Jo Rayner: Good evening, everyone, and welcome to tonight's SA Health update the RSV immunisation program. My name is Jo Rayner, and I'm the State Manager for the RACGP SA, and I'll be facilitating the session for you tonight.
I'd like to start by acknowledging the Kaurna people as the custodians of the land and waters of the Adelaide region on which I meet with you today and pay my respects to elders, past and present. I acknowledge and respect the Kaurna people's cultural, spiritual, physical, and emotional connection with their land waters and community. I would also like to acknowledge any Aboriginal and Torres Strait Islander people present this evening.
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Nicola Spurrier: Thank you so much. And, Jo, the only other thing I'd say is, it might be easier to take questions at the end. I don't mind being interrupted, but it may be that I'm going to cover things anyway. So but really, just to say how delighted I am to be able to give a presentation tonight, because, as a Paediatrician, I am thrilled that we have finally got an RSV maternal and infant protection program in South Australia.
It's a new program, and it's really quite complicated. So I've got my team here to also assist with any questions. We've got Sarah Almond and Mel Fidock from our CDCB Immunisation Branch. But I'm really happy to have Steph Hendrijanto. And now, Steph, I'm not going to say it properly, because I haven't got it right in front of me, but I'm going to just hang on, let me flick the screen. Stephanie Hendrijanto, who is a wonderful GP. That I know well, because I'm doing a little bit of paediatrics still up at Flinders Medical Centre, and Steph helps out on the ward up there as well, and so we've done some ward rounds together, and she was really happy. And I'm delighted she came along tonight because to hear from a GP who's really passionate about this program as well as from me as the Chief Public Health Officer.
So let's move to the next slide, please. It is Reconciliation Week. So now, Na Marni. So, I'm saying, Kaurna yatanga, because I'm on Kaurna Land. I'm in my office at the city Centre, but I love to put this photo here because this is the part of Kaurna Land that I'm very fortunate, very privileged, to live on. And if you recognise it, it's up in Brownhill Creek. The creek goes along the bottom, and I'm looking up towards Crayford and up to Stirling through that valley. And it's been market garden for maybe 200 years, 150 odd years. But actually, it's clearly been lived in for many thousands of years by Kaurna people. And just my personal reflection on that when I get home and I look up and see some stars. I think about all of the aboriginal mothers in particular, who have brought up their kids along this creek line, and would be looking at the same stars as I now look at, so recognizing that this week is reconciliation week. It was sorry day yesterday, and, as all you people know that saying sorry is not about saying you did something wrong. It's a recognition of the past, and there's nothing wrong at all with saying sorry, and it's a way of moving on for everybody. So, reconciliation is a learning journey and I'm hoping that you've all had an opportunity to think about what you're going to learn about Aboriginal culture so that we can have a joined-up future because we're always going to be stronger together.
Excellent. So, and we're also going to be stronger when we have our population vaccinated. So, let's get on and talk about what we're going to do tonight. So, we've got the title. We've got the people's names up here. I've already introduced people. Sorry, Stephanie, I'll one day get my tongue around your name, which is a beautiful name. But let's now look at RSV, so look, these are dot points about how serious RSV is.
I just tell you, as a Paediatrician, I spent so many years treating little ones with RSV. It's the main reason why children are admitted to our hospitals over the winter period, and particularly for those kids under 3 months of age. They're so tiny and they're so vulnerable. And when it comes to actually trying to treat these bubs in hospital with bronchiolitis. There's not all that much you can do. It is really just supportive treatment. So, the vaccination, the prevention being so much better than a cure, it really stands us in good stead. Here, in terms of supportive treatment, we can use high flow oxygen we can put drips in, and such like. But one of the main things that I always got taught in my paediatric training was minimal handling. Because these kids are so fragile, so tiny. Once they get bronchiolitis. If you touch them. If they get upset at all, it really can make them deteriorate quite rapidly.
So as we've got here also young children under 2 years of age, with medical conditions, such as chronic lung disease, and also, of course, congenital heart disease. You may have children like this in your practice. But certainly. I'm sorry I'm just, my phone, but certainly the paediatricians in the hospital are delighted now that they're able to provide protection for those children as well.
And then the other group is, of course, premature babies. So even up into the age of 2, if bubs were born preterm with a low birth weight, then they may still have the residual effects of lung disease associated with their prematurity.
The other group that we know are hospitalised at a higher rate with RSV are Aboriginal infants and young children, but at the end of this right at the last stop point at the end of the day, because bronchiolitis is so common, RSV Bronchiolitis has been so common, most hospital admissions for severe disease are actually in full term babies without any underlying risk factors. And so that's why we are so pleased to now have a population way of protecting all babies.
Last year we did get some Nirsevimab, the monoclonal antibody. We had 2 or 300 doses, and we did focus on getting it to those most high-risk infants. But this year we want to make sure every single South Australian baby is able to receive some form of protection, and that's what we'll talk about next. So over to the next slide. Thank you.
Now, this is as I said at the beginning. This is a complicated immunisation program, and I'm using the term immunisation deliberately, because, as you will know, because you've been and I know, already helping with this program, there's two ways we can immunise people. Well, actually, there's three. So, we can provide a vaccination. And that's an antigen which is mimicking the protein in the virus or bacteria that we're wanting to protect against and we provide the antigen and the body makes antibodies, and also the memory cells. Remember, so that the next time somebody comes across the infectious agent, more antibodies and more killer cells can be made. And that's how we protect.
But also we can protect, or we can develop immunity by an infection. Now, that's the worst way of doing it clearly, because not only do you get some immunity, but you have to go through the infection to get that level of immunity, and also the immunity from infection is often not as good as through vaccination, and children who have had an infection with RSV are still at risk of getting another infection with RSV. So that sort of immunity is not very good either. The other way of doing it is by giving an artificial antibody. And in this instance, there's the monoclonal antibody, and that's the Nirsevimab. I tend to call it sevimab, I think, because I've been not using the Beyfortus, which is the name that's on the packet fit for you out there in your general practice. But the sevimab is the monoclonal antibody.
So it's really important. This is really the main, the thing about this program is we have both a vaccine, and we have a monoclonal antibody. And I asked my team to put the two photos here because the neat bit about this is that the vaccination is for the mother and the baby. Actually, this is the 4th way we protect is, of course, through the maternal placenta when the mum's antibodies or the mum has the vaccine during pregnancy, and the antibodies go through the placenta and then protect the baby.
So different States have done different things over the last 12 months or last 2 years and Sanofi got in first with Nirsevimab and said, look, we'd really like everybody to have a population program and have all babies with Nirsevimab but there actually wasn't enough to go around Queensland and WA got in first and so they've had population programs of all bubs being offered the monoclonal antibody. But then, at the beginning of this year we were able to access the Abrysvo, the maternal vaccine. And I'd said to the government here, and this is using advice from people like Professor Helen Marshall and experts from the National Centre for Immunisation Research Centre, so that's NCRS, the really, my advice was to have a combined program.
There's some real benefits to having a combined program, and one of them is just a simple, practical thing that if you can't get, if there's a supply issue with one thing, it's good to have a backup. And actually, the US, when they started their RSV immunisation program, they ran out. They had problems with the supply of Nirsevimab, and they were so happy they were so pleased that they had the maternal vaccine as well, because it meant they could still protect their population.
The other reason why I think it's really good having this combined program is that actually many mothers would prefer to be vaccinated and get the needle than having their baby have to have a second needle or another needle, so bubs, as you know, they have a heel prick test, they're given a vitamin at birth, and also hepatitis b vaccines. They're already getting some injections. So for mums, when Helen Marshall had done her research, actually, many mothers had said we would prefer to be vaccinated during pregnancy.
So the mums get the vaccine, and the babies get the monoclonal antibody. There is not a vaccine for babies. This is the way it's done in this way.
So probably I've already said some of these things. I really like this poster because it's a lovely visual of protecting your baby against RSV. It doesn't say, Protect yourself during pregnancy. It's about protecting your baby and using this wonderful physiology of the mother's antibodies, going through the placenta and then protecting that baby from the minute they're born.
So we know that vaccination in pregnancy reduces the risk of severe RSV in up to 70%. And it's only you only need that single dose. And the other thing to point out, there is another RSV vaccine. But Abrysvo is the only vaccine approved for use in pregnancy. So, you might have a supply of the other vaccine, and I'll get a slide on that in a moment, for people over the age of 65. But this Abrysvo is the only vaccine approved for use in pregnancy.
A little bit more about the maternal vaccine. So, look, you really want to make sure that the bodies had enough time to make antibodies and transfer it to the baby so that they're protected. So, this is a reason for the first recommendation. If delivery occurs within two weeks of the mother receiving the RSV vaccine, then the infant's recommended to receive Nirsevimab, and that's because the mom hasn't had enough time to make antibody to pass over to the baby. But in any other situation if the mother's had the vaccine, and there's been ample time. The baby does not need the Beyfortus. Sorry, I'm just swapping between the 2 terms, just Nirsevimab comes off my tongue easier. I do apologize.
And the other practice point is, if a pregnant woman accidentally receives or inadvertently receives the RSV vaccine earlier than 28 weeks, and that's what's in our in the ATAGI guidelines, a repeat dose during the same pregnancy is not recommended, because and Mel, please put your hand up if I'm correct on this. My understanding is actually, the trials were from 24 weeks and up, but our ATAGI recommendations are for 28 weeks. So, correct on that. Yes, so it's not. It's not, you know, a die in a ditch, or you'd get too stressed if they accidentally have it at,
you know, 25, or 26 weeks, but you don't need to give another dose. And all of those recommendations and information are in our National Immunisation Program, ATAGI or the Handbook, the Australian immunisation Handbook. And there's also the ATAGI statement.
So again, talking about the vaccination with Abrysvo, the only contraindications are anaphylaxis after a previous dose, or if there was a particular vaccine component, and Mel. I might just get you to jump in. Have we had any issues with? Have we had any reports of anaphylaxis?
Melissa Fidock: No, and definitely not in Australia at this stage, for the early part of the program.
Nicola Spurrier: Yeah. So that's really good news. Very reassuring. Thank you. Just leave your camera on because I might ask you another couple of questions. So the next one is like you would normally, with a vaccination, it should be postponed an individual suffering for an acute febrile illness, because you want somebody to be healthy enough to produce antibodies. You don't want all of their cells, or, you know, pumping out antibody for an infection. You actually want them to be able to generate an antibody response. So that's with an acute febrile illness. But if it's just a minor thing like a tiny bit of a cold, you shouldn't really need to defer the vaccine. So that's something that you all know anyway.
The other important thing is that you can, there's absolutely no reason why you can't do it, is that you can give it at the same time as the other things that you would be offering to women during their pregnancy. So, the flu vaccine covid-nineteen vaccines, or the pertussis vaccine, the DTPA.
I was talking to the head of obstetrics at Flinders Medical Centre and they've decided they will offer the Abrysvo at 34 weeks, which is totally fine. And one of the reasons was, I said, that at the 28-week appointment there was a lot of other stuff happening, a lot of other things going on. And so that's what they decided to do, but there's nothing wrong with giving it together. And, as I said, the recommended time for the RSV is between, the Abrysvo, is between 28 and 36 weeks.
Now, the other important thing with this. I've got a slide on the of the epi curve of RSV. Our RSV season, and you all know it happens in winter. But what we've decided, and this is the national program, we've all decided at AHPC that the RSV vaccine can be given at any time of the year, regardless of the expected birth date. We just thought it was going to get so complicated if we tried to work out the, you know gestational age, plus when the baby is going to be born, and all of that sort of thing. So, we're just rolling this into any time in the year. It's different with the Nirsevimab for bubs that have missed out on having their mother vaccinated. But the RSV vaccine any time of the year.
Right now, I really think this little table is an excellent one, because this shows you the RSV products, this little green table. And you have now got the, and I didn't mention the name of the other vaccine on purpose, because I really just wanted you to focus on a Abrysvo, because that's the one for pregnancy, but some of you may have been asked to give Arexvy, which is the RSV vaccine for adults over 60 years of age. And you can see in that table that that is not funded.
Okay, so ATAGI, as my understanding is, they've had a look at that. It is available in Australia, but people have to pay for it themselves, and it is not cheap. It's quite expensive. So, people will be doing the maths and trying to work out the cost effectiveness of this for the future. But at the moment we don't have a funded RSV program for older Australians. What we do have, though, is, you can see the nip right up the top. So, a Abrysvo for women at the 28 to 36 weeks of pregnancy.
Now we know, because we keep track of any errors in vaccination. But there have been the odd occasion of a vaccine. So, an Abrysvo being given to an infant, and that's clearly what we need to avoid, because it's not designed for infants and infants are too small to mount an antibody response against RSV.
So you can see for infants and children, the only thing there is that they fortis or the Nirsevimab, the monoclonal antibody. So, I really like that little table. It might be something that's worth printing out and popping up on your vaccine fridge or making sure your staff see that.
Now, here we go onto the monoclonal antibody part of this program. So, you might wonder, why is this State funded and parts Commonwealth funded? It's not that the Commonwealth did not want to fund this, let me be clear here. But because we decided as a nation, we wanted to have both things, so that if a mother wasn't able to be vaccinated we could protect the baby even in those situations.
So, the thing about this is because it's not a vaccine. The legislation at the moment for the national immunisation program actually states it's got to be a vaccinate vaccine. And so, until the Commonwealth is able to change their legislation, at the moment the States are paying for the monoclonal antibody program. So, it's a little bit complicated. Nothing that you guys need to worry about because it's us behind the scenes who have to do the purchasing, and it's Mel's team that gets both the vaccine in and the antibody in, and it's where you order from. So, Mel is the director who looks, after all, of the behind the scenes, ordering and distribution across Australia and across South Australia, I should say, you don't want to do the whole of Australia, Mel, I'm sure, but we have a really good. We've got a new vaccine warehouse, or relatively new, and it's very streamlined, and it's fantastic because we can get things out promptly. But you do just think, also, when you're wanting your extra doses, we are a very large State, geographically, with, you know, fairly spread out in terms of the regions where people where our providers are, and we also, of course, now have GP, not just GPs, but we've got other vaccine providers with pharmacists having come on board, and with the Nirsevimab, it's also the hospitals, the maternity hospitals that need it. So, there's a lot of logistics involved making sure that we can efficiently get all of those doses out.
But anyway, getting back to the state funded monoclonal antibody program. This is for babies who have been unprotected. And so that's when a mum has not been able to have an RSV vaccine. But what we really want is to have as many women, pregnant people, to have that vaccine during their pregnancy. So, the baby's automatically protected. And, but of course, you know, I think life gets in the way, and it may not have been possible, and somebody might have gone into preterm labour, and they hadn't had a chance to be vaccinated. So that's what this is for.
And we've said up to 8 months, because the antibody doesn't last 12 months. Okay, it only lasts for a certain period of time. 6 months, probably, is the peak, and we want to make sure that babies over the RSV season receive it, because at the other rest of the year. We really don't see much RSV at all.
And then we want to provide some additional protection for high risk infants. So, Mel, I'm going to get you to jump in just on a practice point. So babies whose mothers have had a vaccine but are also high risk, because they might have congenital heart disease, what is the story with giving monoclonal antibody in that situation?
Melissa Fidock: They, it depends on what age bracket they're in. Sorry, Nicola. So obviously the 1st unprotected babies up to 8 months of age in their first season would receive it, and then the, the high-risk kiddos in their second season. So, if Mum's being vaccinated in that firs season, and obviously the baby's born in less than the 8 months, then the recommendation is for the monoclonal antibody, but then, obviously any other risk factors there. So those high risk, then the recommendation is to have those monoclonal antibodies. So, we need to look at the maternal vaccination status, also the timing, the age of the babies, and what those actual risk factors are.
Nicola Spurrier: Thank you. And that information is all on the website.
Now, this is another really important practice point. And this may be why people got a there could have been a bit of, I was going to say frustrations. Probably it's not maybe not as strong as that, but perhaps a bit bemused. Why, people couldn't order as much of the stock as they felt they might need early on in this program, but I think most of those the understanding is now clearer.
So, the thing with the Bayfortus, the Nirsevimab, is there's 2 different doses again, making it more complicated. So, it's 50 milligrams for babies weighing less than 5 kg and 100 milligrams for babies weighing 5 kg or more in their first season. So, if you think about the weight, normal weight of a newborn, the 50 is going to be most likely given for those newborn babies in the maternity hospitals, where it's been realized that the mother hasn't had a vaccine, and so that tends to be the 50 milligram. So, the other the 100 milligram is likely more to be babies who were born between last October and when those mothers didn't get a maternal vaccine, because the program only started in February. So, they're still less than 8 months. But they're going to weigh more than the 5 kg, and that's the main group, the cohort that the, as well as the mums, of course. But this is the pregnant mums that this is mainly the cohort that GPS will be seeing is this catch-up component. And again, it's added another layer of complexity in this program.
So, we mainly think that GPS would be having a wanting to need to order more of the 100 milligrams than the 50 milligrams. But of course, you know, there might be the need for the 50 as well.
So, infants and children, because it's a monoclonal antibody. They can have it at the same time, or separate to routine, infant and childhood vaccines, and I was happy when I was helping on the ward up at Flinders recently to be able to say to a mum whose child was in, I think, with a UTI, ‘Actually, look at this. Your child's eligible for this, and they haven't had it’ and I can't remember how old they were. They might have been 6 or 7 months old, and the mum was thrilled. She said, I'm not like let's have it in the hospital. And they went off happy, though, and knew that their little one was protected this season,
The only, as again, the only contraindication to anaphylaxis after a previous dose which won't be have happened, because no one's had Nirsevimab up until now, or any component of a monoclonal antibody, which is again unlikely. And Mel, any information on any of these side effects?
Melissa Fidock: So, none recorded in Australia at the time of the program, and being mindful WA, in Queensland, had programs last year as well, so very well tolerated.
Nicola Spurrier: Excellent. So that's really good news. Good to be able to reassure your patients. So next slide. Look, this is too small to read. But it was really just a reminder that we have a schedule for RSV for the monoclonal antibody specific to South Australia, because it's our program. And we understand that the Commonwealth, because it was focusing on the RSV vaccine for mothers may not have had that sort of balance between the RSV vaccine for mums and the monoclonal antibody for babies, but really just to say. Please again print and PIN up our schedule and follow that.
Just a little reminder that in South Australia our requirement is in terms of it being a notifiable condition that, if there are any side effects, we need to report those AEFIs for both the Abrysvo and Beyfortus. So, I know that you all understand that because you do a great job at that, and we get those reports through. But also, you may have wondered whether you need to report doses of Beyfortus or the monoclonal antibody also to AIR like you would with every other vaccine. But this is not a vaccine, so maybe you don't need to. Well, actually, the Commonwealth have made sure that the Australian immune register is capable now of having that reported so that we get a wonderful picture and a record for all parents about what their children have had. So that's also just an important point to make.
I thought you'd be interested to see how our RSV season is going this year. Wouldn't it be good if that lovely red line for 2025 just stayed low? This is the actual number of cases, and people tend to, you know it was notifiable. We made it notifiable since 2021. So that's the data I'm giving you. Of course, in 2021, everyone was being perfect with their infection, prevention, and control. So, there was nothing. But since that time, of course, we've gone back to a standard RSV season. So we tend to, well, people get their swabs done, get their PCRs done when they've got symptoms, so we may find that we have fewer cases being reported, because that's the only way we diagnose it if people are being swabbed. But of course, there are still a lot of adults around that may end up with RSV. But with the other thing we will be tracking, I'm hoping, Mel, and tell me if I'm wrong, but the hospitalization rate as well, because clearly, that's key, because that's the reason we're doing the immunisation program.
But that's where we're up to at the moment. So, around this time, you can see that it kicked up in 2023, and 24, but in 22 it was a bit delayed. So, it's generally around where it was in 23/24. And then I thought, because we're talking about respiratory infections, you might like to see where we're up to with flu. So, we'll just go to the next one. So, I put this on here. You can really see now that the flu numbers are starting to climb. So, it's interesting because the baseline's been higher over the last couple of years than it used to be since the pandemic. And then so you can see that red line was sitting higher for quite a few months. But now we're starting to get that uptick. And, as you know, no previous flu season can predict the next flu season, so, it's anybody's guess what's going to happen here. The only thing I can say definitively is, the more people that have their flu vaccine the better the season will be in terms of impact on our healthcare system, including to your practices as well. So, a big thank you to all the flu vaccines you've already given to all your patients. Keep it up, I think, Mel, it looked like we were just slightly higher than last year, but it's the under-fives that I'm still really concerned about. And just to let you know we have. We've just seen the creative of a media campaign for the parents of young children. And I think it actually is quite a nice campaign. It's really it really sort of touching the hearts of parents about how even healthy kids can get the flu. So, and I know you're talking to Stephanie. You guys do a great job talking to parents about how important it is to get those vaccines. But maybe you'll just go to the end because we've got our resources. So come to our website to see all of those resources. And that's the end of that presentation. But I just also wanted to recognize that it is actually quite difficult post pandemic with the amount of vaccine hesitancy and the information and misinformation disinformation that parents have. You know, I was going to say access, but they don't necessarily access it, because when you're online things just tend to get sent to you if you're on social media that you may not necessarily have sought out, and it's making it very difficult for you at the front line, and I know you do a fantastic job talking to parents about the importance of vaccination and I do really want to thank you for that as well.
So that was the end of the presentation, and what I did want to do was go over to Mel first and I'd love Mel to tell you all how we're going with our vaccine uptake, and also our monoclonal antibody uptake. And then Dr. Steph is going to jump in with some practice tips, and then we will go to some questions. Thank you.
Melissa Fidock: Brilliant. Thank you, Nicola, so, quite excitingly, we've nearly distributed up to nearly 10,000 doses of vaccine across the State, which is a fantastic effort and a vast majority of those to GP services. We're looking at about a 60% uptake for the maternal vaccine at the moment, noting the program only started in February. So, we still want to see that sort of climb a little bit higher with the target, probably towards more 70% for that vaccination.
With our monoclonal antibodies, we're starting to see an increase in our distribution for those with a total quite, quite small, nearly 2,000 doses that have been administered. So that's quite exciting. So, we've got a good coverage across both aspects of the program. But obviously we can always do better.
Nicola Spurrier: Thank you so much, Mel. And really you will have picked up that. The main part of our program is the maternal vaccine. But we're so pleased that we can offer the babies as well. So, I think we could probably do a wee bit more pushing. And, you know, talking to and educating around the Nirsevimab in our maternity hospitals, but also on our paediatric wards. So yeah, I'm interested to know from a general practice point of view. If that if we need to get more messaging out to you, or more information that you can share with parents.
So, Steph, over to you with some practice tips, please.
Stephanie Hendrijanto: Hi, thanks everyone for having me. I'm really excited about this program actually. It sounds complicated in theory. But I think, as everybody gets used to it, it won't tend to be so much certainly, with the maternal RSV vaccine for pregnancy. It's not a new concept to a lot of people, because we've been doing whooping cough similarly for a long time now, and mums are really used to that idea of having that done so that they can pass antibodies to their baby. So that isn't something that takes a lot of convincing for a lot of them. The other thing is particularly with mums who've had kids before, or they've had friends who've had kids, they're also quite familiar with RSV and how nasty it can be for little ones. So, with a little bit of discussion and encouragement, I'm hoping that it won't actually be particularly difficult to get mums to have that. I think it's just everybody's awareness will pick up as time goes on. So hopefully, we do get above that 60-70% rate that we've got now.
The main way. I try and think about it when I've got a baby in is to think about mum and baby essentially as a pair. We at least one of them to have been immunised ideally, mum, during pregnancy. But don't forget that the maternal immunisation only actually came out on the national immunisation program in about February. So that if you think about, you know, 2 weeks into February, babies born from about mid-Feb, some of those mums would have had that immunisation but there's still a reasonable chunk of, you know, 3 and a half to 8 months old babies that will be eligible for Nirsevimab, and not had it yet. I know that in our practice we did a little run through orders of our database to actually look at babies of that age group, and, you know, do a bit of a text to invite people to come in. And we had a lot of people, you know, calling up and asking to have that done which is really great.
And then, yeah, there's kind of a few babies here and there, whose moms, for whatever reason, haven't taken it up during pregnancy. But then have been really happy for baby to have that Nirsevimab with their with their kind of routine immunisation, so it can be given at those 6 week, 4 months, 6 month immunisations, and especially given that it is so well tolerated. There's no problem with co-administering it with those other immunisations as well. The other group, I've found, actually are babies coming from interstate. So, I've had a couple of babies whose families have moved recently from New South Wales, who were very happy to protect their kid against RSV. So, I think there's lots of opportunity for us as GPs to really encourage these immunisations and push to protect our bubbies. Other than that, obviously, it's just a matter also of identifying those higher risk children who can have it in their second RSV season. And again, I'd really encourage all us GPS just to have a think about who might be eligible. Those sorts of kids do tend to stick out in our minds, so there might be some that we're aware of, but I certainly wouldn't just rely on the hospitals to be identifying those babies, because, again, it is pretty opportunistic and, you know, relies on, I guess, having the clinician thing and them at the hospital kind of having that awareness of it, having time to do it and that sort of thing. So if we can jump in on it in GP I think that that would probably be really well received.
Nicola Spurrier: Thank you very much. So that was really interesting about people from interstate, because I am taking it that Victoria and New South Wales don't have a catch up program for the monoclonal antibody this season for the bubs from October. Is that correct? Yeah, I was in Victoria for a paediatric update. And somebody was saying that I actually thought we had the same program nationally. So again, really happy we've done it in South Australia.
Just the other thing I wanted to absolutely clarify. I just want to make sure that it's really clear, and I should have, we should have perhaps put this on the slide. But infants who are at increased risk of severe RSV disease, and there's a list of that, that are eligible for the Nirsevimab, the monoclonal antibody, regardless of their mother's
RSV vaccine status. So, they're going to get a double protection because they're actually at higher risk. So, I just wanted to double check everybody did understand that. It's not that large a group of children we estimated last year. That might be 200 or 300 kids in South Australia like that. And you know their paediatrician or specialist have probably got onto it. But again, you will know those kids in your practice, and we just want to make sure that you know understand that they get the double protection. If you accidentally give a monoclonal antibody to a mum, and the baby's not at severe risk, and the mother was vaccinated and you just you know, you didn't realize. It's not going to be dangerous, but it's still considered a program error which we do want to have reported, because, of course, the doses are really, we've worked them out and paid for them, as in, you know, resource it as per what the recommendations are.
So I’m not sure, I can't see the questions. So Mel, did you want to leap into that section?
Melissa Fidock: I'm more than happy to do that for you, Nicola. And yes, I've just confirmed as published on our website. So, babies less than 8 months of age, even if the mum has been vaccinated and they have high risk conditions, they are still eligible to receive the monoclonal antibodies. So that's confirmed.
So some of the questions. If the Mums had RSV infection prior to pregnancy, can we test the mother for the RSV antibodies before we give the vaccine? Nicola, did you want to answer?
Nicola Spurrier: Well, look, I'd be saying that that's not a contraindication to giving the vaccine, and we know that what we do know is when trials have been done at a population level which haven't taken into account whether the mother's had RSV infection or not, that's what we're basing the evidence on. So, I definitely would not be going down that route and antibodies only because RSV, you know, antibodies against different infectious agents act differently, and last for different variable length of time. So with RSV, we know that the antibodies that you might generate when you have an infection don't last particularly long. Same with our monoclonal antibody. It only lasts up to 6 months. What we don't know yet is how long the maternal antibodies last after being vaccinated. So that's still an open question, but they certainly are covering the baby for that period of time at that highest risk period. So, it doesn't matter if the mother's had RSV before and it doesn't matter if the baby's had RSV before. Just follow the program.
Melissa Fidock: Thanks, Nicola, and that pretty much covers one of the other questions for women needing vaccination in every pregnancy, such as DTPA. So yes, again.
Nicola Spurrier: Yes. So that's what, because it's, of course, only a new vaccine but that is what is currently recommended. If we get new information to say, gee! This is such great vaccine that we don't seem to need to repeat it, but at the moment that's certainly the recommendation.
Melissa Fidock: Lovely. And just to confirm the RSV season is winter.
‘Can we share the recording of this?’ I'll hand that over to the RACGP experts on this in a little bit.
Nicola Spurrier: Let me just stop on the one about the RSV season. Okay? Because it is a slightly different between states. So, I've shown you our epi, and, as I said, we didn't have it notified before that. But I can tell you, as a paediatrician, it was bang in the middle of winter absolutely every single year. But if you're up in Queensland because of their different climate they actually can have RSV earlier. So, they started their program a little bit earlier with the monoclonal antibody. We all had to have the RSV vaccine at the same time, simply because that was when it was started by the Commonwealth.
And now every State, it's all around all the year round for the vaccine for mums, but the antibody is over the winter period for us. So yeah, different states may be slightly different because of that. I can't recall what Northern territory is, but they're more likely to have lined up with Queensland. Now, that's what it's looking like at the moment. But who knows? With climate change and our climate changing climate we're just going to have to keep checking on the epi and adjust accordingly. But this is definitely what we've got at the moment.
Melissa Fidock: And just one other question here, Nicola, they're a little bit confused about the second season. We've only just started the program. So, we're not in the second season, but it's referring to an RSV season. So that's why we'd be double dosing those kiddos.
Nicola Spurrier: Hang on! I'm confused now.
Stephanie Hendrijanto: Yeah, sorry. I mean, basically, babies second RSV season. So not the season of the immunisation program like babies. The second year, I guess, of being exposed to RSV. The RSV season dosing, Nicola, you might want to say, but I think this would be more weight based.
Nicola Spurrier: Oh yes!
Stephanie Hendrijanto: Because they'd be older.
Nicola Spurrier: Absolutely so. This is babies who are now you know, maybe 12 months to 2 years of age, and it's their second year of life or their second experience with an RSV season. So those babies who have medical risk factors are also eligible, even though they're outside the traditional bronchiolitis, you know, when we see bubs admitted. And they're tiny, but we know this age group for kids with severe cardiac or respiratory conditions also can run into trouble with RSV, so they are also eligible for the monoclonal antibody. And these babies are all big. So they'd be getting the 100 milligrams, but I actually think it is. Mel, can you just double check? It is based on weight. And I think it may be two doses of the 100. So, the 200 milligrams depending on how big the bub is.
Melissa Fidock: Correct. 200 milligrams, Nicola, yes.
Nicola Spurrier: So based on weight.
Stephanie Hendrijanto: We had to do, it's 2 of the 100. So, we, basically, you know, gave one on each side, the same time.
Nicola Spurrier: Thank you. Good to have someone here that's actually given it.
Nicola Spurrier: So, it's quite a quite decent amount. So, but you're thinking this is not that many babies, but it's kids that will really get into trouble if they get RSV, so I'm really pleased we've got that. Also, when I was in Victoria for this paediatric update, the chair of ATAGI was there, and he was presenting on RSV. And he was saying that in Victoria they've included in babies experiencing their second RSV season Aboriginal children. ATAGI haven't put that in their current guidelines, but they weren't, they said there wasn't enough evidence or information yet, but Victoria has decided to do that, and I think that's something that we will look at for South Australia next year.
Melissa Fidock: Lovely answered the next question, thank you. ‘Comparison: What is the mortality rate of RSV in children to whooping cough and flu?’.
Nicola Spurrier: Oh, I will have to take that one on notice. I do apologize. I carry a few numbers in my head, but I don't have that. In an unvaccinated child whooping cough is just devastating, just from my own personal experience. Having seen little babies in hospital with pertussis, they're almost impossible to ventilate as well because of that paroxysmal cough. So, yeah, I'd have to get back to you. And we can either say in unvaccinated or unvaccinated. But if we go from first, if you go from the principle that in Australia we have ATAGI, which is a group of very experienced clinicians and researchers in vaccination. They've looked at all of the literature, and they weigh out what is the cost? Because we have to pay for it, of course, but also the risk benefit clinically. So, they look at all of the side effects or potential side effects and the benefits and make a decision based on that. So, you know, with whooping cough it completely outweighs it, and also with flu. I mean, flu is another cause. I think sometimes parents don't understand that bronchiolitis can be caused by a whole lot of different viruses. And one of those is influenza. And so yeah, influenza. And it's definitely for that under-fives, we see kids getting really, really sick. We hope they don't die because we have them in hospital, and we look after them and get them through and nurse them through. But it's not good for the baby. It's not good for the health system, it's not. It's really not good for parents taking time off work and it’s very stressful for families.
Melissa Fidock: Thank you. And what is the recommended vaccine for the elderly? And how long would immunity last? I don't even know that.
Nicola Spurrier: Yeah, I'm not sure how long it lasts, but it's the one we had on the slide. So, it's how do I say, it's a Arexvy. Yeah, Arexvy. It's got the rex in it. So that's the one that's about, how much have we seen it? For in the pharmacy, 200 and something.
Stephanie Hendrijanto: About $300 when I looked last. Yeah, it's fairly expensive. I think when I was having a look at this recently, it's got pretty good protection for those over 65 for at least the first year, and currently a second dose isn't necessarily recommended for the second year, so they thought it provided some coverage into the second year as well. But I don't think there's kind of longer-term data than that at the moment.
Melissa Fidock: Great thanks, Steph, and a wonderful question here: ‘Do you think asthma rates may decline as a result of the program?’
Nicola Spurrier: Oh, that's a million dollar question. I did my PhD many years ago on asthma, actually, and we never really understood did bronchiolitis, did RSV bronchiolitis, cause asthma? Or was it that children who had an asthma tendency more likely to get sick when they got RSV and therefore end up coming to medical attention. So, I don't think we know. But certainly, wouldn't it be wonderful if that was the case, particularly in Australia, where we have such high rates of asthma. Clearly, there's other things, though, because, you know, we know people who are atopic with a family history of asthma. And there's also other allergens that trigger asthma, and there would have to be some other environmental triggers, I think, or part of that causation, because
Australia does have one of the highest rates of asthma, and other countries have got pretty high rates of RSV. But let's just see, that was one of the things I have got in the back of my mind to question as well over coming years.
Melissa Fidock: Great. Thank you, Nicola, and just to double, to confirm if the mum is immunised after 28 weeks, and the baby is less than 8 months of old, the baby does not need the monoclonal antibody if they don't have risk factors?
Nicola Spurrier: You can answer that one.
Melissa Fidock: So, the answer is, yes. So, if the mum has been vaccinated after 28 weeks, baby's born less than 8 months, no significant risk factors, then the baby doesn't need the monoclonal antibody.
Nicola Spurrier: Yes, so you did say yes, but the answer, the question is actually no, they don't need it. So, bubs are protected solely through their mother's immunised vaccination. If they got the vaccine at the right time in pregnancy, the bub doesn't need anything else. It's only babies whose mothers didn't get it at the right time of pregnancy, didn't get it in pregnancy, or have some other severe health condition.
Stephanie Hendrijanto: And I'd encourage people to actually put up that purple poster, you know, up in their treatment rooms, because it does set out really, clearly actually which babies are eligible, or what those risk factors are that make them eligible for an extra dose or a dose in their second season. It's quite clearly laid out.
Nicola Spurrier: And so that really means that about 60%, if we're saying, there's about 60% of maternal vaccine uptake. And there's only a few babies with very severe health problems that need the monoclonal antibody in addition. So, it should be about 60% of babies that do not need the monoclonal antibody if you put it the other way around. So the majority will not need it.
Melissa Fidock: Lovely, and just checking the Medicare status and eligibility for one, the maternal vaccination program and two for the monoclonal antibody program. Do you want me to answer that? Thank you. So, the national immunisation program facilitates the maternal program, and that is for Medicare, eligible patients only. As that is part of the national immunisation program. The monoclonal antibody program is a state funded program, and we have left that open. So I'll leave. Yes, is the answer to that.
Nicola Spurrier: So. Yes, Steph Mel asked me early on, what are we going to do with people who haven't got Medicare? And I said, I want everybody protected. I think we can squeeze enough doses out. So, the Commonwealth, of course it's under the nip, and they organise the Medicare and such, I just want to make sure our bubs in South Australia get protected.
Melissa Fidock: Thank you and a scenario here I have a premature baby born in Victoria 18 months now, moving into the second season. 24 weeks premature. Does she need the monoclonal antibody? So 18 months, moving into the second season, was born at 24 weeks premature. Would that baby be eligible for the monoclonal antibody? It would depend on any other high-risk factors, but I assume at that prematurity there might be.
Stephanie Hendrijanto: Yeah, I think again, that's on the purple poster. But I'm pretty sure it's under 32.
Melissa Fidock: Yeah, 32.
Stephanie Hendrijanto: So, yes, I would have thought that that baby would be eligible and hopefully benefit greatly.
Nicola Spurrier: And I would agree. I was, I'm trying to flick between screens, and then my mouse doesn't work on the other screen. But yeah, so as I had on one of the slides, prematurity. So, babies who are born preterm. So, we've got here. Yeah. And so, it's RSV monoclonal antibodies are for. Where's the second year one? I can't see it, anyway. Yeah, the one of the medical risk factors for severe RSV disease is preterm birth, gestational age, or correct step less than 32 weeks. Yeah. So yes, you may give that to that Victorian baby.
Melissa Fidock: Lovely. Thank you, Nicola, and that's it for the questions. Sorry to jump in there, Jo.
Jo Rayner: That's fine. I was going to say, unfortunately, we've run out of time, but I guess I'd just like to, on behalf of everyone online tonight, thank Professor Spurrier and her team from SA Health for the wonderful presentation tonight. I'm sure you've all gained lots of knowledge. If you've got follow-up questions that perhaps weren't answered, certainly, either send them through to the RACGP and we can send those on to Nicola and her team or obviously, there's lots of information on the SA Health website as well.
Nicola Spurrier: Can I just jump in just to say I really recognize it's very complicated, and you'll see that we were asking each other and double-checking things because it is complicated. There's so many different layers. So, this is where it's really important to have the information up. And if you're not sure, just get on to Mel and Sarah, who's online here tonight as well, and our team are really helpful. Phone in and talk to one of our immunisation nurses that will assist.
Jo Rayner: Great, thank you. So, in a moment there'll be a QR link to an evaluation form that will be on the screen. And it will also be emailed to you at the end of the webinar. If you could take a moment to provide us with some feedback on this evening's webinar, it would be greatly appreciated, as it helps us at the SA faculty to plan future education sessions for our members. Thank you so much for joining us this evening, and we look forward to seeing you next time. Good night.