Guidelines for preventive activities in general practice

Infectious diseases

Immunisation

Guidelines for preventive activities in general practice
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Infectious diseases | Immunisation

Immunisation is recommended from birth for all children, and at particular ages throughout life, according to the Australian immunisation handbook (this is updated regularly).1

GPs need to be aware of groups with lower levels of age-appropriate immunisation.2 Lower immunisation rates at 12 months3 have been associated with:

  • being born overseas
  • no private health insurance
  • being in the highest or lowest socioeconomic quintile
  • being of low birth weight.

All these factors are also associated with lower immunisation coverage at 24 months, with the exception of low birth weight, which was only significant in the very low birth weight category.3

Immunisation recommendations for non-Indigenous Australians without risk factors for vaccine-preventable diseases
 
Table 1. Vaccine recommendations for non-Indigenous Australians based on age and pregnancy status
 
This table is a summary of Australian immunisation handbook vaccine recommendations for non-Indigenous Australians based on age and pregnancy status. Shaded cells represent vaccinations funded under the National Immunisation Program (NIP).a Parentheses indicate that these vaccines are only recommended for a population sub-group. Further detail is provided in the corresponding footnotes. This table is current as of 28/06/2024.

Disease/vaccine antigen Abbrev. Age Pregnancy status
At birth 2
monthsb		 4 months 6 months 12 months 18 months 4 years Adolescents Adults During pregnancy Postpartum
Hepatitis B HepB ✔ ✔* ✔* ✔* (✔)c            
Diphtheria, tetanus, pertussis DTPa/dTpa   ✔* ✔* ✔*   ✔ ✔†
  • 12–13 yearsd
  • 65 yearsd
 ✔e (✔)e
Poliomyelitis IPV   ✔* ✔* ✔*     ✔†        
Haemophilus influenzae type b Hib   ✔* ✔* ✔*  
  • ​
          
Pneumococcal 13vPCV
15vPCV
20vPCV		  
  • ​
  • ​
 check for medical risk conditions
  • ​
      
  • ≥70 years
    
23vPPV              
Check for medical risk conditions		    
Rotavirus    
  • ​
  • ​
                
Measles, mumps, rubella MMR        
  • ​
  • ‡, f
     (✔)g   (✔)h
Varicella VV           ✔‡ ✔h (✔)h    
Meningococcal serogroup B MenB   ✔i  
(Refer to footnote i)
  • 15–19 yearsi
  
(Refer to footnote i)		    
Meningococcal serogroup ACWY  
MenACWY		    
✔j		  
✔j		    
(Refer to footnote j)
  • 15–19 years;
NIP school program dose at 14–16 years j		  
(Refer to footnote j)		    
Influenza (annual) QIV       ✔k  
(Refer to footnote k)
  • ≥65 yearsk
  • ​
  
Human papillomavirus  
HPV		              
  • 9–25
NIP school program dose at
14–16 years l		      
Herpes zoster HZ                
  • ≥65 yearsm
    
 
Key
DTPa = Diphtheria-tetanus-acellular pertussis vaccine (paediatric formulation) IPV = Inactivated poliomyelitis vaccine 15vPCV = 15-valent pneumococcal conjugate vaccine DTPa = Diphtheria-tetanus-acellular pertussis vaccine (paediatric formulation) IPV = Inactivated poliomyelitis vaccine 15vPCV = 15-valent pneumococcal conjugate vaccine DTPa = Diphtheria-tetanus-acellular pertussis vaccine (paediatric formulation) IPV = Inactivated poliomyelitis vaccine 15vPCV = 15-valent pneumococcal conjugate vaccine
dTpa = Diphtheria-tetanus-acellular pertussis vaccine (reduced antigen dTpa = Diphtheria-tetanus-acellular pertussis vaccine (reduced antigen dTpa = Diphtheria-tetanus-acellular pertussis vaccine (reduced antigen
formulation) MenB = Meningococcal serogroup B vaccine 20vPCV = 20-valent pneumococcal conjugate vaccine formulation) MenB = Meningococcal serogroup B vaccine 20vPCV = 20-valent pneumococcal conjugate vaccine formulation) MenB = Meningococcal serogroup B vaccine 20vPCV = 20-valent pneumococcal conjugate vaccine
HepB = Hepatitis B vaccine MenACWY = Meningococcal serogroup ACWY conjugate vaccine 23vPPV = 23-valent pneumococcal polysaccharide vaccine HepB = Hepatitis B vaccine MenACWY = Meningococcal serogroup ACWY conjugate vaccine 23vPPV = 23-valent pneumococcal polysaccharide vaccine HepB = Hepatitis B vaccine MenACWY = Meningococcal serogroup ACWY conjugate vaccine 23vPPV = 23-valent pneumococcal polysaccharide vaccine
Hib = Haemophilus influenzae type b vaccine MMR = Measles-mumps-rubella vaccine QIV = Quadrivalent seasonal influenza vaccine Hib = Haemophilus influenzae type b vaccine MMR = Measles-mumps-rubella vaccine QIV = Quadrivalent seasonal influenza vaccine Hib = Haemophilus influenzae type b vaccine MMR = Measles-mumps-rubella vaccine QIV = Quadrivalent seasonal influenza vaccine
* HepB, DTPa, IPV and Hib are administered at 2, 4 and 6 months of age using a combination vaccine. The first dose can be given as early as 6 weeks of age; refer to footnote (b).
† DTPa and IPV are administered at 4 years of age using a combination vaccine.
‡ MMRV [Measles, mumps, rubella and varicella] are administered at 18 months of age using a combination vaccine.
 
  1. The National Immunisation Program Schedule is available on the Australian Government here [Department of Health immunisation website]. Contact your state/territory health department for further information on any additional immunisation programs specific to your state or territory.
  2. Vaccines scheduled at 2 months of age can be given as early as 6 weeks of age. The next scheduled dose should still be given at 4 months of age.
  3. A booster dose of hepatitis B vaccine is recommended at 12 months of age for infants who were born preterm at <32 weeks’ gestation or whose birth weight was <2000 g, unless a blood test 1 month after the final dose of the primary course showed an anti-hepatitis B (HBs) antibody titre of ≥10 mIU/mL.
  4. DTPa [diphtheria-tetanus-acellular pertussis] vaccine is given in adolescence as dTpa (reduced antigen formulation). School years during which school-based programs are delivered vary among states and territories. Contact your state or territory health department for more details. dTpa vaccine is recommended for any adult who wishes to reduce their likelihood of becoming ill with pertussis. Adults aged ≥65 years are recommended to receive a dose of dTpa if they have not had one in the past 10 years. Adults aged ≥50 years are recommended to receive a booster dose of tetanus-containing vaccine if their last dose was more than 10 years ago. [Adults aged ≥65 years are recommended to receive a dose of dTpa if they have not had one in the past 10 years.] Adults with tetanus-prone wounds are recommended to receive a booster dose of dT or dTpa if their last dose was more than 5 years ago.
  5. dTpa vaccine is recommended and funded during each pregnancy. If a mother was not vaccinated during pregnancy, maternal vaccination is recommended as soon as possible after birth and preferably before hospital discharge.
  6. MMRV should not be given as the first dose of measles-containing vaccine in children aged <4 years.
  7. 2 doses of MMR are recommended for adults born during or since 1966, unless the individual is documented to be immune. MMR vaccine is recommended for women of childbearing age who are seronegative for rubella. Vaccinated women should avoid pregnancy for 28 days after vaccination.
  8. A second dose of varicella vaccine is recommended to provide increased protection and minimise the chance of breakthrough varicella in children and adolescents aged <14 years. This could potentially be given at 4 years of age, or at any time up to 14 years of age (at least 4 weeks after the 1st dose). 2 doses of varicella vaccine are recommended for all adults who are non-immune to varicella. Non-immune women are recommended to receive varicella vaccine before they become pregnant.
  9. MenB vaccine is recommended for all people aged ≥6 weeks who wish to reduce the likelihood of becoming ill with meningococcal disease, and is recommended for infants and children aged <2 years and adolescents aged 15–19 years. Bexsero is the only MenB vaccine that can be used in infants and children aged <10 years. The doses required and the schedule depend on the age at which the vaccine course is started and the presence of at-risk medical conditions. For further details, refer to the Australian immunisation handbook.
  10. MenACWY vaccine is recommended for all people ≥6 weeks of age who wish to reduce the likelihood of becoming ill with meningococcal disease, as well as for infants and children aged <2 years and adolescents aged 15–19 years. The doses required and the schedule depend on the age at which the vaccine course is started, the brand used and the presence of at-risk medical conditions. A single NIP-funded dose of MenACWY vaccine (Nimenrix®) is scheduled at 12 months of age. A single dose of MenACWY vaccine (Nimenrix®) is also provided for adolescents through a school-based program (14–16-year-olds); those aged 15–19 years who did not receive the vaccine at school can receive it from their GP. For further details, refer to the Australian immunisation handbook.
  11. Influenza vaccine is recommended annually for all people aged ≥6 months who wish to reduce the likelihood of becoming ill with influenza. Influenza vaccine is funded under the NIP for all children ≥6 months to 59 months (<5 years) of age, people ≥5 years of age with certain medical conditions predisposing them to severe influenza. For older people aged ≥65 years, the adjuvanted quadrivalent influenza vaccine (aQIV, Fluad Quad®) is funded under the NIP and is preferentially recommended over standard QIV. The QIV is funded under the NIP for adults with a medical condition that predisposes them to severe influenza, pregnant women, non-Indigenous adults aged ≥65 years. For further details, refer to the ATAGI [Australian Technical Advisory Group] advice on seasonal influenza vaccines.
  12. A single dose of HPV vaccine is recommended and NIP-funded for adolescents and young adults (ie aged ≤25years). A 3-dose schedule of HPV vaccine is recommended and NIP-funded for immunocompromised adolescents and adults. School years at which the school-based programs are delivered vary among states and territories. Contact your state or territory health department for more details.
  13. A 2-dose schedule of herpes zoster vaccine (Shingrix®) is recommended and funded under the NIP for adults aged ≥65 years, 2–6 months apart.
 
Note: This table does not include recommendations on use of vaccines in the context of response to, and control of, a disease outbreak, or (specifically) for travel outside Australia. Refer also to Immunisation recommendations for Aboriginal and Torres Strait Islander people without risk factors for vaccine-preventable diseases living in the ACT, NSW, Tas, Vic and Immunisation recommendations for Aboriginal and Torres Strait Islander people without risk factors for vaccine-preventable diseases living in the NT, QLD, SA, WA
 
Reproduced with permission from the National Centre for Immunisation Research and Surveillance. Immunisation recommendations for non-Indigenous Australians without risk factors for vaccine preventable diseases. March 2024 update. NCRIS, 2024. Available at https://ncirs.org.au/sites/default/files/2024-03/NCIRS_Immunisation%20schedule_non-Indigenous%20people%20without%20risk%20factors_March%202024.pdf [Accessed 6 April 2024].
 
State and territory health departments also fund some additional vaccines. Visit the National Immunisation Program for information on state and territory immunisation schedules.
 
COVID-19 regulations change regularly. For information about the COVID vaccines, visit the Australian immunisation handbook.
Vaccination guidance changes over time and vaccination providers are responsible for checking for the latest information. Visit the Australian immunisation handbook and the National Centre for Immunisation Research and Surveillance (NCIRS) for the most up-to-date immunisation information.

The National Immunisation Program lists the recommended funded vaccines for all Australian residents. There are other vaccines that are not funded but are recommended in the Australian immunisation handbook, depending on occupation or travel. There may be variability in vaccines recommended/funded (eg hepatitis A vaccine).

Consent

Consent should be sought from someone with legal capacity before each vaccination. The individual providing consent should have the intellectual capacity to understand specific information and agree voluntarily without pressure, coercion or manipulation. The consent process should include written advice about benefits and harms of the vaccines, risk of not having the vaccine, and what to do after receiving the vaccine.

Information on providing valid consent is available within the Australian immunisation handbook.

Recording, setting up effective recall systems and assessing the need for catch-up vaccinations

Information on recording on the Australian Immunisation Register, setting up effective recall systems and on catch-up vaccinations is available within the Australian immunisation handbook.

Notification of adverse events

The reporting of adverse events following vaccinations varies geographically. It is possible to report directly to the Therapeutic Goods Administration from anywhere in Australia or by telephone on 1800 044 114.

Immunisation recommendations for Aboriginal and Torres Strait Islander people without risk factors for vaccine-preventable diseases vary across states and territories. Refer to NCIRS advice for Aboriginal and Torres Strait Islander people living in the Australian Capital Territory, New South Wales, Tasmania or Victoria, and for those living in the Northern Territory, Queensland, South Australia and Western Australia.

For specific recommendations and advice for Aboriginal and Torres Strait Islander people, also please refer to the Department of Health and Aged Care’s Immunisation for Aboriginal and Torres Strait Islander people and The Royal Australian College of General Practitioners’ National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people.

Adults or children who develop asplenia, human immunodeficiency virus (HIV) infection or a haematological malignancy, or who have received a bone marrow or other transplant, may not be fit for some vaccinations, or may require additional or repeat vaccinations.

Men who have sex with men (MSM) have additional vaccine recommendations:

  • hepatitis A
  • hepatitis B
  • monkeypox (Mpox)
  • human papillomavirus vaccine (HPV).

Meningococcal ACYW and B vaccination should also be considered.

Mpox is a viral illness easily transmitted via sexual activity. A worldwide outbreak in 2022 lead to a successful vaccination campaign to reduce risk of transmission. All MSM are recommended to have a completed Mpox vaccination.

MSM are at higher risk of HPV-related anal cancers. A completed HPV vaccine course is recommended to reduce the risk of anal cancers later in life.

There have been regular outbreaks of meningococcal disease at large MSM gatherings, such as parades, parties and other events that might attract attendance from an interstate or international audience.

People with compromised immunity

Meningococcal B vaccination is recommended for people with compromised immunity, including those living with HIV. There is some emerging evidence of reduction of gonococcal sexually transmitted infections in people who have been vaccinated for Meningococcal B.

Certain vaccines may not be recommended for individuals with compromised immune systems due to contraindications. Further, these people might require additional vaccine doses to increase their protection.1 For more information on vaccination for people who are immunocompromised, refer to the Australian immunisation handbook.

For more information about vaccinations for special risk groups, refer to the Australian immunisation handbook.

Australian immunisation handbook
Australian Immunisation Register (AIR) | The AIR can be used to obtain information on the vaccination history of individuals from birth to age 7 years given since 1 January 1996. The AIR can be contacted by email or telephone on 1800 653 809.
National Centre for Immunisation Research & Surveillance (NCIRS)
National Immunisation Program (NIP) schedule

  1. Department of Health and Aged Care. Australian immunisation handbook. Department of Health and Aged Care, 2023 [Accessed 15 April 2024].
  2. Ward K, Chow MYK, King C, Leask J. Strategies to improve vaccination uptake in Australia, a systematic review of types and effectiveness. Aust N Z J Public Health 2012;36(4):369–77.
  3. Haynes K, Stone C. Predictors of incomplete immunisation in Victorian children. Aust N Z J Public Health 2004;28(1):72–79.
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