Hi Members,
As you know we are seeing a small rises in the number of flu cases presenting to our primary care practices as well as larger numbers of the ILI -influenza like illnesses we have chatted about in previous blog.
There is some great information that we health professionals can access via the health emergency website that gives fortnightly reports including stats from lab test, numbers of ILI reported & breakdown into the type of specimen results for those tested.
http://www.healthemergency.gov.au/internet/healthemergency/publishing.nsf/Content/ozflu2010-jul-sep-pdf-cnt.htm/$File/ozflu-no33-2010.pdf
One of the more interesting points of info is the map of Australia showing the spread & hot spots of the ILI. There are graphs comparing ILI reports over the past 4 years & it also details the information about the number of Emergency Dept presentations as well as absenteeism due to ILI.
How does this help us in our day to day practice? It helps keep us abreast of what is happening with the ILI load in our surrounding areas. You can drill down this info locally with your state & local public health reports. It helps us plan & be prepared for rises in demand for services from our patients, especially fever in children & the higher demand for fit-in appointments to deal with that demand for help from our patients. This type of research where we research & plan for our practice & local community forms part of the advanced nursing competencies & can help us develop the research skills we to chase other info such as stats for diabetes, heart disease when we want to plan other services for our patient groups.
There is still time available to vaccinate to protect the vulnerable against influenza. Keep up the good work. Cheers. Karen
Sunday, September 5, 2010
Wednesday, August 25, 2010
Panvax Junior Expires Now
Hello Dear Members
The Chief Medical Officer has sent through the latest information regarding the H1N1 2009 junior vaccine.The shelf life of the vaccine has been downgraded so please see the following exert from Prof Bishop's bulletin...
"stability testing by the Therapeutic Goods Administration (TGA) of the pandemic influenza vaccine for children, Panvax H1N1 2009 Junior, has shown a decline in potency in the 0.25 ml pre-filled syringes.
As a result, the TGA has informed the manufacturer, CSL, that its registered 12 month shelf life can no longer be supported. CSL have amended the shelf life to 6 months and as a result existing stocks of Panvax H1N1 2009 Junior should now be considered expired.
Importantly similar declines in potency have been identified internationally by other regulators and have led to similar reductions in shelf life for other H1N1 monovalent vaccines.
The safety of the vaccine is not affected.
In Australia, the decline in potency is specific to the Panvax H1N1 2009 Junior vaccine which is supplied in 0.25 mL pre-filled syringes.
Panvax in multi dose vials is not affected, nor are the trivalent seasonal influenza vaccines."
The good news is that the multi dose vial product is safe & stable & can be given to children under 36 months at the scheduled 0.25ml dose.
CSL will be contacting immunisation providers in the next few days to retrieve the product so keep an eye out for that correspondence. What should we do? Set the vaccine aside from your regular stock supply & label as expired & await the CSL recall.
As you are aware the WHO has scaled down the pandemic alert & has now moved into the post pandemic phase. 'As at 1 August 2010, over 18,449 deaths worldwide have been reported associated with the pandemic virus'(DoHA) with high levels of virus activity in NZ & India.
As per my previous blog, there remains an increased incidence of influenza like illness. From the 8,633 specimens tested in the reporting period to 13th August only 357 specimens were positive for influenza & of these 66% were H1N1 2009. More detailed surveillance information & the influenza activity map can be found on the health professional section of www.healthemergency.gov.au as will the full ATAGI advice re junior panvax.
Keep up the good work! Your efforts have helped avert the 2nd wave of the pandemic here in Australia
The Chief Medical Officer has sent through the latest information regarding the H1N1 2009 junior vaccine.The shelf life of the vaccine has been downgraded so please see the following exert from Prof Bishop's bulletin...
"stability testing by the Therapeutic Goods Administration (TGA) of the pandemic influenza vaccine for children, Panvax H1N1 2009 Junior, has shown a decline in potency in the 0.25 ml pre-filled syringes.
As a result, the TGA has informed the manufacturer, CSL, that its registered 12 month shelf life can no longer be supported. CSL have amended the shelf life to 6 months and as a result existing stocks of Panvax H1N1 2009 Junior should now be considered expired.
Importantly similar declines in potency have been identified internationally by other regulators and have led to similar reductions in shelf life for other H1N1 monovalent vaccines.
The safety of the vaccine is not affected.
In Australia, the decline in potency is specific to the Panvax H1N1 2009 Junior vaccine which is supplied in 0.25 mL pre-filled syringes.
Panvax in multi dose vials is not affected, nor are the trivalent seasonal influenza vaccines."
The good news is that the multi dose vial product is safe & stable & can be given to children under 36 months at the scheduled 0.25ml dose.
CSL will be contacting immunisation providers in the next few days to retrieve the product so keep an eye out for that correspondence. What should we do? Set the vaccine aside from your regular stock supply & label as expired & await the CSL recall.
As you are aware the WHO has scaled down the pandemic alert & has now moved into the post pandemic phase. 'As at 1 August 2010, over 18,449 deaths worldwide have been reported associated with the pandemic virus'(DoHA) with high levels of virus activity in NZ & India.
As per my previous blog, there remains an increased incidence of influenza like illness. From the 8,633 specimens tested in the reporting period to 13th August only 357 specimens were positive for influenza & of these 66% were H1N1 2009. More detailed surveillance information & the influenza activity map can be found on the health professional section of www.healthemergency.gov.au as will the full ATAGI advice re junior panvax.
Keep up the good work! Your efforts have helped avert the 2nd wave of the pandemic here in Australia
Sunday, August 1, 2010
Ban lifted on Combined Seasonal Flu vax for under 5s
Belinda our CEO will has contacted those of our members with APNA registered emails to update you on the Latest events in the seasonal flu vaccine program for the under 5 year olds & the lifting of the suspension for the combined flu vaccination in this group. Approval has been given by TGA to recommence the program, as per protocol using only the Influvac or Vaxigrip brand vaccines. The links to this info can be found on our www.apna.asn.au
There has been detailed scientific investigation into the increased reports of febrile convulsion post fluvax in this group. A very detailed report of those Ix & findings can be found on the TGA website by following the link
http://www.tga.gov.au/alerts/medicines/fluvaccine-report100702.htm
Interestingly whilst there were 100 confirmed seasonal flu vaccine related febrile convulsions reported in Australia, in NZ, prior to the suspension of Fluvax, there had only been 10 reported & 9 confirmed Fluvax related reports of febrile convulsion in approx 12,000 given paed doses.
The DoHA surveillance reported on www.healthemergency.gov.au indicates that RSV is currently the predominant circulating respiratory illness for July 2010 but Lab reporting of influenza is increasing. The 2009 H1N1 virus has been the most common strain detected though A/H3N2 & influenza B (untyped)have also been noted.
Those children deemed at high risk can now be vaccinated with Infuvac or Vaxigrip free under the Gov program. Parents of otherwise well children wishing to protect them with vaccine can do so via private script. Parents need to be advised to give paracetamol to control fever & reduce risk of convulsion!
There has been detailed scientific investigation into the increased reports of febrile convulsion post fluvax in this group. A very detailed report of those Ix & findings can be found on the TGA website by following the link
http://www.tga.gov.au/alerts/medicines/fluvaccine-report100702.htm
Interestingly whilst there were 100 confirmed seasonal flu vaccine related febrile convulsions reported in Australia, in NZ, prior to the suspension of Fluvax, there had only been 10 reported & 9 confirmed Fluvax related reports of febrile convulsion in approx 12,000 given paed doses.
The DoHA surveillance reported on www.healthemergency.gov.au indicates that RSV is currently the predominant circulating respiratory illness for July 2010 but Lab reporting of influenza is increasing. The 2009 H1N1 virus has been the most common strain detected though A/H3N2 & influenza B (untyped)have also been noted.
Those children deemed at high risk can now be vaccinated with Infuvac or Vaxigrip free under the Gov program. Parents of otherwise well children wishing to protect them with vaccine can do so via private script. Parents need to be advised to give paracetamol to control fever & reduce risk of convulsion!
Tuesday, June 1, 2010
01/06/2010 Update of the Suspension of Seasonal Flu vaccine for Children Aged under 5 years old
This evening APNA representatives Jenny Dandeaux & Karen Booth, along with colleagues from the other peak primary care groups attended the GP Roundtable with the Chief Medical officer, Prof Bishop & Dr Towler from DoHA for the latest update of the suspension of seasonal flu vaccine for children aged under 5 years old
Detailed scientific investigations have been conducted by ATAGI, the TGA and the National Centre for Immunisation Research and Surveillance into the increased incidence of febrile convulsions in young children following seasonal flu in children in both WA & then compared to the detailed analysis from the other states & territories. Through diligent research it has been determined that the Influenza vaccine seems to be a problem with the CSL Fluvax & Fluvax Jnr and there has not yet been a cause identified for the increase in rates of febrile convulsions
Risk is greater for less than 3 years old.
90% of febrile convulsions occurred in children less than 3 years of age, with a larger proportion of febrile presentations in children less than one year. The majority of febrile convulsion occurred within 12 hours of vax. Most of these reactions were associated with the CSL Fluvax product
The decision has been made to maintain suspension in children under 5years
There has been a deliberate change to terminology to reflect the scientific data. This will now change to apply to children under / less than 5 years, so the combined seasonal influenza vaccine may be given to children 5 years AND older.
Due to increased demand for seasonal combined flu vaccine & the extension of the eligibility criteria for flu vaccination programs to at risk groups, there has a been a shortage in vaccine supply for private prescriptions. Vaxigrip now is in plentiful supply.
The CMO further advises that children under the age of 5 years may be vaccinated with the seasonal influenza vaccine after clinical assessment. The decision to proceed with the seasonal flu vaccine is at the doctor’s discretion and will be dependent on the child’s clinical condition, risk related past medical history AND possible bad outcomes from influenza infection and may be given the child may be vaccinated with a non Fluvax vaccine
Scientific Findings
An audit of both the CSL Fluvax vaccine and the production plant has not found any abnormalities.
The scientific testing regime is being extended under chairmanship of Prof Peter Doherty, ATAGI, the TGA and the National Centre for Immunisation Research and Surveillance in consultation with CDC in Atlanta, USA.
Brief Epidemiology Update
When examining the data from ED presentations for febrile convulsion it was noted that numbers increased when vax program for under 5’s was in progress and decreased when the program was suspended. This data was cross referenced against type of vaccine given, finding higher rates in Fluvax recipients
Current surveillance is showing lower levels of flu infection. Regular surveillance updates can be obtained from the Health Emergency Website or follow the link http://www.healthemergency.gov.au/internet/healthemergency/publishing.nsf/Content/ozflucurrent.htm
Use of Antiviral 2010 Season
This year DoHA is not expecting any shortage or problems with availability of antiviral medications and these will be dispensed via local pharmacy prescriptions
People in vulnerable groups should be considered for benefits of antiviral medication when presenting with flu-like symptoms. Clinicians should continue to use lab testing to assist clinical management as needed.
DoHA will be adding this info to the website. http://www.immunise.health.gov.au/
The Bottom Line is that the influenza vaccination is now available for children who are 5 years of age and up. (The previous criteria was for over 5 year olds, i.e.: 6 years & up)
Children, under 5 years who are at risk, should have the influenza vaccination at the discretion of the doctor & under supervision, with instructions how to treat fever, (appropriate age Paracetamol & keeping the child cool). At this stage it is recommended that Influvac & Vaxigrip be used for under 5’s (at the correct dose), as there seems to be less incidence of febrile convulsions from these 2 providers, although it is admitted that they have not been used in the same numbers as Fluvax.
CSL is looking at the retrieval of Fluvax cold chain data & other data to carry out their own investigations.
NB: Pandemic H1N1/ Panvax has a high safety profile with less than1:1000 reports of febrile convulsion and should continue to be offered to all at risk groups
Please check the links for that latest news & APNA will keep you posted, Cheers, Karen
Detailed scientific investigations have been conducted by ATAGI, the TGA and the National Centre for Immunisation Research and Surveillance into the increased incidence of febrile convulsions in young children following seasonal flu in children in both WA & then compared to the detailed analysis from the other states & territories. Through diligent research it has been determined that the Influenza vaccine seems to be a problem with the CSL Fluvax & Fluvax Jnr and there has not yet been a cause identified for the increase in rates of febrile convulsions
Risk is greater for less than 3 years old.
90% of febrile convulsions occurred in children less than 3 years of age, with a larger proportion of febrile presentations in children less than one year. The majority of febrile convulsion occurred within 12 hours of vax. Most of these reactions were associated with the CSL Fluvax product
The decision has been made to maintain suspension in children under 5years
There has been a deliberate change to terminology to reflect the scientific data. This will now change to apply to children under / less than 5 years, so the combined seasonal influenza vaccine may be given to children 5 years AND older.
Due to increased demand for seasonal combined flu vaccine & the extension of the eligibility criteria for flu vaccination programs to at risk groups, there has a been a shortage in vaccine supply for private prescriptions. Vaxigrip now is in plentiful supply.
The CMO further advises that children under the age of 5 years may be vaccinated with the seasonal influenza vaccine after clinical assessment. The decision to proceed with the seasonal flu vaccine is at the doctor’s discretion and will be dependent on the child’s clinical condition, risk related past medical history AND possible bad outcomes from influenza infection and may be given the child may be vaccinated with a non Fluvax vaccine
Scientific Findings
An audit of both the CSL Fluvax vaccine and the production plant has not found any abnormalities.
The scientific testing regime is being extended under chairmanship of Prof Peter Doherty, ATAGI, the TGA and the National Centre for Immunisation Research and Surveillance in consultation with CDC in Atlanta, USA.
Brief Epidemiology Update
When examining the data from ED presentations for febrile convulsion it was noted that numbers increased when vax program for under 5’s was in progress and decreased when the program was suspended. This data was cross referenced against type of vaccine given, finding higher rates in Fluvax recipients
Current surveillance is showing lower levels of flu infection. Regular surveillance updates can be obtained from the Health Emergency Website or follow the link http://www.healthemergency.gov.au/internet/healthemergency/publishing.nsf/Content/ozflucurrent.htm
Use of Antiviral 2010 Season
This year DoHA is not expecting any shortage or problems with availability of antiviral medications and these will be dispensed via local pharmacy prescriptions
People in vulnerable groups should be considered for benefits of antiviral medication when presenting with flu-like symptoms. Clinicians should continue to use lab testing to assist clinical management as needed.
DoHA will be adding this info to the website. http://www.immunise.health.gov.au/
The Bottom Line is that the influenza vaccination is now available for children who are 5 years of age and up. (The previous criteria was for over 5 year olds, i.e.: 6 years & up)
Children, under 5 years who are at risk, should have the influenza vaccination at the discretion of the doctor & under supervision, with instructions how to treat fever, (appropriate age Paracetamol & keeping the child cool). At this stage it is recommended that Influvac & Vaxigrip be used for under 5’s (at the correct dose), as there seems to be less incidence of febrile convulsions from these 2 providers, although it is admitted that they have not been used in the same numbers as Fluvax.
CSL is looking at the retrieval of Fluvax cold chain data & other data to carry out their own investigations.
NB: Pandemic H1N1/ Panvax has a high safety profile with less than1:1000 reports of febrile convulsion and should continue to be offered to all at risk groups
Please check the links for that latest news & APNA will keep you posted, Cheers, Karen
Friday, April 30, 2010
Yesterday the Chief Medical Officer convened an urgent information update for the immunisers regarding the current suspension of the seasonal flu program in the 5 years & younger age group.
The situation so far, is that the batches examined to this point have not been identified as a cause for the upsurge in the WA reports of adverse events. The TGA is in WA investigating each case. WA is the largest provider of influenza vaccine to children in Australia & therefore reactions draw from a much larger vaccinated paed population than the other states.
Numbers found so far – 57 cases from WA, 1 ACT, 4 NSW. 4 Qld. 2 SA, 1 Tas, 6 Victoria, 2 in non identified states. 77 reports febrile convulsions –more with temps etc. The one very sick child in WA has recovered, it is noted that the child had other underlying health issues. The expected reaction rate is normally 1:1000-1:10000.
Clear advice must be given on febrile reactions to vaccines. Temperatures and febrile convulsions are normal part of vaccination and indeed childhood illnesses and do not have long term ramifications on child’s well-being.
Immuniser are asked to continue to proved data to ACIR to help track paed doses given. The CMO again stressed that it is safe to continue vax in 6 years & over. Children should develop very high levels of immunity even if the 2nd dose is delayed for some time after the recommended 4 week interval between dose 1 & 2
The plain swine flu/pandemic H1N1 vaccine is safe to continue giving to younger children. The CMO suggest those children at high risk of complications from influenza should be vaccinated against swine flu.
The situation so far, is that the batches examined to this point have not been identified as a cause for the upsurge in the WA reports of adverse events. The TGA is in WA investigating each case. WA is the largest provider of influenza vaccine to children in Australia & therefore reactions draw from a much larger vaccinated paed population than the other states.
Numbers found so far – 57 cases from WA, 1 ACT, 4 NSW. 4 Qld. 2 SA, 1 Tas, 6 Victoria, 2 in non identified states. 77 reports febrile convulsions –more with temps etc. The one very sick child in WA has recovered, it is noted that the child had other underlying health issues. The expected reaction rate is normally 1:1000-1:10000.
Clear advice must be given on febrile reactions to vaccines. Temperatures and febrile convulsions are normal part of vaccination and indeed childhood illnesses and do not have long term ramifications on child’s well-being.
Immuniser are asked to continue to proved data to ACIR to help track paed doses given. The CMO again stressed that it is safe to continue vax in 6 years & over. Children should develop very high levels of immunity even if the 2nd dose is delayed for some time after the recommended 4 week interval between dose 1 & 2
The plain swine flu/pandemic H1N1 vaccine is safe to continue giving to younger children. The CMO suggest those children at high risk of complications from influenza should be vaccinated against swine flu.
Friday, April 23, 2010
Jenny Dandeaux & I attended the TC with Jim Bishop & DoHA for the update of the "Suspension of the Seasonal Flu program for children < 5 years". Please see below for the latest info!!
WA has seen a spike in suspected adverse events in the past few weeks with approx 44 children presenting with fever & febrile convulsions. (The seasonal presentation of fever with convulsion in 2009 was 31 cases, 2008 was 29 cases).
Currently the true cause of the spike in these presentations is not known so until the true cause can be identified the government has decided to suspend (not cancel) the combined flu program for the under 5 age group until further notice.
The WA health dept reports that there is a much higher than usual seasonal occurrence of circulating viral respiratory illnesses in WA at this time, which may account for the rise in febrile illnesses.
Currently the investigations include:
• Testing the WA batches
• Looking for other underlying causes of fever, those reported cases are also being re-examined for other signs of respiratory illness
• All states are checking there emergency dept paed admission data to look for similar presentations to ascertain whether the problem is national or only a WA “spike”
The CMO expects the scientific Investigation team should be able to sort through this info fairly quickly to identity the cause of these events. Other contributing factors have been the delay by clinicians in reporting adverse events at the time of occurrence.
The TGA has info relating to the Ix on http://www.tga.gov.au/alerts/medicines/fluvaccine.htm
The TGA recommends that adverse events be reported as soon as possible using the standard adverse event protocol. Follow this link to the TGA health professional page for further info to report adverse events http://www.tga.gov.au/hp/index.htm
As febrile convulsion is usually a disorder in the <3 year age group, The CMO recommends that the seasonal program for older children & adults should continue. He also stressed that it is important for vaccinators to record & report the paed doses to the ACIR so that doses can be collated & traced back to pts as needed.
The CMO letter to immunisation providers can be viewed on http://www.healthemergency.gov.au/internet/healthemergency/publishing.nsf/Content/latest-cmo.
APNA will update the info for members as we receive it.
WA has seen a spike in suspected adverse events in the past few weeks with approx 44 children presenting with fever & febrile convulsions. (The seasonal presentation of fever with convulsion in 2009 was 31 cases, 2008 was 29 cases).
Currently the true cause of the spike in these presentations is not known so until the true cause can be identified the government has decided to suspend (not cancel) the combined flu program for the under 5 age group until further notice.
The WA health dept reports that there is a much higher than usual seasonal occurrence of circulating viral respiratory illnesses in WA at this time, which may account for the rise in febrile illnesses.
Currently the investigations include:
• Testing the WA batches
• Looking for other underlying causes of fever, those reported cases are also being re-examined for other signs of respiratory illness
• All states are checking there emergency dept paed admission data to look for similar presentations to ascertain whether the problem is national or only a WA “spike”
The CMO expects the scientific Investigation team should be able to sort through this info fairly quickly to identity the cause of these events. Other contributing factors have been the delay by clinicians in reporting adverse events at the time of occurrence.
The TGA has info relating to the Ix on http://www.tga.gov.au/alerts/medicines/fluvaccine.htm
The TGA recommends that adverse events be reported as soon as possible using the standard adverse event protocol. Follow this link to the TGA health professional page for further info to report adverse events http://www.tga.gov.au/hp/index.htm
As febrile convulsion is usually a disorder in the <3 year age group, The CMO recommends that the seasonal program for older children & adults should continue. He also stressed that it is important for vaccinators to record & report the paed doses to the ACIR so that doses can be collated & traced back to pts as needed.
The CMO letter to immunisation providers can be viewed on http://www.healthemergency.gov.au/internet/healthemergency/publishing.nsf/Content/latest-cmo.
APNA will update the info for members as we receive it.
Tuesday, April 6, 2010
Examining the knowledge of and attitudes to pandemic influenza among general practice staff
Prior to the 2009 flu epidemic, the authors surveyed PNs & GPs in a sample of areas to determine thier attitude & perceived preparedness for the impending swine flu epidemic. I was in the survey group & good to see the results. It is reassuring that we, as health professionals feel, on the whole prepared to deal an epidemic provided we have adequate support in particular personal protection equipment & access to vaccination & antivirals for the health workers & their families.
http://www.mja.com.au/public/issues/192_07_050410/sea10925_fm.html
http://www.mja.com.au/public/issues/192_07_050410/sea10925_fm.html
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