Dated: 23 November 2020 - Department of Health, Victoria



lefttop00Coronavirus (COVID-19) updateVictorian local council immmunisation servicesSecondary school immunisation programDated: 23 November 2020 Key messages Delivery of the secondary school immunisation program has been the most impacted by the COVID-19 pandemic. Providing Meningococcal ACWY vaccine to Year 10 students (or age equivalent) is the clinical priority due the risk profile of the disease in the short term and the second dose of HPV vaccine to the Year 7 students of 2020 in the long term. There is an increased risk of vaccine errors with the unnecessary administration of additional doses of adolescent vaccines. Always check the Australian Immunisation Register before administering vaccine.Consent provided for vaccination in 2020 remains valid in 2021 however services are advised to communicate with parents/guardians prior to administering any catch-up vaccines to ensure no new health concerns have arisen for the adolescent that might impact on their suitability for vaccination.Background Delays caused by school closures at various intervals of the COVID-19 pandemic response impacted in delivery of the secondary school program. Almost 60 per cent of councils will be delivering dose 2 of HPV vaccine in 2021 to complete the 2020 program.The unusual circumstances arising from the impacts of the pandemic present some challenges for completion of the 2020 secondary school immunisation program, which will coincide in many places with commencing delivery of the 2021 secondary school program. Clinical considerationsMeningococcal ACWY Adolescents aged 15 to 24 years have the highest rate of meningococcal carriage and are thought to play a role in transmitting the bacteria in a community. Meningococcal frequently presents as meningitis or septicaemia, infections can progress rapidly to serious disease or death in previously healthy people.Services are urged to make every attempt to deliver Meningococcal ACWY to eligible year 10 students in 2020. If your service is unable to offer Meningococcal ACWY to all eligible students in Year 10 before the end of the year, you may wish to consider: directing parents/guardians to seek the vaccine for the student from a GP or pharmacist immuniser, oroffering the vaccine to these students at community immunisation sessions over the school holidays, ororganising catch-up sessions when school returns in 2021 for students who missed out.HPV Dose 2 intervalThe second dose of the HPV vaccine should not be delayed. Timely vaccination ensures adequate protection before sexual debut. If the second dose can be administered in 2020 and it is more than 5 months but less than a six-month period between dose 1 and dose 2, then the second dose can be administered. 2020 is an exceptional year and this scenario can be implemented in 2020. The Australian Immunisation Register (AIR) will validate the second dose administered in this scenario.Avoid unnecessary extra dosesThe disruption of delivery of the 2020 secondary school immunisation program in Victoria poses an increased risk of unnecessary administration of additional doses of adolescent vaccines. Some parents/guardians may have sought vaccines from other immunisation providers as school closures interrupted or delayed the usual delivery schedule for vaccines. To avoid error, prior to administering adolescent vaccines:check the Australian Immunisation Register (AIR) to ascertain if an adolescent has received vaccines from another immunisation provider prior to administering any vaccine. ?report vaccine doses administered to the Australian Immunisation Register in a timely manner.Asking the young person if they have received a vaccine is not considered sufficiently reliable to manage the risk. While this process will require additional administrative time, reviewing the vaccination history on AIR will help maintain the trust of parents/guardians who are concerned about their child’s health and wellbeing and avoiding unnecessary additional vaccines for adolescents.Persons receiving an additional dose of HPV vaccine in a short period of time are likely to experience a local injection site reaction of redness and swelling and pain which diminishes over a few days, however they are unlikely to experience any significant detrimental effects.What are the AIR due and overdue rules and how might they impact catch-up delivery of the 2020 program?The Australian Immunisation Register (AIR) due and overdue rules indicate that an individual is not considered overdue for HPV dose 2 until the dose interval is 13 months. Hence if a Year 7 student received HPV dose 1 on 20/03/2020 they will not be considered overdue until 21/04/2021(13 months later). Reminder letters are sent to parents/guardians from AIR when the vaccine is overdue. Services are advised to plan to deliver the second dose of HPV as soon as possible after the required interval and before 13 months has elapsed since dose 1.The AIR rules indicate that an adolescent is overdue the Meningococcal ACWY vaccine at 17 years of age and AIR reminder letters are sent to adolescents shortly after their seventeenth birthday. COVID-safe deliveryContinue to follow the advice provided by the Department of Health and Human Services to all immunisation providers (updated 11 August) including guidance on seeking alternative models of delivery for the program if relevant.Undertaking daily attestationsThe current advice is that daily attestations should continue to be undertaken until 31 December 2020. For updates monitor the department’s COVID-19 information for community health services.Service delivery considerationsConsent for vaccination remains validConsent provided by parents/guardians in 2020 for adolescent vaccines remains valid even if the vaccine is being delivered in 2021. However, it is important that parents/guardians are aware of their ability to contact council to discuss any health changes they think might impact on the students’ suitability for vaccination and to reiterate their right to withdraw consent at any time prior to vaccination day. These issues have been included in support resources, specifically the template letter to parents/guardians of Year 8/Year 11 students and the template school newsletter item.Payment for 2020 vaccines delivered in 2021Subsidy payments for vaccines delivered in 2021 will be disbursed in 2022, regardless of whether the vaccine was originally due to be delivered in 2020. Consider extra communicationCouncil immunisation services should consider how they will be communicating the delivery of 2020 vaccines in 2021 with the school community, and continue to work closely with school immunisation coordinators to ensure that parents/guardians are aware of the situation and what they need to know and do as a result. Sample wording is included in support resources.Have students moved schools between school years?Services may wish to work with their schools to identify students who have transferred into Year 8 and Year 11 to identify a process for ascertaining these students’ vaccination needs, specifically, if they missed a vaccine/s in Year 7/Year 10. Access to school groundsSome schools have been reluctant to allow immunisation teams on site following the opening of schools in metro Victoria in term 4. The Department of Education and Training have updated their Operations Guide for schools to clarify that immunisation teams are allowed on school grounds and should be supported to deliver the secondary school immunisation program as a health priority. A letter from the Deputy Chief Health Officer, Communicable disease has been distributed to school principals. See Support resources to access this letter.Do students need to socially distance when receiving vaccines on school grounds?Some schools choose to comply with social distancing requirements for students when they are outside of the classroom and others do not. Following the approach of the school with regards to students social distancing is advised. Immunisation staff should continue to observe social distancing from school staff, team members and students when not administering a vaccine. Accessing personal protective equipmentCoordinate with other areas of local council providing health services funded by DHHS (for example, maternal and child health services) to order and access the personal protective equipment PPE you require.Planning for additional sessions Some services are holding additional sessions over the school holiday period to further complete the 2020 immunisation program for adolescents.Additional sessions may need to be planned in 2021 meaning services may need to consider the impact on staff availability and scheduling and vaccine storage capacity for additional vaccines as well as business-as-usual vaccines. Should your capacity be exceeded, parents/guardians can be advised to seek the necessary vaccines from GPs (Year 7 and Year 10 students) or pharmacist immunisers (for Year 10 students aged 15 years and older only). Support resourcesPlease be aware that these resources offer suggested wording and approaches, however each service should adapt these resources to meet the needs of their own communities and service delivery plans. The following resources can be found at statement regarding student contact details?(amended to include COVID impact on 2020 program)An example letter from school principals to parents/guardians of Year 7 and Year 10 students to let them know that their contact information is shared with the relevant local council for the purposes of delivering the secondary school immunisation program unless they request otherwise. (two pages)School newsletter article about the secondary school immunisation program (amended to include COVID impact on 2020 program)An example article from inclusion in school newsletters or communiques to alert parents/guardians of Year 7 and Year 10 students to the secondary school immunisation program. Also includes suggested wording for delivery of 2020 vaccines in 2021 as a result of the COVID pandemic. (one page)Fact sheet for secondary schoolsA brief summary of the secondary school immunisation program for Victorian secondary schools including annual steps and key dates. (two page fact sheet) including information relating to the impact of the COVID pandemic on the secondary school program.Letter template for parents/guardians of Year 8 students completing 2020 programSuggested wording for schools to adapt when communicating with parents regarding their child being due to receive dose 2 of HPV vaccine to complete their 2020 immunisation program. Letter template for parents/guardians of Year 11 students completing 2020 programSuggested wording for schools to adapt when communicating with parents regarding their child being due to receive Meningococcal ACWY vaccine to complete their 2020 immunisation program. Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne.This publication can be found at ? State of Victoria, Australia, Department of Health and Human Services, November 2020. ................
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