Immunisation for Health Practitioners (306)

Immunisation for Health Practitioners (306)
Assessment 4 : Catch-up worksheet and vaccine administration
Student’s name
(as per AHPRA registration) :
Student’s ID :
Health profession :
Tutor’s name :
Month of course commencement :
Due date :
States / Territory student is
practicing in :

Table 1 - Catch-up worksheet for children <10 years of age for NIP vaccine
(Adapted from The Australian Immunisation Handbook Figure 2.1.1)
Vaccines
No. of
previous
doses
No. of
doses
required at
current age
Dose
number
due now
Further
doses;
intervals
Student’s comments
Example 2 4 4 4 weeks
Diphtheria, acellular
pertussis, tetanus
(DTPa)
4 5 2 42months
Poliomyelitis (IPV) 3 4 1 42 weeks
Hepatitis A 2 2 0 Not needed
Hepatitis B 2 2 0 Not needed
Haemophilus
influenzae type b
(Hib)
2 2 0 Not needed
Pneumococcal
(13vPCV) 4 4 0 Not needed
Pneumococcal
(23vPPV) 0 1 1 42months
Meningococcal
vaccine (delete as
appropriate)
1. Monovalent
meningococcal C
conjugate
vaccine
(MenCCV)
2. Quadrivalent
meningococcal
conjugate
vaccines
(4vMenCV)
3. Meningococcal
B vaccine
1 1 0 Not needed

(MenBV also
known as
4CMenB)
Measles / Mumps/
Rubella (MMR) 2 2 0 Not needed
Rotavirus 2 2 0 Not needed
Varicella 1 0 0 Not needed
Influenza 2 2 0 Not needed
Catch-up appointments
Visit 1 Vaccine brand name and
dose number
Site / route of
administration Student’s comments
Current visit
Infanrix* hexa Intramuscular (IM)
injection
Prevenar 13 Intramuscular (IM)
injection
Rotarix Oral
Visit 2 Vaccine brand name and
dose number
Site / route of
administration Student’s comments
What is the
Interval from Visit
1?
2
months
(delete as
Infanrix* hexa Intramuscular (IM)
injection (NCIRS, 2015)
Prevenar 13* Intramuscular (IM)
injection
Rotarix Oral