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Discussion Starter · #1 · (Edited)
So, as many of you might recall, we started selectively vaccinating the kids. They had the MMR in 2013. Then we moved. I miss our old GP. His kids had had mumps and chickenpox as kids and he didn't bat an eye about that kind of stuff.

Anyway, we went to a new practice today. I thought they might be more accommodating given it's a GP along with alternative medicine services offered and talks about "holistic medicine." We met the new GP and I explained our situation and my goals and concerns.

He listened for the most part and was pretty respectful. DD (10.5) got a dT today. She did well. Cried a bit beforehand. Said, "that wasn't so bad," afterwards, but still managed to sucker me out of two new toys and an iPad case.

The problem arose with DS (7) as I expected. The Australian government states that it is permissible and recommended that infant combo vaccines be given to children up to age 10. Canada, the US, and even the manufacturers themselves do not recommend this:

QUADRACEL should not be administered to children after their seventh birthday or to adults because the quantity of diphtheria toxoid and pertussis antigens may provoke enhanced local reactions, fever and malaise.
http://www.guildlink.com.au/gc/ws/sw/pi.cfm?product=swpquadr10112

So, we're stuck. This is the frustrating bit. The GP was good in that he listened, he even phoned the head of Infectious Diseases at the children's hospital to discuss what he also saw as contradictory information between the manufacturer and the government. But TPTB won't budge. They state that kids up to age 10 are fine with the infant combos, no matter what the manufacturers state. I find that a bit rich as the manufacturer would know their own product (I hope) and have trialled it in specific conditions and if they say no kids over age 7, well, that suits me.

There is no no-fault compensation scheme here. So, what happens if the unthinkable does occur? Legally, can the manufacturer hold up their hands and say, "Well, you used it contrary to the product stipulations. We said no kids over age 7 on our monograph."

So, I told the GP that we were prepared to wait (or take DS to Canada). He was a bit put off and said that he wished I'd reconsider the Quadracel as "tetanus is everywhere" (yes, I have heard this for years and we've somehow managed to get to this point…if your government is going to be ridiculous about this and go against even the CDC recommendations--and I don't usually even consider them a paragon of wisdom--then I don't have much of a choice in the matter). My home country says it's too risky. The CDC says it's too risky. The manufacturer says it's too risky. No thanks.

So, anyway, one vaccine down and a long road ahead. I don't know if we'll stay with this GP beyond the dT/Tdap series. Even though he's willing to listen, too much "oh, you'll need Chickenpox, and hep B, and and and…" for my liking. He recommended Hib for Pete's sake. Kids over age 5 aren't supposed to receive it according to the handbook:

The product information for Act-HIB, Hiberix and Liquid PedvaxHIB states that these vaccines are indicated for use in children aged 2 months to 5 years.
http://www.health.gov.au/internet/i...andbook10-home~handbook10part4~handbook10-4-3

I guess unless it's part of Infanrix and then it's okay according to the government…sheesh…except for what the pesky manufacturer states…

INFANRIX®-IPV/Hib (combined diphtheria, tetanus, acellular pertussis, inactivated poliomyelitis, Haemophilus influenzae type b vaccine) should not be administered to persons 5 years of age or older.
http://www.gsk.ca/english/docs-pdf/product-monographs/Infanrix-IPV-HIB.pdf
 

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Discussion Starter · #2 ·
Forgot to mention that DD got b/w for a measles, mumps, and rubella titre. If it comes back good, then we're skipping the second dose. DS is having his b/w done at that point as well.
 

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Wow, that is crazy about the contradictory info.
 
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Discussion Starter · #4 · (Edited)
Wow, that is crazy about the contradictory info.
Well, it just ticks me off more than anything that policy is supposedly determined by the science. The science supplied by the manufacturers based on their trials, right? So, if the manufacturers do not recommend using a product after a certain age, what is informing this policy? I've asked GPs this countless times and they also go back to the standard, "Well, the Australian Technical Advisory Group on Immunisation…they're the experts, they know what they're doing."

This is the blurb on the front of the Handbook:

http://www.health.gov.au/internet/immunise/publishing.nsf/content/handbook10-home


The Handbook’s clinical recommendations are based on the best scientific evidence available at the time of publication from published and unpublished literature. Where specific empiric evidence was unavailable, recommendations were formulated using the best available expert opinion relevant to Australia.

In some instances, the ATAGI recommendations differ from vaccine product information sheets (PI); these differences are detailed in the relevant vaccine chapters under the heading ‘Variations from product information’. Where a variation exists, the ATAGI recommendation should be considered best practice.

It's just nonsensical. The recommendation about the infant combos up to age 10 isn't even considered a "variation from product information" in the Handbook. It's recommended standard practice and completes contradicts the product usage info mandated by the manufacturer. Sigh.

Plus, the whole part about making policy based on unpublished literature and opinion (when there is no evidence) doesn't fill me with confidence.
 

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Discussion Starter · #5 ·
Found another gem about the discrepancy of manufacturers and the ATAGI:

The product information for Infanrix hexa states that these vaccines are contraindicated in children with encephalopathy of unknown aetiology or with neurologic complications occurring within 7 days following a vaccine dose. The ATAGI recommends instead that the only contraindication is a history of anaphylaxis to a previous dose or to any of the vaccine components.
http://www.immunise.health.gov.au/i...andbook10-home~handbook10part4~handbook10-4-3

This really raises the red flags for me with the ATAGI. The manufacturer states that Infanrix should be contraindicated if your child suffers post-vaccine encephalopathy or neurological complications. The ATAGI says this is not a valid enough reason to forego it and only anaphylaxis is the only valid excuse.
 

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Discussion Starter · #7 ·
Can you just say no? I don't know the laws in Australia.
Well, I can say no, as far as I know, to their regulation that DS must receive the DTaP. He'll just end up with nothing for now as they won't give the Td/Tdap until he turns 10. The other option is going to NZ where I found a bit more flexibility in their national guidelines that kids aged 7 and over can receive the Td/Tdap (although the Aussie guidelines are recommended).
 

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Well, I can say no, as far as I know, to their regulation that DS must receive the DTaP. He'll just end up with nothing for now as they won't give the Td/Tdap until he turns 10. The other option is going to NZ where I found a bit more flexibility in their national guidelines that kids aged 7 and over can receive the Td/Tdap (although the Aussie guidelines are recommended).
wow :eek:
 

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Discussion Starter · #9 · (Edited)
So, update. We have a new GP. For some reason, the last one just up and quit one day (by email, no less).

I like the new one. He's in his 60s, pretty easy going. Willing to discuss the issues. He said that getting titres before getting additional doses of the MMR was a good idea and that in his mind, many of the additional doses some children receive with the various vaccines are unnecessary.

However, he also thought not going with the Infanrix for DS was perhaps a bit too cautious, he says he has given it to children my son's age with no perceived ill effects, but as a parent, he acknowledged it was my decision to make.

(For the lurkers, the background on the Infanrix vs ADT Booster saga).

Anyway, my daughter got the last Td today and is finished that series. No more MMRs either based on her titre test.

We are waiting to hear what the IMAC (Immunisation Advisory Centre) in New Zealand has ruled about bringing DS over to that country to have the Td done there. Apparently, the New Zealand Immunisation Handbook and the NZ licensing for the ADT Booster state that it is possible to use the Td booster/Tdap as a primary immunisation course in children over age 7 (even though they recommend the Infanrix as well). So, once IMAC has contacted the practice where we propose to bring my son, we can find out whether it's a go or not. And to think critics who say that parents who don't follow the schedule are somehow just airheads going with the flow and questioning based on some airy-fairy nonsense off the web. Trying to get around bad policy over here in Australia and vaccinate our son with a product we believe to be the "safer" and better option will cost us a lot more in the long run than if we just did what the Australian Dept of Health/ATAGI said, despite the lack of science for their recommendation.
 

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Discussion Starter · #10 · (Edited)
Oh and downside for today. Getting a titre test (MMR) done on an almost 8 year old who now remembers it all too well and even with a mouthful of chocolate after the fact declares, "I'm NEVER having a blood test again ever!"
 

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Discussion Starter · #11 · (Edited)
We are waiting to hear what the IMAC (Immunisation Advisory Centre) in New Zealand has ruled about bringing DS over to that country to have the Td done there. Apparently, the New Zealand Immunisation Handbook and the NZ licensing for the ADT Booster state that it is possible to use the Td booster/Tdap as a primary immunisation course in children over age 7 (even though they recommend the Infanrix as well). So, once IMAC has contacted the practice where we propose to bring my son, we can find out whether it's a go or not.
Today's eye roll. IMAC emailed back and said that they could not advise me of their decision because they are only licensed to give advice within New Zealand. They told me to ask the clinic in question to contact them.

I emailed the GP's clinic and asked them to follow up with IMAC to find out what the decision was. The manager of the clinic sent me an email today saying that her staff were just too busy to deal with this situation and advised me to take my request elsewhere. Even though I did all the legwork with IMAC and had already sent a lengthy letter outlining the situation; and there was, presumably, nothing left for the clinic staff to do but find out if IMAC would allow it or not (yea or nay), book an appointment, and receive their fees.

So, now I understand that for some public health workers the impetus for boosting uptake and compliance takes second place to perceived inconvenience. Too bad. I guess my son will remain without his Td until we go back to Canada for a visit or he turns 10. One thing's for sure, I'll be rolling my eyes when I hear about a HCW complain about uptake rates. I'm a parent looking to vaccinate, but it's too much of a bother for a GP clinic to help me do so.
 

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Today's eye roll. IMAC emailed back and said that they could not advise me of their decision because they are only licensed to give advice within New Zealand. They told me to ask the clinic in question to contact them.

I emailed the GP's clinic and asked them to follow up with IMAC to find out what the decision was. The manager of the clinic sent me an email today saying that her staff were just too busy to deal with this situation and advised me to take my request elsewhere. Even though I did all the legwork with IMAC and had already sent a lengthy letter outlining the situation; and there was, presumably, nothing left for the clinic staff to do but find out if IMAC would allow it or not (yea or nay), book an appointment, and receive their fees.

So, now I understand that for some public health workers the impetus for boosting uptake and compliance takes second place to perceived inconvenience. Too bad. I guess my son will remain without his Td until we go back to Canada for a visit or he turns 10. One thing's for sure, I'll be rolling my eyes when I hear about a HCW complain about uptake rates. I'm a parent looking to vaccinate, but it's too much of a bother for a GP clinic to help me do so.

Ugh. It's times like this that it becomes obvious that their goal is compliance, not actually vaccination. I'm running into similar issues here in Canada being told that for my 8 month old there is no trivalent dTap option, only penta or hexavalent. "That's not what's on the schedule". Surely if the goal was as many kids vaccinated as possible they would want to try to accommodate spacing out.


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Discussion Starter · #13 · (Edited)
Ugh. It's times like this that it becomes obvious that their goal is compliance, not actually vaccination. I'm running into similar issues here in Canada being told that for my 8 month old there is no trivalent dTap option, only penta or hexavalent. "That's not what's on the schedule". Surely if the goal was as many kids vaccinated as possible they would want to try to accommodate spacing out.


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Exactly. It is about compliance and anyone who does something that requires a bit of critical thought is automatically told no.

Just as an aside, I've noticed that the trivalent vaccines are no longer offered here. The GPs here recommend the hexa for everything (even though at my son's age, he's too old to receive a stand alone Hib vaccine). GSK doesn't even have one on their list...the only combo option left with the fewest number of antigens is Infanrix-IPV. Same with Sanofi and Quadracel. It's frustrating for sure for parents who want options.
 

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Exactly. It is about compliance and anyone who does something that requires a bit of critical thought is automatically told no.

Just as an aside, I've noticed that the trivalent vaccines are no longer offered here. The GPs here recommend the hexa for everything (even though at my son's age, he's too old to receive a stand alone Hib vaccine). GSK doesn't even have one on their list...the only combo option left with the fewest number of antigens is Infanrix-IPV. Same with Sanofi and Quadracel. It's frustrating for sure for parents who want options.

Same here. I can't find a trivalent dTap licensed in Canada for under 7. It's all infanrix-hexa or infanrix. My province calls for the hexa, but they're willing to not mix in the hep B and do it as pentavalent instead if I want to go that way. Anything less than that though is apparently not possible at all, unless I want to wait until he's old enough to get Tdap instead. I suspect that when he turns one we'll have issues as well because the schedule calls for MMRV instead of MMR, but it might be easier because MMR is still licensed here for now. At this point he's has no vaccines because I'm not ready yet and I'm really uncomfortable with hexa/pentavalent.


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Discussion Starter · #15 ·
Oh and downside for today. Getting a titre test (MMR) done on an almost 8 year old who now remembers it all too well and even with a mouthful of chocolate after the fact declares, "I'm NEVER having a blood test again ever!"
Results back. Seroconverted for all 3 (including the mumps) after the one dose of the MMR. I'm bringing the kids' positive lab results to their school. There's two primary schools in greater Melbourne with reported measles cases and the principals of these schools have ordered all unvaccinated children and staff to remain home for 21 days. So, I'm just covering our bases in case we hear of a case reported at my kids' school.
 

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Results back. Seroconverted for all 3 (including the mumps) after the one dose of the MMR. I'm bringing the kids' positive lab results to their school. There's two primary schools in greater Melbourne with reported measles cases and the principals of these schools have ordered all unvaccinated children and staff to remain home for 21 days. So, I'm just covering our bases in case we hear of a case reported at my kids' school.
Wonderful news!!!
 

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Discussion Starter · #17 ·
Wonderful news!!!
Yeah, I'm pleased. I was really hoping that we could avoid the second dose, for a number of reasons I won't bother going into. I'm just glad that I'll be able to give the documentation to them and they can keep it on file so my kids can stay in school if a case is reported.
 

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Discussion Starter · #18 ·
Oh and as an aside, I think I've read over 30-40 posts on social media in the past two days misinformed about the schedule, the need for boosters with certain vaccines, etc. With the current cluster of measles cases around Melbourne, a lot of people have been posting that it's because adults have not done their bit and kept up with their scheduled boosters. Trouble is, there are no measles boosters recommended for adults after the two-dose series (in Australia, Canada, or the US). Sure, many women in their childbearing years get a MMR booster when their rubella titre comes back low, but a routine universal booster for men and for women who are not planning to become pregnant? No.

So, I guess the lesson is, speak to your GP. Sure, if you're concerned, get a titre done. But don't necessarily trust the commenters on social media to know the schedule inside out or the intricacies of current health policy and recommendations.
 

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Oh and as an aside, I think I've read over 30-40 posts on social media in the past two days misinformed about the schedule, the need for boosters with certain vaccines, etc. With the current cluster of measles cases around Melbourne, a lot of people have been posting that it's because adults have not done their bit and kept up with their scheduled boosters. Trouble is, there are no measles boosters recommended for adults after the two-dose series (in Australia, Canada, or the US). Sure, many women in their childbearing years get a MMR booster when their rubella titre comes back low, but a routine universal booster for men and for women who are not planning to become pregnant? No.



So, I guess the lesson is, speak to your GP. Sure, if you're concerned, get a titre done. But don't necessarily trust the commenters on social media to know the schedule inside out or the intricacies of current health policy and recommendations.

It's the same with Pertussis here. My province (and most if not all provinces) only recommend one "lifetime dose" of Tdap. Now I was recommended to get it after the baby was born because it had been more than 10 years ago that I got mine but that's not an official recommendation, they recommend Td every 10 years but Tdap only once. There's all this push about pertussis but no one seems to understand the schedule.


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Discussion Starter · #20 ·
It's the same with Pertussis here. My province (and most if not all provinces) only recommend one "lifetime dose" of Tdap. Now I was recommended to get it after the baby was born because it had been more than 10 years ago that I got mine but that's not an official recommendation, they recommend Td every 10 years but Tdap only once. There's all this push about pertussis but no one seems to understand the schedule.


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I think the confusion around the Tdap is contributing to it, not just with the timing of Tdap boosters itself, but some people have taken the "every 10 years message" and just generalised it to all vaccines. Hence, the number of posts I saw from people telling others that they were supposed to get a MMR booster every 10 years.

The Tdap recommendations vary and are contradictory and seem to be changing every year. For example, there are still sections of the Pink Book, of the Immunization Guide (Canada), and to a lesser extent the Immunisation Handbook (Australia) that discuss the matter of giving tetanus boosters more often than were recommended in the past and the potential for reactions because of this practice, yet the recommendation about Tdap and each pregnancy still stand. So, depending on your source and context, it's either potentially more risky to have tetanus shots more frequently than every 5 or 10 years or it isn't. I suppose it's not surprising there's a bit of confusion out there, not just with the Tdap but many others.
 
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