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Vaccines for Preventable Diseases

College of Health and Medicine students as well as Health Care Workers, are at a higher risk than the general population of having contact with vaccine preventable diseases. This place both the student and people in their care at risk of transmission of these diseases. All students must therefore submit evidence of immunity to the specified vaccine preventable diseases to the College of Health and Medicine Professional Experience Placement (PEP) Staff prior to PEP.

Students may have already received some or all vaccinations. Sources of vaccination evidence may include child health records, vaccination clinics, GP medical records and local councils. Students previously immunised in Australia may also be able to download their immunisation history from the Australian Immunisation Register. College of Health and Medicine students are required to upload their vaccination records into InPlace, together with relevant screening, serology and chest x-ray reports as appropriate. All evidence must be scanned into a single PDF file. All entries must be legible and in English.

Students are responsible for organising their own immunisations and all associated costs.

Diptheria, Tetanus AND Pertussis (dTpa)

Diphtheria is a contagious and potentially life threatening bacterial infection, most commonly affecting the pharyngeal mucous membranes causing respiratory and eating difficulties

Transmission: by respiratory droplets or fluid from the mouth, nose and skin. Infectious for up to 4 weeks from onset of symptoms.

Complications: diphtheria toxin, which is produced by the bacterial infection, can cause inflammation of the heart and may result in death.

At risk: anyone not immune through vaccination or previous infection.

Tetanus is a bacterium infection usually found in soil, animal faeces and dust. It causes painful muscle spasms.

Transmission: usually by injury and it is not spread from person to person.

Complications: toxin from the bacterium can attack the nervous system and may be fatal.

At risk: babies of mothers not fully immunised and older adults who have never been fully immunised.

Pertussis is a highly infectious, bacterial infection causing severe coughing bouts and apnoea.

Transmission: by respiratory droplets through the infected person coughing and sneezing. Cough may last for 3 weeks or more and in children it may be accompanied by paroxysms leading to ‘whoop’ sound or vomiting.

Complications: can be fatal in babies under 12 months old.

At risk: anyone not immune through vaccination or previous infection.

Immunisation against dTpa

Diphtheria Tetanus and Pertussis vaccines are all combined into a single dose of dTpa vaccine. All students who have not had an adult dTpa vaccination within the last 10 years will require a booster dTpa vaccination.

Evidence of Immunity to Diphtheria, Tetanus and Pertussis (dTpa)

Students must provide documented evidence:

  • Adult dose of dTpa vaccine within the last 10 years, including batch number.
  • If a batch number is not available, a booster adult dTpa vaccination will be required – this is a mandatory NSW Health requirement.
  • Serology, or tetanus toxoid or diphtheria/tetanus vaccinations are not accepted.

Hepatitis B Virus (HBV)

Hepatitis B Virus (HBV) is a blood-borne viral disease, causing liver infection.

Transmission: via blood or other bodily fluids entering broken skin &/or mucous membranes.

Complications: chronic hepatitis B infection, cirrhosis and liver cancer.

At risk: health care professionals, injecting drug users who share IV needles, haemodialysis patients, people who are not immune through vaccination or from previous Hepatitis B infection.

Immunisation against Hepatitis B

All students who are not immune to Hepatitis B at enrolment require vaccination. The Australian Immunisation Handbook (online) recommends a full adult (>20 years of age) course of 3 x Hepatitis B vaccinations over a 6-month period, with follow up Hepatitis B surface antibody serology 4-6 weeks after the 3rd Hepatitis B vaccination.

Recommended Vaccination schedule: Vaccination at 0, 1 and 6 months, with at least 4 months between the 1st and 3rd Hepatitis B vaccination. Hepatitis B surface antibody serology is required 4-6 weeks after the 3rd Hepatitis B vaccination to confirm immunity status.

Evidence of Immunity to HBV

Students are required to provide evidence of a history of age appropriate Hepatitis B vaccination AND Hepatitis B Surface Antibody serology.

  • Evidence of a history of age appropriate Hepatitis B vaccinations includes
    • Documented evidence of previous age appropriate Hepatitis B vaccinations
      OR
    • Where Hepatitis B vaccination records cannot be located a Health Care Provider must document on Immunisation Record/Vaccination Card ‘confirmed verbal history of age appropriate Hepatitis B vaccinations obtained from student’
    • NSW Students only:
      In addition to the above, NSW Health Hepatitis B Statutory Declaration form must be completed by the student and witnessed by a Health Care Provider or an Authorised Nurse Immuniser, this must accompany the Vaccination Card. This is only acceptable when all attempts to find Hepatitis B vaccination records have failed.
  • Hepatitis B surface antibody serology is required 4-6 weeks after the 3rd Hepatitis B vaccination. Only a NUMERICAL value on the serology report will be accepted. A surface antibody level ≥10 mIU/Ml indicates immunity.

Students are able to attend their 1st PEP in the first year of their course once they have begun their course of Hepatitis B vaccinations (if required). Second year students MUST have completed the full course of Hepatitis B vaccinations (if required) AND provided evidence of their Hepatitis B surface antibody serology results before they can attend PEP.

NOTE: NSW Paramedic students must have completed the full course of Hepatitis B vaccinations (if required), including Hepatitis B surface antibody serology prior to attending their first emergency ambulance placement.

Non-Responders

If after completing an age appropriate primary course of Hepatitis B vaccinations, a student is Hepatitis B Surface Antibody (HBsAb) negative (<10mIU/mL), the student will require testing for current or past Hepatitis B virus infection. If no evidence of current or past Hepatitis B virus infection is detected, a booster/4th dose of Hepatitis B vaccination followed by repeat Hepatitis B surface antibody serology 4 weeks after the booster/4th dose must be undertaken. If a student remains HBsAb negative (<10mIU/mL), they will require a 5th and 6th dose given one month apart with repeat Hepatitis B surface antibody serology 4 weeks after the 6th dose.

Students who are persistent non-responders need to be reviewed by an Infectious Diseases Physician for further assessment and management, including consideration for intra-dermal Hepatitis B vaccination. If they remain seronegative, the student is considered unprotected against HBV. They will require Hepatitis B Immunoglobulin (HBIG) within 72 hours of significant exposure to HBV-infected blood or body fluids.

Students who have a history of Hepatitis B Virus (HBV) are required to complete the UTas College of Health and Medicine Safety in Practice Immunisation Variation Form.

Measles, Mumps and Rubella (MMR)

Measles is a highly infectious viral disease causing generalised un-wellness, with a distinctive rash.

Transmission: by respiratory droplets. Infectious before symptoms appear and for several days afterwards.

Complications: ear infection, pneumonia or encephalitis.

At risk: anyone born during or after 1966 who have not been immunised and babies under 12months old who have not had first MMR vaccination.

Mumps is a viral disease primarily affecting the salivary glands causing fever, loss of appetite, tiredness and headaches.

Transmission: by respiratory droplets.

Complications: if infected after puberty, serious complications can occur- swelling of testes/ovaries, encephalitis or meningitis (rare).

At risk: anyone not immune through vaccination or previous infection.

Rubella is a viral disease causing fever, rash, runny nose, conjunctivitis and swollen lymph nodes. Aching joints are also common, especially in women.

Transmission: by respiratory droplets and direct contact. Infectious before symptoms appear and for several days afterwards.

Complications: if contracted in early stages of pregnancy, miscarriage & birth defects may occur.

At risk: anyone not immune through vaccination or previous infection.

Immunisation against Measles, Mumps and Rubella (MMR)

MMR vaccine is a combined single dose vaccine. All students without documented evidence of 2 MMR vaccinations or serological evidence of immunity to Measles, Mumps and Rubella are required to be immunised (2 MMR vaccinations at least 4 weeks apart). As it is a live vaccine, MMR vaccinations must be administered 1 month apart from a Tuberculin Skin Test (TST) /Mantoux. If other live vaccines are to be administered, then these must be administered either on the same day as the MMR vaccine or there must be a 4-week interval between live vaccines.

Evidence of Immunity to Measles, Mumps and Rubella

Students are required to provide documented evidence:

  • 2 MMR vaccinations at least 4 weeks apart,
    OR
  • Serological evidence of immunity (positive IgG) to measles and mumps AND a Rubella serology report with a numerical value ONLY,
    OR
  • Born before 1966.

Varicella (VZV)

Varicella is a viral disease with a rash that usually begins as small lumps that later turn into blisters then scabs.

Transmission: in the early stages of infection, varicella is spread through coughing and respiratory droplets. In later stages of infection, varicella is spread through contact with the fluid from the blisters.

Complications: relatively minor in children but can be severe in adults and the immunocompromised causing pneumonia and inflammation in the brain.

At risk: anyone not immune through previous vaccination or infection.

Immunisation against Varicella

Students without documented evidence of varicella vaccination or no serological evidence of varicella immunity are required to have 2 varicella vaccinations at least 4 weeks apart. As it is a live vaccine, varicella vaccinations must be administered 1 month apart from a Tuberculin Skin Test (TST) /Mantoux. If other live vaccines are to be administered, then these must be administered either on the same day as the VZV vaccine or there must be a 4-week interval between live vaccines.

Evidence of Immunity to Varicella

Accepted evidence of immunity to varicella include:

  • If vaccinated under 14 years of age, 1 dose of varicella vaccination OR
  • If vaccinated 14 years or older, 2 doses of varicella vaccination at least 4 weeks apart OR
  • Serological evidence of immunity (positive IgG) to varicella.

Tuberculosis (TB)

Tuberculosis (TB) is a bacterial infection that can affect any part of the body, with lungs the most common site.

Transmission: by respiratory droplets spread by the infected person coughing, sneezing or speaking.

At risk: anyone who was born or lived and travelled for more than 3 months in a country with a high incidence of TB or those who have been in contact with anyone who has TB infection of the lungs or respiratory tract.

Tuberculosis Screening

Each Australian state and territory have different TB screening requirements. Please see below for individual state TB screening requirements.

School of Medicine staff will advise Bachelor of Medicine and Bachelor of Surgery students if screening is required.

All other College of Health and Medicine students will need to seek advice from their GP to determine whether a student requires TB screening.

Launceston or the North West If a student’s GP recommends that TB screening is required, as there is no specific referral form, the GP must send a referral letter stating Mantoux testing request to:

  • Northern Integrated Care Service

    41 Frankland Street, Launceston
    Ph.  (03) 6777 4145
    Fax. (03) 6336 2433
    Hobart

If a student’s GP recommends that TB screening is required, this needs to be performed at either Royal Hobart Hospital or Hobart Pathology.

For the Royal Hobart Hospital, as there is no specific referral form, the GP must send a referral letter stating Mantoux testing to:

  • Royal Hobart Hospital

    Respiratory Clinic
    Wellington Clinics, Level 10, 42 Argyle Street, Hobart
    Ph.  (03) 6166 0000
    Fax. (03) 6234 3982

All students MUST complete NSW Health Attachment 7: Tuberculosis (TB) Assessment Tool. Students will require TB screening if:

  • was born in a country with a high incidence of TB
    OR
  • has resided or travelled for a cumulative period of 3 months or longer in a country or countries with a high incidence of TB
    OR
  • may have previously been assessed as compliant for TB but has resided or travelled for a cumulative period of 3 months or longer in a country or countries with a high incidence of TB since their last TB assessment.
    OR
  • has had contact with a person known to have infectious TB disease.

NSW students can now be screened using either an Interferon Gamma Release Immunoassay (IGRA) blood test or a Tuberculin Skin Test (TST). However, if students have previously been screened for TB, they must be screened again using the same method as a baseline.

NSW students requiring TB screening can have an Interferon Gamma Release Immunoassay (IGRA) blood test at their GP. IGRA is an acceptable and validated alternative to TST for TB screening. GP must document date of IGRA test and test results on Vac Card. A positive or indeterminate IGRA will require TB Clinical Review at a NSW Health Chest Clinic.

Students can also have TB screening- TST at their nearest NSW Health Chest Clinic. A GP or Pathology Company cannot perform a TST. Students are encouraged to book an appointment as early as possible as clinic bookings are limited.

Evidence of Tuberculosis Screening

If students require TB screening, part of this screening is recording history of BCG vaccination. It must be recorded on their Vaccination Record Card if they have or have not had a BCG vaccination as history of BCG will contribute to assessing the screening results.

Mantoux Tests Interpretations:

  • Reaction is negative, and no BCG scar, no further action.
  • Reaction > 8 mm and no BCG, CXR required and results recorded on Vaccination Card.
  • Reaction is negative, and BCG scar present, repeat mantoux test, if still negative,  no further action.
  • Reaction >10mm and BCG confirmed, CXR required and results recorded on Vaccination Card.

All students require either a Tuberculin skin test (TST) also known as a Mantoux test or Interferon Gamma Release Immunoassay (IGRA). Students who are current ACT Health staff must provide evidence of previous screening. All students MUST complete ACT Health Form 3 Tuberculosis (TB) Assessment Tool. Any yes answer in part 1a-c will require a clinical review.

Evidence of Tuberculosis Screening

Students should ensure that if they previously have had a BCG vaccination, that it is recorded on their immunisation record.

Interferon Gamma Release Immunoassay (IGRA)

IGRA is an acceptable and validated alternative to TST for TB screening. Students that meet the criteria for screening can elect not to have a TST and have an IGRA performed instead. For the purpose of this procedure, a positive or indeterminate IGRA is regarded as positive and requires TB clinical review.

Tuberculin Skin Testing (TST)

TST results will only be accepted if performed by an accredited Chest (TB) Clinic in Australia. TST positivity depends on the underlying risk/immune status of the student and history of BCG vaccination. For the purpose of this procedure, a TST ≥5mm is regarded as positive and requires TB clinical review.

Tuberculosis clinical review

A TB clinical review is conducted by an accredited Australian Chest (TB) Clinic. The Department of Respiratory and Sleep Medicine at the Canberra Hospital (ph: 02 6244 2066) is the only accredited TB Clinic in Canberra. A clinical review is conducted to determine the need for Latent Tuberculosis Infection treatment and exclude TB disease. This may involve a Chest X-Ray.

Influenza (FLU)

Influenza is a highly contagious viral infection causing fever and chills cough, sore throat and runny or stuffy nose.

Transmission: by respiratory droplets through the infected person coughing and sneezing, or through touch- handshake. Spreads easily in small or crowded spaces.

Complications: pneumonia or heart failure.

At risk: anyone not immune through annual vaccination but the elderly and small children are particularly at risk.

Immunisation against Influenza

The Influenza vaccine is adapted each year to meet anticipated strains of influenza. One seasonal annual influenza vaccination is mandatory for all College of Health and Medicine students undertaking PEP.

Evidence of Annual Influenza Vaccination

Evidence of the annual influenza vaccination MUST be provided 2 weeks prior to 1st June each year using the

  • Safety in Practice Annual Influenza Vaccination Form (PDF, 135KB)

  • Other forms of evidence include pharmacy/ hospital influenza consent form, GP immunisation summary/list/statement or NSW Health Vaccination Record Card for Health Care Workers and Students. All other forms of evidence MUST include student name, date of birth, influenza vaccine name, vaccine batch number, date of administration, vaccinator name, signature and practice stamp/letterhead.


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