R Letter

Cúm là gì?

Respiratory syncytial virus (RSV) is a virus that causes both upper and lower respiratory tract infections. Children under 1 year of age, individuals with underlying medical conditions (e.g. chronic cardiac and lung disease), the older population and immunocompromised people are more likely to experience serious disease requiring hospitalisation. 

Cần để ý những gì

Cold-like symptoms such as rhinorrhoea (runny nose), fever, wheeze, headache and cough are common. Symptoms generally appear 1 to 5 days after exposure and can last 8 to 15 days.  

Symptoms may progress to shortness of breath, wheezing, bronchospasm and feeding problems (in children). One third of children develop otitis media (ear infections).  

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. It is estimated that bacterial co-infections occur in around 30% of hospitalised patients. In older adults, RSV can exacerbate chronic obstructive pulmonary disease or lead to heart failure.  

Bệnh lây truyền qua đường nào

RSV is highly contagious and can be transmitted via the inhalation of droplets containing the virus. RSV can also be transmitted when a person touches a contaminated surface and then touches their face. 

People with RSV are generally considered infectious for 3 to 8 days. However, some people continue to spread the virus for up to 4 weeks. 

Dịch tễ học

Children and older adults have the highest rates of RSV infection. Almost all children will have experienced infection by the age of 2 years. Aboriginal and Torres Strait Islander adults are at greater risk of RSV-associated hospitalisation than non-Indigenous adults. Reinfection occurs throughout the lifetime since natural infection does not provide long-term immunity. 

RSV infections are commonly seasonal, with a peak in cases usually seen over autumn and winter in temperate climates, and during the rainy season in tropical climates.  In recent years, RSV notification rates have increased significantly in Australia.  

Phòng ngừa

PractiSing good hand hygiene is important in preventing infections. Previous infection with RSV Có thể provide some immunity but this protection is not long term.

Monoclonal antibodies

Monoclonal antibodies are a type of immunoglobulin, or immune system proteins. They are a medication that can aid the body’s immune response to help prevent disease. There are two monoclonal antibodies approved for use to prevent RSV in Australia:  

• Palivizumab (Synagis) 
• Nirsevimab (Beyfortus) 

Palivizumab is available for some infants who are considered at higher risk of developing severe disease from RSV infection (due to medical conditions such as prematurity, chronic lung disease and specific cardiac conditions). Doses are calculated according to the infant’s weight and administered via intramuscular injection every month over the winter period (usually May to October in southern Australia). Palivizumab can be privately purchased and may be funded for infants by their individual hospital. 

Nirsevimab can be administered from birth as a single intramuscular injection offering protection for at least 5 months. It is recommended for all infants entering their first RSV season. Children with a high risk of severe RSV disease due to medical conditions may also consider another dose before going into their second RSV season. Nirsevimab is not currently funded through the NIP, however various jurisdictions have announced state-funded programs. 

Co-administration with vaccines 

Nirsevimab or Palivizumab can be given on the same day as tất cả vắc-xin.  

Phản ứng phụ 

Side effects from monoclonal antibodies are not common but can include injection site tenderness and swelling, mild respiratory symptoms and rash. Nirsevimab can in rare circumstances cause fever within 7 days.  

Vắc-xin

Arexvy is a vaccine available for the prevention of RSV infection. It is an adjuvanted recombinant vaccine requiring a single dose of 0.5 mL administered intramuscularly. It can be co-administered with all other vaccines and can be administered at any time of year. Arexvy is currently only available through private purchase.  

Whilst Arexvy is registered and available or use in all individuals aged 60 years and over, ATAGI khuyến nghị its use in: 

• all adults aged 75 years and over  
• Aboriginal and Torres Strait Islander adults aged 60-74 years 
• adults 60-74 years with specified medical conditions. 

Booster doses of Arexvy are not currently recommended. 

Phản ứng phụ

Common side effects following administration of Arexvy include phản ứng tại chỗ tiêm (pain, redness and swelling), malaise, headache and fatigue. These side effects generally occur in the first 48 hours following vaccination and last 1-2 days.  

Symptoms can be managed at home with supportive measures such as a cold compress and oral analgesia. Antibiotics, antihistamines and steroids are không recommended to treat injection site reactions, which are caused by an inflammatory response to the vaccine and are not the result of an infection or allergy.

Precautions and contraindications

Use of Arexvy is contraindicated in any person who has experienced anaphylaxis to a previous dose or anaphylaxis to any component of Arexvy.  

It should not be administered to infants or pregnant women due to a lack of safety and efficacy data. Should inadvertent administration occur, a report to a vaccine safety service (SAEFVIC in Victoria) should be submitted and the patient informed using the open disclosure process. Adverse events should be monitored. 

Tài liệu

• ATAGI Statement on the Clinical Use of Arexvy (RSV PRE-F3) Vaccine for RSV 
• TGA Arexvy Guidance 
• TGA Palivizumab Guidance 
• TGA Nirsevimab Guidance 
• RCH Kids health Information: Respiratory syncytial virus 
• RCH Nursing Guidelines: Palivizumab for at-risk patients 
• ResViNET: About RSV 
• McNab S, Ha Do LA, Clifford V, et al. Changing Epidemiology of Respiratory Syncytial Virus in Australia – Delayed Re-emergence in Victoria Compared to Western Australia/New South Wales (WA/NSW) After Prolonged Lockdown for Coronavirus Disease 2019 (COVID-19). Clinical Infectious Diseases. 2021 Dec 16; 73(12): 2365-2366. doi: 10.1093/cid/ciab240 

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.

Tài nguyên:

• MVEC influenza vaccine recommendations

Meningococcal vaccines

Viêm não mô cầu 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.

não mô cầu 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.

Tài nguyên:

• MVEC Meningococcal disease and vaccines
• MVEC: Vắc xin viêm não mô cầu ở bệnh nhân có nguy cơ đặc biệt và bệnh nhân bị ức chế miễn dịch
• ATAGI: Clinical advice on changes to recommendations for the use and funding of meningococcal vaccines from 1 July 2020

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 2^thứ 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.

Tài nguyên:

• MVEC: Varicella

Special risk groups

Những người có nguy cơ cao mắc các bệnh có thể phòng ngừa bằng vắc-xin (VPD) được xếp vào nhóm 'nguy cơ đặc biệt' trong Sổ tay Chủng ngừa Úc.

Điều này bao gồm các quần thể có nguy cơ đặc biệt (ví dụ: Thổ dân và Người đảo Torres Straight) và những người có nhu cầu tiêm vắc-xin bổ sung (ví dụ: tiêm phòng cho bà mẹ; trẻ sinh non). Nó cũng có các phần chi tiết về những người có nguy cơ đặc biệt do ức chế miễn dịch (bệnh và/hoặc điều trị), ví dụ như Asplenia, ung thư/hóa trị.

Tài nguyên:

• Cẩm nang Tiêm chủng Úc: Tiêm chủng cho các Nhóm Nguy cơ Đặc biệt

Additional resources

Further information about childhood vaccination can be found at:

• The Better Health Channel: Healthy Living: Immunisation
• ATAGI: Clinical advice on changes to recommendations for the use and funding of meningococcal vaccines from 1 July 2020
• ATAGI: Clinical advice on changes to vaccine recommendations and funding for people with risk conditions from 1 July 2020
• National Immunisation Program Schedule
• MVEC: Victorian council immunisation sessions

Rituximab is becoming a frequently used treatment option for many patients with complex medical needs, including in oncology and rheumatology. 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-attenuated vaccines.

Prior to commencing treatment

Where possible please ensure patients are 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. The same principle also applies to COVID-19 vaccines.

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 exception to this, may be for influenza and COVID-19 vaccines. Some studies have indicated that a partial 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).

Due to the potential risk for severe COVID-19 disease and its complications in this population, which may outweigh the lack of vaccine response, COVID-19 vaccination whilst on rituximab could be considered.

COVID-19 vaccination and rituximab

Studies are still ongoing to determine optimum timing and vaccine efficacy in patients on rituximab. However, based on evidence from other vaccines, the assumption is that there is a diminished response to COVID-19 vaccination.

Therefore, important principles to consider for this group of patients include:

• it is not recommended to delay initiation or disrupt optimum timing of rituximab if being used for cancer treatment
• due to its immunosuppressive effects, patients on rituximab are at higher risk of severe COVID-19 disease and poor COVID-19 disease outcomes.

As such, COVID-19 vaccination could be performed as close to the end of a rituximab cycle as possible, or prior to the initiation of therapy. There is no current data to inform optimum timing of two-dose COVID-19 vaccination regimes and intervals.

tham khảo MVEC: immunosuppression and vaccines

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. COVID-19 vaccination is encouraged.

huyết thanh học

There is no need to check serology pre- or post-rituximab therapy. There is currently no established immune correlate of protection for COVID-19.

Patients should be aware of their immune suppression and avoid potential exposures to vaccine preventable diseases. The need to continue preventative measures such as social distancing, mask wearing and hand hygiene should be discussed. 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: Vắc xin sống giảm độc lực và globulin miễn dịch hoặc sản phẩm máu]. Any previous vaccine history (routine vaccines) should be disregarded due to the loss of immune memory. There is currently no recommendation for additional booster doses of COVID-19 vaccines.

Vui lòng tham khảo trước MVEC: Post rituximab therapy immunisation guideline for re-immunisation recommendations.

Tài liệu

• MVEC: Post Rituximab therapy immunisation guideline
• MVEC: Khuyến nghị vắc-xin cúm
• DHHS: Medical exemption forms
• Australian Immunisation Handbook: Post-exposure prophylaxis for people non-immune to hepatitis B
• Australian Immunisation Handbook: Post exposure prophylaxis for people non-immune to measles
• Australian Immunisation Handbook: Post exposure prophylaxis for people non-immune to varicella
• Australian Immunisation Handbook: Post exposure prophylaxis for people non-immune to tetanus
• Cheng D, Barton R, Greenway A, Crawford N Rituximab and protection from vaccine preventable diseases; applying the evidence to pediatric patients. Expert Review of Vaccines 2016 Volume 15(12): 1567-1574

Cúm là gì?

Viêm dạ dày ruột do Rotavirus gây ra bởi virus RNA không có vỏ bọc. Đây là nguyên nhân phổ biến gây viêm dạ dày ruột do virus ở trẻ em. Trên toàn cầu, đây là nguyên nhân phổ biến nhất gây tử vong liên quan đến viêm dạ dày ruột do virus ở những trẻ dưới 5 tuổi.

Cần để ý những gì

Viêm dạ dày ruột do Rotavirus thường xảy ra sau thời gian ủ bệnh 1-3 ngày. Các triệu chứng của bệnh bao gồm nôn mửa, tiêu chảy, sốt, mất nước và buồn ngủ. Các triệu chứng có thể đặc biệt nghiêm trọng ở trẻ em bị suy dinh dưỡng hoặc suy giảm miễn dịch.

Bệnh lây truyền qua đường nào

Rotavirus có thể lây truyền qua đường phân-miệng.

Phòng ngừa

Nhiễm rotavirus trước đó không cung cấp khả năng miễn dịch suốt đời. Vệ sinh tay và khử trùng các bề mặt bị ô nhiễm là các biện pháp quan trọng để ngăn ngừa lây truyền.

Trước khi đưa vắc xin rotavirus vào Chương trình Tiêm chủng Quốc gia (NIP) vào năm 2007, khoảng 10.000 trẻ em (<5 tuổi) phải nhập viện mỗi năm vì viêm dạ dày ruột do rotavirus, với trung bình một ca tử vong mỗi năm. Các tỷ lệ này đã giảm đáng kể kể từ khi được giới thiệu.

Vắc-xin

Có hai loại vắc-xin rotavirus sống giảm độc lực dành cho trẻ em ở Úc:

• Rotarix- 2 liều, có trên NIP lúc trẻ 6 tuần tuổi và 4 tháng tuổi
• Liệu trình RotaTeq- 3 liều, trước đây được cung cấp trên NIP, hiện có sẵn thông qua kịch bản riêng.

Có dữ liệu hạn chế về tính an toàn và hiệu quả của vắc-xin rotavirus khi được tiêm ngoài các nhóm tuổi cụ thể. Vì lý do này, nên tiêm vắc-xin rotavirus trong một khung thời gian nhất định, đặc biệt chú ý đến giới hạn độ tuổi cao hơn. Nếu không thể tuân thủ các khung thời gian khuyến cáo cho việc tiêm phòng, nên ngừng tiêm chủng vô thời hạn. Trẻ sinh non được khuyến nghị tiêm vắc-xin dựa trên tuổi theo thời gian, không phải tuổi đã điều chỉnh.

*trong khi vắc-xin nên được dùng bằng đường uống nếu có thể, trẻ sơ sinh có ống dẫn thức ăn (ví dụ: ống thông mũi-dạ dày/PEG) có thể nhận vắc-xin vi-rút rota qua ống của chúng. Vắc xin Rotavirus không bao giờ được tiêm.

Không bắt buộc phải tiêm vắc-xin Rotavirus để trẻ được coi là đã tiêm vắc-xin thông thường. Không phải vậy bắt buộc cho các mục đích của luật không jab không trả tiền hoặc không jab không chơi.

Xin lưu ý, nếu trẻ sơ sinh phun ra một lượng nhỏ vắc-xin thì đó vẫn được coi là liều hợp lệ và không cần lặp lại. Nếu họ nhổ gần hết liều vắc-xin trong vòng vài phút sau khi tiêm, thì nên tiêm một liều lặp lại trong cùng một lần khám.

Tác dụng phụ và quản lý

Tác dụng phụ của việc chủng ngừa rotavirus thường xảy ra hơn trong vòng 7 ngày đầu tiên sau khi chủng ngừa và có thể bao gồm nôn mửa, tiêu chảy và khó chịu.

Các liệu pháp hỗ trợ như paracetamol và chất lỏng bổ sung (sữa mẹ/sữa công thức) có thể giúp kiểm soát các triệu chứng. Thực hành vệ sinh tay tốt đặc biệt quan trọng khi xử lý tã lót bẩn trong giai đoạn này để giảm thiểu nguy cơ lây truyền vì vi-rút có thể thải ra phân sau 7-10 lần tiêm chủng.

Tác dụng phụ rất hiếm có thể bao gồm sốc phản vệ. Trẻ sơ sinh nên được theo dõi trong 15 phút sau khi tiêm chủng để theo dõi các triệu chứng.

Có một số gợi ý từ nghiên cứu của Úc và quốc tế rằng có một sự gia tăng nhỏ trong các trường hợp lồng ruột ở trẻ sơ sinh được uống vắc-xin rotavirus. Lồng ruột là một tình trạng hiếm gặp khi ruột trượt hoặc lồng vào bên trong gây tắc nghẽn. Trẻ sơ sinh có thể khóc, co chân lên và sau đó nôn mửa và đôi khi có máu trong phân. Trong hầu hết các trường hợp, nguyên nhân của lồng ruột không được biết đến. Người ta ước tính rằng nguy cơ gia tăng khi tiêm vắc-xin rotavirus có nghĩa là có thêm 6 trường hợp mắc bệnh trên 100.000 trẻ được tiêm chủng.

Các biện pháp phòng ngừa

Cả hai loại vắc-xin rotavirus đều là vắc-xin uống giảm độc lực. Theo lý thuyết, có nguy cơ viêm dạ dày ruột liên quan đến vắc-xin nếu tiêm vắc-xin cho trẻ sơ sinh bị suy giảm miễn dịch. Tuy nhiên, đối với một số trẻ sơ sinh bị suy giảm miễn dịch ít nghiêm trọng hơn, lợi ích của việc bảo vệ nhờ vắc-xin có thể lớn hơn nguy cơ này. Làm rõ thêm về mức độ suy giảm miễn dịch có thể được tìm kiếm từ dịch vụ tiêm chủng chuyên khoa.

Trẻ sơ sinh sống trong các hộ gia đình có người bị rối loạn suy giảm miễn dịch hoặc tình trạng miễn dịch suy giảm vẫn có thể được tiêm phòng. Nên tư vấn về vệ sinh tay và vứt bỏ tã bẩn để giảm thiểu nguy cơ lây truyền vi-rút vắc-xin.

Đối với trẻ sơ sinh bị suy giảm miễn dịch (không phải rối loạn suy giảm miễn dịch kết hợp nghiêm trọng) hoặc sống chung với HIV, lợi ích của việc tiêm vắc-xin được cho là lớn hơn bất kỳ nguy cơ tiềm ẩn nào của bệnh viêm dạ dày ruột liên quan đến vắc-xin.

Chống chỉ định

Không nên tiêm vắc-xin rotavirus cho bất kỳ trẻ sơ sinh nào có tiền sử lồng ruột trước đó hoặc bất thường đường ruột bẩm sinh khiến trẻ dễ bị lồng ruột.

Trẻ sơ sinh bị rối loạn suy giảm miễn dịch kết hợp nghiêm trọng (SCID) không nên tiêm vắc-xin rotavirus do nguy cơ viêm dạ dày ruột liên quan đến vắc-xin và thiếu khả năng của hệ thống miễn dịch để tạo ra phản ứng miễn dịch bảo vệ.

Không nên tiêm vắc-xin cho trẻ sơ sinh bị sốc phản vệ với liều vắc-xin rotavirus trước đó.

Trẻ sơ sinh có mẹ đã tiêm thuốc chống thấp khớp làm thay đổi bệnh sinh học (bDMARDS) trong ba tháng cuối của thai kỳ không nên tiêm vắc-xin mà không hỏi ý kiến bác sĩ chuyên khoa.

Tài liệu

• MVEC: Tiêm chủng cho trẻ sinh non
• Cẩm nang Chủng ngừa Úc: Rotavirus
• Thông tin sức khỏe của RCH Kids: Viêm dạ dày ruột
• Bánh xe định lượng và quản lý GSK Rotarix (Rotarix Wheel) LỖI

Cúm là gì?

rabies là an acute viral encephalomyelitis (inflammatory disease of the brain and/or spinal cord) caused by infection with the rabies virus, a type of lyssavirus. Other lyssaviruses include Australian bat lyssavirus (ABLV) and the European bat lyssavirus (EBLV).

Rabies is transmitted to humans via bites or scratches from animals infected with the virus. Infection with các rabies virus, and other lyssaviruses, resultS in Một progressive inflammation of the brain and spinal cord. Without vaccination Và effective post-exposure management, rabies là almost always fatal. 

Cần để ý những gì

The incubation period of rabies is generally between 3 and 12 weeks, but the onset of symptoms has occurred as early as days after exposure or as long as 19 years later.   

Early signs of infection involve non-specific symptoms, such as loss of appetite, cough, fever, headache, discomfort and fatigue, nausea and vomiting, and sore throat. There also may be discomfort, paraesthesia (prickling or itching sensation) and fasciculations (muscle twitching) at the site of the scratch or bite.  A person may show signs of anxiety, confusion and agitation. These initial symptoms last 1 to 4 days. Following this, symptoms progress to: 

• delirium and bizarre behaviour 
• disorientation
• hallucinations 
• hypersalivation, hyperthermia and hyperventilation (signs of autonomic instability) 
• hydrophobia (fear of water) 
• paralysis 
• insomnia.

The disease progresses rapidly. Once clinical signs have developed, the person’s neurological status will deteriorate over a period of up to 12 days, resulting in death. There is no specific treatment for rabies.

Bệnh lây truyền qua đường nào

Rabies is a zoonotic disease (spread between animals and humans). Dog species (including wolves, coyotes, foxes and jackals) are the main source of infection for humans. Skunks, raccoons, monkeys and bats can also harbour infection.  

Human exposure occurs primarily through the scratch or deep bite of an infected animal. Transmission can also occur if saliva of an infected animal comes into direct contact with a person’s mucosal surface (nose, eyes or mouth).  

The virus travels from the site of the injury to the brain by moving along nerve pathways.

Dịch tễ học

Rabies is found in animals on all continents of the globe except Antarctica. Australia is currently rabies free. However, ABLV has been known to occur in fruit bats and insectivorous bats.  It is difficult to determine the disease burden in animals, due to the impracticalities of testing wild and domestic animals. 

Each year, rabies infection causes approximately 59,000 human deaths worldwide, 95% of these occurring in Africa and Asia. The burden of disease in humans is higher in rural, low-income populations. Children are more likely to be infected due to their size and proximity to the ground, being less likely to appreciate an animal’s temperament, and their tendency to make sudden movements or loud noises which are intimidating to animals. 

Phòng ngừa

According to the World Health Organization, vaccinating dogs in rabies-prone regions is the most cost-effective strategy for preventing rabies in people.

People who will be travelling to, or living in, rabies-prone regions should take preventative measures. These include:

• avoiding close contact with wild and domestic animals (this is especially important for children)
• not feeding, patting or playing with animals
• getting vaccinated.

Vaccination

Vaccines can be administered either before potential exposure (pre-exposure prophylaxis), or after exposure has occurred (as part of post-exposure prophylaxis). 

Pre-exposure vaccination requires fewer vaccine doses and eliminates the need for immunoglobulin if exposed (except for those who are severely immunocompromised). Immunoglobulin may be expensive and difficult to source in developing countries.  

There are 2 rabies vaccines available in Australia: 

• Verorab 
• Rabipur 

Both Verorab and Rabipur are inactivated vaccines and can be administered via the intramuscular (IM) route or the intradermal (ID) route.  

It is preferable but not essential to use the same brand of vaccine for the entire course. If using the same brand is not possible, vaccination should not be delayed, and the alternate brand should be used. 

Boosters and serology 

Recommendations for vaccine boosters and serology (blood testing to check antibody levels) vary on a case-by-case basis. Individuals should seek personalised advice from their healthcare provider (e.g. immunisation provider, travel medicine adviser or other specialist consultant). 

It is especially important for individuals in the following groups to speak with their health provider for specific advice on boosters and serology: 

• immunocompromised individuals 
• laboratory workers who work with live lyssaviruses 
• people with ongoing exposure to bats or potentially rabid mammals. 

Table 2: Immunisation Handbook Serology recommendations

* Or, receive a booster dose every 3 years without checking serology.

A single IM booster dose is recommended for people with significant ongoing exposure risk: 

• when serology is < 0.5 IU/mL   
• 12 months after dose 1 of primary course of vaccination (whether pre- or post-exposure) then every 3 years after first booster (may check serology first).

Các biện pháp phòng ngừa

People with anaphylaxis to egg should receive Verorab instead of Rabipur. 

People with latex allergy should receive Rabipur instead of Verorab.  

Phối hợp với các loại vắc-xin khác

Verorab and Rabipur can be co-administered with other vaccines, using separate injection sites.  

Tetanus vaccination status should also be considered after a bite or scratch from an animal, see MVEC: Tetanus. 

Tác dụng phụ của vắc-xin

Common side effects following rabies vaccination include nausea, headache, injection site pain and myalgia (muscle aches). 

Due to the seriousness of disease, post exposure vaccination should never be delayed, even in those who have experienced an unpleasant side effect or who have a history of allergic reactions. A specialist immunisation service should be contacted for specific advice. 

Tài liệu

• Australian Immunisation Handbook guideline 
• RCH post-exposure Clinical Practice Guideline
• Overseas post-exposure prophylaxis guidelines
• Ordering vaccines online 
• DOH notification requirements 

Cúm là gì?

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.

Liên hệ

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

Máy nhắn tin: 4330 via hospital switchboard (03) 9345 5522.

E-mail: [email protected]

Mô phỏng: (03) 9345 4100.

Tài liệu

• The Royal Children’s Hospital, Immunisation Service Drop-in Centre
• MVEC: Vắc xin BCG
• MVEC: Khuyến nghị vắc-xin cúm
• MVEC: Chứng sợ kim tiêm
• MVEC: Meningococcal vaccines
• MVEC: Catch up immunisations
• MVEC: Private vaccine prices at The Royal Children’s Hospital