Don’t forget routine immunisations and use any patient contact as an opportunity for vaccination—says Professor Nick Wood of the National Centre for Immunisation Research & Surveillance at the University of Sydney.

“There are concerns internationally, particularly at the WHO level, about the impact of COVID and how that has resulted in the decline in uptake of routine vaccinations”, Professor Wood says. The result, he explains, is an increased risk of diseases such as measles and polio.

When seeing a patient, Professor Wood suggests assessing risk and considering opportunistic vaccinations based on the concept of the HALO principle – consider the patient’s Health, Age, Lifestyle and Occupation.

The 2023 flu vaccination season is underway. Uptake so far, according to Professor Wood, is about 25% in the over 65 age group and less than 5% in the under 5 age group, although he reflects it is early days. The 2022 flu season, he reports, had an overall uptake of close to 70% in the over 65s and about 30% in the under 5 age group. Flu notifications in 2022 were highest in the under 5 age group, followed by the over 65’s, hence both remain the highest risk groups. The 2022 flu vaccine, he reports, reduced hospitalisation by 50%.

When administering the flu vaccine, consider a COVID booster and pneumonia vaccination, Professor Wood reminds us. Co-administration of the flu vaccine with others is generally considered safe, with the exception of FluadQuad and Shingrix, for which a five to seven day interval is recommended. Additional doses of the flu vaccine are not routinely recommended.

However, if a patient is planning to travel to the northern hemisphere later in the year and wants to reduce their risk of flu there, an additional dose towards the end of the Australian flu season is reasonable, Professor Wood says.

A new pneumococcal vaccination, Vaxneuvance, will soon be available as an alternative to Prevenar 13, advises Professor Wood. ATAGI has yet to provide advice, but the Pharmaceutical Benefits Advisory Committee says it’s appropriate for non-indigenous adults over the age of 70, indigenous adults over 50, or people with an increased risk of pneumococcal disease over the age of 15. While there is no preference between the two vaccines, Vaxeuvance contains an additional two serotypes.

Professor Wood reminds us to consider a tetanus booster in those aged over 50, with several cases and a death from tetanus having occurred in Australia in recent times.

“By middle age, 1:5 people have low or undetectable anti-toxin”, he says. A booster is recommended if the last dose was over 10 years ago and is particularly important for travellers to countries where access to healthcare services might be difficult.

Japanese Encephalitis is in Australia and is likely to stay, Professor Wood says, with 45 cases since 2021.

“Encephalitis is rare, at 1 in 250 infected individuals, but when it happens it can be devastating”, he says. ATAGI has recommendations about which groups should consider vaccination, and each state and territory also has additional recommendations based on local risk.

“Don’t forget the old”, says Professor Wood. With a recent measles alert in Sydney and a couple of cases on the Sunshine Coast, the importance of keeping focus on the routine vaccination schedule is critical.

Professor Wood will be providing a concise yet invaluable immunisation schedule update during the 27 June webcast. This will include important updates on several childhood vaccinations. Register here to attend.