V Letter

大多数可在澳大利亚使用的疫苗都是通过肌内或皮下途径给药，其中一些是皮内或口服给药。通过推荐的途径接种疫苗并使用正确的技术对于确保最佳的免疫反应、最大限度地减少副作用和降低患者受伤的风险至关重要。

给药途径

注射疫苗

肌内和皮下注射

皮内注射

准备注射部位

接种疫苗前，注射部位的皮肤应明显清洁。注射前不需要擦拭干净的皮肤。如果皮肤明显变脏，请用酒精清洗/一次性酒精棉签清洁该部位，并在注射前让该部位完全干燥。如果推荐的部位出现活动性/感染性湿疹，请考虑更换部位以最大限度地降低发生湿疹的风险 注射部位脓肿.如果没有合适的替代部位，请考虑使用酒精清洗液/一次性酒精棉签清洁该部位，并在注射前让该部位完全干燥。

用于接种疫苗的推荐针头尺寸、长度和角度

* 表格改编自 澳大利亚免疫手册

疫苗接种定位

资源

• MVEC：注射部位反应
• MVEC：注射部位结节
• MVEC：与疫苗接种相关的肩伤 (SIRVA)
• DHHS：“我应该在哪里注射疫苗？”海报

背景

Vaccine-associated enhanced disease (VAED) is a rare phenomenon where a person who has been vaccinated experiences A (usually) more severe clinical presentation of an infection than would normally be seen in an unvaccinated person. The mechanism秒 for how VAED occurs 是 complex and not clearly understood. Mechanisms may include 这 behav我our 的 Antibodies generated from vaccination 和 abnormal T-cell responses. With the exception of dengue vaccination, where use is restricted to minimi秒e VAED risk (see below), vaccines that have been associated with VAED are no longer in use.

诊断

It can be difficult to distinguish between breakthrough disease (when disease occurs in a vaccinated individual because of inadequate vaccine protection) and VAED. To identify a case of VAED, it is necessary to have a clear understanding of the clinical presentation and usual course of the natural disease. VAED is identified by comparison to the natural disease; the clinical presentation of VAED is atypical, modified or more severe. Factors to be considered when assessing a possible case of VAED include:

• expected background rates of disease
• age
• sex
• time of symptom onset after vaccination
• duration of disease
• clinical course and progression of disease
• any co-morbidities.

Various laboratory and clinical diagnostic parameters can be used to help assess the possibility of VAED, including detailed review of all cases of possible vaccine failure.

Associations

Vaccines that have been associated with the development of VAED include an inactivated respiratory syncytial virus (RSV) vaccine, an inactivated measles vaccine and a vaccine for dengue fever. (Note that the RSV and measles vaccines associated with VAED are not in use in Australia.)

VAED was observed in the 1960s during clinical trials for an inactivated whole-virus vaccine against RSV. In these trials, some children who had received the vaccine and then were later diagnosed with RSV infection developed more serious disease. As a result, this vaccine was never approved for general use.

People who received an inactivated measles vaccines in the 1960s were found to be more likely to develop an atypical form of measles disease if they were infected. This vaccine is no longer available, and the current measles-containing vaccines are not associated with the same adverse effects.

Dengvaxia, a live-attenuated recombinant dengue vaccine that is currently the only licensed dengue vaccine globally, has also been associated with VAED. If given to someone who has never had dengue infection, Dengvaxia can increase the risk of serious disease if the person is infected with dengue after vaccination. For this reason, Dengvaxia is only recommended in specific groups of people who have already had dengue infection, for prevention of subsequent, more serious secondary infection, within closely defined criteria.

Given the rare possibility of VAED, careful surveillance for potential VAED is an important part of both development of new vaccines, and post-licensure vaccine safety surveillance. 

对未来剂量的影响

All vaccines currently available through the 国家免疫计划 (NIP) are not linked to VAED.
COVID-19 vaccines are not linked to VAED.

Dengvaxia is registered by the Therapeutics Goods Administration (TGA), but is not currently marketed in Australia.

资源

• Brighton Collaboration Case Definition of the term “Vaccine Associated Enhanced Disease”
• Gartlan C, Tipton T, Salguero FJ, Sattentau Q, Gorringe A, Carroll MW. Vaccine-associated enhanced disease and pathogenic human coronaviruses. Front Immunol. 2022;13. doi:10.3389/fimmu.2022.882972
• CHOP: Antibody-dependent enhancement (ADE) and vaccines
• Munoz FM, Cramer JP, Dekker CL, et al. Vaccine-associated enhanced disease: Case definition and guidelines for data collection, analysis and presentation of immunization safety data. 疫苗. 2021;29(22):3053–3066. doi:10.1016/j.vaccine.2021.01.055 
• ATAGI: Clinical advice of the use of Dengvaxia for Australians
• Bigay J, Le Grand R, Martinon F, Maisonnasse P. Vaccine-associated enhanced disease in humans and animal models: Lessons and challenges for vaccine development. Front Microbiol. 2022;13. doi:10.3389/fmicb.2022.932408 

背景

Vaccines work by activating an individual’s immune system to form antibodies and memory cells in response to a pathogen (disease-causing organism), without the individual having to be infected with that pathogen. This means that if or when that pathogen is encountered in the future, the immune system will be able to respond effectively to fight infection, either minimising the symptoms experienced or preventing disease altogether.

Vaccines can be categorised into types based on the technology that they use to initiate an immune response. This technology is referred to as a ‘vaccine platform’.

灭活疫苗

Inactivated vaccines are created by using killed or deactivated pathogens or parts of pathogens that are unable to replicate and cause symptoms of disease. This approach to vaccine manufacturing has been used for decades to produce vaccines such as those for hepatitis A and B, polio and the polysaccharide pneumoccal (Pneumovax 23) vaccine. Nuvaxovid (Novavax) is an example of an inactivated protein-based 新冠肺炎 vaccine which utilises only part of the virus (the spike protein).

A benefit of these vaccines is that they are safe to administer to most people including 孕 或者 breastfeeding women or those with 免疫妥协. However, the immune response induced by this mechanism alone may not be as strong or long-lasting compared with that from vaccines using other platforms. To overcome this challenge, booster doses or an adjuvant (ingredient added to vaccines during their manufacture to promote a stronger immune response and better disease protection) may be required.

减毒活疫苗

Live-attenuated vaccines contain a whole pathogen that has been weakened (attenuated) in a laboratory making it less capable of replicating and causing disease. Examples of live-attenuated vaccines include the 麻疹, mumps, rubella, 水痘（水痘） 和 rotavirus vaccines.

Live-attenuated vaccines typically induce a strong immune response and provide long-lasting immunity meaning fewer doses are required. The main disadvantage of using this platform is that these vaccines are not recommended for use in people who are immunocompromised due to the theoretical risk of causing vaccine-associated disease or to pregnant women due to the potential harm to the unborn baby. In addition, they take longer and are more difficult to mass produce because the pathogen needs to be grown under enhanced biosafety protocols in specialised laboratories.

Genetic vaccines

Genetic vaccines use one or more of a pathogen’s genes (DNA or mRNA) to invoke an immune response. The COVID-19 vaccines Corminaty (Pfizer) and Spikevax (Moderna) are examples of mRNA vaccines and they contain the genetic code specific to the spike protein portion of the virus.

Genetic vaccines can be produced faster than traditional manufacturing methods as development can begin as soon as the genetic sequence of a pathogen is available. Genetic vaccines are only capable of producing proteins and are unable to modify the host’s (vaccine recipient) own genetic material (DNA or mRNA).

Viral vector vaccines

Non-replicating and replicating viral vector vaccines are types of genetic vaccines. They work by using a modified virus (viral vector), which doesn’t cause disease in humans, to carry a portion of the pathogen’s genetic code into human cells.

In non-replicating viral vector vaccines, the individual’s cells will then produce proteins (antigens) specific to the pathogen to trigger an immune response. The COVID-19 vaccine Vaxzevria (AstraZeneca) is an example of a non-replicating viral vector vaccine.

Replicating viral vector vaccines have a similar mechanism but will also create new viral particles to enter further human cells, allowing a quicker and stronger immune response. Replicating viral vector vaccines best mimic natural infection and hence produce a strong immune response and can be used in lower doses.

While viral vectors are well tolerated and highly immunogenic in most people, pre-existing immunity to the viral vector used may hamper the immune response to the vaccine.

Nanoparticle-based vaccines

Nanoparticle-based vaccines have received increasing interest in recent years due to their good safety profile and high immunogenic potential.

Nanoparticle vaccines are constructed by attaching selected key components of a pathogen (such as the COVID-19 spike protein or viral DNA) to an engineered nanoparticle (nanocarrier). This nanoparticle is commonly an engineered virus-like particle (a molecule that mimics the virus but is not infectious). These nanoparticles are highly stable and less prone to degradation than traditional protein vaccines. Gardasil 9 (human papillomavirus) and Nuvaxovid (Novavax COVID-19) vaccines are examples of this approach.

资源

• Australian Immunisation Handbook: Types of vaccines
• Children’s Hospital of Philadelphia, Vaccine Education Centre: Making vaccines: How are vaccines made
• Frontiers in Immunology: Progress and Pitfalls in the Quest for Effective SARS-CoV-2 (COVID-19) Vaccines

整个维多利亚州的每个地方议会都为所有受资助的国家免疫计划 (NIP) 疫苗的管理提供定期免疫会议。会议免费参加，需要 NIP 疫苗的所有年龄段的人都可以接种疫苗。会议由经过认证的护士免疫接种员在医疗支持下进行。一些委员会还可以选择为那些不符合资助疫苗资格标准的人购买额外的疫苗，例如脑膜炎球菌（Nimenrix® 或 Bexsero®）、流感和水痘疫苗 [参见资源]。所有接种的疫苗都记录在 澳大利亚免疫登记 (AIR).

请参阅下表了解您当地议会的联系方式，以获取有关会议时间的更多信息。

大都会议会

区域委员会

有关此页面的任何反馈，请 在这里联系我们.

资源

• DHHS：维多利亚州的免疫计划和免费疫苗的资格标准
• MVEC：澳大利亚免疫登记

At MVEC we strongly encourage people to seek answers to their questions and to be well informed with evidence-based information. We know that nearly half of all parents have some concerns about immunising their children, ranging from minor concerns to more serious degrees of vaccine hesitancy. Many people also have questions about COVID-19 vaccines for themselves and their families.

There is a lot of information available to people, particularly on the internet, which can be quite overwhelming. There is also a lot of misinformation, and conspiracy theories, and it can be hard to know which information sources to trust and what is true. Research suggests that information alone is not enough to address people’s concerns about immunisation, even when it comes from recommended sources. That is because vaccine conversations matter, and how we discuss vaccines is often just as important as what information is shared.

Talking to people who have questions about vaccines

One of the most effective strategies to address people’s questions and concerns about vaccines is through a discussion with a trusted health care provider like a GP, nurse, paediatrician or midwife. Effective conversations are non-judgemental and help guide people towards accepting vaccination.

Having a combative conversation with a person who has questions about vaccines is never helpful. If possible, try to work out where the person may sit on the vaccine hesitency spectrum. They may have only minor concerns, more serious concerns or they may refuse vaccines all together. This often becomes apparent quite quickly as you start the conversation and helps you tailor your conversation accordingly.

Here are the key steps to have an effective vaccine conversation:

1. Find out all of the person’s questions and concerns

• Start with an open-ended question, like “What concerns do you have?”
• Try to just listen and not jump in and correct their beliefs straight away. This is what we call “resisting the righting reflex”
• Encourage them to share all their concerns before you start responding. They may even mention their most important concern last.
• At this point, once they have had a chance to list their concerns, summarise them to check your understanding.

2. Acknowledge concerns and share knowledge

• Not everyone is “vaccine hesitant”. Having questions is very normal, especially with the newer COVID-19 vaccines. People are likely to be more receptive to what you have to say if you acknowledge their concerns without judgement.
• It is helpful to ask if you can share what you know about vaccine safety and effectiveness and provide some good resources and information. Try to keep your explanations clear and check for understanding.
• At this point, it is good to reinforce their motivation to accept vaccination.

3. Discuss disease severity

• It is always good to bring the discussion back to centre on disease severity, rather than focusing exclusively on the vaccines. This reminds people why we are vaccinating and reinforces the benefit.

4. Recommend vaccination

• Lastly, make a clear and strong recommendation to have the vaccine(s). This reinforces the importance of vaccination and clearly shows that you believe this is the best way to protect the person against vaccine preventable diseases.
• If it is possible and the person is willing, deliver the vaccine(s) or explain where they need to go to receive them.

5. Continue the conversation

• If the person is not yet ready to accept vaccination, keep the communication open and invite them back at a later time to continue the conversation.

Talking with friends and family can also have an influence on people’s vaccine hesitancy. If you’re someone who wants to encourage others to vaccinate, you can take some of the strategies we recommend for healthcare providers into your discussions with people in your life.

This seems obvious, but the best approach is not to judge people, correct them, or jump into battle. This just entrenches people’s beliefs and makes them defensive. And they probably won’t trust you or want to talk to you openly about this topic anymore!

How to tackle misinformation

We’ve all heard people spreading misinformation and myths about vaccines. While it can be tempting to try to correct misinformation whenever you hear it, this can actually give the issue more oxygen. But if you notice that misinformation is spreading widely and beginning to affect people’s vaccination behaviour, it may be time to step in.

If an individual is spreading misinformation, try to speak with them privately. It’s not effective to have a public debate, either in person or online. Acknowledge the emotion and try to look for the truth together.

If you are debunking a particular myth, start by clearly restating the truth. Then, explain why the myth is untrue, and provide an alternative explanation for what the person is experiencing.

For example, if someone believes that the flu vaccine gives them the flu because they feel sick after the vaccine, it’s not enough to simply tell them that is untrue. Explain why this is untrue – the vaccine contains a killed virus that cannot cause the flu. Then follow this with an alternative explanation for the person’s symptoms – this is your body generating an immune response to the vaccine, and these symptoms are much more mild and brief than actual flu symptoms.

Finally, end by restating the truth. People remember what we say first and last, and what we say more than once. Make sure it’s the truth and not the myth that sticks in their minds.

资源

Talking to people who have concerns

• NCIRS Sharing Knowledge About Immunisation (SKAI) project
• MumBubVax: Talking about immunisation for mothers and babies
• The Conversation: Everyone can be effective advocate for vaccination- here’s how

Communicating about COVID-19 vaccines and vaccine safety

• World Health Organization: COVID-19 vaccines- safety surveillance manual
• Pre print MJA: Communicating with patients and the public about COVID-19 vaccine safety: recommendations from the Collaboration on Social Science in Immunisation
• COSSI: A COVID-19 vaccine strategy to support uptake amongst Australians: Working Paper November 2020
• ABC news: How to talk to friends and family feeling unsure about COVID-19 vaccines
• The COVID-19 Vaccine Communication Handbook

Addressing misinformation or talking about vaccination in online forums

• World Health Organization: How to respond to vocal vaccine deniers in public
• BMC Public Health: How organisations promoting vaccination respond to misinformation on social media: a qualitative investigation
• UNICEF: Vaccine misinformation management guide
• Tips on countering conspiracy theories and misinformation

什么是流行性感冒？

Varicella (chickenpox) is a highly contagious disease caused by infection with the varicella-zoster virus (VZV). After a person recovers, the virus stays dormant (inactive) within the dorsal root ganglia of the spinal nerves and can later be reactivated, presenting as herpes zoster (shingles). 

流感症状

Symptoms begin 7 to 21 days after exposure to the virus. Fever, rhinorrhoea (runny nose) and lethargy lasting 1 to 2 days are the first signs of disease (prodromal period). This is followed by the appearance of a pruritic (itchy) rash which is initially maculopapular (flat discoloured areas and raised areas) then becomes vesicular (fluid-filled blisters). The vesicles rupture then crust over, usually within 10 to 14 days. The rash can cover any part of the body including inside the mouth, on the scalp, eyelids and genital area. Unvaccinated children may experience 200 to 500 lesions. Approximately 5% of cases will be subclinical (symptoms are so mild they remain undetected under clinical examination).  

Most cases of varicella are self-limiting (will resolve by itself), but complications can include secondary bacterial infections, septicaemia (blood infections), pneumonia, meningitis, encephalitis and acute cerebellar ataxia (uncoordinated muscle movements). 

Varicella infections during pregnancy can result in congenital varicella syndrome in the child. Symptoms of congenital varicella syndrome include skin scarring, eye anomalies, limb defects and neurological malformations. The risk of congenital varicella syndrome is higher when infection occurs in the second trimester. Infants who have been exposed to varicella through a maternal varicella infection can develop herpes zoster, but this is rare. 

Despite vaccination, some people may still develop disease if exposed to infection. This is known as breakthrough disease. Breakthrough varicella symptoms are usually mild. Patients are typically afebrile and develop fewer skin lesions. People experiencing breakthrough disease are contagious and can transmit disease to others. 

结核病是如何传播的？

Varicella is transmitted by inhaling respiratory droplets that are made airborne when an infected person coughs or sneezes. It can also be spread by direct contact with the fluid inside the vesicles or through contact with items that have been contaminated with vesicle fluid. 

A person with varicella is considered infectious for 1 to 2 days prior to the onset of the rash until all the lesions have crusted. 

流行病学

Varicella is highly infectious. More than 80% of non-immune household contacts of an infected individual will develop disease.  

Prior to the introduction of vaccination in Australia in 2005, there were 240,000 cases of varicella annually, resulting in 1,500 hospitalisations and an average of 7 to 8 deaths. The rate of hospitalisation for varicella infection was reduced to 2.1 per 100,000 people in 2013. Most of these children were aged under 18 months, the scheduled age for varicella vaccination. (NB: Children can be safely vaccinated from 9 months of age.) 

Infants less than 4 weeks of age, premature neonates, unimmunised adolescents, 孕 women and immunosuppressed individuals are at 这 greatest risk of severe disease and complications if they become infected. 

预防措施

Vaccines can provide protection against varicella infection. 

^ MMRV combination vaccines must not be given as the first dose of measles-containing vaccine in children < 4 years due to the higher rates of fevers (see precautions and contraindications below).
* Whilst not registered for use in those aged ≥ 12 years, ATAGI recommends it may be used up to 14 years. MVEC advises that its use may also be considered in older adults when protection against measles, mumps and rubella is also required.
shaded boxes – varicella vaccine is routinely offered on the NIP as a single dose at 18 months. AIR will consider vaccination from 12 months of age as a valid dose.
阴影方框表示未注册用于该年龄组别
shaded boxes indicate live-attenuated vaccines.

建议

A single dose of varicella vaccination (in combination with measles, mumps and rubella) is funded on the NIP at 18 months of age. (NB: Children can be safely vaccinated from 9 months of age.)

A second dose (not funded) is recommended for greater protection to reduce the incidence of breakthrough disease. A minimum interval of 4 weeks is recommended between doses of live-attenuated vaccines.

Anyone non-immune aged 14 years and over should receive a catch-up course of 2 doses (administered 4 weeks apart) for adequate protection.

Household contacts of 免疫功能低下 individuals are recommended to complete their immunisation schedule on time.

Common vaccine side effects

注射部位反应 (occurring in the first 48 hours) and fever (occurring 5 to 12 days after vaccination) are common side effects.

A maculopapular or vesicular rash (with 2 to 5 lesions) occurring 5 to 26 days after vaccination will develop in approximately 5% of vaccine recipients. If this occurs, it is recommended that lesions should remain covered until they crust over to avoid potential transmission of the virus to others. Transmission of the vaccine virus to contacts is extremely rare. Worldwide there have only been 11 documented cases of virus transmission from a recently vaccinated person to unvaccinated individuals.

Precautions and contraindications

All varicella vaccines are live-attenuated vaccines and are therefore contraindicated in pregnancy and in those with immunocompromise.

Children and adults who have been diagnosed with IFNAR1 should seek advice from an immunisation specialist or immunologist prior to vaccination.

There are recommended intervals between immunoglobulins or other blood products and administration of injected live-attenuated vaccines. Refer to MVEC：减毒活疫苗和免疫球蛋白或血液制品.

When administered as the first dose of an MMR-containing vaccine, MMRV 疫苗秒 have been associated with higher rates of fever in children. It is therefore recommended that MMRV vaccines are administered as the second dose only of the 2-dose course of MMR in children under 4 years of age.  

暴露后预防

Vaccination (first or second dose) can be provided within 3 to 5 days of exposure to varicella (provided it is not contraindicated). This can reduce the likelihood of varicella disease developing. 

Neonates (whose mother develops infection up to 7 days prior to delivery or within 2 days after delivery), infants under 1 month of age (if mother is seronegative), pregnant women, premature infants (while still hospitalised, regardless of maternal serology) or immunosuppressed individuals who are exposed to varicella disease should receive Zoster Immunoglobulin (ZIG). 

Repeat doses of ZIG may be given if a person is exposed to varicella again more than 3 weeks after the first dose of ZIG.

资源

• RCH Kids health information: Varicella fact sheet
• Australian Immunisation Handbook: Varicella
• MVEC：带状疱疹
• MVEC：减毒活疫苗和免疫球蛋白或血液制品