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0:00
Welcome everyone and thanks for joining us.

0:03
We're here to chat about the flu immunisation programme for 2026.

0:10
It's great that so many people can join us.

0:12
Flu is obviously an important topic and consumes a lot of your time at the start of and during the season, so really good to have you here.

0:23
I'm Stephen Lambert, I'm a public health physician and I work in the Communicable Diseases branch with my colleagues from the Immunisation programme.

0:32
They do all the hard work in getting us organised for the flu season and many of them have helped with this presentation today, so I'd like to thank them very much for their assistance and support.

0:46
And they'll be online answering questions and they'll chat as you ask them while I'm talking and we'll have some time for questions at the end.

0:54
This session's being shared, so if there are colleagues who couldn't make sessions being recorded, So if there are colleagues who couldn't make it this morning, a bit of an early start, it'll be available online for them interview if they wish to.

1:13
So let's get started.

1:14
I'd like to start by acknowledging the traditional custodians of the lands that we're on.

1:19
I'm in Brisbane this morning on yoga and terrible people's lands and I acknowledge their unbroken connection to lands and waters and their elders past and present.

1:32
I just also want to start by reminding everyone online who does frontline immunisation work that you have a really strong position, a powerful position.

1:43
You have a powerful voice in terms of supporting people with their decision making around being vaccinated.

1:51
So almost every research study that looks into this topic around what made you get vaccinated or what made you make the decision to vaccinate your child, at the top of the list is almost always my the doctor suggested it was a good idea, that practise nurse said I should do it.

2:14
So having confidence in your voice to assist parents, to assist individuals make that decision is really important.

2:23
Vaccines are safe and effective, they prevent illness and death, and your positive advice is likely to be one of the key activities that switches someone over from being unsure or not having made a decision to make, making that decision to get vaccinated.

2:40
So anything we can do to help you be confident in engaging with parents, individuals, that's what these talks are about.

2:50
And yeah, really keen to do what we can to support you in being strong advocates for immunisation.

2:58
We're going to talk about the flu this morning, the vaccines, the state, the NIP and the statewide programme.

3:06
Of course, we're going to talk about Flu Mist, which is the new vaccine on the list this year.

3:14
And I'm going to point you towards resources that are available for you to go through after the talk if you need more information.

3:22
But of course we're always here to assist if you have questions.

3:26
The staff and the immunisation programme are very willing to assist and support if you have things that you'd like to raise with them.

3:36
So let's get started.

3:37
I'm not going to talk too much about the epidemiology of flu today because I'm sure you've heard all of that in the last how many of the years you've been dealing with the flu.

3:47
But I guess just a reminder that the flu is bad.

3:51
It's not just a cold.

3:52
It comes with a whole constellation of symptoms that remind you that it's not a cold.

3:57
Often fevers, chills, shakes, muscle aches, it interrupts your day to day activity, you have problems sleeping but you're exhausted, you feel just unwell and that can go on four days to a week and then often there's a tail to it.

4:14
So whilst you're not in the acute period of the flu, you often feel tired, exhausted, recovering from it for some time afterwards.

4:25
There's an annual predictability to the flu, so no one should ever be surprised that every year we have flu peak.

4:33
Although as you can see with the picture on the slide, these vary in terms of their intensity, so where they reach in terms of a peak, but also they spread.

4:44
Some of them are more short and sharp, others are sort of spread over many months and that we know the flu circulates all year round.

4:53
We're also seeing more flu in the summer season.

4:57
So flu is with us all the time and what the programme is about is trying to prevent infection during that peak.

5:06
We know flu is more severe in people who have a range of conditions, particularly if they're old and their immune systems aren't as good as they used to be.

5:16
Pregnant women are really at high risk of the flu.

5:19
So if a woman gets influenza during pregnancy, her risk of ending up in hospital is 3 times that of her non pregnant sister or friend of the same age and people with comorbidities.

5:34
So a whole range of conditions to do with heart problems, lung problems, neurological problems, diabetes.

5:42
So lots of people in our community who had these conditions will often suffer with the worst case of the flu.

5:50
You all know, and we'll have seen from circulating viruses, but also the components of the vaccines.

5:57
There are different types and subtypes of the flu.

6:00
So we talk about A and BH-3 and H1 are the A types and B Victoria at the moment is the B type.

6:08
I've just got a line through B and Agata there.

6:11
So for many years Yamagata circulated, but during COVID, Yamagata disappeared.

6:17
So we haven't had a Yamagata detection since COVID and it looks as though we're very confident that COVID has made the Amigada extinct.

6:27
And that's one of the reasons why this year we're moving to a trivalent away from the quadrivalent vaccines.

6:36
Also worth noting that every year in Queensland when we have the flu, often on any given day there are hundreds of people, 200 odd people in the hospital with the flu.

6:49
So this is in the condition that we just manage in the community obviously, but older people, people with comorbidities, but sometimes those people who are healthy and well.

7:01
And when we look at children in particular, about half of the children who end up in hospital don't have a comorbidity that would put them at higher risk.

7:11
So for that childhood age group, you know, people often say, you know, I don't need the flu vaccine, my kids don't need the flu vaccine.

7:20
They're healthy and well.

7:22
But we know that for a proportion of people who end up in hospital, they started out healthy and well, but flu made them very sick.

7:33
Just like to share with you coverage figures from 2025 by age group.

7:41
You can see Queensland's in the middle here and for whatever reason we had a full age group funded programme last year but it didn't really sink into improving coverage figures.

7:54
So as you look across in particular, you can see for this under 5 age group where we'd be obviously very keen to make sure children are protected as Queensland compared to every other jurisdiction had the lowest coverage figure.

8:10
So all of us have got some work to do to really try and get not just children but across the age group, people more used to having a flu vaccine, that it's something that they do every year, that they do as a family.

8:26
How do we prompt and support them making a decision to get vaccinated?

8:31
We've got a fully funded programme for everyone in the state again this year and that's fantastic.

8:37
But I know being in the department and having the discussions, it's getting harder for us to justify having a fully funded programme when our coverage is low and at in certain age groups, the lowest in the country.

8:54
So we're very keen to do whatever we can to support you and you can tell us what we need to do to support you better, to really push people, challenge people, encourage people, remind them that the flu is bad, it's worth preventing, and anything that we can do to prevent the flu is a worthwhile activity.

9:18
So what are the key changes to the programme for 2026?

9:21
As I mentioned, we're moving to a trivalent formulation.

9:25
So those Yamagata B strains that were circulating for many decades, they've dropped out due to COVID.

9:33
So all of those COVID control measures that we didn't particularly particularly enjoy following, they made the Yamagata virus extinct globally.

9:45
So that was a pretty amazing thing and meaning that that part of the vaccines dropped out.

9:53
There are changes in two dose recommendations.

9:55
So we've removed A2 dose recommendation other than for children with medical risk factors at those age 2 to 9 years, no longer need a second dose in their first year.

10:10
And we've added in adults, all age groups, people with medical risk conditions, the first time they're having their flu vaccine, they need 2 doses in that year.

10:20
The availability of live attenuated flu vaccine is also new this year.

10:25
So flu misters in the country, it's registered from 2 years of age to under 18 years of age.

10:31
And a number of jurisdictions have got a fun funded programme for some children including Queensland where our two to five year olds.

10:40
So that's five year old inclusive.

10:43
So anyone from 2:00 to under the age of 6, not yet had their 6th birthday is eligible.

10:51
So as I mentioned, just to orientate ourselves with the dosing landscape, there is a little bit of complexity to this.

11:04
I guess the key things to remember are looking at the age groups and who might be eligible for what and how many doses they need.

11:15
Six months to two years, 2 doses unless they've had a vaccine in the past and then it's 1 dose and all injectable vaccine only.

11:28
So no flu missed under the age of two years, 2 to 9 years, only a single dose unless you've got that medic, one of those medical at risk conditions and then you're getting 2 doses.

11:41
And this group here particular at risk conditions having had a hemopoietic stem cell transplant, solid organ transplant or party cell therapy all across the age groups, they're getting 2 doses this year.

11:57
And so for those or this entire age group, they can have injectable or vaccine or flu mist, noting that flu mist is only funded 2 to under 6 year olds.

12:11
The 6 to 18 year olds can have flu mist, but it'll need to be provided outside of the state funded programme similar in this age group, flu mist or injectable vaccine at risk, only one dose here and then working age adults, let's call them only one dose of injectable vaccine, 2 doses for this special group, the first time this year that two doses are being recommended for them as mentioned.

12:48
And then of course, our over 65 age group where we want to make sure that particularly for all of that age group that they are offered and take a free flu vaccine under the NIP.

13:02
So they're an injectable single dose and again 2 doses for this new at risk category.

13:11
So what vaccines are we using this year?

13:14
These are all egg based trivalent vaccines.

13:17
Flu missed here for the first time.

13:20
Flu ad for our older age group, funded under the NIP for 65 years and older 50 to 65.

13:28
It's now registered for that age group.

13:30
So if you're interested in getting an adjuvanted vaccine, you can arrange to do that, but it's not on the NIP and not being funded through the state programme.

13:41
So that would have to be a private purchase.

13:44
And of course, vaccine group.

13:46
These are the viruses that are in our vaccines this year.

13:50
And I'll just quickly flip to cell based trivalent vaccines.

13:54
So you might have seen as I switched, the only virus to change is that H3 N 2.

14:00
It's an A Sydney rather than a Singapore with this virus thought to be better in terms of being grown in the cell based structure, potentially giving some theoretical advantage in terms of protection, but giving strong protection equivalent to the non cell based vaccines.

14:28
So this cell based product included and available for use this year as well.

14:40
So you can see here just in terms of nip eligibility.

14:45
Vaccine grip in flu cell packs only available for those aged 5 to 64 years.

14:52
Of course, anyone over 65 years of age should be getting the adjuvanted flu that had.

15:01
Queensland's free flu vaccination programme is an adjunct to the NIP.

15:07
Of course, it commences in at the beginning of this month, the month wherein and ends at the end of September.

15:16
So this programme is about making sure that any Queenslander who wants to get a flu vaccine can get a flu vaccine, can get the vaccine for free.

15:28
There's no Medicare linkage to this requirement, so anyone who walks can get it.

15:33
Obviously we don't immunise children under six months of age, but anyone from six months should be offered and can receive a flu vaccine.

15:43
The cost of the vaccine should not be a barrier to them being immunised.

15:48
Of course we use our NIP funded vaccines first, so for any of those groups who are eligible under NIP, they get an NIP provided vaccine.

15:57
But for everyone else we have the state funded programme and the reimbursement model is exactly the same as last year, so if you're used to using it last year, everything will look the same.

16:11
New this year, as I mentioned is Flumist state funded programme for children aged 2 to five years, so under six years of age, not yet had their 6th birthday.

16:22
It can be ordered from the immunisation programme in the same way your other vaccines can, and it is available on the private market for 6 to 18 year olds, but you'll need to make your own arrangements about getting that.

16:41
There's a selection tool available to assist you in making those choices about what vaccine should be used.

16:49
It comes in a printable PDF form.

16:52
Includes both NIP and state funded flu mist and for all of the other vaccines, all of the other people.

17:00
There's some information at the bottom of this another table just to give us an idea about who's eligible for what.

17:10
So vaccine group and flu cell vax is mentioned available for a large cross section of the age group.

17:20
This slider pink colour means funded for everyone in this box under the NIP.

17:26
This darker pink colour means there's NIP vaccine available not for the whole age group, but for certain at risk groups, so Aboriginal and Torres Strait Islander people, pregnant people and those people with medical risk conditions.

17:44
Of course over here we've got flu mist for our two to five year old inclusive and available on the private market and Flu add funded only for our over 65 group.

17:58
Under the NIP, all of the blue is private market vaccine.

18:11
So we're going to talk a little bit bit about Flumis to get you across the details and get you used to it.

18:18
So this is a live attenuated influenza virus.

18:21
So the influenza viruses are uniquely adapted to multiplying, to reproducing their best at the warmer temperatures of the lungs.

18:35
That's how they work.

18:36
They do have an effect in the upper Airways, but they really get to work down in your lungs where it's moist and warm.

18:44
So Flumist, a live attenuated influenza vaccine, is designed on the concept that they restricted using genetics, how the virus can replicate, where it can replicate.

18:57
So Flumist doesn't locate down in the warmer parts of the lungs.

19:02
It does its best in the cooler temperatures in the upper Airways, which means that you get exposure to those key flu antigens in the upper airway that stimulates your immune response and then you have a good robust immune response ready to attack flu viruses when they enter in the upper airway.

19:25
That's the the idea, the thinking behind that the vaccine, it's intranasal, so it's a spray into your nostrils.

19:33
Approved by TJ for children 2 to 18 years and as noted, funded in the state programme, QLD's programme for two to five years.

19:43
Not yet had your 6th birthday.

19:46
It's well tolerated, a great needle free option particularly for children in that age group where they might be needle avoidant and it provides really good protection against the flu, including severe disease.

20:01
This vaccine's been used in the northern hemisphere for many decades.

20:05
Millions of doses have been given to children.

20:08
That's a large school based programme in the United Kingdom that's been in place now for nearly a decade and it the vaccine works well, provides strong protection there.

20:19
Side effects from Flumist are usually mild and short lived, as with all vaccines.

20:25
More serious side effects including anaphylaxis are like injectable vaccines, extremely rare.

20:32
So Flumist comes as a box of either one or ten single use pre filled nasal applicators supplied as one or 10.2 mils ready to use.

20:44
You don't need to do anything else with it to prepare it for use.

20:49
It's a suspension.

20:50
It's colourless to pale yellow, clear to opalescent.

20:54
There might be, you might see some small white particles in the material.

21:00
That's nothing to be worried about and should still be used.

21:05
The administration instructions.

21:06
So when we have a look at Flu Mist, we've got the stopper up this end, the divider here, the Flumist material in the syringe and the expiration date.

21:18
Just to note that Flumist doesn't have an expiration date of four years or five years.

21:26
There's a relatively narrow window.

21:28
So for every dose you give, please check the expiration date and make sure that it's able to be used.

21:36
You remove the rubber tip protector, don't need to do anything yet with the dose divider.

21:41
It stays in place for the first administration of a spray up one of the nostrils.

21:49
Then you remove the clip, the dose divider at the bottom and give the second dose.

21:56
So you can see here.

21:59
Let's go back to the picture.

22:02
So here's the stopper that you remove first.

22:06
You can see this plastic dose divider here.

22:09
You don't touch that at all before giving the first spray up the first nostril, remove the dose divider and then give the second dose.

22:19
OK.

22:21
So as mentioned, side effects are uncommon.

22:23
So when they've done the large studies, of course runny nose nasal congestion occurs in about 50 to 60% of children, but that's not all that different to children who received placebo.

22:37
So children in this age group have runny noses and nasal congestion quite commonly.

22:44
A small contribution from flu mist, but nothing particularly problematic.

22:49
Might have a mild headache, tightness or reduced appetite for a short period afterwards.

22:55
There's no difference between flu mist and inactivated vaccine with regard to serious adverse events.

23:03
Contraindications to flu mist so moderate or severe immunocompromised.

23:08
We've got our injectable non live vaccines for people in this for children in this category shouldn't be given during pregnancy.

23:18
So that older teenage group, that's something to keep in mind if they've had anaphylaxis after a previous dose of any influenza vaccine, anaphylaxis after any components, or if they're taking oral aspirin or salicype therapy due to the theoretical concern about Ray's syndrome.

23:38
So we try and avoid live virus infections and people who are having oral aspirin.

23:46
Flu mist and egg allergy will be a question you might have to deal with.

23:49
So the product information for flu mist lists severe allergy to egg as a contraindication, but the advice from ATAGI is that we should be giving flumist to children who have egg allergy in the same way that we are giving injectable vaccines.

24:10
So it contains a very small amount of the egg protein that causes the allergic issues.

24:17
And as I said, the ATAGI statement in the handbook chapter all support that.

24:24
Even those who have a history of anaphylaxis can receive flu, mist and other injectable vaccines.

24:31
More information in the handbook and from a Target.

24:34
If you need that, store it 2 to 8°.

24:38
As I mentioned the short shelf life of 15 weeks so please be checking the expiry date.

24:45
Keep the nasal applicator, keep the whole vaccine in the carton to protect it from light before you're using it.

24:54
So don't decant them from their boxes and keep them in a lunch box or something similar in your fridges and report cold chain breaches as you normally would to the department.

25:10
Positioning for flu mist is important.

25:12
So as this age group, the two to not yet 6 year old age group, they're old enough to be up and about and walking around and they might sit still, might be sitting on a chair looking happy, not going to be a problem.

25:28
But we still do need to think about positioning because whilst they might stick things up their noses, they're not used to an adult approaching them and sticking something up their nose.

25:38
So to avoid missing the nostril, having their head pull away at the wrong time, not administering the dice properly.

25:47
Really important to get whoever's with them, mum, dad or another adult to hold them in a gentle way out.

25:56
Hold their head still so they're not turning or shaking when you're giving the vaccine.

26:01
So sitting on a parent's lap, head resting back on the chest, hand on the forehead and then around the rest of the body.

26:09
Quick delivery and distract.

26:10
Does you need to Does flue mist work?

26:15
So it's considered to have equivalent effectiveness at least to inactivated vaccines?

26:21
What about shedding of the virus?

26:23
So the weakened virus can be shed for a few days after administration but not insufficient amounts to be transmitting to other people?

26:33
Can we give flue mist to a child with a blocked or runny noise?

26:37
So deferred, if there's a thought that the nose is so blocked that it's really going to stop administration in those situations, you can wait till the nose isn't blocked.

26:50
But for some of these children that might be quite a while.

26:54
You can always use injectable vaccine.

26:57
So it's really only those situations, not my children have a little bit of a runny nose, but they really have a highly congested nose that's going to be a barrier for any of the flu mist material to get up the nose.

27:14
Can it be given at the same time as other vaccines?

27:17
So like all of the other flu vaccines, you can give them at the same time or at any interval.

27:22
There's no issue about timing.

27:27
If you've got someone in the household who's immunocompromised with a serious illness, is there concern about them being inadvertently exposed to the vaccine virus?

27:38
That's never been documented in all of the millions of doses that have been given.

27:43
But if there's particular concern in an individual household, they're anxious about that.

27:49
You can always just give injectable vaccine to the child.

27:52
What if a full dose of blue mist isn't delivered?

27:58
All of the material suggests that if you're getting some of the liquid up the nose, even if they've moved the head a bit and it's not quite got up there, that there's no need to repeat dicing.

28:09
Of course, if you've sprayed and it's completely outside of the nostril, that's a different story.

28:15
Lots of resources available for us all.

28:17
So of course Anatagi statement on seasonal flu, there's there's an updated a handbook chapter with lots of good information in that.

28:28
NCS of course have their FAQs, lots of other material available and the Sharing Knowledge about Immunisation page to assist us with conversations with parents around encouraging uptake.

28:45
We've got our State Queensland Health Immunisation programme.

28:49
There's a free online course that's been updated to include all of the latest information for our 2026 season.

28:58
If you have any issues or problems, questions, concerns, please get in touch with the immunisation team and let us know what's going on.

29:08
We're here to help if you've got delivery or logistic issues, Quick Admin is our email address.

29:16
And for flu, in particular, Quick Flu.

29:22
Thanks so much to all of the staff who assisted with preparing this, our colleagues in Phi branch, Ashish and Mahana who assisted with all the flu data.

29:31
And thanks to all of you for coming along.

29:35
Any questions?

29:38
It's Allison Darty.

29:40
I don't know if you can hear me.

29:41
I can.

29:42
Allison.

29:42
Yes, I'm sorry.

29:43
I'm underneath my Stephen Dart, which is my husband.

29:47
I just have a so I just want to understand if we have a 5 year old that's going to be turning 6 and they're having the flu vaccine, the flu mist and the flu vaccine for the very first time and they do have a medical at risk health condition.

30:03
So they're going to be having a second dose, but then they're going to be turning 6.

30:07
When they're going to be having that second dose.

30:10
Do we then just give them the injection?

30:13
No, if they've if they've had their first dose of flu mist finish with that as well.

30:18
So if they're, you know, five years and 11 months and 30 days and you give it give the second flumist to match the first dose.

30:27
All right, thank you.

30:28
No, Hi, Denise.

30:35
I was just wondering there are some questions if the parent Rebecca, not here today.

30:45
Just could everyone go on mute?

30:46
Sorry, I'm sorry.

30:49
I just, the hands have just appeared for me.

30:53
Wellington Point.

30:53
Family practise.

31:00
Hand up.

31:02
No.

31:02
Cheryl May.

31:10
Yeah.

31:10
Cheryl, what's your question?

31:18
You look as though you're still on mute.

31:20
Cheryl, if you're talking, might go to Carmel.

31:42
Kamal, you've got your hand up.

31:49
No.

31:49
Let's go to Liz.

31:51
I can see you're unmuted, Liz.

31:53
Hopefully we can hear you.

31:54
Yes.

31:55
Can you hear me?

31:56
Yeah.

31:56
Yeah.

31:56
Good.

31:56
Yeah.

31:58
With the the Flumers, Flumers temporary, is there any capacity for a bit of flexibility beyond that for neurodivergent children who would really struggle with immunisation?

32:09
It was one of my concerns when I saw that Queensland was only doing to five, but it is available on up to 17.

32:16
Yeah, unfortunately the lease, the programme really is just for that age cohort.

32:23
This is the first year we're giving it and hopefully if it's successful and we get good uptake and good reports back about its use that there might be an opportunity to expand the programme this year.

32:39
Certainly for children who are needle phobic, it's registered for that other age category, so 6 to 18 years of age.

32:48
So it will be a discussion with the family about using flu mist from the private market for for their child.

32:58
Thank you.

32:59
Yeah, Cheryl still hand up caramel danita.

33:09
I was just wondering if the parent wants has a three year old and wants the injectable form, it's not an issue?

33:19
Not at all.

33:19
So the injectable forms are available under the NIP.

33:24
So none of that's changed.

33:26
So the NIP, same as last year, any child under the age of 5-6 months to five years of age eligible for fully funded NIP injectable vaccine.

33:38
It's a vaccine group, not flu cell vaccine that age group.

33:41
So absolutely can get injectable vaccine.

33:47
Mary, I have two quick questions.

33:51
One is what's the cost of it on the private market?

33:56
I haven't seen the cost on the private market.

33:58
A final cost, has anyone else?

34:04
I did hear it was about $70.00.

34:06
So that's that's around the price point I was expecting it would be.

34:11
Yeah, I think we heard from the AstraZeneca Rep that it may be at the cost price may be around $50.00, but obviously there may be a margin popped on top of that.

34:25
Yeah, I heard 5050 to $70.

34:29
You're right.

34:29
Go ahead.

34:31
Sorry, while I'm on, I just wondered, I popped a question in the chat, but I thought it might also follow on from a just Racing question around.

34:40
If people out of the Queensland flu mist eligibility age group wanting to seek it privately, will they be, will that also be included in the free flu programme in Queensland for reimbursement for at least partial cost?

35:00
So for the same amount that would be reimbursed and then whereby a parent may need to then pay just the gap as opposed to the full amount?

35:08
Yeah.

35:08
So is there someone from the programme who wants to talk about that?

35:12
So we do reimburse providers and individuals go Scott, thank you for joining me good morning everybody happy happy Thursday, great webinar.

35:29
The answer is, is there's no change to the rules of the programme, Sarah.

35:32
So we, I think basically since the ascension of the programme, we've been allowing that.

35:38
But we do ask providers to just make sure that their patients are absolutely informed that there is a free flu option available to them.

35:50
And that basically we would expect that that $25 meant that the administration costs for the vaccine would be covered.

36:02
And we also really want to make sure that patients, consumers know before that they agree going ahead that there will be an out of pock gap payment and that, yeah, that and that once that gap payment is all that subsidy is applied that there's really no claim, further claims that can be made from Coincide Health.

36:26
So I hope that sort of answers the questions.

36:28
Really no change from the rules from previous year's programmes.

36:36
Thanks.

36:36
Thanks.

36:37
Thanks, Scott.

36:38
It was more around whether flu mist, private flu mist stock would also be reimbursed.

36:44
Obviously not the full amount that it costs the provider to purchase, but yeah, it's it applies to any flu vaccine, Sarah, that's been purchased from private market.

36:55
Perfect.

36:56
Thank you.

37:00
What next Cheryl, you've still got your hand up.

37:06
No, Janine.

37:14
Janine times 2.

37:15
Oh yeah, sorry.

37:16
Just no go for it.

37:17
Could you please clarify if we're getting flumers to say 2 year old and the mother is pregnant and we're shedding, is it what's the risk to the mother?

37:26
So never been documented that a shed the virus has infected another person.

37:31
So there's absolutely no contraindication when the mother's pregnant.

37:37
If if, as I mentioned, if there's concern about someone in the household who's highly immunocompromised, as I said, there's been absolutely no documentation even in that context of transmission from a vaccinated child.

37:52
But understand that it might be difficult to convince people of that or for whatever reason reason, they just want to be specifically cautious.

38:02
But again, a pregnant lady, healthy feet, absolutely no issue about giving the child flumist.

38:11
So mom doesn't have to take any precautions.

38:13
No, just just go ahead.

38:15
Thank you.

38:17
Well, mom, mom shouldn't bend down and kiss the child's nose as soon as they've been immunised or anything like that.

38:22
So just standard, you know, handling of the child.

38:26
Yeah.

38:27
Thank you.

38:28
Stephen, a couple of people have just asked in the chat about the intervals between live vaccines and why flu Mist might be considered slightly differently.

38:38
I didn't know if you'd be happy to quickly talk to that point.

38:42
Yeah, look, there's no issue about Co administration or administering any time.

38:48
That's the advice from ATAGI.

38:50
So looking at time windows between flu mist and other products, there's just no issue around interfering.

38:57
Perhaps it's got something to do with the route of administration.

39:00
So instead of injecting into muscle or subcutaneously, we're giving the vaccine up the nose.

39:08
So we're exposing the nasopharynx, the nasal or passages to the virus.

39:13
That's where the immune response, the primary immune response is being developed, which is a different immunological location to injectable vaccines.

39:24
How's that?

39:27
Thank you.

39:28
Right, Janine.

39:32
Janine, 2.

39:38
No, Cheryl.

39:44
No more hands up for people wanting to ask questions at the moment.

39:50
How are we going in the chat Sarah?

39:54
I think the team has answered most of the questions.

39:58
The recording link will be available on our website after the webinar and you should be able to access it through the chat.

40:06
So if you have any issues with that, please get in touch with us and the team will help you out.

40:11
And if you have questions afterwards, Sarah, they can just pop them into this chat.

40:15
We'll be monitoring it to answer.

40:19
Yes, that's that's correct.

40:21
Same as same as our previous sessions.

40:24
So great.

40:25
Also, Larell's popped in the chat.

40:28
If there are any further questions, they can be sent through on email.<spelling>immunisation</spelling>@health.qld.gov dot AU.

40:37
Good, there's still 2 hands up from Cheryl and Janine, but we haven't had luck getting you.

40:44
So one last chance to ask you a question Janine.

40:50
Sorry there wasn't any other other question.

40:53
We don't.

40:53
Oh, good on you.

40:55
That's an old hand.

40:56
Thanks Janine.

40:58
Good Cheryl.

41:03
No silence.

41:04
So thanks so much everyone for coming.

41:08
Really exciting programme this year with Flumist available for the two to under 6 year olds on our state funded programme and available in the private market up to 18 years of age.

41:25
Just a couple of last questions before we finally wrap up back.

41:29
Thank you.

41:29
Steven, I just had a question about resources.

41:32
Do you know if there's going to be any collateral developed like brochures or posters to advertise flu mist to patients?

41:40
Might let the team answer that.

41:42
Thank you.

41:44
So generally the the company would, you know be managing some of that marketing aspect.

41:51
Scott, did I hear your voice?

41:53
Steve, Mr Watch this space.

41:54
There's definitely resources being developed, lots and lots of collateral, lots of investment being made.

42:02
So hopefully over the next sort of week or so, a couple of weeks, we'll see those resources becoming publicly available.

42:09
The answer's yes.

42:11
Yep.

42:11
Thanks, Scott.

42:13
Apologies again for my team's dying.

42:16
I'm not sure why that happened, but as we all know, Teams has a mind of its own some time.

42:22
Hopefully we can edit that short break out of the online recording if we can.

42:28
But otherwise, yeah, really exciting opportunity for us this year with Flume is to target that two to six year old under 6 year old age group and really boost our coverage figures.

42:43
And a great opportunity if children are having flu is to talk about availability of NIP or state funded vaccine for everyone else who isn't under six months of age.

42:54
So hopefully a good strong uptake.

42:57
We're here to help you and support you in any questions or issues that you have with the vaccines or the programme this year.

43:05
So please get in touch.

43:07
Don't, don't.

43:10
So don't feel awkward or uncomfortable about coming to us with questions.

43:16
We're really keen to support you as frontline providers in making sure that you're confident and you can be confident talking to parents and families.

43:27
Thanks again for attending.

43:28
We'll talk to you again soon.

43:30
Have a great day everyone.

43:34
Thank you.

43:35
Thanks, Steven.

View transcript

0:03
Well, we might get started.

0:05
We've got a little bit to get through.

0:07
Welcome everyone.

0:08
Thanks so much for joining us.

0:11
For those of you who I haven't met, I'm Stephen Lambert.

0:14
I'm one of the medical officers in Communicable Diseases branch in the Department of Health in Queensland Health.

0:23
We sit in Hurston, across the road from the OR, Brisbane and Women's hospitals.

0:32
Today I'm gonna chat to you about measles.

0:36
And you've probably been hearing a lot about measles in the media lately, so a good time to have a catch up and discuss measles.

0:46
I'd first like to start by acknowledging the traditional custodians of the lands we're all on today.

0:51
I'm in Brisbane, as I mentioned, on the lands of Jaggara and terrible people.

0:57
We acknowledge their unbroken connection to the lands and waters over many 10s of thousands of years and I pay my respects to elders past and present.

1:06
I'd also like to say thank you very much to the immunisation team who have helped with putting these slides together and of course who run the programme that we all rely on.

1:16
So thanks to team.

1:19
So I'm going to talk about measles itself and prevention.

1:23
What's been happening lately with measles?

1:26
Measles containing vaccines, eligibility for funded MMR vaccination, and key clinical resources.

1:35
Just ask everyone to go on mute if they can.

1:38
There's a bit of noise coming through.

1:55
Oh, Stephen, just.

1:56
I'm gone.

1:56
Stephen, you're on mute.

1:57
Sorry.

1:59
We're just trying to work through that.

2:01
Now.

2:01
Hold on.

2:03
Apologise, everyone.

2:11
How's that?

2:13
Yeah, we can hear you now.

2:13
Thank you, Stephen.

2:14
Oh, what's going on?

2:16
Teams is a now friend today for some reason.

2:19
Apologies.

2:20
No worries.

2:22
So measles viral illness, highly contagious, one of the most contagious pathogens known to man so that if you have a measles case, the likelihood of transmission is as high with measles as it is with any other condition.

2:39
It's an RNA virus, so it belongs to the paramedics of Veridae viruses.

2:44
So other viruses in that stream include rubella and mumps and in that there to together in the MMR vaccine, symptoms appear roughly 7 to 14 days after initial contact and you get nonspecific symptoms before the rash occurs.

3:02
So those nonspecific symptoms can include a fever, a cough, a runny nose, conjunctivitis with running eyes.

3:12
They'll feel tired, might feel a bit terrible, and then 24 hours or so after that initial prodrome, you get the rash appearing.

3:24
In the books it says the rash tends to start on the top of the body, so the face and the neck, before spreading down the rest of the body.

3:33
But like everything in a textbook, that works most of the time or some of the time, but it's not always the case.

3:40
So you shouldn't reject A measles case because they're rash started it on their knees or their feet or anything like that.

3:51
Measles have spread via respiratory droplets and aerosols.

3:55
So people with measles who are coughing or sneezing or even just talking or singing with the discharge from the mouth or the nose, that can spread measles very efficiently.

4:06
Measles hangs in the air and lands on surfaces so that you can catch measles in a room where a case is being for up to two hours if there's no good air exchange.

4:18
So if you're in a room without air conditioning or the windows open, the virus can hang around and sit there and infect a person two hours after the case met.

4:29
So really very infectious.

4:33
It's infectious just before the symptoms start.

4:36
So four or five days before the rash appears, typically until four days after the rash appears.

4:43
So you've got that window of, you know, 8 days or so where the virus where the person who has measles can infect other people.

4:54
So it's on the window.

4:57
The time from exposure to getting symptoms is typically 10 days.

5:02
It can take up to 18 days, and there are some reports in the literature of incubation periods, so up to 23 days, but they're a real extreme and shouldn't be considered typical.

5:14
So we typically talk about 10 days after being exposed, people might know how to look up our notifiable conditions in for Queensland.

5:25
So if you just Google QLD notifiable conditions, you'll be able to see recent counts of all of these diseases, including measles.

5:35
So we have had 25 measles cases reported in Queensland so far.

5:41
Half of those have been someone coming in from overseas with the condition and then the other half have been due to people being infected from those original cases.

5:55
Earlier in the year we were seeing lots of importations in Australia from Vietnam, but lately it's been mostly Indonesia, particularly Bali.

6:05
So if you've got families in your practise or individuals in your practise or even friends that you know who are going to Bali, make sure that they've had their measles vaccines because the worst thing to do is to come home with measles, particularly in parents.

6:24
People in their 30s or 40s get can get very, very sick with measles.

6:29
Up to 1/3 of adults who get measles end up in hospital in Australia, so we've had outbreaks confirmed around the state, Cairns, Gold Coast, Brisbane, Townsville, Middle Mount and the Sunshine Coast.

6:43
So really nowhere is too remote or too big to get measles cases that can occur anywhere.

6:52
So we always need to be vigilant when people come in, particularly with a fever, feeling unwell soon after travel, have measles in mind.

7:02
And obviously, if they've got a typical measles rash or a rash, that really should set your alarm bells off.

7:12
Why are we seeing measles in Australia where we're seeing measles in Australia?

7:15
Because there's lots of measles activity around the world.

7:19
We've actually done pretty well over the last decade or so with improvement in global measles control, particularly using a lot of vaccine in Africa where there were a lot of cases prior to a more intensive use of vaccine.

7:38
And that saved many 10s or hundreds of thousands of lives over the last decade or so using measles vaccine in less developed parts of the world.

7:51
So, but since COVID, with a reduction in overall vaccination activity, gaps in routine coverage after the pandemic, we've seen a sharp increase both in the number of measles cases, but also deaths due to measles as well.

8:08
And as I mentioned, active outbreaks across Southeast Asia, including Indonesia and Vietnam in particular.

8:15
But nowhere is immune, pardon the pun, from measles outbreaks in our part of the world.

8:22
So the places Australians like to go to travel for a cheap holiday in Southeast Asia, almost certainly we'll be experiencing a surge of measles cases at the moment.

8:34
But it's not just our part of the world.

8:36
We know that in Europe there are lots of countries with reported cases, and you may have seen a lot in the news about outbreaks both in in the United States, but also in Canada, which is having its largest measles outbreak for more than 20 years.

8:54
And it's very likely that those outbreaks in North America and in South America will mean that we see the Americas as a whole lose their measles elimination status, which they've had for quite some time now.

9:10
So who's at highest risk of getting measles?

9:13
And it's anyone who's not protected.

9:15
So if you don't have immunity against measles and you're exposed to someone who has the infection, the chances that you will get infected are very high, so 90 to 95%.

9:27
So almost no one escapes measles if they've got no immunity and they're exposed to someone with the condition, children at five years of age, under five years of age who haven't been immunised, particularly at risk, immunocompromised and pregnant people.

9:45
And stopping outbreaks requires a very high level of herd immunity.

9:51
So when we talk about herd immunity, it's not meant, it's an insulting term, but we're really talking about the people around the individual.

10:00
So we need the population immunity level to be at 95 percent or higher.

10:07
That's pretty easy to achieve in places like nursing homes when most of the residents will have had measles as a child.

10:17
Once you have measles infection itself, you have really good lifelong protection, but for younger people who haven't managed to be infected.

10:27
So we've had measles elimination in Australia at least for 20 years now.

10:33
WHO declared measles eliminated in 2014, but it was for a good decade or more before that that we really were seeing this typical elimination pattern where we didn't have widespread measles cases.

10:48
We only saw measles when people, travellers return, travellers or backpackers or visitors brought measles in and then we had some limited local spread.

10:58
So we've really had that pattern now for almost 25 years, even though elimination was only declared in 2014.

11:06
What that means is that younger children in particular, but also all of us, we don't get regularly exposed to measles in our community.

11:16
So we don't get that nice boost that we might get if we had some low level measles infection from circulating virus.

11:25
So that's a particular issue for unimmunised children.

11:29
They don't get immunity from infection and if they don't get immunity from immunisation, they have 0 immunity on board, which means that if they're exposed, the chances they'll be infected are really high.

11:45
And we really want to avoid measles because of the complications.

11:50
They can be serious and as we say with a lot of these infectious diseases, at the most severe end you can end up with people who are maimed or injured for life from the infection.

12:02
But people can occasionally die from measles infection as well, so it's not something you really want to be playing around with.

12:09
The most common types of side effects from measles include middle ear infections.

12:17
So what we typically see is people get the virus, get the rash, and then they get the secondary bacterial infections from inflamed mucosa.

12:27
So up in that head area where they've got the runny nose, the runny eyes, they're feeling dreadful.

12:34
After a few days of that and not dissimilar to the flu and other respiratory viruses, you get the bacteria come in and take over.

12:42
They give you a middle ear infections, they can give you an pneumonia.

12:46
Measles is associated with a nasty diarrhoea and that tends to be that and the pneumonia, the two things that often lead to particularly adults in their 30s or 40s or 50s, if they get measles, it's often the dehydration and the pneumonia that puts them in hospital.

13:07
You can get encephalitis, so an inflammation of the brain due directly to the virus.

13:14
Pregnancy related complications can be severe for women who aren't immune at all.

13:20
So it increase if a pregnant woman gets measles in pregnancy, her risk of death increases 10 times and it can result in miscarriage, still birth or premature birth.

13:34
So all things we really want to avoid during pregnancy, one to three of every thousand people who are infected with measles will die.

13:44
And it's often due to those secondary infections that I mentioned, particularly pneumonia.

13:49
And you may have heard of a condition called subacute sclerising pan encephalitis.

13:54
Now it is rare, and it's good that we don't have thousands of cases of measles in Australia every year, but nearly one in every two and a half thousand people who get infected can end up with SSPE, which is a condition where the measles virus slays dormant and slowly over time destroys your brain is the best way to describe it.

14:20
So children can be infected and then some years later will one day have a funny neurological symptom, the next day have another neurological symptom within a relatively short period of time, end up in a coma and die.

14:38
It's universally fatal when it occurs.

14:41
Thank goodness it's reasonably rare and in Australia where we don't have measles circulating, it's even rarer now.

14:51
So measles, it's a notifiable condition.

14:54
So that means when a laboratory diagnosis it, they tell us in the health department and the public health, your local public health unit will swing into action.

15:05
You will probably hear very quickly from the public health unit because there's quite a bit of activity required when you have a measles case in terms of trying to identify contacts and of those who might be susceptible.

15:19
We can offer them early measles vaccine.

15:22
So if you get measles vaccine within 72 hours of exposure, it can prevent you from developing measles yourself.

15:31
But then also there are other people for whom we might offer some immunoglobulin.

15:37
Normal human immunoglobulin can protect against the severe outcomes of measles, particularly in immunocompromised very young children and pregnant women.

15:48
So if you have a case of measles in your practise, public health unit will be there to help you work through all of those issues.

16:00
Measles containing vaccines.

16:02
So there are a number of them that we use at the moment.

16:05
One dose of measles is pretty good, provides great protection to almost all people.

16:11
So 90 ish percent of people, 90 to 95% of people and about 5% up to 5% of people won't develop immunity after that first dose.

16:23
And really that second dose is there to really bring that population level immunity up as high as possible.

16:31
And we our estimates are that up to 99% of people who had that second dose will be immune to measles.

16:42
In Australia, we use measles, mumps and rubella vaccines and measles, mumps, rubella and varicella or chicken pox vaccine.

16:51
All it's a combined vaccine.

16:53
All of those components of the vaccine are live attenuated, which means that they're able to produce a vaccine infection in you.

17:05
So the virus replicates the vaccine, virus replicates in your body and stimulates the immune system, turns on your antibodies, turns on your T cells, which then have good memory for protecting you against measles if you should ever be exposed.

17:24
A lot of controversy about the MMR vaccine.

17:26
We're now some distance from it.

17:29
But in 1998, people might remember Andrew Wakefield in the UK published a terrible paper about the development of gastrointestinal symptoms and autism in children who had been who had been vaccinated with measles vaccine.

17:47
That was all debunked with many large studies over the subsequent decade or so.

17:53
But one of the things that came out of that episode was that people just wanted to give single measles vaccines by themselves, along with monovalent rubella and monovalent mumps.

18:07
But none of those vaccines are registered in Australia.

18:10
So people might ask you for that, but it's not available in Australia.

18:16
People who are pregnant or severely immunocompromised shouldn't receive these vaccines.

18:21
The pregnancy recommendation is really around the rubella component.

18:27
Now, as you could imagine, we've been using rubella vaccines for many decades now and at times they've been inadvertently given to pregnant women.

18:36
And in that experience of using rubella vaccine in that way given to pregnant women, there's been no evidence of an increased risk of rubella type symptoms in the delivered infant.

18:50
So that's really just a very sensible precaution, but not something that we're specifically concerned about.

19:04
And people who are severely immunocompromised should avoid getting live virus vaccines like measles in a similar way that they should avoid getting any kind of viral infection because their bodies aren't working as well as they could at that point in time to fight off infection.

19:25
So the vaccines we have in Australia for use, MMR comes as Priorix or MMR 2, both registered for use for people from 12 months of age.

19:37
We do use them a little bit earlier and I'll talk about that soon.

19:41
And then we have the MMRV combinations, Pyrux, Tetra and pro Quad.

19:47
So that's just the standard measles, mumps, rubella vaccine with chicken pox thrown in as well.

19:54
We give MMR vaccines for the first dose and MMR vaccines for the second dose.

20:00
We don't.

20:01
When the MMRV vaccine, sorry, MMRV vaccine for the second dose, when the MMRV, MMRV vaccine was being developed, it was hoped that that would be available to be used for both doses, so the first and the second dose.

20:19
But in large studies using MMRV, there was a slightly, ever so slightly increased risk of febrile seizures in the week to 10 days following receipt of MMRV.

20:33
So the recommendation was that we didn't want children to have even a slightly increased risk of a febrile seizure following vaccination and there was no increased risk if we gave MMRV as the second dose compared to MMR.

20:54
So our schedule has ended up being MMR for the first dose and MMRV for the second dose.

21:02
NMRV is used in people under 14 years of age.

21:07
So the the amount of chicken pox in the vaccine isn't enough for older people, so we don't use it for them.

21:14
And if older people need chicken pox protection, they need to have a chat to their to you guys about just getting varicella vaccines for that.

21:29
It's NIP funded, of course.

21:32
So there's two dose course on the schedule funded schedule, all children 12 months of age of or older.

21:39
You really want to get it in on those recommended time points at 12 and 18 months of age to provide good protection.

21:46
So I mean, Australians travel now even with very young children, so you want them protected as soon as possible rather than having them linger and be exposed in the community.

22:00
NIP funding also available for all people younger than 20 years of age who haven't received the vaccines in childhood.

22:08
That's really for anyone.

22:10
You don't need to check whether they're a refugee or their visa status or whether or not they have a Medicaid card.

22:16
It's for anyone who shows up and for refugees and humanitarian entrants over 20 years of age.

22:24
NCS has this nice decision tool.

22:26
It's fairly straightforward and there's a QR code there if you want to check it out.

22:32
But if you just Google NCS measles decision tool, you'll find it.

22:38
People born before 1966 in Australia and that year varies depending on the country, but in Australia, people born before 1966 are considered immune from having been exposed in childhood.

22:54
So like all of these early childhood infections, we assume, and we know that a lot of almost everyone, almost 100% of people were infected in childhood when we weren't using vaccines to protect people.

23:10
So no MMRS required for that age group.

23:12
But if you're older, it depends on whether or not you've had previous doses and whether or not they've been given properly.

23:19
We want everyone to have had two doses, both doses given after the 1st birthday with at least four weeks between the two doses.

23:30
So you can use that decision tool and the notes as well as NIP funded vaccines, there's a state funded programme and it really covers the gap that exists in it on the NIP really providing vaccine for anyone.

23:51
So children who are older than six months but less than 12 months who are travelling.

23:56
So if you've got a family who's going to Bali and they're taking their eight month old, they can have their measles vaccine early.

24:04
So you need to be aware that children down to six months of age can get a vaccine if they're travelling to countries where measles is endemic or where outbreaks are occurring.

24:17
So good to keep that in mind for your travellers.

24:20
If you get a dose before 11 months of age, that's considered a dose 0.

24:26
So children, those children still need 2 doses, with the first dose given after 12 months of age or four weeks after the first dose, whichever is the longer period, and then their second dose at 18 months of age.

24:42
Adults born during or after 1966 who haven't had two or don't have serology, you can give those safely, Give those people 2 doses of measles vaccine with the second dose at least four weeks after the first dose.

24:59
It's not linked to Medicare eligibility and you use quick supplied doses for these people.

25:05
So with the NIP plus the state programme, there's really no one who you should be concerned about giving an MMR vaccine to.

25:15
Everyone's eligible.

25:16
We want everyone to be protected.

25:20
Typical side effects local reactions from measles containing vaccine pain, swelling, redness are the most common.

25:29
You can get this sort of low level measles type illness where a fever can be present usually sort of around the one week to 10 day mark.

25:39
Last two or three days the child can be a bit tired, a bit cranky and can even have a sort of a very faint measles like rash.

25:51
But none of that is infectious.

25:53
You can't transmit it to other people.

25:56
We mentioned before febrile seizures.

25:58
These are a very reasonably rare side effect following both MMR and MMR.

26:03
They For MMR the numbers are about one.

26:09
In 3000 children will have their procedure due to the vaccine, which was very unpleasant for the short time that it happens is obviously something that you don't want parents to have to manage.

26:30
But when they do occur, they tend to be very short lived and the child recovers completely.

26:37
Thrombocytopenia or where your platelet numbers reduce can occur in one to in one in 20,000 to 30,000 doses given that might present itself with easy bruising and or bleeding.

26:53
So if that happens and they've people have had a recent vaccine, keep that in mind and anaphylaxis as with all vaccines can occur but very rare.

27:03
So one per every two to 14,000,000 in doses MMR or MMRV vaccine can be given as the same time as other live attenuated vaccines, other inactivated vaccines and other immunisation products such as RSV specific monoclonal antibodies like you said them that but of course you use separate syringes and separate injection sites for different vaccinations or antibody products.

27:38
If you don't give MMR or MMRV at the same visit you the recommendation is to wait at least four weeks between giving MMR, MMRV and another live vaccine.

27:56
People born before 1966, we consider them not to have infection.

28:02
You can consider serology, but it's not something we routinely recommend because that immunity that people get from early childhood infection is really robust and last lifelong.

28:15
Even if you can't measure detectable antibody, we know that for these individuals that if they're exposed to measles, their sleepy old immune system kicks into gear and to protect them from infection, booster and catch up doses.

28:32
So it's important to review vaccination status for people who are in high risk settings where we wouldn't want them to be infected and potentially infecting other people.

28:43
So healthcare workers in care facilities, correctional facilities and childhood educators, they need those two doses just like everyone else.

28:54
So as I've mentioned people born in Australia before 1996, no catch up required.

29:03
If people have got a documented history of measles infection, you don't need to immunise them.

29:08
But I'd be very careful about what evidence you accepted for that.

29:12
If it were me, I'd really need to see PCR confirmed infection, not just a blood test or anything else like that.

29:20
You want to make sure they've really had measles before you don't immunise them.

29:27
And the simple message here is if people don't have documentation of receiving 2 doses of measles vaccine, you need to assume that they haven't been vaccinated.

29:41
In a lot of the outbreak cases who have returned from overseas, that initial case, the story often is something like, oh, mum would have made me have everything.

29:52
So I'm I'm I've certainly had measles vaccine.

29:56
The problem is that mum might have been having an off week or an off month or whatever and not managed to get a child to their immunisation into an immunisation session at for some people.

30:13
So that AIR or the ACIR started at 19 in 1996, so children born in the 70s or 80s weren't getting reminders.

30:24
It's not easy to check their immunisation status.

30:28
So unless you've got a handheld record or an old childhood book, like a Red Book or something similar that actually documents measles vaccine receipt, you need to assume that they haven't been given.

30:42
You can do serology, but it's often just as easy to vaccinate somebody.

30:47
Measles vaccines are safe and effective.

30:50
If you've got someone, a young adult who comes in, if they're from overseas, they're too old for an air record.

30:58
There's no record on air.

31:00
It's just safe to assume they've never been vaccinated and start them on that two dose course to protect them.

31:09
Can you get measles after vaccine?

31:11
We do get breakthrough infections.

31:13
The vaccine, measles vaccine is one of the best vaccines we have.

31:16
It provides really long lasting high quality immunity.

31:20
So it is rare to get measles if you're fully vaccinated.

31:24
If you do get a breakthrough infection, it's unlikely that you will get, very unlikely you'll get severe side effects and even more unlikely that you will transmit to other people.

31:35
So this, your immune system works well enough to keep it contained into your own body.

31:41
I mentioned before the Andrew Wakefield study, we won't, you've probably heard a bit about that over the years.

31:49
So we won't go through that in detail.

31:57
What's happened Tom?

31:58
Has something happened?

32:00
Can people still hear me and see my slides?

32:02
We can see you, Steven, but it does appear your slides, your maybe your screen.

32:08
It looks like you're sharing your screen that which has Ocelot.

32:14
That's a bit strange.

32:15
Let me unshare reshare.

32:26
That's not going to be the right.

32:27
How's that?

32:32
Yep, perfect.

32:33
Thank you, Steven.

32:33
I'm not sure what happened then.

32:34
Sorry about that.

32:36
I won't go into great deal about the Wakefield study.

32:39
I think people have heard a lot about that.

32:41
Suffice to say that in the decade following that study, there was a huge investment in doing other research to tease out this issue about MMR vaccine and autism or inflammatory bowel disease.

32:56
All of those studies showed that if anything, if you get an MMR vaccine, your chances of developing these conditions is slightly lower than if you don't.

33:07
Very large studies done particularly in Scandinavian countries where they have high quality linked data sets were able to show that there is absolutely no evidence for an increased risk about autism or inflammatory bowel disease receiving these vaccines.

33:25
If you need some further guidance or information to share with parents, you might be aware of the sharing knowledge about immunisation or Sky resources available from the NCS website.

33:37
Measles children who are not travelling to measles endemic areas, are they able to receive MMR early?

33:45
No, not routinely.

33:47
So the the later they get it, the better immune response they will have.

33:53
So with their developing immune system, we don't want to give it too early and perhaps impede that development of immunity.

34:03
But as mentioned, there are certain situations where you can give it down to six months of age travelling to an endemic area.

34:10
And if if we were in the situation where, for example, in one part of Queensland there was a large and ongoing outbreak, public health at that time may recommend children down to six months of age be immunised.

34:26
If an infant is a contact of someone who has measles, they may be offered MMR or recommended to have MMR early to prevent them from developing infection.

34:38
Lots of great resources on the Queensland Health Immunisation website.

34:43
As you will know.

34:44
There's the visual tools that have been really good at familiarising us with the look of the products for using and a whole range of other information that you should take a look at if you have any questions.

35:02
And some QR codes for you both for our websites for sharing knowledge about immunisation and NCS measles information and that's it.

35:17
Thanks everyone.

35:18
I will stop sharing and see if there are any questions or issues or problems.

35:24
Any questions in the chat, Tom?

35:27
Thank you, Stephen.

35:31
There's been lots of questions in the chat, Stephen, and we've been working away at answering as many of those as possible.

35:38
I think we've covered most of them.

35:41
Any common themes?

35:44
A lot of questions around the documented doses for people born on or after 1966.

35:51
What level of evidence needs to be presented?

35:54
And then a little bit about the history of measles vaccination programmes in Australia in terms of the, you know, how, what would we expect the population to have between 1966 and now?

36:10
But I think we've answered most of those.

36:13
Does anyone have any questions or would like to open the floor to discuss?

36:25
In the chat I've just posted a link.

36:27
NCS have this great page if you're really interested and want to know around history of immunisation in Australia.

36:34
So if you go to that page, they list all of the vaccine preventable conditions and if you click on MMR, it talks you through the key years and changes that have been made to the schedule.

36:46
So when we started using monovalent measles vaccine, when we started using measles mumps vaccine, when we started using MMR vaccine and what the recommendations and funding were.

36:59
So you, you know, you can get a good sense of, you know, if you get someone who was born in 1972, what were we using then?

37:08
Was there any recommendation around particular types of vaccine?

37:15
Sarah, you've got your hand up.

37:18
Thanks.

37:18
Stephen, there was just a quick question around if someone gives a dose to an infant under so in that early period prior to starting the NIP schedule.

37:29
And then obviously, we're suggesting or saying that the recommendation is that they need to get the further 2 doses to meet the requirements under the NIP.

37:37
I think the question was just around what's the long term immunogenicity of giving that earlier dose and do they need to have the subsequent to NIP funded doses to ensure that they have long term immunity.

37:53
That's a really, that is a really great question, a really interesting question.

37:57
So the headline is we want to avoid giving an early dose if we can.

38:02
That's why we have the schedule at 12 months of age, but more importantly we want to avoid children under 12 months of age getting measles.

38:11
So it's a bit of a balance.

38:12
If you've got an 8 month old going to Bali at the moment, it's a no brainer.

38:17
You would absolutely recommend they get MMR.

38:20
Getting MMR a little bit earlier in those children does mean with the research that's been done, even if they get two more doses, their immune response overall is going to be suppressed a bit.

38:37
We don't think that that's an issue.

38:39
It's not, you know, halved or 110th.

38:42
It's just their overall antibody level after their what will be their third dose is even a bit lower than children who have just two doses at the right time.

38:55
So we don't want to give an early dose without good reason.

38:59
But if there's good reason, absolutely give it.

39:01
And certainly if there was a widespread outbreak in public health, we're recommending an early dose.

39:07
Absolutely give that early dose.

39:10
But the trick is to make sure that if you give that early dose at 8 months of age, absolutely try and reinforce to these parents or put them on a recall schedule, actual practise, get them back at 12 months of age and 18 months of age to make sure they get their MMRMMRV to really maximise their protection.

39:37
Thanks, Steven.

39:41
Yeah, the vaccine kicks in pretty quickly.

39:43
So it would be effective in that, you know, week to 10 days after getting immunised.

39:50
So, you know, you probably don't want best to give it, you know, prior to them going and you'd like to have them both to have protection.

40:00
But also if they're going to have, you know, that 5% or so of children who get a fever and are a bit grizzly after vaccine at 7 to 10 days, nice for them to be over that before they travel.

40:12
So get it in, you know, a couple of weeks before they go if you can.

40:23
We've been using, Liz, we've been using MMR vaccines for since the 1960s.

40:29
They're around in the late 1950s, early 1960s.

40:33
And these vaccines have not changed.

40:36
They work so well that there's been no need to change them.

40:39
So these are the vaccines we're using today are the same measles vaccines I got when I was an infant.

40:53
Right.

40:58
Tom's recording this, I think Tom.

41:00
And so it'll be, Yep, it'll be online about for people to review if they want to or you if you have colleagues who have been able to attend.

41:10
And because it's recorded, I think the chat's also available.

41:13
So if you think of a question this afternoon or later in the week that you'd like an answer to, if you pop the question in the chat, we'll be sort of watching the chat and answering it as we go along.

41:25
But yeah, measles, obviously an infection we don't want anyone to get.

41:30
It can be very serious, causing lots of really unpleasant complications.

41:35
One of the things we haven't talked about is that in the research in the last five to 10 years, it shows that not only does measles cause a serious illness, but it actually wipes out a lot of your immune memory to other infections.

41:55
So our understanding is that the reason so many children die after getting measles, they can die immediately of measles.

42:04
But in the two to three years following infection, your immune system that you've built up in early childhood with all of those infections you get is wiped out by the measles virus.

42:16
And then you can be at high risk of getting all of those childhood infections again when you don't have a good immune system because measles has has wiped it out.

42:27
It's a very damaging illness to get very damaging virus for the whole body.

42:34
Great, 8:15 that's probably enough.

42:37
We've all got jobs to get to and lives to lead.

42:40
Thanks so much for coming everyone.

42:42
As I said earlier, really thank you to the immunisation programme who keep us all on track.

42:49
Prepare these slides for me and we go through them and get the immunizations around the state as we need them.

42:58
Tom's posted in the chat the immunisation at health.qld.gov dot AU email address so if you have any questions or problems, please get in touch and let us know.

43:12
Happy to answer any questions that we can.

43:16
Thanks everyone.

43:17
Thank you for coming great Tom Cheerio.