IMMUNISATION

Immunisation is of vital importance in preventing a number of very nasty and frequently fatal illnesses. Because many immunisation programs have been extremely successful, many of the diseases have become very rare - so rare that many people now know little of them - diseases such as diphtheria, smallpox and polio - these diseases were much more common and killed many more people than infections such as HIV and hepatitis about which we hear so much. Smallpox - the scourge of much of the world for centuries, has been completely eradicated by immunisation.

It is imperative that we do not become complacent about immunisation, as these diseases could rapidly re-emerge if the number of people with immunity from vaccination should decline.

[immunisation schedule - children]   
[immunisation schedule - adult]    
[st agnes immunisation]      [hepatitis A]     {hepatitis B] 
[influenza vaccine]     [pneumococcal vaccine]-[ incl Prevenar]  
[MMR vaccine]    [chickenpox]    [meningococcal vaccine]
[polio]    [ Hib ]
[Triple Antigen IPV - tetanus, diphtheria, whooping cough, polio]   
[ Gardasil - HPV, genital warts]   [Rotavirus]

NEW   AUSTRALIAN  IMMUNISATION  SCHEDULE

A new immunisation schedule applying to children born after 1st May 2000 was introduced several years ago. The main change was the introduction of hepatitis B vaccination for infants. 
From November 1st 2005, this schedule has been further modified. The most recent changes include the inclusion of polio with the diphtheria, tetanus and pertussis injection, universal pneumococcal vaccination and chickenpox vaccination at 18 months. Hepatitis A is also provided for all indigenous children.

The schedules are detailed below.
Click on the heading to go direct to your schedule.
Children born AFTER 1st MAY 2000
Children born BEFORE 1st MAY 2000
Adults
New Vaccines

St Agnes provides a full immunisation service, a doctor appointment is necessary on each occasion.

Schedule for children born BEFORE 1st MAY 2000 is :

Children

4 Years (prior to school entry)
Diphtheria, Tetanus and Pertussis
Polio 
Measles, Mumps and Rubella

10 to 13 Years (Year 8)
Hepatitis B - repeated after 1 and 6 months

15 to 19 Years (prior to leaving school)
Diphtheria and Tetanus
Polio

Schedule for children born  AFTER 1st MAY 2000 is :

Children

At Birth (less than 7 days)
Hepatitis B

2 Months
Diphtheria, Tetanus, Pertussis,Hib, Hepatitis B and Polio (Infanrix Hexa)
Pneumococcal (Prevenar) 
Rotavirus  (Rotateq) - those born from 1/5/2007

4 Months
Diphtheria, Tetanus, Pertussis,Hib, Hepatitis B and Polio (Infanrix Hexa)
Pneumococcal (Prevenar) 
Rotavirus  (Rotateq) - those born from 1/5/2007

6 Months
Diphtheria, Tetanus, Pertussis,Hib, Hepatitis B and Polio (Infanrix Hexa)
Pneumococcal (Prevenar)
Rotavirus  (Rotateq) - those born from 1/5/2007

12 Months
Measles, Mumps and Rubella (Priorix)
HiB      (Hiberix)
Meningococcal C  (Neisvac C )

18 Months
Chickenpox (varicella)     (Varilix or Varivax)
Indigenous Australians
Hepatitis A    (VAQTA)

2 Years
Indigenous Australians
Hepatitis A        (VAQTA)
Pneumococcal    (Pneumovax 23)

4 Years (prior to school entry)
Diphtheria, Tetanus, Pertussis and Polio (Infanrix/IPV)
Measles, Mumps and Rubella   (Priorix)

Year 8 students
Hepatitis B  (2 doses)   (H-B Vax II)
Human Papilloma Virus (genital warts)  (3 doses) (Gardasil)   boys (from 1/2/13) and girls
Chickenpox (varicella)     (Varilix or Varivax) - if not previously vaccinated or had chicken pox

Year 9 students
Diphtheria, Tetanus and Pertussis   (Boostrix)

ADULTS

At 50 Years
Diphtheria and Tetanus

Post Partum ( for non immune women )
Measles, Mumps and Rubella

Over 15 Years ( Aboriginal and Torres Strait Islanders)
Pneumococcal  (repeated every 5 years)
Influenza (repeated every year)

Over 65 Years
Pneumococcal  (now single dose for most people)
Influenza (repeated every year)

Indigenous Australians
Pneumococcal    (Pneumovax 23) at ages 50 and 65 years

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ST AGNES SURGERY'S IMMUNISATION RATE

In 1998 the Commonwealth began reporting on the immunisation rates for children up to age 6 years achieved by individual general practices - this was part of the Australian Childhood Immunisation Register.

All children attending the practice are included in the reporting - even visitors attending the practice only once.

ST AGNES and TEA TREE SURGERY have achieved a marked improvement in the immunisation rates of our patients with these new systems now available.

OUR OVERALL IMMUNISATION RATE :

LATEST (February 2013 )   97.3%

(as of February 2013)                                         ( to top of page )

HEPATITIS A Vaccine

Hepatitis A ('infectious hepatitis') is an easily transmitted viral infection spread by poor hygiene. It is particularly common in countries and areas with poor sanitation.

While many infections have few symptoms, the most common form of illness is acute hepatitis, or ‘yellow jaundice’. Patients feel off colour, have no appetite, pass brown urine and develop yellow skin and eyes. Most people recover fully, but occasionally the acute infection is very severe and can be fatal. The incubation period is 2 to 4 weeks. Unlike hepatitis B, there is no chronic carrier state.

  Hepatitis vaccine is available in two forms :

  Hepatitis A alone (e.g. Havrix A). Two injections are required, 6 to 12 months apart. Immunity develops 2 to 4 weeks after the first injection.

  Hepatitis A + B ( e.g. Twinrix)  - This gives immunity to both hepatitis A and B. Three injections are required, 1 and 6 months after the first.

Hepatitis A vaccination is recommended for :

Neither hepatitis A nor B are live vaccines.

  Hepatitis A vaccine should NOT be given to those with a previous allergic reaction to either hepatitis A or B vaccines, or where there is a fever over 38.5.

  Adverse reactions to the vaccines are very uncommon although 20% to 50% of people may feel a little off colour and have some soreness at the injection site. Fever or headache are quite uncommon.

  Both vaccines can be given during pregnancy.
Click here to download the hepatitis A sheet

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HEPATITIS  B Vaccine

Hepatitis B is a serious infection which is transmitted by contact with infected blood or body fluids.

Infection may result in acute hepatitis with jaundice, but more often results in the development of a chronic carrier state which may have no associated symptoms (and for which there is no treatment).

Carriers pass on the infection for many years and are at a high risk of developing chronic active hepatitis and liver cancer.

Hepatitis B is most commonly transmitted by sharing injection equipment, needle-stick injury, sexually or from a carrier mother passing it on to her child at birth or while breast feeding.

Since 2000, hepatitis B has been part of the routine childhood immunisation schedule, with doses given at birth, 2, 4 and 6 months.

Older children and adults can be immunised – 3 injections are required, with injections 1 and 6 months after the first dose. Subsequent ‘boosters’ are not normally required.

People at high risk of infection (e.g. health care workers and those with reduced immunity) can have a blood test after vaccination to ensure that the course has been effective.

Hepatitis B is also available in combination with hepatitis A vaccine.

The following people are strongly advised to be immunised :

Hepatitis B is not a live vaccine.

Adverse reactions are infrequent – most often feeling ‘off colour’ and soreness at the site of injection. Fever is uncommon.

The vaccine should NOT be given if there has been a serious reaction to previous hepatitis b vaccine, or if there is a severe allergy to yeast.

Hepatitis B vaccine can be given during pregnancy.

There is no benefit, or harm, in vaccinating hepatitis B carriers.
Click here to download the hepatitis B information sheet

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CHICKEN POX ( Varicella ) VACCINE

Chickenpox is a very common infection caused by the varicella zoster virus. Spread by sneezing or coughing, once a person is infected, it takes 14 to 21 days for the illness to develop.

Although normally a fairly harmless infection, chickenpox can be more serious and cause serious complications at times. The most common serious complications are pneumonia and encephalitis ( inflammation of the brain ). Severe cases and serious complications are more likely to occur in teenagers and adults.

CHICKEN POX VACCINES prevent chickenpox in most cases.

The vaccine can be given to children 13 months of age and over.
Children up to 12 years require a single injection only.
Those 13 years of age and over require two injections - 4 to 8 weeks apart.

Chicken Pox vaccine is provided free for children born on or after 1st May 2004 and is given at 18 months.

Reactions to the vaccine are usually mild - around 15 % of people develop a fever, usually 14 to 21 days later, and around 20 % get some redness around the injection site - usually in the first 2 days. Occasionally one or two chickenpox blisters may appear - mostly near the injection site.

Aspirin should NOT be taken to treat any fever which develops ( paracetamol or Nurofen are safe) - (aspirin should never be used for the treatment of fever as it may be associated with a fatal complication - Reye's Syndrome).

 Chicken pox vaccines are live vaccines and should NOT BE GIVEN where :

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INFLUENZA VACCINE

The 2013 influenza vaccine is available from early March. This year the vaccine is made up of A California ('Swine /H1N1'), A Victoria and B Wisconsin strains - the Victoria and Wisconsin strains are new to this years vaccine.

Influenza vaccination is recommended for ALL people 65 years and older, all aboriginal people 15 years and older, as well as those at increased risk from respiratory infections, including people with :
- heart disease
- respiratory disease ( asthma, emphysema etc.)
- renal or metabolic disease ( diabetes, kidney failure etc.)
- impaired immunity ( malignancy, chemotherapy, HIV etc.)
- and other chronic illness
- all pregnant women
- children between 6 months and 10 years on long term aspirin therapy.
The vaccine is FREE to all of the above people.

Carers and service providers to at risk people should also consider immunisation against influenza.

Flu vaccinations can be given to children over 6 months of age.

Approximately 10 % of people receiving influenza injections will experience a local reaction, usually redness and swelling, and around 1 in a million Guillane-Barre Syndrome ( an inflammation of nerves causing a degree of paralysis).

Influenza Vaccine Sheet can be opened and printed by clicking here : download

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PNEUMOCOCCAL VACCINE

Pneumococcal infection is the most common cause of pneumonia in Australia. The infection can also cause meningitis and blood poisoning.
People with chronic illness and the elderly are at most risk. Vaccination is an important measure available to prevent pneumococcal infection.

A SINGLE injection of Pneumovax is required with a booster after 5 years only for those at risk of invasive pneumococcal disease. (recommendation as of 2012)

The NHMRC recommends Pneumococcal vaccination for :

Pneumovax vaccine SHOULD NOT be given where the person :

COMPLICATIONS are rare :

Pneumovax Vaccine is NOT a live virus – you cannot get infection from the injection.

Serious side effects are very rare

Pneumovax is free for everyone 65 and over, indigenous people 50 and over, indigenous people 10 and over with specific illnesses and children with specific illnesses at 4-5 years.

A printout of the Pneumococcal fact sheet can be obtained by clicking : Download

PNEUMOCOCCAL IMMUNISATION in CHILDREN    ( Prevenar )

As well as pneumonia, children, particularly those at high risk, may also develop meningitis or septicaemia (blood poisoning).
Pneumococcal vaccines are effective in reducing these serious forms of the disease, but less effective in preventing the more common middle ear infections.
Prevenar, the vaccine used in small children, is slightly different to Pneumovax which is used in older children and adults. Neither are live vaccines.
For children born before 1/1/2002 FREE vaccine is ONLY available to the ‘at risk’ group of children, but parents can purchase the vaccine for other children.
Free Pneumococcal vaccine will be provided FREE for ALL children born after 1/1/2003. Those born after 1/1/2005 will have three injections - at 2, 4 and 6 months.
A CATCHUP program will be provided during 2005 for children born between 1/1/2003 and 1/1/2005 - the number of injections depending on the child's age at the time of their first injection (injections must be at least 2 months apart)
        1 to 6  months        3 doses
        7 to 17 months       2 doses
        18 to 24 months      1 dose               
        ( boosters given as per the 'at risk' group )

At risk groups:
-ATSI children under 2 years
-children living in Central Australia under 2 years
-ATSI children living in Central Australia, or with similar risk, under 5 years
-children with the following medical risk factors under 5 years
        -congenital immune deficiency
        -on immunosuppressive therapy, including high dose steroids
        -reduced spleen function incl. absent spleen or sickle cell anaemia
        -HIV or AIDS
        -renal failure or persisting nephrotic syndrome
        -Down’s Syndrome
        -heart disease with heart failure or cyanosis
        -all premature infants with lung disease
        -all premature infants born at less than 28 week
        -cystic fibrosis
        -type 1 diabetes
        -CSF leak, intracranial shunt or cochlear implant

The vaccine is normally given at 2, 4 and 6 months, with no booster.

ATSI children should have a Pneumovax booster between 18 and 24 months.

Medical ‘at risk’ children should have a Prevenar booster at 12 months and a Pneumovax booster at 4 years.

There is a higher rate of inflammation at the site of injection with Prevenar than with triple antigen and the injection should be given in a different limb to the other vaccines administered at that visit.

The only contra-indication to vaccination with Prevenar is a previous allergic reaction to the vaccine.

Children prone to high fevers or febrile convulsions should have a dose of paracetamol prior to vaccination.  
Click here for download Pneumococcal Vaccine in Children.

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Measles, mumps and rubella frequently cause serious illness and even death, or, in the case of rubella, serious complications if contracted during pregnancy.

All people aged 18 to 30 years as at 1^st July 2001 are strongly advised to have a booster MMR (measles, mumps, rubella) vaccination. The vaccine is provided free by the government.

Reactions to the vaccine are uncommon, although 1 in 10 people will develop discomfort at the site of the injection and may feel off colour.

1% of people develop a slight rash or joint pains.

Rarely, ( 1 in 1,000,000) mild, self limiting encephalitis ( inflammation of the brain) may develop.

The following people should NOT be vaccinated :

1 Women who are pregnant or who may become pregnant within 2 months.
2 People with untreated malignancy or reduced immunity (including AIDS).
3 People on very high dose steroids.
4 Those who have had a severe allergic reaction to neomycin or gelatin.
5 Those with an inter-current febrile illness.
6 Within 1 month of another live vaccine (except oral polio).
7 Within 3 months of a blood transfusion or immunoglobulin injection.

Allergy to eggs is NOT a contraindication.

There is no evidence of any link between autism and inflammatory bowel disease and MMR vaccination.

This MMR Fact Sheet may be downloaded by clicking : Download

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MENINGOCOCCAL DISEASE

Meningococcal infection, while uncommon, can cause serious, often fatal infection - meningitis and septicaemia (blood poisoning). Children under 4 years of age and teenagers, 15 to 20 years, are at most risk of serious infection. The meningococcal infection has a rapid onset of high fever, marked un-wellness with shock, severe headache and a mottled rash (like bruising) - death within 24 hours of onset is not uncommon.
There are 2 strains of meningococcus - type B and C. Type C is associated with most serious infections.
Meningococcal vaccine gives protection against the C strain of meningococcus, but not the B strain.

Children over 6 weeks of age can be vaccinated. From January 2003 Meningococcal vaccine will be provided free for children between 1 and 5 years of age at our surgery. 
(Children turning 1 on or after 1st January 2003 will have the vaccine as part of the '12 month' injections.
Children over 1 year and not turning 5 until after 1st January 2003 can receive free vaccine through their general practice - including our Tuesday afternoon immunisation clinic.
Children turning 5 on or before 1st January 2003 - up to and including children aged 14 will receive vaccine in a free school based program to be delivered in 2004-5.
Those aged 15 to turning 19 after 1st January 2003 will receive free vaccine via their GP, school or other special program.)
Dosage : 
- children under 1 year of age require 3 injections, at at least monthly (preferably 2 monthly) intervals. It is recommended that meningococcal vaccine not be given at the time of the routine 2, 4 and 6 monthly vaccinations.
- those 1 year and over ( including adults ) only require a single injection.
Meningitec should NOT be given :
- if there has been an allergic reaction to previous Meningitec injection
- if there is an allergy to diphtheria vaccine, latex or aluminium salts
- in the presence of a fever over 38.5 degrees
- during or immediately prior to pregnancy or while breastfeeding
- in the presence of impaired immunity - cancer, immune suppressant medication etc
- the elderly
The vaccine is not a live vaccine - it cannot cause meningitis or other infection.

Reactions are usually of a minor nature - irritability, fever up to 39 degrees and redness at the site of vaccination. More serious side effects are very rare.

Approximate cost : $70 per injection - if not eligible for the free program.

A detailed information sheet about meningococcal disease and the vaccine can be opened and printed by clicking here.

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POLIOMYELITIS   ( ‘Infantile Paralysis’)

  Polio is an extremely contagious viral infection of the gut. Following infection some people will develop variable degrees of paralysis which may result in permanent disability or death. Polio was very common in Australia until around 1960 when immunisation dramatically reduced its incidence – however it is still common in some countries.

Until recently vaccination was by live polio virus - this has now been replaced for childhood immunisation with an inactive vaccine which is incorporated within the triple antigen vaccine and does not have the potential issues associated with the live virus - Triple Antigen IPV.

OLD VACCINE 
Unlike most vaccines, oral polio vaccine (OPV) is a live vaccine. The usual course is given as 2 drops of OPV medicine at 2,4 and 6 months with a booster at 4 years.

  Reactions to oral polio vaccine are uncommon, but precautions need to be taken because live virus is excreted in the child’s stool for approximately 6 weeks after each dose – an infection could be picked up by susceptible people from the faeces.
Very rarely (there have been 2 cases in Australia in the past 13 years) the vaccine can cause a form of paralytic polio in the person receiving it – vaccine associated paralytic poliomyelitis (VAPP).

The following people should NOT be vaccinated with oral polio vaccine

- Fever greater than 38.5 (delay immunisation)
- Severe reaction to a previous dose of polio
- Severe allergy to neomycin, polymyxin or streptomycin
- In the presence of vomiting or diarrhoea (delay immunisation)
- In individuals or where there are house-hold contacts : 
        - **taking high dose steroids or on immunosuppressive medication or whole body radiotherapy 
        - **With a malignancy of their immune system (lymphoma, leukaemia or Hodgkins Disease)  
        - **HIV infection 
        - **During pregnancy

  An alternate to oral polio is available – a non live vaccine (IPV), given by injection, can be used in the **above instances.

  Because the live vaccine virus is excreted in faeces for 6 weeks, carers should be very careful with hygiene, particularly when changing nappies - which should be safely disposed of.
Click here to download polio page.

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DIPHTHERIA, TETANUS, WHOOPING COUGH (pertussis), POLIO     ‘Triple Antigen IPV'

Diphtheria caused more deaths in Australia than any other infection in the early 1900’s. It is a highly contagious bacterial infection typically affecting the throat and tonsils with the formation of a thick grey membrane over those areas. Death is either due to asphyxiation by the membrane or from the effects of a toxin produced by the bacteria which affects the heart and nervous system. Now uncommon here, countries where immunisation levels have fallen have seen the re-emergence of this deadly disease.

Tetanus is a bacteria which lives in soil and contaminates wounds, where it produces a powerful toxin, The toxin attacks the nervous system causing increasing muscle spasm and rigidity. The muscles of the jaw are usually first affected, hence the name ‘lock jaw’. Even with modern treatment, 10 % of those infected will die.

Whooping Cough (pertussis) is one of the most contagious bacterial infections known. Beginning with a runny nose and sore throat, it progresses to a severe spasmodic cough which persists for around 3 months. Coughing episodes are often followed by a typical ‘whoop’ sound and vomiting. Life threatening complications are pneumonia, inflammation of the brain (encephalitis) and brain haemorrhage from the severe coughing. Children under 6 months of age are at the greatest risk of fatal complications.

In 1999 an ‘acellular’ form of the pertussis component of the vaccine was introduced into the Australian immunisation schedule – this has resulted in a much lower rate of side effects compared with the older forms of the vaccine.

Triple Antigen IPV immunises against each of these three diseases and polio – it is not a live vaccine.

The primary course of Triple Antigen IPV involves immunisation at 2, 4 and 6 months and a booster at 4 years of age.

Adverse reactions have been dramatically reduced with the introduction of the new ‘acellular’ vaccine. 

Triple Antigen IPV does not increase the risk of SIDS (it is reduced by immunisation) or epilepsy.

The following children SHOULD NOT be immunised with triple antigen (although tetanus and diphtheria alone may usually be given) :

Precautions should be taken with a history of :

Children with active or progressive neurological disease can be vaccinated, but immunisation should be deferred if there has been a convulsion in the previous 3 weeks.

Click here to download Triple Antigen information.

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HAEMOPHILUS INFLUENZA B      ( Hib )

Haemophilus is a bacterial infection which usually causes sore throat, middle ear infection or cough. However, in young children, usually under 5 years, it can cause the serious infections meningitis or epiglottitis – both of which are fatal without urgent treatment. Indigenous children are at particular risk.

In 1993 routine Hib immunisation was introduced in Australia – since then the incidence of serious haemophilus infection has declined by more than 90 %.

Hib vaccine is not a live vaccine.

Hib is given as part of the standard immunisation schedule at 2, 4 and 12 months.

Because invasive haemophilus disease is rare after the age of 5, older children and adults do not require vaccination.

People who have, or are to have their spleen removed, should be given a single dose.

Adverse reactions to the vaccine are unusual – up to 5 % of children will get redness and swelling at the injection site – this normally resolves within 24 hours of vaccination. 

The only CONTRA-INDICATION to Hib vaccination is a severe allergic reaction to a previous dose.

As with other vaccines, immunisation should be deferred in the presence of fever over 38.5 degrees.

Click here to download Hib page

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GARDASIL - HPV (genital wart) Vaccine

HPV (genital wart) virus infection has been shown to be the causative agent for cancer of the cervix. There are at least 40 strains of the virus, but 2 strains account for about 70 % of cases of cervical cancer.
Gardasil is a new vaccine which protects against 4 strains of the virus, but, importantly, it protects against the strains which cause 70 % of the cancers.
Australia is embarking on a national program which will ultimately immunise all girls in year 8, through a free school based program.
There was an initial free 'catch up' program to immunise girls and women 13 to 26 years of age in the 2 years commencing 1/7/2007 - this program  has now ceased.
3 injections of the vaccine are required, with the 2nd and 3rd doses 2 and 6 months after the first one. The vaccine is not a live virus.
In South Australia the school program commenced in April 2007 and was provided to girls in years 8 to 12.
Girls who miss out at school will be able to go to their doctor for immunisation.
Boys between 9 and 15 years can also be vaccinated.
From 1st February 2013 boys were also included in the free schools program.  
The vaccine costs approximately $150 per injection ($450 for the course).
Those in the eligible age group who have already had genital warts or 'HPV infection' should still be vaccinated - because there are so many strains of the virus.
Because the virus covers only 70% of the potential cervical cancer causing HPV infections, women must still have regular Pap smears even though they have been immunised.
(the vaccine has not been proven effective nor shown to be safe in women over 26)
Adverse reactions are uncommon and usually minor.
Gardasil should not be given to those with immediate allergy to yeast, those with PKU, in the presence of a high fever, during pregnancy (although no adverse outcomes have been reported) or where there has been an allergic reaction to a previous dose.
Gardasil can be given while breast feeding.
Click here to download Gardasil page.

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ROTAVIRUS  

(on schedule for babies born from 1/5/2007)

Rotavirus is the most common cause of severe gastroenteritis in infants and small children. The illness is usually associated with high fever, severe vomiting and diarrhoea which frequently lead to dehydration and hospital admission. The illness can last 6 to 9 days. It is estimated that around half a million children die worldwide each year as a result of rotavirus infection.

Rotateq is a live vaccine containing 5 strains of the virus – the vaccine is given orally, with doses at 2, 4 and 6 months. It is now part of the regular childhood immunisation schedule.
The vaccine only protects against rotavirus – not against the many other causes of gastroenteritis.

As the vaccine is live it should not be given to children who have illnesses which affect their immune system such as cancer, AIDS, blood disorders or who are taking medication which may weaken the immune system e.g. cortisone or chemotherapy. Where a child is not gaining weight or growing as expected, has diarrhoea or vomiting or has a high fever, medical assessment prior to vaccination is advised. Vaccination should not be given if there has been a significant reaction to a previous dose or the child is allergic to any ingredient ( sucrose, sodium citrate, sodium phosphate monobasic monohydrate, sodium hydroxide, polysorbate 80).The vaccine contains no preservative or thiomersal.

Reactions to the vaccine are uncommon – some children developed diarrhoea, vomiting, fever, runny nose, cough or wheeze and ear infection in the period after vaccination but the incidence was around the same as children not vaccinated in the same period.
Suggestions that intussusception ( a serious bowel obstruction) is associated with the vaccine appear unfounded.

The course of vaccinations must be completed in the 6 to 32 week period and is not available to older children or adults.

Rotarix is another vaccine against rotavirus but does not form part of the ‘free’ schedule of vaccines in South Australia.

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