Last partial update: August 2022  - Please read disclaimer before proceeding

Immunisations

General information regarding immunisations

All Australians, including adults, need to ensure that their vaccinations are up to date. (About 25 per cent of Australian adults over 50 years of age are not immune to tetanus and 40 per cent are not immune to diphtheria.)

 

This means people need to update their immunisations if they have missed any and ensure that they have future vaccinations at the appropriate time. Exceeding the recommended time interval between doses, including missing doses, does not mean the course needs to be restarted or that supplementary doses need to be given. All that needs to be done is for the missed doses to be administered, although some doses can be omitted depending on the age of the person when they are receiving ‘catch-up doses’. Seek a GP’s advice on the doses needed to ‘catch-up’.

 

Vaccinations should not be postponed by minor illnesses such as upper respiratory tract infections. (Temperature should be below 38.5 degrees celcius) It is pleasing to note that the level of fully immunized babies (one year olds) has been steadily increasing recently and is now over 91 per cent. In 1997, this figure was only 75 per cent.

 

The current vaccination schedule can be accessed by clicking on the link below and people should check this to see whether their immunizations are up to date. Please remember that vaccination schedules change reasonably regularly and it is worthwhile checking immunisation protection at each GP visit. As an example, Hepatitis B was not part of the childhood vaccination schedule of many adult Australians and thus many adults have not been immunized against this disease.

 

Missed immunisation doses

Exceeding the recommended time interval between doses does not mean the course needs to be restarted or that extra doses need to be given. All that needs to be done is for the missed doses to be administered, although on occasions some doses can be omitted depending on the age of the person when they are receiving the catch-up doses.  Check with a GP to see if any missed doses need to be ‘caught up’.

 

Australian immunisation schedule

The Australian Government’s ‘Immunise Australia Program’ website.

The information section of this site provides the answers to many commonly asked questions about immunization and the Australian Immunisation Handbook can be accessed from the home page of this site.

 

 

 

Some notes on vaccinations

  1. Vaccinations should not be postponed by minor illnesses such as upper respiratory tract infections.
  2. Immunisation levels should be checked in adults and missed doses administered.
  3. People who have a compromised immune system should not have live attenuated vaccines and those who have had a severe reaction need to notify their doctor before receiving any vaccine.
  4. Questions regarding the need to immunise and general concerns regarding immunisation are addressed in the Commonwealth Government website mentioned above.

 

Notes on a few specific vaccinations

 Covid 19 

 The situation with Covid 19 is changing on an almost daily basis and it is difficult for a site like this to provide up to date information. There is also a multitude of sources of information on this issue that vary greatly in their accuracy. The best course of action  is to listen toand take Government health advice. This especially is the case with regard to vaccination. While Australians were quick to take up vaccination initially, as of August 20222 only about 70% of adults are fully vaccinated and those less than optimally vaccinated are at risk of serious initial  disease and are more likely to get chronic disease ('long Covid') if they contract the virus. 

Chickenpox vaccination

The vaccination against chickenpox (varicella) is also fairly new. Most adults will have been exposed to this disease during their childhood and will thus not require vaccination. However, some adults are at increased risk of infection or pose a treat to others if they become infected. These people include women who are considering becoming pregnant, child care workers, parents of young children and household contacts immunosuppressed persons and they should consider being immunized. (Testing for immunity can be done to see if immunisation is required but is not essential.) Two injections are required and women need to ensure they do not become pregnant for one to two months after vaccination.

Influenza and pneumococcal vaccination in adults

Common vaccinations given to older adults are the influenza and pneumococcal vaccinations, which are recommended for all adults over the age of 65 and earlier in people at increased risk. At risk groups include Aboriginals and Torres Strait Islanders and those with significant other illnesses, such as heart disease. It is also recommended for adults travelling in large groups. These vaccinations are provided free by the Australian government. These vaccinations have been shown reduce both hospital admissions and death rates. Those allergic to egg or egg protein should not be given the influenza vaccine. These vaccinations are provided free by the Australian government.

 

 Herpes Zoster ('Shingles') vaccination

Vaccination against Herpes Zoster isrecommended for most adults over the age of 70. There are two vaccinations. The first is Government funded but this vaccination is inferior. It is only 40% effective initialy and this drops very significantly over the next 7 years. It is a live attenuated vaccination and can actually cause illness in people who are immunocompromised. (It should not be given to immunocompromised people.)   The other vaccine is 90% effective and its effectiveness doesn't reduce much with time. It is also not an attenuated live virus and thus can't cause illness. It is however quite expensive (about $500 for the two required doses and it is not Government funded.

It is important to remember that there are effective anti-viral treatment drugs for shingles but to be effective they must be given within 3 days of the rash developing. 

Tetanus and diptheria vaccination in adults

M any adults lose their immunity to tetanus and diphtheria as they age. In Australian adults over the age of 50 years, about 40 per cent have inadequate immunity to diphtheria and about 25 per cent are susceptible to tetanus. Serious illness and deaths still occur from these diseases in older people and it is important to have a booster immunization at 50 years.

Rota virus vaccination

Rota virus is the most common cause of viral gastroenteritis in the world and in Australia, especially in children. While it causes very few deaths in Australia, it is responsible for the admission to hospital each year of about 10,000 young children. (In the under-developed countries of the world it is responsible for the death of half a million children annually.) Two vaccines against this disease are now available. (There was a vaccine for Rota Virus released some eight years ago that very slightly increased the risk of intussusception (a bowel disease) in children. Very extensive testing has excluded this as a problem for the new vaccines.) The vaccines act to reduce symptoms in babies that contract the disease. It is especially useful for babies at higher risk of illness from a Rota Virus infection.

 

Immunisation requires two or three injections of live attenuated virus vaccine. (The two available vaccines contain different strains of the attenuated virus.) The vaccines are now on the subsidised government immunization schedule. 

 

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Guide to infectious diseases that require exclusion from school*

 

These recommendations are a guide only. All individual cases need to be discussed with a medical practitioner. All children who are physically unwell from an infection should not attend school.

 

Illnesses that require exclusion from school**

 

Illness

Time child needs to be kept away

Chicken pox

Stay away from school until fully recovered or at least until 5 days after the spots first appear. (The presence of a few scabs is allowable.)

Conjunctivitis

Until discharge from eyes as stopped. (For traucoma, return to school after treatment has started)

Diarrhoea (viral or bacterial

Stay away from school until diarrhea has stopped.

Hand, foot and mouth disease

Stay away from school until all blisters have dried up.

Hepatitis A

Return to school when sufficiently recovered but at least until 7 days after jaundice begins.

Herpes

(Cold sores)

May need to stay away if can not follow hygiene practices, especially young children. Otherwise can go to school with sores covered where possible.

Impetigo

(School sores)

Stay away from school until treatment has begun. Sores that are still present need to be covered.

Meningitis

Stay away from school until well.

Meningococcal infection

Stay away from school until treatment has finished and well enough.

Mumps

Return to school after nine days or once swelling goes down (which ever is sooner).

Ringworm, scabies, lice

Return to school once treatment has begun.

Rubella

(German measles)

Return to school once fully recovered or four days after rash started.

Streptococcal infection

Stay away from school until has had antibiotics for 24 hours and feels well.

Whooping cough

Stay away from school until has had antibiotics for 5 days and feels well.

Worms

Stay away from school if diarrhea is present.

 

Illnesses requiring exclusion from school when the child has come in contact with a person with the disease (but does not yet have the disease)

 

Illness

Exclusion period

Measles

If not immunized, the child should stay away for 14 days from the last time he/she contacted the person with measles. (If immunized previously or within 3 days contacting with the person with measles, no exclusion from school is required.)

Meningococcal infection

Children who have been in contact with a person with meningococcal infection need to stay away from school unless they are currently receiving the antibiotic rifampicin.

Whooping cough

If not immunized, other children in the house aged 7 and under must stay away from school for 14 days after the last exposure to the infection or until they have taken 5 days of a two week course of antibiotics for the infection.

 

Illnesses that do not require exclusion from school

 

Cytomegalovirus

Glandular fever

Hepatitis B

Hepatitis C

Hookworm

HIV (human immunodeficiency virus) / AIDS

Parvovirus (‘Slapped cheek disease’ or ‘fifth disease’ )

 

*These recommendations are a guide only. All individual cases need to be discussed with a medical practitioner.

**All children who are physically unwell from an infection should not attend school.

 

 

Preventing food-borne infections in Australia

The vast majority of food-borne illness in Australia is due to contamination from microorganisms, mostly bacteria (and the toxins they produce) and viruses. It is a common problem with about four to seven million cases occurring each year. Most cases are associated with restaurants and caterers.
Some foods are more likely to cause illness than others. They include:

Adopting good food handling procedures at home will reduce the risk. These include:

People at high risk of serious illness from infections include young children, the elderly, immuno-compromised people and pregnant women. They need to seek medical attention sooner rather than later if they develop a significant bout of food poisoning.

Traveller's diarrhoea

Roughly 50% of travellers to developing countries will develop traveller's diarrhoea. It is most commonly caused by a vartiety of bacterial organisms, includinng Escherichia coli, Campylobacter jejuni, Salmonella species, and Shigella species. Protozoal infections (especially giardia) are common causes of persistent diarrhoea in treavellers. There is no long lasting immunity to these organisms so previously living in an an indemic area does not provide protection once the person has left.

Most cases settle quickly and hydration is the main issue. Sending a sample of feces for examination (and antibiotic treatment) should be considered when;

Some travellers take antibiotic medication to use in case they get an infection but resistance is becoming an increasing problem. For example, increasing quinolone resistance has meant that drugs such as norfloxacin and ciprofloxapen are becoming less effective.

Enteric fever (typhoid and paratyphoid) - This illness is caused by two different types of salmonella bacteria. Typhoid vaccination is useful if going to endemic areas, especially if staying for a prolonged period. (The vaccination is only about 70% effective against typhoid and not effective at all against paratyphoid.

Hepatitis A - Hepatitis A is transmitted by faecal-oral route and while most cases are self-limiting, some people develop severe illness which can cause death. (THis is more likely in people over 50 years, where the death rate is 2% to 3%.) There is a vaccine against this condition. Half the cases that present in Australia are contracted overseas.

Food and water safety

Many infectious diseases are transmitted via contaminated food and water. While it is not always possible to adhere to the boil it, cook it, peel it or forget it rule, some simple precations are very helpful;

 

Avoiding Sexually Transmitted Diseases

Most sexually transmitted diseases (STD) can be prevented by common sense and a responsible attitude to sex. This unfortunately is not always the done thing and unsafe sexual practices are responsible for about one per cent of all burden of disease. The list of serious sexually transmitted diseases is large and includes HIV/AIDS, hepatitis B, genital herpes, chlamydia, syphilis, genital warts and gonorrhoea. Cervical cancer from Human Papilloma Virus could also be added to this list and the trauma associated with an unwanted pregnancy should not be forgotten.

 

STDs are most common in young people. (The average age of infection with chlamydia in Australia is 15 to 24 years in women and 20 to 35 years in men.) Young people are more vulnerable because they are less likely to be in a long-term relationship, are more likely to have multiple partners, and are more likely to take risks such as participating in intercourse without condoms.

 

Preventative measures were partly covered in the section on the preventing teenage pregnancy and this section is worth reading again. Prevention should include the following.

 

 

Diseases that are predominantly transmitted by sexual intercourse 

 

Chlamydia – A sexually transmitted disease epidemic in Australia

Chlamydia is a sexually transmitted infection that is increasing greatly in incidence in both young men and young women; the incidence in Australia has increased significantly over the past 12 years. (74,300 cases were reported in Australia in 2010.) It is difficult to diagnose because in both men and women there are often very few symptoms, if any. At least 50 per cent of infections are symptom free. Women with the infection sometimes experience a vaginal discharge, pain with sexual intercourse or abdominal pain, but most symptoms are mild and transient and thus not acted upon. The highest rates of infection occur in 15 to 25 year old females, the group most at risk of contracting the disease, and 25 to 35 year old males. However, the disease is present in all adult age groups.

 

Long-standing chlamydia infection in women is important because it can cause infections around the ovaries and fallopian tubes. The resultant scarring may lead to fertility problems, with about five per cent of women with the disease becoming infertile. It can also result in ectopic pregnancies. (Ectopic pregnancies are pregnancies that occur in the fallopian tubes and they can cause serious problems due to bleeding.)

 

The main risk factor for chlamydia is having multiple sexual partners.

 

To assist in preventing transmission of this disease, it is important that condoms are used with all sexual intercourse. When entering a long-term relationship, it is important that both partners are tested for chlamydia and other sexually transmitted diseases before condom use is ceased. (In the past, it has mostly been women that have been tested for the disease.)

 

Chlamydia screening programs have been introduced in several countries and have helped to significantly reduce the incidence of the disease. Those at high risk (i.e. people who do not use condoms all the time, especially if they have multiple sexual partners) should discuss being screened for the disease on a yearly basis with their GP. Pap smear visits are a good time to also do clamydia screening tests, although Pap smears are usually done every two years. At present few at risk females are screened in Australia. Some GPs are wary about talking to young people about their sexual activity, fearing that it might stop them from coming back. Thus, do not be afraid to bring up the topic even if a doctor doesn’t.

 

Chlamydia infection is diagnosed by testing a urine sample and is easily treated (with antibiotics); but re-infection will obviously occur unless condom use is maintained and all present sexual partners are treated. Past partners should also be notified and future long-term partners will need to be screened for the disease.

 

Genital herpes

There are two herpes simplex viruses that cause genital herpes; type 2 (HSV-2) and type 1 (HSV-1). HSV-1 is the usual cause of cold sores around the mouth but it can also cause genital herpes if oral lesions are present when oral sex is practiced. The HSV-2 virus is the more common cause of genital herpes, although in the under 20 age group HSV-1 has become the more common virus involved, presumably because of a higher incidence of oral sex.

 

Genital herpes is most commonly acquired in late adolescence and early adulthood and the risk increases with the number of sexual partners. In all, about 90 per cent of adult couples will have at least one partner who previously contracted oral HSV-1 from exposure to an oral cold sore, most commonly in childhood. Thus, most couples will be exposed in some way to this virus. People who have previously been had oral HSV-1 cold sores are immune from getting HSV-1 genital infections and tend to get less severe initial HSV-2 infections which are often asymptomatic. Thus, many HSV-2 infections go unnoticed.

 

Constant condom use is not 100 per cent effective in preventing transmission of genital herpes but is helpful in preventing transmission from an infected male to a female partner. Condom use is less effective in preventing female to male transmission, mainly because the usual site of infection in females is the vulva. However, while condom use can slow down the process, the reality is that in a long-term relationship an infected partner will almost always infect an uninfected partner eventually. (The rate is about 10 per cent per year.) 

 

A person with their first infection usually has an irritated looking red rash that may be blistery and ulcerated. It is often painful and can last up to three weeks. However, milder presentations are becoming increasingly common with some mild enough for the condition not to be noticed. The severity of the infection is more to do with the immune response of the infected person and not the virus itself. Thus, there is no guarantee that a person infected from a partner with mild symptoms will also develop an infection with mild symptoms. Very severe reactions including spread to other parts of the body including the brain can occur in people who have a compromised immune system e.g. people with HIV.

 

Both herpes simplex viruses unfortunately continue to live in the skin nerve endings near the site of the initial infection and recurrences of the infection occur at regular intervals. These recurrences are milder than the initial infection, often lasting less than a week and tend to become less frequent with time.

 

Most people who test positive to HSV-2 have no idea that they have the disease. It is likely that most transmissions occur from people with a mild, asymptomatic infection (i.e. little or no evidence of infection) and people who have had obvious evidence of the disease are still likely to be infective at times when they have no symptoms; that is, in between recurrences. (It is still wise however not to have intercourse while active infection is present.)

Testing for the disease is best done by taking a PCR swab from an active lesion. Blood testing is not as helpful as it does not tell where the infection lies. (It will be positive in people with an oral cold sore as well.)

 

Blood testing can however be useful in testing a woman who wishes to become pregnant and has a male partner with the disease. Women who become infected while they are pregnant have an increased risk of transmitting the illness to the foetus, especially if the infection occurs in the third trimester. If the woman is not infected, treatment of the male partner throughout the pregnancy with suppressive anti-viral drug therapy and abstinence from vaginal sex later in the pregnancy is recommended. Transmission to the baby during delivery from a mother with an active infection may also occur and caesarean section is recommended when active infection exists at the time of delivery.

 

Treatment is with the antiviral drugs acyclovir and valaciclovir. These medications reduce the severity of initial infections but treatment of the initial infection does not influence the incidence of recurrent infections. However, long-term suppressive drug therapy does reduce recurrence rates by about 70 per cent and will obviously also help reduce the likelihood of transmission; but not eliminate it!! (This is particularly useful early in relationships and in pregnancy as described above.) The use of antiviral drugs during recurrences reduces the length of infections by up to 24 hours.

 

Unfortunately there is no vaccine against this disease.

 

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HIV/AIDS

HIV is a viral infection that is mainly transmitted through sexual intercourse, with anal intercourse being the easiest method of spread. In Australia it mainly occurs in homosexual men (89 per cent), with the average age at diagnosis now being about 34 years in this group. Heterosexual transmission is responsible for about 10 per cent of new cases.

 

In Africa and other developing countries, vaginal intercourse is the more common method of spread. Transmission associated with intravenous drug use accounts for only about two per cent of cases in Australia but is a more common method of spread in Europe, Asia and the USA. Worldwide there were five million new cases in 2003.

 

Transmission by accidental needle stick injury only occurs in about 0.3 per cent of exposures to needles used by infected individuals and transmission by blood transfusion is exceedingly rare.

 

Perinatal transmission from an infected mother to her baby occurs in about 20 to 45 per cent of cases unless preventative measures are taken. Such preventative measures can reduce this rate to about 5 per cent and include antiviral drug treatment during the pregnancy, the labour and after delivery, birth by caesarean section, and avoidance of breast feeding.

 

Generally the rate of HIV infection is starting to increase again and between 2000 and 20005 there was a 41 per cent increase in new case diagnosed. (In

Victoria, the number of new HIV cases increased from 140 in 1999 to 286 in 2005.) This increase has coincided with a significant rise in the incidence of unprotected anal intercourse amongst homosexual men. The reason for this is not clear, although it may be that men are less afraid of HIV/AIDS now that there is better treatment available.

 

Preventing HIV/AIDS infection involves the following.

 

Post HIV exposure prophylaxis

People who have had unprotected sexual intercourse with a person who has HIV or has a high risk of having HIV can reduce their risk of contracting the disease by taking a course of antiretroviral medications. Two or more drugs are usually taken for a period of 28 days and should be commenced as soon as possible after contact (within 72 hours).

 

Similar post-exposure prophylaxis can be used for needle stick injuries where the chance of HIV exposure is significant. This treatment can give no guarantee of infection avoidance and should never be seen as a back up for using unsafe sexual / drug use practices.

 

Preventing needle stick injuries

Needle stick injuries can be minimised by adequate training of health professionals in the safe use and disposal of needles. Important points include the following.

  • Needles should not be re-capped or bent after use
  • Needles should not be removed from disposable syringes after use
  •  ‘Sharps’ containers need to be rigid
  • ‘Sharps’ containers should be close to work sites to aid immediate disposal
 ‘Sharps’ containers need to be kept out of the reach of children.

 

Hepatitis B

Hepatitis B is a viral infection that affects the liver, with some chronic infections causing serious liver damage and liver cancer. About 25 to 40 per cent of people with chronic infections die from the disease. Whether infected individuals eradicate the illness or develop a long term chronic infection depends on the age at which they are infected. People who develop the disease in early childhood have 90 per cent chance of being chronically infected. Only about five per cent of those infected in adult develop chronic disease.

 

Most cases in countries with a high incidence of the disease, such as China, South East Asia and the Pacific nations, occur due to infection from mother to baby at birth. In adults, transmission is mostly through sexual contact or injecting drug use. There are thought to be about 200,000 carriers of the disease in Australia. Transmission by needle stick injury occurs in about three to 30 per cent of exposures from needles used by infected individuals, depending on the infectiousness of the affected person.

 

Preventing Hepatitis B infection involves the following.

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Cervical cancer

 

About 90 per cent of cervical cancer is caused by the human papilloma virus that is contacted as a sexually transmitted disease. This topic is covered in detail in the section on cervical cancer.

See section on Cervical cancer prevention

 

 

Other important infectious diseases

Hepatitis C

Hepatitis C is another viral infection that predominantly affects the liver. It is almost always transmitted by blood-to-blood contact, with 90 percent of the new cases in Australia occurring in association with injecting drug use. (A very large percentage of injecting drug users has the disease.) There are about 15,000 new cases per year at present and the spread of the disease is increasing quickly. There are thought to be about 250,000 people with hepatitis C in Australia. About 75 per cent of infected people become infected chronically and can thus transmit the disease. Of these, about 30 per cent become chronically unwell, 15 per cent develop liver cirrhosis and liver failure, and 5 per cent develop liver cancer. Hepatitis C is the most common cause of liver cancer in Australia and a major reason for people requiring liver transplant. The rate of transmission with sexual intercourse is thought to be quite low, although the presence of menstrual blood may increase the risk. Transmission at birth is thought to be about five per cent and there is no established way to stop this transmission, although caesarean section may be of some help.

Preventing Hepatitis C infection involves the following.

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Dental caries (Tooth decay)

Dental caries is the most common disease known to man. It is due to acid, produced by bacteria in the mouth, that slowly destroys the hard tissues of the tooth and can occur as soon as teeth are present in the mouth (i.e. in young children). Over the past few decades its incidence has decreased dramatically in communities where artificial fluoridation of the water supply is practiced. In most cases dental caries can be avoided by good health prevention that includes the following.

 

 

Teeth and fluoride

Fluoride is a very important in reducing the incidence of dental caries in our community. Most water supplies have fluoride added to them and this provides adequate fluoride. However, it will only do so if the person drinks tap water. Bottled water and other bottled drinks generally do not contain fluoride.

 

People who do not get fluoride via their water supply and wish to take advantage of this very important tooth protective measure will need to take fluoride tablets.

 

Fluoride is most important when teeth are forming as it is its incorporation into the developing tissues of the teeth that provide most benefit regarding resistance to tooth decay. This occurs from birth until about the age of six or seven. The use of fluoridated water from birth decreases tooth decay by up to 65 per cent.

 

Fluoride applications: In older children and adults, fluoride can be applied to the outside of teeth to help reduce the amount of tooth demineralisation that acids cause in the mouth. This can be applied through the use of fluoride tooth pastes, gels, mouth rinses or foams. These products should be spat out and not swallowed as they are meant for topical use only. They are also not suitable for children under the age of six as they may cause fluorosis. (See below.) Dentists usually apply products with higher fluoride concentrations to teeth at check-ups.

 

Fluoride supplements: Some water supplies in Australia are not fluoridated and these people will not benefit from this important preventative health measure. In the past fluoride tablets have been recommended as an alternative. However, there have been issues with ensuring people get the right dosage, with some children not taking enough to gain benefit and others taking excess and getting fluorosis. (See below.) The fact that most water supplies that are not fluoridated have a natural fluoride content means that people using this water will get some degree of protection and fluoride supplements should probably only be considered where the fluoride level in the water supply is particularly low; below 0.3mg/L. (It may also be considered in children at higher risk of developing dental caries.) The best option is to try to get the water supply fluoridated.

 

Fluorosis: Ingesting excessive amounts of fluoride when the teeth are forming may lead to too much fluoride being incorporated into the teeth and this can cause yellowy flecking marks in the teeth. If intake is very excessive, it can also cause pitting and chipping of the teeth. This process is termed fluorosis. It usually only occurs when children under the age of six use high-fluoride content tooth paste and swallow the paste rather than spitting it out, thus ingesting far more than they would normally get from the water supply. The risk can be minimised by ensuring that children under the age of six use reduced fluoride tooth pastes specifically designed for young children and avoid swallowing tooth paste. To ensure that this occurs, children under the age of six should be supervised when brushing their teeth.

 

 

Infectious diseases and pregnancy

This section is dealt with in detail in the section on 'Preparation for pregnancy'. (Click on link below.)

See section on  Preparation for pregnancy.

 

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