Following on from the report from the TGA investigation into an apparent cluster of side effects due to Pneumovax 23 the Northern Territory have released their updated adult vaccination protocol for Pneumovax 23.
There has been one change to the guidelines. There is no change to the Indigenous schedule.
NON-Indigenous adults over 65yrs do not receive a first or second revaccination of Pneumovax
The Therapeutic Goods Administration (TGA) has completed their investigation into the cluster of severe local injection site reactions in March 2011 that continued into April 2011.
Advice was then given to not administer the second adult dose of Pneumovax 23.
The investigation has now completed. The TGA considers that the increased reports of local reactions was not batch related but due to two factors. (Pneumovax 23 does have known high rates of local reactions after a repeat dose.)
the increased number of people having a repeat dose following the inclusion of Pneumovax 23 vaccine in the National Immunisation Program in 2005 with revaccination after five years
the increased reporting that followed the publicity of the batch recall.
The TGA has now advised that revaccination:
should not be given routinely to immunocompetent individuals (that is, those with a healthy immune system)
should be considered for patients at a high risk of serious pneumococcal disease, provided that at least five years has passed since the previous dose of Pneumovax 23.
Note this now differs from the current Australian Immunisation Handbook (9th edition 2008).
A discussion I had today with the acting in-charge at Communicable Disease Control Directorate, Department of Health, Western Australia indicates the schedule will most likely remain unchanged for Indigenous Australians.
Until this is put to us in writing (Medical Cordinator CDC WA is on leave at present) continue to withhold the second Pneumovax 23 ADULT dose.
Canada has a travel advisory for California. A health advisory on pertussis (whooping cough).
In most countries pertussis is a notifiable illness. This year California has had a sevenfold increase in pertussis notifications. All other states have declined a little or remained about the same as last year.
I imagine a lot more people from Canada travel to California to Australia and a sevenfold increase sounds quite a lot. The number of notifications up to 24th August was 3,311. Checking all current health advisories from Canada shows no current health advisory for Australia yet Australia has about 2000 notifications for pertussis each month.
Year to date figures (5th September) show Australian pertussis notifications for this year have reached 14865 (and probably will be lower than last year’s number of 29737). If we look at it another way Australia has so far had 14865 pertussis cases for around 22 million people with California having 3311 cases for 36 or so million people.
This table from the Department of Health (2005 figures the latest I could find a comparison) shows it very clearly.
Why haven’t the Canadians issued a travel advisory against Australia. As an Australian I feel ignored!. Perhaps they are worried about 3311 notifications all packed close together in a state only twice as big as Victoria, our second smaller state.
But enough joking.
Pertussis is a life threatening condition. In Australia sixty per cent of all notifications are in the over 20 age group. With a vaccination schedule including vaccination for pertussis at 2, 4, 6 months and 4 years of age (some states have a booster at school) babies under six months of age are at highest risk (21% of notifications in 2008) due to partial immunisation. Between 1993 and 2006 there were 21 deaths in Australia caused by pertussis. 17 of these were in infants less than twelve months of age.
There is some good information here and here(PDFs).
Maintaining the cold chain is difficult out bush. I wrote in August about the high temperatures reached in the planes transporting our pharmaceuticals. Power failures are regular in many remote communities and can lead to failure of the cold chain rendering the vaccines and other refrigerated items unusable. Over time I have built up a reasonable database of various drug stabilities at higher temperatures. However many of these studies do not reflect the temperatures to which these drugs may be exposed to.
These community generator power failures often necessitates removing these drugs in a safe and approved manner from these communities and replacing them quickly. This often means items transported from another community.
We could use foam containers and freezer blocks. During summer the ideal method is that mentioned (p31) in the “Strive for 5” vaccine storage guidelines, placing a polystyrene container in a much larger cooler and surrounding the container with freezer blocks or using a specialised vaccine cold box as recommended by the WHO.
Some emergency missions to overseas disasters have used large portable fridges. However these have needed careful monitoring with certain drugs placed in certain areas and adjustments to the thermostat if numbers of items are removed. Whilst these are good for setting up a remote emergency clinic they do require some specialised knowledge to maintain the correct storage for various drugs.
I have been trialling a new portable refrigerator. It has a volume of 25 litres which allows us to transfer adequate quantities of drugs urgently to a clinic until bulk supplies arrive in a week or two by plane.
I have been using it for several months monitoring temperatures with a third party data logger. The temperature monitoring and alarm system seem quite accurate. The fridge does use a different sort of cooling system than the compressor style, allowing more accurate temperature control. There are two baskets inside the refrigerator so there is no direct contact by the vaccine or blood products with the sides where they may freeze.
The power cord could be more robust, and it requires an optional DC converter to run inside on AC power (Engel etc require just a separate cord to plug into the unit). It is light, but seems quite solid and has handled rough bush trips with ease.. I would have liked some way to be able to lock the fridge. It also now comes with a printer option for temperature recording and I will be including this option in future purchases as we expand our on-lands logistics capability.
But then I think we have it easy compared to some locations around the world! This is the Vaccine Fridge CFS49IS System with CFS standing for “Camel Fridge System”.
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