Pneumovax 23 Final Update

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

Download (PDF, 126KB)

Pneumovax 23 Update

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.

The complete TGA advice

A Load of Pertussis

old phot of vaccinationCanada 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.

Most recent notification rates per 100,000 population for frequently notified vaccine preventable diseases, by country of residence

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).

Vaccines and a Spoonful of Sugar

A good cold chain and some reliable electricity production, as well as reliable drug fridges are pretty important out bush. I’ve even written a few posts on the subject (listed at bottom of post). I even have a couple in draft form so watch out!

vaccinationI was very interested in this news article Spoonful of sugar helps the medicine keep cool. There is a lot of work being done on a couple of viruses, pox and adenovirus to be able to use them as a platform for a range of other vaccines including HIV-Aids, tuberculosis and malaria.

Live vaccines need to be refrigerated. And of course the parts of the world where these diseases are most prevalent are the more remote and poorest areas without electricity.

By using a couple of sugars currently used as biological stabilisers, and slowly drying this virus-sugar mix they can vitrify (basically wrap it in “glass”) the product so it retains its stability without refrigeration at up to 45C for six months. You then take it to the remote location, reconstitute and start vaccinating. Now this has only been done in a lab but is exciting for the future.

Of course it will change the way we handle vaccines around the world, not just in the Third World. Out bush our temperatures during transport can get quite high. This graph is the temperature monitored by a data logger on it’s way from remote central Australia to Tasmania.

graph showing temperatures reached during transportation

It will also dramatically cut costs. The World Health Organisation estimates it costs 20% more than other drugs in cold chain transfers and storage (logistics).

Out where I am we might have a refrigeration mechanic out every few months. He may or may not have the right parts. If not, we wait a month until they arrive and then another few months until a refrigeration mechanic is out again. I try to minimise this delay by having a number of spares already out bush to be available when required.

But I’m in a first world country and can afford to do this.

Reference: R. Alcock, M. Cottingham, C. Rollier, J. Furze, S. D. De Costa, M. Hanlon, A. Spencer, J. Honeycutt, D. Wyllie, S. Gilbert, M. Bregu, A. V. S. Hill, Long-Term Thermostabilization of Live Poxviral and Adenoviral Vaccine Vectors at Supraphysiological Temperatures in Carbohydrate Glass. Sci. Transl. Med. 2, 18ra12 (2010).

Other Cold Chain Posts::
Cold Chain
Cold Chain 2
Data Loggers

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