2016-02-01
Residential Care Home Vaccination Programme
Benefits of Getting Seasonal Influenza Vaccination and Pneumococcal Vaccination
Respiratory infection caused by seasonal influenza or pneumococcal infection is common. It can be a serious illness with complications to the weak and frail and elderly persons and may even lead to death in the most serious cases. During influenza pandemics, secondary bacterial pneumonia is an important cause of morbidity and mortality. Vaccination is one of the effective means to prevent seasonal influenza, pneumococcal infection and its complications. It can also lower the risk of hospitalisation and mortality among elderly people.
Seasonal Influenza and Vaccination
Influenza is an infectious viral disease. It can be caused by various types of influenza viruses. In Hong Kong, the two subtypes of influenza A virus, H1N1 and H3N2, and influenza B virus, are most commonly seen. Influenza occurs in Hong Kong throughout the year, but is usually more common in periods from January to March and from July to August. The virus mainly spreads by respiratory droplets. The disease is characterised by fever, sore throat, cough, headache, muscle aches, runny nose and general tiredness. It is usually self-limiting with recovery in two to seven days. However, it can be a serious illness to the weak and frail and elderly persons, and may be complicated by bronchitis, pneumonia or even death in the most serious cases. Serious influenza infection can occur even in healthy individuals.
- Seasonal Influenza Vaccine Composition
The vaccine provided under Residential Care Home Vaccination Programme (RVP) 2015/16 contains the following:
-an A/California/7/2009 (H1N1)pdm09-like virus
-an A/Switzerland/9715293/2013 (H3N2)-like virus
-a B/Phuket/3073/2013-like virus
-a B/Brisbane/60/2008-like virus
​Inactivated seasonal influenza vaccine is used under RVP 2015/16
- Recommended Dose
Persons aged 9 or above should receive one dose of seasonal influenza vaccine every year.
To ensure adequate immunity against seasonal influenza, children under 9 years old who have never received any seasonal influenza vaccine are recommended to be given 2 doses of seasonal influenza vaccine with a minimum interval of 4 weeks. Children below 9 years, who have received seasonal influenza vaccine in the 2014/15 season or before are recommended to receive one dose in the 2015/16 season.
Persons who have already been vaccinated with the 2015 southern hemisphere seasonal influenza vaccine are recommended by the Scientific Committee on Vaccine Preventable Diseases to receive the 2015/16 seasonal influenza vaccine, with an interval of at least 4 weeks.
- Who should not receive inactivated seasonal influenza vaccination
People who are allergic to a previous dose of inactivated influenza vaccine or other vaccine components are not suitable to have inactivated seasonal influenza vaccination. For vaccine components, please refer to drug insert. For example, FluarixTM Tetra contains Gentamicin Sulphate. Individuals with mild egg allergy who are considering an influenza vaccination can be given inactivated influenza vaccine in primary care. Individuals with diagnosed or suspected severe egg allergy should be seen by an allergist/immunologist for evaluation of egg allergy and for administration of inactivated influenza vaccine if clinically indicated. Those with bleeding disorders or on anticoagulants should consult their doctors for advice. If an individual suffers from fever on the day of vaccination, the vaccination should be deferred till recovery.
- Why should pregnant women receive seasonal influenza vaccination
Influenza vaccination in pregnant women has shown benefits for both mother and child in terms of reduced acute respiratory infections. The World Health Organization considers inactivated seasonal influenza vaccine safe in pregnancy and there is no evidence showing such vaccine can cause abnormality in foetus even if given during the first trimester. However, pregnant women should not receive live attenuated influenza vaccine because it contains a live virus. Pregnant women should consult obstetrics and gynaecology doctors for any queries. Inactivated seasonal influenza vaccine is used under RVP 2015/16.
- What are the possible side effects of the inactivated seasonal influenza vaccine
Inactivated seasonal influenza vaccine is very safe and usually well tolerated apart from occasional soreness, redness or swelling at the injection site. Some recipients may experience fever, muscle and joint pains, and tiredness beginning 6 to 12 hours after vaccination and lasting up to two days. If fever or discomforts persist, please consult a doctor. Immediate severe allergic reactions like hives, swelling of the lips or tongue, and difficulties in breathing are rare and require emergency consultation. Influenza vaccination may be rarely followed by serious adverse events such as Guillain-Barré syndrome (1.03 per million vaccinees), meningitis or encephalopathy (1 in 3 million doses distributed) and severe allergic reaction (anaphylaxis) (9 in 10 million doses distributed). However, influenza vaccination may not necessarily have causal relations with these adverse events. The risk of Guillian-Barré Syndrome after influenza vaccination (17.20 per million) is higher than after influenza vaccination (1.03 per million).
Pneumococcal Infection and Vaccination
Pneumococcal infection represents a wide range of diseases caused by the bacterium Streptococcus pneumoniae (or more commonly referred as pneumococcus). While pneumococcus is a common cause of mild illnesses such as sinus or middle ear infections, it may also cause severe or even life-threatening invasive pneumococcal diseases such as pneumonia, septicaemia, and meningitis etc.The case fatality rate for invasive pneumococcal diseases is substantially higher among elderly persons.
The treatment of pneumococcal infections usually involves the use of antibiotic(s). But there is a problem of increasing resistance of the bacterium to antibiotics, which makes prevention of pneumococcal infections important. One of the most effective means of preventing pneumococcal diseases is by immunising with pneumococcal vaccines.
Residents of Residential Care Homes for the Elderly and residents aged 65 years or above of Residential Care Homes for Persons with Disabilities who have never received pneumococcal vaccine before are eligible for one dose of free pneumococcal vaccination under RVP.
23-valent pneumococcal polysaccharide vaccine (23vPPV) is used under RVP 2015/16.
- Who are not suitable to receive 23-valent pneumococcal polysaccharide vaccine (23vPPV)
Severe allergic reaction following a prior dose of 23vPPV or to the vaccine component is a contraindication to further doses of vaccine. For individuals who will undergo elective splenectomy, 23vPPV should be given at least 2 weeks before the procedures if possible. 23vPPV should not be given during chemotherapy or radiation therapy for cancer.
- What are the adverse events associated with 23vPPV
23vPPV has been demonstrated to be safe. Slight swelling and tenderness at the injection site may occur shortly following injection. Local reactions are more severe following a second dose but nearly all reactions resolve within a few days without treatment.
- Can 23vPPV be received together with seasonal influenza vaccine
23vPPV can be given with seasonal influenza vaccine at the same time, but should be administered with a different syringe and at a different injection site.