन्फ्लुएंजा
• MVEC: RSV
• एमवीईसी: कोविड-19
• MVEC: Immunosuppression in pregnancy and infant vaccine recommendations
• एमवीईसी: स्तनपान और टीकाकरण

इन्फ्लुएंजा क्या है?

Measles, also known as rubeola, is a highly contagious viral illness. It is caused by the measles virus which belongs to the मसूरिका परिवार।

किन लक्षणों पर नज़र रखने की आवश्यकता है?

Infection usually begins with 3-4 days of fever, malaise, cough, coryza (runny nose) and conjunctivitis. Small white spots, known as Koplik spots, are also present on the buccal mucosa (mucosal surface of the cheeks) of an infected person.

3-4 days later a maculopapular rash (red with a combination of flat and raised areas) then develops, often beginning on the face before becoming more generalised and can last up to 7 days. Very rarely does a measles infection occur in the absence of a rash.

Complications of a measles infection include pneumonia and otitis media (ear infection). Approximately 1 in 1000 people will develop encephalitis (brain inflammation) which carries a mortality rate of 10-15%. Sub-acute sclerosing panencephalitis (SSPE) is a rare progressive neurological disorder that can develop 2-10 years after an initial measles infection. It is characterised by encephalitis and demyelination (loss of the protective covering of the nerve fibres) causing behaviour changes, seizures and muscle rigidity. SSPE is fatal in all cases.

Measles infections during pregnancy can result in miscarriage and prematurity.

यह कैसे संचारित होता है?

Measles can be spread by an infected person coughing or sneezing respiratory droplets or through the direct contact with infected nasal or throat secretions. An environment can remain infectious for up to 2 hours after an infectious person has been present.

The incubation period is 7 to 18 days (more commonly 10 days), with a person able to transmit disease for up to 5 days prior to the onset of the rash, and as long as 4 days after the rash develops.

Humans are the only reservoirs for the measles virus.

एपिडेमियोलॉजी (महामारी विज्ञान)

Prior to the introduction of vaccination in 1963, measles infections contributed to 2.6 million deaths globally each year. Despite extensive vaccination campaigns worldwide, measles infection still carries a significant burden in some countries contributing to 142 000 deaths globally in 2018.

Within Australia, however, high rates of vaccine coverage led to the WHO declaring Australia “measles-free” in 2014. Measles infections are still seen in non-immune individuals travelling internationally, placing unimmunised Australians at risk of infection.

रोकथामं

Live-attenuated measles-containing vaccines are highly effective in protecting against disease. A 2-dose course of vaccination is routinely provided on the National Immunisation Program (NIP) for children as combination vaccines at:

• 12 months of age – Priorix (measles- mumps- rubella (MMR))
  • NB: the MMR vaccine M-M-R II can no longer be ordered as of 1 July 2025, but existing stock can still be used
• 18 months of age – Priorix-Tetra (measles-mumps-rubella-varicella (MMRV))

In addition, babies aged between 6 months and 11 months travelling overseas, non-immune women planning pregnancy or non-immune women after delivery, and any person born since 1966 who does not have evidence of 2 doses of vaccination/is seronegative is eligible to receive funded measles-containing vaccines.

Due to high rates of circulating measles virus in the years preceding 1966 and the life-long immunity invoked by natural infection, those born during this time are considered already immune and generally do not require vaccination.

Contraindications

Live-attenuated vaccines such as measles-containing vaccines are contraindicated in individuals with immune compromise due to the risks of adverse events and the chance of developing vaccine-related disease.

Additionally, प्रेग्नेंट औरत should not receive measles-containing vaccines due to the potential risks to the unborn baby. Instead, vaccination at least 4 weeks prior to pregnancy or vaccination in the postnatal period is recommended.

एहतियात

Specific intervals between the administration of immunoglobulins or other blood products and administration of measles-containing vaccines are recommended. This is due to the potential for any circulating donated antibodies affecting the immune response to vaccination.

दुष्प्रभाव

7-10 days following MMR vaccination, individuals may experience fever, malaise, and a non-infectious rash lasting 2-3 days.

MMRV vaccines are not recommended as a first dose of a measles-containing vaccine in children < 4 years of age due to the increased risk of fever and febrile seizures.

एक्सपोज़र के बाद प्रोफिलैक्सिस

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

Infants ≤ 5 months of age born to non-immune mothers or mothers with < 2 documented doses of measles vaccination, individuals of any age with immune compromise, and pregnant women, may be recommended to receive Normal Human Immunoglobulin (NHIG) if exposed to disease [refer to resources].

संसाधन

• Australian Academy of Science: measles- everything you need to know
• Australian Immunisation Handbook: Table: Post-exposure prophylaxis needed within 72 hours of 1st exposure for people exposed to measles
• Australian Immunisation Handbook: Table: Recommended intervals between immunoglobulins or blood products, and measles-mumps-rubella, measles-mumps-rubella-varicella or varicella vaccination
• World Health Organization: measles
• MVEC: MMR vaccine and autism
• RCH Clinical Practice Guideline: illness in the returned traveller
• Better Health Channel: measles