Secondary School Immunization Program

Many adolescents can receive recommended vaccines free of charge at school. These programs are usually run in partnership with schools and are delivered in school settings by trained nurse immunisers.

How school immunization works#

Routine adolescent vaccines are typically offered to students in the early and later years of secondary school. Before any vaccine is given, consent must be provided by a parent, guardian or other person responsible for the student’s medical decisions. Consent is usually completed on a consent card or, at some schools, online.

Some tips to help prepare an adolescent for a school-based vaccination:

• give them a good breakfast beforehand
• have them wear a loose shirt so the upper arm is easy to reach
• make sure they are feeling well on the day
• encourage them to tell the teacher or nurse if they feel nervous or unwell

It is important that students tell the immunization provider before vaccination if they:

• are unwell on the day, for example with a fever
• have a disease, or are having treatment, that lowers their immunity
• have ever had a severe reaction to a vaccine
• have a history of hives after a vaccine
• have any severe allergies, such as an anaphylactic reaction to yeast or latex
• are pregnant

After being vaccinated, students should stay at the place of vaccination for at least 15 minutes. This allows staff to watch for any immediate reaction and to provide rapid medical care if it is needed.

Human papillomavirus (HPV)#

HPV is the name for a group of viruses that affect both females and males. It is very common to be infected with one or more types of HPV soon after sexual activity begins. The body usually clears the infection naturally and there are no symptoms, but some types of HPV can cause serious illness, including several cancers of the genital area and cancers of the mouth and throat.

The HPV vaccine protects against high-risk HPV types that can cause cell changes and cancer. The benefits are greatest when the vaccine is given before exposure to the virus, which is why it is offered to young people in early secondary school, before they become sexually active. If a vaccinated person later comes into contact with these viruses, their immune system can respond more effectively, preventing disease or greatly reducing its severity.

For most people the HPV vaccine is given as a single injection into the upper arm. Some adolescents — for example, those with significant immunosuppression — need a three-dose course; a doctor can advise on this.

The HPV vaccine is safe and well tolerated. Vaccines must pass strict safety testing before they are approved, and their safety continues to be monitored once they are in use. Side effects are usually only very mild.

Cervical screening is still important later in life for vaccinated women and other people with a cervix, because the vaccine does not protect against every type of HPV that can cause cervical cancer.

Diphtheria#

Diphtheria is a serious bacterial disease that causes inflammation of the nose, throat and windpipe. The bacteria produce a toxin that makes an abnormal membrane grow in the throat, which makes it hard to swallow and breathe and can even cause suffocation. The toxin can also spread through the body and cause serious complications, including paralysis and heart failure. About 10 per cent of people who get diphtheria die from it. It spreads when you inhale droplets from the cough or sneeze of an infected person.

Tetanus#

Tetanus is caused by bacteria that live in soil, dust and manure. The bacteria can enter the body through a wound, which may be as small as a pin prick. Tetanus cannot be passed from person to person.

It is a serious disease that causes muscle spasms and breathing problems. The toxins affect the nervous system, with muscle spasms first felt in the neck and jaw. Tetanus can lead to breathing difficulties, painful convulsions and abnormal heart rhythms. Around one in 10 people infected with the bacterium will die. Tetanus is uncommon where the vaccine is widely used, but adolescents who have not been immunized, or who have not had a booster, are at risk.

Whooping cough (pertussis)#

Whooping cough is a highly contagious disease that affects the airways and breathing. It causes severe coughing spasms, often followed by vomiting, and the cough can last for months. It spreads when you inhale droplets from the cough or sneeze of an infected person.

Protection from both the disease and the vaccine fades over time, so a booster dose is recommended for adolescents to maintain immunity into adulthood.

The diphtheria-tetanus-pertussis booster#

Diphtheria, tetanus and pertussis vaccines are given together as a combination booster, delivered as a single injection into the upper arm. The booster extends protection against all three diseases into early adulthood.

The booster contains a small amount of diphtheria and tetanus toxins that have been modified to make them harmless, small purified parts of the whooping cough bacteria, a small amount of aluminium salt and a preservative. It has lower concentrations of the diphtheria and whooping cough components than the vaccine given to young children. It is safe and well tolerated in adolescents, and can be given at least four weeks after a recent tetanus-containing vaccine.

Meningococcal disease#

Meningococcal disease occurs when meningococcal bacteria, which are commonly carried harmlessly in the nose or throat, invade the body and cause serious illness. Older teenagers and young adults are the most likely to carry the bacteria and spread them to others.

Invasive meningococcal disease is rare but serious. It most often appears as septicaemia (infection in the blood) or meningitis (inflammation of the membranes covering the brain). Less commonly it can affect the joints, throat, lungs or intestines. Most people recover if it is diagnosed early, but it can cause permanent disability through loss of limbs, deafness, blindness, scarring, or kidney or liver failure. Death occurs in up to 10 per cent of cases. Worldwide, the serogroups A, B, C, W and Y most commonly cause disease.

Vaccination is the key way to prevent meningococcal disease. The Meningococcal ACWY vaccine is a combined vaccine that protects against the A, C, W and Y strains, and studies show it can provide up to 97 per cent immunity in adolescents. It is given as a single injection into the upper arm. Adolescents who previously received a Meningococcal C vaccine should have the ACWY vaccine for the best protection against all four strains.

Meningococcal ACWY vaccines have been shown to be safe in large population studies across all ages, from infants to adults. Most reactions are mild and settle on their own. The vaccine contains no live bacteria and cannot cause meningococcal disease.

Possible side effects#

Any vaccine can cause mild reactions, and there is a very small risk of a serious allergic reaction. Common mild side effects include:

• pain, redness and swelling at the injection site
• a small, temporary lump where the injection was given
• low-grade fever
• feeling unwell
• headache

Mild reactions can be eased by placing a cold, wet cloth on the sore injection site, drinking extra fluids, not over-dressing if there is a fever, and taking paracetamol. Less common side effects include a rash or hives.

This is why students should stay at the place of vaccination for at least 15 minutes afterwards, so they can be watched for any reaction. A severe allergic reaction — for example, facial swelling or difficulty breathing — is rare, but if it happens, immediate medical attention will be provided. If reactions are severe, persistent or worrying, contact your doctor or hospital.

If a student is known to faint easily or is very anxious, or has a history of hives after a vaccine, it is important to tell the immunization provider beforehand. In some cases it may be better for them to be vaccinated by a doctor rather than at school.

If a vaccine is missed#

If a student misses a school vaccination, they can catch up as soon as possible through a local immunization service, some pharmacies or a doctor. The vaccines themselves are free, although the provider may charge an administration or consultation fee.

Adolescents who do not attend a mainstream school — including those in remote learning or home schooling — can be immunized through a local immunization service, some pharmacies or a doctor. Adolescents with disability should have the same access to immunizations as everyone else; ask your provider about resources that can help make the experience easier.

Your immunization provider can also advise on any early childhood vaccines that may have been missed, or any other vaccines that may be needed, and can tell you how to obtain a record of your child’s immunization history.

Key points#

• Students should tell their immunization provider beforehand if certain health conditions apply.
• Tell the provider if the student has a disease, or is having treatment, that lowers their immunity.
• It is very common to be infected with one or more types of HPV soon after sexual activity begins.
• Some adolescents, such as those with significant immunosuppression, need a three-dose HPV course.
• Diphtheria bacteria produce a toxin that can spread through the body and cause serious complications, including paralysis.

Where to get help#