Page 64 - rp-may-2020

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CPD CREDITS
CPD ACTIVITY 62
RET AIL PHARMA C Y • MA Y 2020
VACCINES IN THE FIRST YEAR OF LIFE
LEARNING OBJECTIVES:
After completing this CPD activity,
pharmacists should be able to:
• Describe the vaccine schedule in the
first year of life.
• Describe the diseases prevented
or clinical response modified by
these vaccines.
• List common and rare adverse effects
to vaccines administered in the first
year of life.
2016 Competency Standards:
1.3, 3.2, 3.5.
Accreditation number:
A2005RP2 (exp: 30/04/2022).
Jo Comper, B Pharm
(Hons) M Pharm
Jo is an accredited pharmacist
who undertook HMRs in her
hometown, Cairns, and in
outback Australia. Her basic
training was in the UK’s National Health System
and she undertook a Masters course at the
University of Nottingham. She now carries out
freelance work for various organisations and
universities, developing continuing professional
development articles and lecture series.
Introduction
There are 26 vaccine doses administered
in the first year of life to an infant
who is born and resides in Australia.
Some infants who identify as Aboriginal
or Torres Strait Islander people, or infants
who are immunocompromised will
receive additional doses depending on
which state or territory they reside in.
1
These recommendations are developed by
the Australian Technical Advisory Group on
Immunisation and approved by the National
Health and Medical Research Council.
Vaccines administered to infants are free
and the vaccine history of every child
who has received vaccines in Australia is
recorded on the Australian Immunisation
Register. The National Immunisation
2
Program (NIP) schedule changes often
and pharmacists should keep up to date
with vaccine changes. A chart of the
schedule can be downloaded from the
Australian Government’s Department of
Health website.
Community pharmacists should offer
families with infants vaccine information,
promote vaccination, and ensure disease
prevention is optimised in the community.
This article will discuss the vaccines
administered in the first year of life and
prominent diseases prevented through
vaccination programs
Hepatitis B vaccine
This is the first vaccine an infant has in
their first seven days of life. The first dose
1
is often given in hospital or by a visiting
midwife for home births. It is followed
up by a further three doses (contained
in Infanrix hexa) in the first six months to
provide immunity. The first hepatitis B
1
vaccine was funded for infants at high
risk to prevent vertical (mother to baby)
transmission and horizontal (chronically
infected household member) transmission
in 1987. The Engerix-B and H-B-Vax II
4
vaccines are manufactured by different
processes using recombinant procedures.
The hepatitis B surface antigen content
of an ‘equivalent’ dose of these vaccines
is different. Switching vaccine brands is
not recommended. The contraindications
and adverse effects are reported in
Table 2. The long-term effectiveness of
infant hepatitis B immunisation programs
was demonstrated in the 30-year follow-
up of the national program in Taiwan.
Vaccination rates following the introduction
of the vaccine to all infants from 1988
were over 88 per cent. Between 1977 and
1980, and 2009 and 2011, the incidence
of hepatocellular carcinoma among
individuals aged five to 29 years declined
by more than 80 per cent. Hepatitis
B-related mortality declined by more than
90 per cent for infants.
5
Infanrix hexa vaccine
Infanrix hexa is a combination of six
different vaccines:
• Diphtheria toxoid.
• Tetanus toxoid.
• Acellular pertussis vaccine.
• Poliomyelitis vaccine (inactivated).
• Haemophilus B conjugate vaccine.
• Hepatitis B vaccine.
The combined vaccine and the pneumonia
vaccine are administered at the same
time to the infant in separate arms, often
by two nurses to minimise the reaction
from the infant. This combination vaccine
first became available in 2008 on the
NIP schedule and was funded in three
states. Combined diphtheria toxoid,
tetanus toxoid, and acellular pertussis
vaccine (DTPa) is administered on five
occasions from six to eight weeks through
to four years of age. Further booster(s)
are administered later in life as per NIP
schedule. There are three different types
of Infanrix vaccines available, which are
scheduled at different ages. The selection
of the wrong vaccine is a common
dispensing error.
The contraindications and adverse
effects of Infanrix hexa are reported
in Table 1.
Whooping cough and pertussis vaccine
Pertussis whole cell vaccine was one
of the first vaccines to be introduced
alongside diphtheria and tetanus toxoids
in the 1920s. It became part of Australia’s
immunisation program in 1942.
4
Pertussis, also known as whooping
cough, is caused by the Gram-negative