The Australian Immunisation Handbook 10th Edition

2.1 Pre-vaccination

Page last updated: 30 August 2016

This chapter has been amended on July 2016.

The following sections discuss steps and procedures that should occur before a vaccination encounter.

2.1.1 Preparing an anaphylaxis response kit

The availability of protocols, equipment and drugs necessary for the management of anaphylaxis should be checked before each vaccination session. An anaphylaxis response kit should be on hand at all times and should contain:

  • adrenaline 1:1000 (minimum of three ampoules – check expiry dates)
  • minimum of three 1 mL syringes and 25 mm length needles (for intramuscular (IM) injection)
  • cotton wool swabs
  • pen and paper to record time of administration of adrenaline
  • laminated copy of adrenaline doses (Table 2.3.2 or back cover of this Handbook)
  • laminated copy of ‘Recognition and treatment of anaphylaxis’ (back cover of this Handbook).

Refer to 2.3.2 Adverse events following immunisation for details on recognition and treatment of adverse events following immunisation (in particular, refer to ‘Use of adrenaline’ and ‘Use of adrenaline autoinjectors for anaphylaxis treatment’ in that section).

2.1.2 Effective cold chain: transport, storage and handling of vaccines

The cold chain is the system of transporting and storing vaccines within the temperature range of +2°C to +8°C from the place of manufacture to the point of administration.1 Maintenance of the cold chain is essential for maintaining vaccine potency and, in turn, vaccine effectiveness. This is vital, not only for those vaccines provided as part of the National Immunisation Program, but also for vaccines purchased by the patient via prescription from a pharmacist. In such cases, both the doctor issuing the prescription and the pharmacist dispensing the vaccine must inform the patient of the need for maintaining, and how to maintain, the cold chain for the vaccine they have purchased.

All immunisation service providers must be familiar with, and adhere to, the National vaccine storage guidelines: Strive for 5 (2nd edition).1 This publication can be accessed free of charge from (www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/IMM77-cnt)

The National vaccine storage guidelines: Strive for 5 contains specific details on setting up the infrastructure for a vaccination service, and immunisation service providers should refer to this document to ensure that satisfactory equipment and procedures are in place before commencing vaccination services.1

These guidelines also provide instructions on how best to transport vaccines from the main storage facility to outreach or external clinics. Purpose-built vaccine refrigerators (PBVR) are the preferred means of storage for vaccines. Domestic refrigerators are not designed for the special temperature needs of vaccine storage.

Cold chain breaches

Despite best practices, cold chain breaches sometimes occur. It is important to report any cold chain breaches so that revaccination of patients or recall of unused vaccines can be undertaken, if required.

Do not discard or use any vaccines exposed to temperatures below +2°C or above +8°C without obtaining further advice. Isolate vaccines and contact the state/territory health authorities (refer to Appendix 1) for advice on the National Immunisation Program vaccines and the manufacturer/supplier for privately purchased vaccines. Recommendations for the discarding of vaccines may differ between health authorities and manufacturers.

2.1.3 Valid consent

Valid consent can be defined as the voluntary agreement by an individual to a proposed procedure, given after sufficient, appropriate and reliable information about the procedure, including the potential risks and benefits, has been conveyed to that individual.2-6 As part of the consent procedure, persons to be vaccinated and/or their parents/carers should be given sufficient information (preferably written) on the risks and benefits of each vaccine, including what adverse events are possible, how common they are and what they should do about them7 (the table inside the front cover of this Handbook, Side effects following immunisation for vaccines used in the National Immunisation Program (NIP) schedule, can be used for this purpose).

For consent to be legally valid, the following elements must be present:6,8

  1. It must be given by a person with legal capacity, and of sufficient intellectual capacity to understand the implications of being vaccinated.
  2. It must be given voluntarily in the absence of undue pressure, coercion or manipulation.
  3. It must cover the specific procedure that is to be performed.
  4. It can only be given after the potential risks and benefits of the relevant vaccine, risks of not having it and any alternative options have been explained to the individual.

The individual must have sufficient opportunity to seek further details or explanations about the vaccine(s) and/or its administration. The information must be provided in a language or by other means the individual can understand. Where appropriate, an interpreter and/or cultural support person should be involved.

Consent should be obtained before each vaccination, once it has been established that there are no medical condition(s) that contraindicate vaccination. Consent can be verbal or written. Immunisation providers should refer to their state or territory’s policies on obtaining written consent (refer to Appendix 1 Contact details for Australian, state and territory government health authorities and communicable disease control).

Consent on behalf of a child or adolescent

In general, a parent or legal guardian of a child has the authority to consent to vaccination of that child; however, it is important to check with your state or territory authority where any doubt exists.2,5 A child in this context is defined as being under the age of 18 years in Tasmania, Victoria and Western Australia; under the age of 14 years in New South Wales; and under the age of 16 years in the Australian Capital Territory, South Australia and the Northern Territory. Queensland follows common law principles.

For certain procedures, including vaccination, persons younger than the ages defined above may have sufficient maturity to understand the proposed procedure and the risks and benefits associated with it, and thus may have the capacity to consent under certain circumstances. Refer to the relevant state or territory immunisation service provider guidelines for more information.

Should a child or adolescent refuse a vaccination for which a parent/guardian has given consent, the child/adolescent’s wishes should be respected and the parent/guardian informed.2

Consent on behalf of an adult lacking capacity

A careful assessment should be made of an adult’s capacity to give valid consent to a vaccination. If the adult lacks capacity, practitioners should refer to relevant state and territory laws relating to obtaining consent from a substitute decision-maker. For example, this may occur for influenza vaccination of an elderly person with dementia. Refer to the enduring guardianship legislation appropriate for your state or territory for further advice.

Resources to help communicate the risks and benefits of vaccines

Plain language should be used when communicating information about vaccines and their use. The person to be vaccinated (or their parent/guardian) must be encouraged and allowed to ask for further information and have sufficient time to make a decision about whether to consent or not.9,10

It is preferable that printed information is available to supplement any verbal explanations.11 The summary table Comparison of the effects of diseases and the side effects of NIP vaccines inside the back cover of this Handbook provides some basic information necessary to communicate the risks and benefits of vaccination. The table can be photocopied and used freely as required.

More detailed information concerning vaccines and their use is available from the following sources:

  • The Immunise Australia website (www.immunise.health.gov.au) includes the booklet Understanding childhood immunisation, which contains frequently asked questions and links to state and territory health department websites. Several of these sites offer multilingual fact sheets.

Refer also to Appendix 4 Commonly asked questions about vaccination.

Evidence of consent

General practice or public immunisation clinics

Consent may be given either in writing or verbally, according to the protocols of the health facility, but it must meet the criteria for valid consent. Evidence of verbal consent should be documented in the clinical records. If a standard procedure is routinely followed in a practice or clinic, then a stamp, a sticker or a provider’s signature indicating that the routine procedure has been followed may be used. For paperless medical records, a typed record of verbal consent may be made in the patient’s file, or a copy of written consent scanned into the file.

Explicit verbal consent is required before administration of any vaccine, even when written consent has been given at previous vaccination encounters for the same vaccine. Verbal consent should be documented in the patient’s file each time it is given.

School-based vaccination programs

Consent is required for provision of individual vaccines or a vaccine course offered in school-based vaccination programs.

In school-based, and other large-scale, vaccination programs, the parent or guardian usually does not attend with the child on the day the vaccination is given, and written consent from the parent or guardian is desirable in these circumstances. However, if written consent is not able to be provided, or if further clarification is required, verbal consent may be sought by telephone from the parent or guardian by the immunisation service provider. This should be clearly documented on the child’s consent form. In some jurisdictions, older adolescents may be able to provide their own consent for vaccinations offered through school-based vaccination programs (refer to 'Consent on behalf of a child or adolescent' above). Consent requirements and vaccines offered in these programs vary between jurisdictions. Refer to the relevant state or territory school-based vaccination program guidelines for more information.

2.1.4 Pre-vaccination screening

Immunisation service providers should perform a comprehensive pre-vaccination health screen of all persons to be vaccinated. For some individuals, alterations to the routinely recommended vaccines may be necessary to either eliminate or minimise the risk of adverse events, to optimise an individual’s immune response, or to enhance the protection of a household contact against vaccine-preventable diseases.

Providers should:

  • ensure that they have the right person to be vaccinated
  • ensure which vaccine(s) are indicated, including any previously missed vaccine doses
  • consider whether alternative or additional vaccines should be given
  • check if there are any contraindications or precautions to the vaccines that are to be given
  • ensure that the patient to be vaccinated is the appropriate age for the vaccines to be given
  • check that the correct time interval has passed since any previous vaccine(s) or any blood products were given.

Refer also to 2.1.5 Catch-up and relevant disease chapters for further details.

Steps for pre-vaccination screening

Follow these steps to complete the pre-vaccination screening process:

  • Provide the person to be vaccinated or the parent/carer with the Pre-vaccination screening checklist (Table 2.1.1).
    • Some of the questions in this checklist are deliberately non-specific so as to elicit as much important information as possible.
    • The checklist may be photocopied and handed to the person to be vaccinated or the parent/carer just before vaccination.
    • The checklist may also be photocopied and displayed in the clinic/surgery for easy reference for the immunisation service provider.
  • For vaccination of adults, seek additional information about the occupation and lifestyle factors that may influence vaccination requirements. This is discussed in more detail in 2.1.5 Catch-up below under ‘Catch-up schedules for persons ≥10 years of age’.
  • If you identify the presence of a condition or circumstance indicated on the pre-vaccination screening checklist, refer to Table 2.1.2, which lists the specific issues pertaining to such condition(s) or circumstances and provides the appropriate action with a rationale.
  • Where necessary, seek further advice from a specialist immunisation clinic, a medical practitioner with expertise in vaccination, the immunisation section within your state or territory health authority, or your local Public Health Unit (refer to Appendix 1 Contact details for Australian, state and territory government health authorities and communicable disease control).
Printable version of Table 2.1.1 - Pre-vaccination screening checklist (Word 21 KB)
Table 2.1.1: Pre-vaccination screening checklist

Pre-vaccination screening checklist

This checklist helps decide about vaccinating you or your child today. Please fill in the following information for your doctor/nurse.
Name of person to be vaccinated
Date of birth:
Age today:
Name of person completing this form:
Please indicate if the person to be vaccinated:

  • - is unwell today
  • - has a disease that lowers immunity (e.g. leukaemia, cancer, HIV/AIDS) or is having treatment that lowers immunity (e.g. oral steroid medicines such as cortisone and prednisone, radiotherapy, chemotherapy)
  • - is an infant of a mother who was receiving highly immunosuppressive therapy (e.g. biological disease modifying anti-rheumatic drugs (bDMARDs) during pregnancy
  • - has had a severe reaction following any vaccine
  • - has any severe allergies (to anything)
  • - has had any vaccine in the past month
  • - has had an injection of immunoglobulin, or received any blood products or a whole blood transfusion within the past year
  • - is pregnant
  • - has a past history of Guillain-Barré syndrome
  • - was a preterm infant
  • - has a chronic illness
  • - has a bleeding disorder
  • - identifies as an Aboriginal or Torres Strait Islander
  • - does not have a functioning spleen
  • - is planning a pregnancy or anticipating parenthood
  • - is a parent, grandparent or carer of a newborn
  • - lives with someone who has a disease that lowers immunity (e.g. leukaemia, cancer, HIV/AIDS), or lives with someone who is having treatment that lowers immunity (e.g. oral steroid medicines such as cortisone and prednisone, radiotherapy, chemotherapy)
  • - is planning travel
  • - has an occupation or lifestyle factor(s) for which vaccination may be needed (discuss with doctor/nurse) Please specify:

Note: Please discuss this information or any questions you have about vaccination with your doctor/nurse before the vaccines are given.

Before any vaccination takes place, your doctor/nurse should ask you:

  • - Did you understand the information provided to you about vaccination?
  • - Do you need more information to decide whether to proceed?
  • - Did you bring your/your child’s vaccination record card with you?

It is important for you to receive a personal record of your or your child’s vaccinations. If you do not have a record, ask your doctor/nurse to give you one. Bring this record with you every time you or your child visit for vaccination. Make sure your doctor/nurse records all vaccinations on it.

Conditions or circumstances identified using the pre-vaccination screening checklist

The recommended responses for immunisation service providers to make if any conditions or circumstances are identified by using the pre-screening checklist are summarised in Table 2.1.2.

Note: Only vaccines recommended on the NIP schedule are included in Table 2.1.2. For information on other vaccines, refer to the relevant disease-specific chapter in Part 4 of this Handbook or to vaccine product information.

For reference, Table 2.1.3 provides a list of live attenuated vaccines.

Table 2.1.2: Responses to relevant conditions or circumstances identified through the pre-vaccination screening checklist
Condition or circumstance of person to be vaccinated Action Rationale12-14
Is unwell today:
  • acute febrile illness (current T ≥38.5°C)
  • acute systemic illness
Defer all vaccines until afebrile.
Note: Children with minor illnesses (without acute systemic symptoms/signs) should be vaccinated.
To avoid an adverse event in an already unwell child, or to avoid attributing symptoms to vaccination
Has a disease that lowers immunity, is receiving treatment that lowers immunity or is an infant of a mother who received immunosuppressive therapy during pregnancy Refer to 3.3.3 Vaccination of immunocompromised persons or 3.3.2 Vaccination of women who are planning pregnancy, pregnant or breastfeeding, and preterm infants.
In some cases, expert advice may need to be sought before vaccination (refer to Appendix 1).
Note: Persons living with someone with lowered immunity should be vaccinated, including with live viral vaccines (refer to below).
The safety and effectiveness of the vaccine may be suboptimal in persons who are immunocompromised.
Live attenuated vaccines may be contraindicated.
Has had anaphylaxis following a previous dose of the relevant vaccine Do not vaccinate. Seek further medical advice to confirm causality and to assist with other vaccinations.
Refer also to ‘Contraindications to vaccination’ below.
Anaphylaxis to a previous dose of vaccine is a contraindication to receiving the same vaccine.
Has a severe allergy to a vaccine component Refer to Appendix 3 for a vaccine component checklist.
Do not vaccinate but seek specialist advice (refer to Appendix 1). The patient may still be able to be vaccinated, dependent on the allergy.
Anaphylaxis to a vaccine component is generally a contraindication to receiving the vaccine.
Has received a live attenuated viral parenteral vaccine* or BCG vaccine in past 4 weeks Delay live attenuated viral parenteral vaccines by 4 weeks. The immune response to a live attenuated viral vaccine (given parenterally) may interfere with the response to a subsequent live viral vaccine given within 4 weeks of the first.
Has had any blood product in the past 7 months, or has had IM or IV immunoglobulin in the past year Check which product the person received and the interval since administration. Refer to Table 3.3.6 Recommended intervals between either immunoglobulins or blood products and MMR, MMRV or varicella vaccination.
If not eligible, make a return appointment for this vaccination, and send a reminder later if necessary.
Antibodies in these products may interfere with the immune response to MMR, MMRV and varicella vaccines.
The recommended interval to vaccination varies depending on the immunoglobulin or blood product administered.
Is planning a pregnancy or anticipating parenthood Ensure women planning pregnancy and household members have received vaccines recommended for their age group. For example, 2nd dose of MMR (if born after 1966); varicella; dTpa; and/or have had appropriate pre-conception serological testing.
Refer to 3.3.2 Vaccination of women who are planning pregnancy, pregnant or breastfeeding, and preterm infants.
Advise women not to become pregnant within
28 days of receiving live viral vaccines.*
Vaccinating before pregnancy may prevent maternal illness, which could affect the infant, and may confer passive immunity to the newborn.
Is pregnant Refer to Table 3.3.1 Recommendations for vaccination in pregnancy.
Influenza and pertussis vaccines are recommended for all pregnant women.
Live vaccines* should be deferred until after delivery.
Vaccination of household contacts of pregnant women may also be required (refer to recommendations in relevant disease chapter).
There is insufficient evidence to ensure the safety of administering live vaccines during pregnancy.
Inactivated vaccines are generally not contraindicated in pregnancy.
Has a history of Guillain-Barré syndrome (GBS) Refer to 3.3.3 Vaccination of immunocompromised persons and 4.7 Influenza.
Risks and benefits of influenza vaccine should be weighed against the potential risk of GBS recurrence (seek further advice as per Appendix 1).
Persons with a history of GBS may be at risk of recurrence of the condition following influenza vaccine.
Was born preterm Refer to 3.3.2 Vaccination of women who are planning pregnancy, pregnant or breastfeeding, and preterm infants.
Preterm infants born at <28 weeks gestation and/or with chronic lung disease require extra pneumococcal vaccinations (refer to 4.13 Pneumococcal disease).
Preterm infants born at
<32 weeks gestation and/or <2000 g birth weight may require an extra dose of hepatitis B vaccine
(refer to 4.5 Hepatitis B).
Preterm infants may be at increased risk of vaccine-preventable diseases (e.g. invasive pneumococcal disease), and may not mount an optimal immune response to certain vaccines (e.g. hepatitis B).
Has a severe or chronic illness Refer to 3.3 Groups with special vaccination requirements.
These persons should receive recommended vaccines such as pneumococcal vaccine and annual influenza vaccination.
If there is significant immunocompromise, they should not receive live vaccines* (refer to above).
Persons with a severe or chronic illness may be at increased risk of vaccine-preventable diseases (e.g. invasive pneumococcal disease), but may not mount an optimal immune response to certain vaccines.
The safety and effectiveness of some vaccines may be suboptimal in persons who are immunocompromised (refer to above).
Has a bleeding disorder Refer to 3.3.5 Vaccination of persons with bleeding disorders.
The subcutaneous route could be considered as an alternative to the intramuscular route; seek specialist advice (refer to Appendix 1).
Intramuscular injection may lead to haematomas in patients with disorders of haemostasis.
Identifies as an Aboriginal or Torres Strait Islander Refer to 3.1 Vaccination for Aboriginal and Torres Strait Islander people.
Refer to the National Immunisation Program for specific recommendations for Aboriginal and Torres Strait Islander people.
Some Indigenous persons are at increased risk of some vaccine-preventable diseases, such as influenza, pneumococcal disease and hepatitis A.
Does not have a functioning spleen Refer to 3.3.3 Vaccination of immunocompromised persons, ‘Persons with functional or anatomical asplenia’.
Check the person’s vaccination status for pneumococcal, meningococcal, influenza and Hib vaccinations.
Persons with an absent or dysfunctional spleen are at an increased risk of severe bacterial infections, most notably invasive pneumococcal disease.
Is a parent, grandparent or carer of an infant
≤6 months of age
Ensure parents, grandparents and carers of infants up to 6 months of age have been offered all vaccines recommended for their age group, including dTpa. Persons in close contact are the most likely sources of vaccine-preventable diseases, in particular pertussis, in the newborn.
Lives with someone who is immunocompromised Ensure all recommended vaccines (in particular MMR, varicella and influenza vaccines) have been offered to household members of immunocompromised persons.
Refer to above and 3.3.3 Vaccination of immunocompromised persons.
Household members are the most likely sources of vaccine-preventable diseases among immunocompromised persons (who often are unable to be vaccinated, especially with live viral vaccines).
Is planning travel Refer to 3.2 Vaccination for international travel Travellers may be at increased risk of certain vaccine-preventable diseases.
Has certain occupation or lifestyle factors Refer to 3.3 Groups with special vaccination requirements, and ‘Catch-up schedules for persons ≥10 years of age’ in 2.1.5 Catch-up below. Workers in certain occupations (e.g. healthcare workers and persons working in early childhood education and care), and those with certain lifestyle factors (e.g. persons who inject drugs) may be at increased risk of certain vaccine-preventable diseases.

* Live attenuated vaccines are classified in Table 2.1.3 below.
† Refer to 4.9 Measles, 4.11 Mumps or 4.18 Rubella for further information.
‡ Refer to 4.2 Diphtheria, 4.12 Pertussis or 4.19 Tetanus for further information.

Table 2.1.3: Live attenuated parenteral and oral vaccines
Live attenuated parenteral vaccines Live attenuated oral vaccines
Viral Bacterial Viral Bacterial
Japanese encephalitis (Imojev)
Measles-mumps-rubella ( MMR)
Measles-mumps-rubella-varicella ( MMRV)
Varicella
Yellow fever
Zoster
BCG Oral rotavirus vaccine Oral typhoid vaccine

Contraindications to vaccination

There are only two absolute contraindications applicable to all vaccines:

  • anaphylaxis following a previous dose of the relevant vaccine
  • anaphylaxis following any component of the relevant vaccine.

There are two further contraindications applicable to live (both parenteral and oral) vaccines:

  • Live vaccines (refer to Table 2.1.3) should not be administered to persons who are significantly immunocompromised, regardless of whether the immunocompromise is caused by disease or treatment. The exception is that, with further advice, MMR, varicella and zoster vaccines can be administered to HIV-infected persons in whom immunocompromise is mild. (Refer to 3.3.3 Vaccination of immunocompromised persons, and individual disease-specific chapters.)
  • In general, live vaccines should not be administered during pregnancy, and women should be advised not to become pregnant within 28 days of receiving a live vaccine (refer to Table 3.3.1 Recommendations for vaccination in pregnancy in 3.3 Groups with special vaccination requirements).

False contraindications to vaccination

No-one should be denied the benefits of vaccination by withholding vaccines for inappropriate reasons.

Conditions listed in Table 2.1.4 below are not contraindications to vaccination. Persons with these conditions should be vaccinated with all recommended vaccines.

Table 2.1.4: False contraindications to vaccination
The following conditions are not contraindications to any of the vaccines in the National Immunisation Program schedule:
  • mild illness without fever (T <38.5oC)
  • family history of any adverse events following immunisation
  • past history of convulsions
  • treatment with antibiotics
  • treatment with locally acting (inhaled or low-dose topical) steroids
  • replacement corticosteroids
  • asthma, eczema, atopy, hay fever or ‘snuffles’
  • previous infection with the same pathogen
  • prematurity (vaccination should not be postponed and can be given if the infant is medically stable). Refer also to 3.3.2 Vaccination of women who are planning pregnancy, pregnant or breastfeeding, and preterm infants.
  • history of neonatal jaundice
  • low weight in an otherwise healthy child
  • neurological conditions, including cerebral palsy and Down syndrome
  • contact with an infectious disease
  • child’s mother is pregnant
  • child to be vaccinated is being breastfed
  • woman to be vaccinated is breastfeeding
  • recent or imminent surgery (refer also to 3.3.6 Vaccination before or after anaesthesia/surgery)
  • poorly documented vaccination history.

2.1.5 Catch-up

Every opportunity should be taken to review a person’s vaccination history and to administer the appropriate vaccine(s). If the person has not had documented receipt of vaccines scheduled in the NIP appropriate for his/her age, plan and document a catch-up schedule and discuss this with the person to be vaccinated or their parent/carer. The assessment of vaccination status should be based on the schedule for the state or territory in which the person to be vaccinated is residing.

The objective of catch-up vaccination is to complete a course of vaccination and provide optimal protection as quickly as possible. The information and tables below will assist in planning a catch-up schedule.

An online ‘catch-up calculator’ for NIP vaccines is hosted by South Australia Health (at immunisationcalculator.sahealth.sa.gov.au) and is available to assist in determining appropriate catch-up schedules for children ≤7 years of age across Australia. When using such resources, also check the accuracy of information provided by referring to your current state/territory immunisation schedule and the current edition of the Handbook.

If still uncertain about how to plan the catch-up schedule, or for more complicated catch-up scenarios, seek further advice (refer to Appendix 1 Contact details for Australian, state and territory government health authorities and communicable disease control).

For recently arrived migrants, the World Health Organization website (apps.who.int/immunization_monitoring/globalsummary) lists immunisation schedules provided by other countries, which may supplement information regarding which vaccines a child/adult arriving from overseas may have received (refer also to 3.3.8 Vaccination of migrants to Australia).

Confirmation of vaccination history

The most important requirement for assessment of vaccination status is to have written documentation of vaccination. The approach of immunisation service providers to the problem of inadequate records should be based on the age of the person to be vaccinated, whether previous vaccines have been given in Australia or overseas, and the vaccines being considered for catch-up.

Detailed information on the vaccine registers used in Australia and how to obtain vaccination records is provided in 2.3.4 Immunisation registers, but is also described briefly below.

Children, adolescents and young adults <20 years of age

The Australian Childhood Immunisation Register (ACIR) commenced on 1 January 1996 and holds records of vaccinations given since then to children (between birth and their 7th birthday). From 1 January 2016, the register will accept records of vaccinations given to older children, adolescents and young adults <20 years of age (referred to as ‘young individuals’ in ACIR legislation) if the vaccination was given after 1996. Details of a child’s, adolescent’s or young adult’s immunisation history can be obtained via the ACIR secure site within the Health Professionals Online Services (HPOS) (www.humanservices.gov.au/hpos) or the ACIR Enquiry Line (1800 653 809). If it is believed that vaccines have been given but are not recorded on the ACIR, every effort should be made to contact the relevant immunisation service provider. If confirmation from the nominated provider or the ACIR cannot be obtained, and no written records are available, the vaccine(s) should be considered as not received, and the individual should be offered catch-up vaccination appropriate for their age.

Prior to January 2016, vaccination information was not recorded on the ACIR for children, adolescents or young adults aged ≥7 years. Documented vaccinations given to a child, adolescent or young adult <20 years of age that are not captured on the ACIR can be added to the register by immunisation service providers. This is done through the ACIR secure site within HPOS or by completing an Immunisation History form. (Refer also to 2.3.4 Immunisation registers, ‘Reporting to the Australian Childhood Immunisation Register’.)

Certain vaccinations received during adolescence may be recorded by other registers. For example, the National HPV Vaccination Program Register (the HPV Register) holds details of human papillomavirus (HPV) vaccinations reported to the Register since the commencement of the HPV Vaccination Program in April 2007. The HPV Register initially only recorded vaccinations for females, but since 2013 also records vaccinations given to males. Details of HPV vaccinations held by the HPV Register can be obtained by phoning the Register on 1800 478 734 (1800 HPV REG). (Refer also to 2.3.4 Immunisation registers.)

Some states and territories also maintain records of vaccinations delivered through school-based programs. Information on how to obtain such records can be obtained from state and territory government health departments (refer to Appendix 1 Contact details for Australian, state and territory government health authorities and communicable disease control).

From the 2017 school year, the HPV Register will become the Australian School Vaccination Register, which will capture adolescent vaccinations given through school programs (refer to 2.3.4 Immunisation registers ‘School vaccination program registers’).

Adults (≥20 years of age)

From September 2016, all vaccinations given in general practice or community clinics over the life of an individual will be captured in the Australian Immunisation Register (AIR), which is an expansion of the ACIR. Adults who received vaccinations prior to September 2016 may only have patient-held and/or provider-held documentation of previous vaccination history or, in some instances, these may not be available. Information for certain vaccinations may be available from other sources, such as the HPV Register (which from the 2017 school year will become the Australian School Vaccination Register (ASVR) and also capture other adolescent vaccinations which are given through school programs) and the Australian Q Fever Register. (Refer also to 2.3.4 Immunisation registers.)

Incomplete documentation of prior vaccination

If receipt of prior vaccination cannot be confirmed via the above methods, it should generally be assumed that the vaccine(s) required have not been given previously. All efforts should be made to confirm and ensure appropriate documentation of prior receipt of vaccines.

For most vaccines (except Q fever), there are no adverse events associated with additional doses if given to an already immune person. In the case of diphtheria-, tetanus- and pertussis-containing vaccines and pneumococcal polysaccharide vaccines, frequent additional doses may be associated with an increase in local adverse events; however, the benefits of protection may outweigh the risk of an adverse reaction. (Refer also to 4.2 Diphtheria, 4.12 Pertussis, 4.13 Pneumococcal disease or 4.19 Tetanus.) Additional doses of MMR, varicella, inactivated poliomyelitis (IPV) or hepatitis B vaccines are rarely associated with significant adverse events.

Use of laboratory testing to guide catch-up vaccination

Laboratory testing (via serology, antigen detection or polymerase chain reaction (PCR)) can be reliably used for certain diseases (hepatitis A, hepatitis B, measles, mumps, rubella and varicella) to determine immunity from prior vaccination and/or infection and may be useful to guide the need for catch-up vaccination. However, for other diseases, laboratory testing is not routinely recommended to guide the need for catch-up vaccination as it is not necessarily reliable and/or detection of a previous infection (e.g. due to one serotype) does not protect against subsequent disease. As a previous infection is not a contraindication to immunisation against that same disease, in most circumstances, and for most vaccines, it is more practical to offer vaccination rather than laboratory testing. Refer also to recommendations regarding serological testing before and after vaccination in various disease chapters.

If serological testing is performed, interpretation of the results may be enhanced by discussion with the laboratory that performed the test, ensuring that relevant clinical information is provided.

The ACIR accepts natural immunity to a disease as a valid exemption to vaccination for certain antigens (refer to 2.3 Post-vaccination, ‘Reporting to the Australian Childhood Immunisation Register’).

Determining when a vaccine dose is valid according to age and interval since last dose

A ‘valid’ vaccine dose is a dose that is considered immunogenic (and safe) given the age and health status of the recipient and the interval since the recipient’s last dose of the same vaccine. For children who are vaccinated at an age younger than that routinely recommended, or for children and adults in whom the interval between vaccine doses is shorter than the usual recommended interval, information regarding both the minimum acceptable age for the 1st dose of an infant vaccine (Table 2.1.5) and the minimum acceptable intervals between vaccine doses (Tables 2.1.7 to 2.1.12) can be used to determine whether additional vaccine doses and/or catch-up vaccination is required. For more details refer to the following sections.

Planning catch-up vaccination

This and the following two sections are dedicated to planning catch-up vaccination. In the following two sections information is presented by age of the vaccine recipient (children aged <10 years and persons aged ≥10 years). A number of tables and figures are provided to help plan a catch-up schedule:

  • Figure 2.1.1 is a worksheet for calculating and recording which vaccines are required in children aged <10 years, the number of doses outstanding and the timing of these doses (refer to ‘Using the catch-up worksheet (Figure 2.1.1) for children <10 years of age’ below).
  • Table 2.1.5 lists the minimum acceptable ages for the 1st dose of scheduled vaccines in infants.
  • Table 2.1.6 can be used to assess the number of doses a child should have received if they were on schedule. Check under the current age of the child to see how many doses they should have already received and use that number of doses as the starting point for calculating a catch-up schedule. For example, a child who is 18 months old now should have received 3 doses of DTPa, 3 doses of IPV, etc.
  • Table 2.1.7 lists the minimum acceptable interval between doses under special circumstances, such as catch-up vaccination. Vaccine doses should not be administered at less than the acceptable minimum interval.15 In the majority of instances, doses administered earlier than the minimum acceptable interval should not be considered as valid doses and should be repeated, as appropriate, using Table 2.1.6.
  • Tables 2.1.8 to 2.1.11 are for calculating catch-up for Haemophilus influenzae type b (Hib) and pneumococcal vaccination of children.
  • Table 2.1.12 can be used to calculate a catch-up schedule for persons aged ≥10 years.

In addition, the following principles should generally be applied when planning catch-up vaccination:

  • When commencing the catch-up schedule, the standard scheduled interval between doses may be reduced or extended, and the numbers of doses required may reduce with age. For example, from 16 months of age, only 1 dose of (any) Hib vaccine is required.
  • As a child gets older, the recommended number of vaccine doses may change (or even be omitted from the schedule), as the child becomes less vulnerable to specific diseases.
  • For incomplete or overdue vaccinations, build on the previous documented doses. In almost every circumstance, it is advisable to not start the schedule again, regardless of the interval since the last dose, but to count previous doses. One exception to this rule is for oral cholera vaccine (refer to 4.1 Cholera).
  • If more than one vaccine is overdue, 1 dose of each due or overdue vaccine should be given at the first catch-up visit. Further required doses should be scheduled after the appropriate minimum interval (refer to Table 2.1.7).
  • A catch-up schedule may require multiple vaccinations at a visit. Give all the due vaccines at the same visit – do not defer. Refer to 2.2.9 Administering multiple vaccine injections at the same visit.
  • The co-administration of two combination vaccines containing the same antigen is not routinely recommended but may be acceptable when providing catch-up vaccinations where no alternative vaccine(s) or schedules are available. For example, catch-up vaccination for multiple infant vaccines using Hib-MenCCV and another Hib-containing combination vaccine.
  • The standard intervals and ages recommended in the NIP schedule should be used once the child or adult is up to date with the schedule.
  • Some persons will require further doses of antigens that are available only in combination vaccines. In general, the use of the combination vaccine(s) is acceptable, even if this means the number of doses of another antigen administered exceeds the required number.
  • For some vaccines, catch-up vaccination is not recommended. For example, rotavirus vaccination is not recommended if the 1st (and subsequent) vaccine doses are not able to be provided within the prescribed upper age limits (refer to ‘Catch-up guidelines for individual vaccines for children <10 years of age’ below).

Using the catch-up worksheet (Figure 2.1.1) for children <10 years of age

A catch-up schedule for a child <10 years of age should be planned by taking into account the guidelines above in conjunction with the catch-up tables (listed above). The catch-up worksheet (Figure 2.1.1) provides a method of recording these steps.

To use the catch-up worksheet:

  1. Record the child’s details, including date of birth and current age in the top left corner of the worksheet.
  2. For each vaccine, determine how many doses have been received and the date that the last dose was given. Record this in the ‘Last dose given’ column of the worksheet. If documentation is adequate, include previous vaccinations given in another country (receipt of these vaccines should be entered onto the ACIR for a child <7 years of age – refer to 2.3.4 Immunisation registers).
  3. Refer to Table 2.1.6 to check how many doses of each vaccine are required for the child’s current age. Enter this number in the ‘Number of doses required at current age’ column of the worksheet.
  4. Assess other factors that may affect the type or number of vaccines required. These should have been ascertained during pre-vaccination screening (refer to 2.1.4 Pre-vaccination screening above, the pre-vaccination screening check list (Table 2.1.1) and table of responses (Table 2.1.2) and may include:
    • anaphylaxis to any vaccine or one of its components (that vaccine is contraindicated)
    • immunocompromise due to disease or treatment (refer to 3.3 Groups with special vaccination requirements)
    • children identifying as Aboriginal or Torres Strait Islander (refer to 3.1 Vaccination for Aboriginal and Torres Strait Islander people
    • children with underlying medical risk condition(s) that predisposes them to invasive pneumococcal disease (refer to 4.13 Pneumococcal disease)
    • preterm infants born at <32 weeks gestation (refer to ‘Hepatitis B vaccine’ and ‘Pneumococcal conjugate vaccines (13vPCV and 10vPCV)’ in ‘Catch-up guidelines for individual vaccines for children <10 years of age’ below).

Record any factors that affect the schedule in the ‘Comments’ column beside the relevant vaccine.

  1. If any variations to the schedule are necessary due to recorded factors (e.g. a child who is immunocompromised may require different vaccines), adjust the ‘number of doses required’ accordingly.
  2. For each vaccine, compare the number of doses received, as recorded in the ‘Last dose given’ column, with the number of doses required for the child’s current age.
  3. If the child has already received the number of doses required for a particular vaccine, cross through the relevant ‘Dose number due now’ and ‘Further doses’ columns. Ensure that the minimum acceptable interval has been observed for all doses previously received, particularly if the child commenced their vaccination program overseas.
  4. If the number of doses received, as recorded in the ‘Last dose given’ column, is less than the number of doses required, administer a dose of the relevant vaccine now, and record this in the ‘Dose number due now’ column. If this dose still does not complete the required doses, enter the further dose numbers in the ‘Further doses’ column.
  5. To schedule the next dose at the most appropriate time (usually at the earliest opportunity), refer to Table 2.1.7 for the minimum acceptable interval required between doses. Record when the next dose is due in the ‘Further doses’ column.
  6. Convert this information into a list of proposed appointment dates, detailing vaccines and dose number needed at each visit on the ‘Catch-up appointments’ section of the worksheet.
  7. Record this catch-up schedule in your provider records and provide a copy to the child’s parent/carer.
  8. Once a child has received relevant catch-up vaccines, give the remaining scheduled vaccines as per the recommended NIP schedule. For example, for a 12-month-old child who is brought up to date with all vaccines including the 12-month vaccinations, the 2nd dose of MMR-containing vaccine should be given at 18 months of age, not 4 weeks after the last received dose.

Figure 2.1.1: Catch-up worksheet for children <10 years of age for NIP vaccines

This worksheet can be used in conjunction with Tables 2.1.6 and 2.1.7.

Figure 2.1.1: Catch-up worksheet for children <10 years of age for NIP vaccines
CATCH-UP WORKSHEET
Name:

DOB:

Age:
Last dose given
Dose number and date
Number of doses required at current age* Dose number due now Further doses
Interval
or date
Comments
DTPa          
Poliomyelitis (IPV)          
Hepatitis A          
Hepatitis B          
Hib          
Pneumococcal (13vPCV)‡§          
Pneumococcal (23vPPV)          
MenCCV          
MMR          
Rotavirus         DO NOT give after upper age limits for each dose.
Refer to 4.17 Rotavirus, Table 4.17.1.
Varicella          
CATCH-UP APPOINTMENTS
Date Vaccines and dose number Interval to next dose Comments
     
     
     
     

* Refer to Table 2.1.6 Number of vaccine doses that should have been administered by the current age of the child and Table 2.1.7 Minimum acceptable dose intervals for children <10 years of age.
† Refer to Table 2.1.8 for Hib vaccine catch-up recommendations.
‡ Refer to Tables 2.1.9, 2.1.10 and 2.1.11 for pneumococcal vaccine catch-up recommendations.
§ Previous doses of pneumococcal conjugate vaccine may have been given using 7-valent (7vPCV) or 10-valent (10vPCV) vaccine(s).

Table 2.1.5: Minimum acceptable age for the 1st dose of scheduled vaccines in infants in special circumstances*
Vaccine Minimum age for 1st dose in special circumstances* Action if a vaccine dose is inadvertently administered prior to the recommended minimum age16
DTPa 6 weeks If the 1st dose of DTPa-containing vaccine was administered at ≤28 days of age, it is recommended that the dose is repeated. This repeat dose should be given at 2 months of age. The NIP schedule should be followed thereafter, with the next dose of DTPa-containing vaccine given at 4 months of age.†‡
If the 1st dose of DTPa-containing vaccine was administered between >28 days and <42 days (6 weeks) of age, it does not necessarily need to be repeated. Limited data suggest that administration at this age will still be safe and immunogenic. The NIP schedule should be followed thereafter, with the next dose of DTPa-containing vaccine given at 4 months of age.
Poliomyelitis (IPV) 6 weeks Refer to DTPa-containing vaccines above.
Hib 6 weeks Refer to DTPa-containing vaccines above.
Hepatitis B§ 6 weeks§
(Note: this excludes birth dose of hepatitis B vaccine)§
Refer to DTPa-containing vaccines above.
Pneumococcal
(13vPCV or 10vPCV)
6 weeks If the 1st dose of PCV was administered at
≤28 days of age, it is recommended that the dose is repeated. This repeat dose should be given at 2 months of age. The NIP schedule should be followed thereafter, with the next dose of PCV given at 4 months of age.
If the 1st dose of PCV was administered between >28 days and <42 days (6 weeks) of age, it does not necessarily need to be repeated. Limited data suggest that administration at this age will still be safe and immunogenic. The NIP schedule should be followed thereafter, with the next dose of PCV given at 4 months of age.
Rotavirus 6 weeks If the 1st dose of rotavirus vaccine was administered at ≤28 days of age, it is recommended that the dose is repeated.
This repeat dose should be given at 2 months of age. The NIP schedule should be followed thereafter, with the next dose of rotavirus vaccine given at 4 months of age.
If the 1st dose of rotavirus vaccine was administered between >28 days and <42 days (6 weeks) of age, it does not necessarily need to be repeated. Limited data suggest that administration at this age will still be safe and immunogenic. The NIP schedule should be followed thereafter, with the next dose of rotavirus vaccine given at 4 months of age.
For all doses of rotavirus vaccine it is important to ensure the upper age limits for dose administration are not exceeded (refer to 4.17 Rotavirus, Table 4.17.1).
Meningococcal 6 weeks If the 1st dose of either 4vMenCV or MenBV is administered between >28 days and <42 days (6 weeks) of age, the dose does not necessarily need to be repeated; however, expert advice should be sought.
Hepatitis A (Indigenous children in NT, Qld, SA and WA only) 12 months If the 1st dose of hepatitis A vaccine is administered at <12 months of age, and ongoing protection against hepatitis A is required, the 1st dose should be repeated.
MMR# 12 months MMR vaccine may be given from 9 months of age, in certain circumstances, such as for post-exposure prophylaxis for measles (refer to 4.9 Measles), but it is recommended that the 1st dose be repeated if it was given at <12 months of age**
Refer to note on MMRV below.#
Varicella†† 12 months If a varicella-containing vaccine is administered at <12 months of age, the dose should be repeated, preferably at 18 months of age.
Refer to note on MMRV below.#

* Special circumstances may include infants/children being vaccinated during an outbreak of a certain disease, before overseas travel, or opportunistic vaccination following early attendance to a provider. These ages will often differ from routinely recommended ages of administration under the NIP schedule. In some instances, these ages will also result in the dose not being considered by the Australian Childhood Immunisation Register (ACIR) as ‘valid’ for the purpose of calculating immunisation status. If the ACIR age requirement differs from the minimum ages in this table, this is noted.
† If the need to repeat the 1st dose of vaccine is not recognised until the infant is older (e.g. a 4-month-old infant presents for vaccination and has only previously received 1 dose of DTPa-hepB-IPV-Hib or 13vPCV vaccines both at age ≤28 days), repeat these vaccines now (and count these as dose 1), then proceed with subsequent schedule as per NIP and/or catch-up recommendations for these vaccines described in this chapter.
‡ The minimum age from which the combination vaccine DTPa-hepB-IPV-Hib (or the antigens contained within it) is considered a valid dose on the ACIR is 1 month (>28 days) of age.16
§ Monovalent hepatitis B vaccine should be given at birth (up to 7 days of age). However, for subsequent doses where hepatitis B-containing combination vaccine is given at 2, 4 and 6 months of age, the minimum age for the 1st dose (scheduled at age 2 months) is 6 weeks of age. If a hepatitis B-containing combination vaccine dose is inadvertently administered prior to 6 weeks of age, follow the recommended action for DTPa-containing vaccines. If an infant has not received a birth dose within the first 7 days of life, a primary 3-dose course of a hepatitis B-containing combination vaccine should be given at 2, 4 and 6 months of age; catch-up of the birth dose is not necessary.
¶ The listed minimum age only applies to the Menveo 4vMenCV brand and MenBV, which can both be used in infants (refer to 4.10 Meningococcal disease). MenCCV is recommended for use in infants at 12 months of age. The ACIR will record MenCCV given at ≥11 months of age as a valid dose for the purposes of calculating immunisation status. It is expected that a single dose of MenCCV provided at ≥11 months (but before 12 months) of age is likely to be immunogenic. As such, doses given in this timeframe may not need to be repeated in all circumstances.
# MMRV vaccine is recommended as the 2nd (not 1st) dose of MMR-containing vaccine in children <4 years of age. However, if MMRV has been inadvertently given as the 1st dose of MMR-containing vaccine, that MMR-containing dose does not need to be repeated, unless it was provided at <12 months of age (as per MMR and monovalent varicella vaccines).
** Note: The ACIR will record MMR vaccine given at ≥11 months of age as a valid dose, for purposes of calculating immunisation status. There is some evidence that a dose provided at ≥11 months (but before 12 months) of age is sufficiently immunogenic, especially in infants born to mothers with measles antibody derived from vaccination rather than natural infection. As such, doses given in this timeframe may not need to be repeated in all circumstances.16
†† One monovalent varicella vaccine, Varilrix, is registered for use from 9 months of age, and can be provided from ≥9 months of age in special circumstances, for example, prior to travel. However, if a dose has been provided at <12 months of age, it should be repeated.

Table 2.1.6: Number of vaccine doses that should have been administered by the current age of the child

This table can be used in conjunction with Figure 2.1.1 Catch-up worksheet for children <10 years of age for NIP vaccines.

Table 2.1.6: Number of vaccine doses that should have been administered by the current age of the child
Vaccine Current age
  0 to <2
months
2 to <4
months
4 to <6
months
6 to <12
months
12 to 18
months
>18 months to <4 years 4 years
to
<10 years
DTPa*   1 2 3 3 4 5*
Poliomyelitis ( IPV)   1 2 3 3 3 4
Hepatitis A         1 2 2
Hepatitis B §   1 2 3 3 3 3
Hib Complex – refer to Table 2.1.8 for Hib vaccine catch-up
Pneumococcal ( 13vPCV and 23vPPV) Complex – refer to Tables 2.1.9, 2.1.10 and 2.1.11 for pneumococcal vaccine catch-up
MenCCV         1 1 1
MMR         1 2 2
Rotavirus # There are specific age limits as per 4.17 Rotavirus, Table 4.17.1 NO CATCH-UP
Varicella           1 1

* A total of 5 doses of DTPa-containing vaccine are recommended for children <10 years of age; 3 doses as part of the primary schedule for infants (recommended at 2, 4 and 6 months of age) and 2 booster doses (recommended at 18 months and 4 years of age); refer to 4.12 Pertussis. If the 1st booster dose recommended at 18 months of age (dose 4) is given after the child is 3.5 years of age, the 2nd booster dose recommended at age 4 years (dose 5) is not required.
† If the 3rd dose of IPV is given after 3.5 years of age, a 4th dose is not required. However, if using a combination vaccine it is acceptable to give a 4th dose.
‡ Indigenous children resident in the Northern Territory, Queensland, South Australia and Western Australia only. Dependent on jurisdiction, the 1st dose is given at 12–18 months of age, followed by the 2nd dose 6 months later at 18–24 months of age. Consult relevant state/territory health authorities for advice regarding catch-up in children >2 years of age.
§ A birth dose of monovalent hepatitis B vaccine is recommended for all infants; however, if this was not given, a catch-up birth dose is not necessary. Where the birth dose was given, in the usual circumstances where hepatitis B-containing combination vaccines for children are used for catch-up, a further 3 doses of hepatitis B-containing vaccine are recommended. In the unusual circumstance where a child requires catch-up only for hepatitis B vaccination, the standard monovalent hepatitis B vaccination schedule of 0, 1, 6 months can be adopted to work out the remaining number of doses required and intervals of the catch-up schedule (refer to 4.5 Hepatitis B).
MMRV can be given as the 2nd dose of MMR-containing vaccine where both MMR and varicella are required (refer to 4.9 Measles and 4.22 Varicella).
# There is no catch-up for rotavirus vaccine (refer to 4.17 Rotavirus).

Table 2.1.7: Minimum acceptable dose intervals for children <10 years of age

This table can be used in conjunction with Figure 2.1.1 Catch-up worksheet for children <10 years of age for NIP vaccines and Table 2.1.6 Number of vaccine doses that should have been administered by the current age of the child.

Note: These are not the routinely recommended intervals between vaccine doses. These minimum intervals are only to be used under special circumstances, such as when catch-up vaccination is required until a child is back on schedule for their age. These intervals may differ from the routinely recommended intervals between doses under the NIP schedule. If providing catch-up using a combination vaccine, it is important to ensure that minimum intervals are met for all antigens.

Table 2.1.7: Minimum acceptable dose intervals for children <10 years of age
Vaccine Minimum interval between dose 1 and 2 Minimum interval between dose 2 and 3 Minimum interval between dose 3 and 4 Minimum interval between dose 4 and 5
DTPa* 4 weeks 4 weeks 6 months 6 months
Poliomyelitis (IPV) 4 weeks 4 weeks 4 weeks  
Hepatitis A 6 months      
Hepatitis B§ 1 month§ 2 months§    
Hib Refer to Table 2.1.8 for Hib vaccine catch-up
Pneumococcal (13vPCV and 23vPPV) Refer to Tables 2.1.9, 2.1.10 and 2.1.11 for pneumococcal vaccine catch-up
Meningococcal Minimum acceptable dose intervals vary for the different meningococcal vaccines.
Refer to footnote
MMR# 4 weeks      
Rotavirus** Rotarix 4 weeks      
RotaTeq 4 weeks 4 weeks    
Varicella#†† 4 weeks      

* DTPa-containing vaccines can be used where necessary for primary course or catch-up doses in children <10 years of age.
If the 1st booster dose of DTPa vaccine recommended at 18 months of age (dose 4) is given after the child is 3.5 years of age, the 2nd booster dose recommended at age 4 years (dose 5) is not required. Refer to Table 2.1.6 above.
† If the 3rd dose of IPV is given after 3.5 years of age, a 4th dose is not required. However, if using a combination vaccine, it is acceptable to give a 4th dose.
‡ Indigenous children resident in the Northern Territory, Queensland, South Australia and Western Australia only.
§ Australian-born infants typically receive a monovalent hepatitis B birth dose (which can be regarded as dose 0 [zero] for the purposes of this table) followed by a primary course of hepatitis B-containing vaccine consisting of 3 doses at 2, 4 and 6 months of age (given as DTPa-hepB-IPV-Hib). In addition to the minimum intervals between doses outlined in this table, the minimum recommended interval between dose 1 and dose 3 is 4 months (refer to 4.5 Hepatitis B). The final dose of the primary hepatitis B vaccine course (with or without a birth dose) should preferably be administered at ≥24 weeks of age. However, if the final dose is given at <24 weeks but ≥16 weeks (approximately 4 months) of age, it is not necessary to repeat the dose for the child to be considered as fully immunised by the ACIR. Note: The ACIR accepts a minimum interval of 4 weeks between any hepatitis B vaccine dose to allow children who have been immunised using 3-dose schedules (typically provided overseas) to be considered as fully immunised.16
¶ The recommended schedule for meningococcal vaccines varies for different formulations (refer to 4.10 Meningococcal disease). The minimum acceptable interval between conjugate vaccines containing meningococcal serogroup C (MenCCV, Hib-MenCCV and 4vMenCV) is 8 weeks. The minimum acceptable interval between primary doses of MenBV is 4 weeks for infants aged <6 months. There is no clinical trial data in older children for minimum intervals less than the routinely recommended interval of 8 weeks. In circumstances where MenBV and 4vMenCV are indicated, the vaccines can be administered concurrently based on first principles. (Refer also 4.10 Meningococcal disease).
# MMR is recommended as the 1st dose of MMR-containing vaccine in children <4 years of age (refer to 4.9 Measles). MMRV is recommended to be given as the 2nd dose of MMR-containing vaccine. MMRV can be given 4 weeks following the 1st catch-up dose of MMR vaccine or as catch-up for the 2nd dose of MMR where varicella is also required.
** Refer to 4.17 Rotavirus, Table 4.17.1 for upper age limits for administration of rotavirus vaccines. Catch-up is not recommended.
†† Two doses of varicella-containing vaccine are not routinely recommended in children <14 years of age; however, a 2nd dose can be provided to offer increased protection against varicella (refer to 4.22 Varicella).

Catch-up guidelines for individual vaccines for children <10 years of age

The advice below on catch-up for individual vaccines should be considered with the general principles for planning catch-up vaccination described in more detail in ‘Planning catch-up vaccination’ above.

DTPa vaccine

Monovalent pertussis vaccine is not available in Australia. DTPa-containing vaccines can be used for catch-up of primary or booster doses in children aged <10 years, where required.

Children <10 years of age should receive a total of 5 doses of DTPa-containing vaccine; 3 doses as part of the primary schedule for infants (recommended at 2, 4 and 6 months of age) and 2 booster doses (recommended at 18 months and 4 years of age) (refer to 4.12 Pertussis). However, if the 1st booster dose recommended at 18 months of age (dose 4) is given after the child is 3.5 years of age, the 2nd booster dose recommended at age 4 years (dose 5) is not required.

Because the 18-month booster dose was not routinely recommended between 2003 and 2015, there will be children who have only had 3 primary doses of DTPa-containing vaccine prior to a booster dose at 4 years of age. In these circumstances, providing the child’s 4th dose of DTPa-containing vaccine was administered after 3.5 years of age, they do not require any further doses until the single booster dose recommended during adolescence (refer to 4.12 Pertussis) However, any child aged ≥18 months to ≤3.5 years who has not previously received a booster dose of DTPa-containing vaccine at 18 months of age should receive their 1st booster dose (dose 4) now, followed by a 2nd booster dose at 4 years of age (with a minimum interval of 6 months between these doses). These children should then receive their next booster dose during adolescence as routinely recommended (refer to 4.12 Pertussis).

Hepatitis B vaccine

Australian-born infants typically receive a monovalent hepatitis B vaccine dose at birth followed by a 3-dose primary course of hepatitis B-containing vaccine at 2, 4 and 6 months of age (usually given as DTPa-hepB-IPV-Hib). The birth dose hepatitis B vaccine is only scheduled for infants up to 7 days of age. If this dose was not given, a catch-up birth dose is not necessary. Where the birth dose was given, a further 3 doses of hepatitis B-containing vaccine are recommended (refer to 4.5 Hepatitis B). For all infants, the final dose of the primary hepatitis B vaccine course (with or without a birth dose) should preferably be administered at ≥24 weeks of age. However, if the final dose is given at <24 weeks but ≥16 weeks (approximately 4 months) of age, it is not necessary to repeat the dose (refer to Table 2.1.7).

In the circumstance where a child requires catch-up vaccination only for hepatitis B, but not any other components in the hepatitis B-containing combination vaccines, the standard schedule of monovalent hepatitis B vaccine (0, 1, 6 months) can be used for the remaining dose(s) if required (refer to 4.5 Hepatitis B), with minimum intervals as specified in Table 2.1.7.

In preterm (<32 weeks gestation) or low-birth-weight infants (<2000 g birth weight) it is recommended to give hepatitis B vaccine at birth, 2, 4 and 6 months of age, followed by either serological testing for anti-HBs or a hepatitis B booster dose at 12 months of age. For details, refer to 3.3.2 Vaccination of women who are planning pregnancy, pregnant or breastfeeding, and preterm infants and 4.5 Hepatitis B.

Hib vaccine

The recommended number of doses and intervals for Hib vaccines vary with the vaccine type and age of the child. For catch-up recommendations refer to Table 2.1.8.

PRP-OMP is the Hib formulation contained in Liquid PedvaxHIB. PRP-T is the Hib formulation contained in the other Hib-containing vaccines: Act-HIB, Hiberix, Infanrix hexa, Menitorix and Pediacel. Where possible, the same brand of Hib-containing vaccine should be used for all primary doses. If different Hib vaccines (i.e. PRP-OMP and PRP-T vaccines) are used in the primary series, then 3 doses (of any Hib vaccine) are required for the primary series, at 2, 4 and 6 months of age, with a booster of a Hib-containing vaccine at 12 months of age (provided as either the combination vaccine Hib-MenCCV or monovalent Hib vaccine – refer also to ‘Meningococcal C conjugate vaccine (MenCCV)’ below).

For extremely preterm and/or low-birth-weight infants (<28 weeks gestation or <1500 g birth weight), 4 doses of a Hib-containing vaccine (irrespective of the brand used) should be given, at 2, 4, 6 and 12 months of age (refer to 3.3.2 Vaccination of women who are planning pregnancy, pregnant or breastfeeding, and preterm infants).

Refer also to 4.3 Haemophilus influenzae type b.

MMR vaccine, MMRV vaccine and varicella vaccine

If no previous documented doses have been given, catch-up for MMR vaccine consists of 2 doses of MMR-containing vaccine, given at least 4 weeks apart (refer to 4.9 Measles). If no previous documented varicella vaccination has been given, a single dose of varicella-containing vaccine is recommended in children aged <14 years (refer to 4.22 Varicella).

If a child receives varicella vaccine at <12 months of age, a further dose should be given at 18 months of age. In this circumstance MMRV vaccine may be given where the 2nd dose of MMR vaccine and a dose of varicella vaccine are both required (refer below and to 4.22 Varicella).

MMRV vaccines should only be administered as the 2nd dose of MMR-containing vaccine in children <4 years of age. If no previous doses of MMR vaccine have been administered in a child aged >12 months and <4 years, MMR vaccine should be administered as the 1st dose and then MMRV vaccine can be administered 4 weeks later as the 2nd dose of MMR-containing vaccine. MMRV can be used as the 1st dose of MMR-containing vaccine in children ≥4 years of age, up to age 14 years (refer to 4.9 Measles and 4.22 Varicella).

Meningococcal C conjugate vaccine (MenCCV)

A single dose of MenCCV-containing vaccine is recommended for children at 12 months of age (as either MenCCV or the combination vaccine Hib-MenCCV). If a dose has not been given at ≥12 months of age (or if dose(s) were given at <12 months of age), a single dose of MenCCV is recommended (refer to 4.10 Meningococcal disease). Both MenCCV and Hib-MenCCV can be used for catch-up vaccinations for either meningococcal C or Hib in children <10 years of age, if required.

4vMenCV and MenBV are recommended for certain children at increased risk of meningococcal disease due to age and/or other risk factors (refer to 3.3 Groups with special vaccination requirements and 4.10 Meningococcal disease).

Pneumococcal conjugate vaccines (13vPCV and 10vPCV)

The number of doses and recommended intervals of 13vPCV required for catch-up vaccination vary with the age of the child, their health and Indigenous status, and the state or territory of residence (Refer to Tables 2.1.9, 2.1.10 and 2.1.11 below).

Table 2.1.9 is for children who are not at increased risk of invasive pneumococcal disease (IPD) (including Indigenous children living in the Australian Capital Territory, New South Wales, Victoria and Tasmania). Table 2.1.10 is for Indigenous children residing in the Northern Territory, Queensland, South Australia and Western Australia. Table 2.1.11 provides catch-up details for children with a medical condition(s) associated with an increased risk of IPD. (Refer also to 4.13 Pneumococcal disease.)

If 13vPCV is not available, and 10vPCV is being used, 10vPCV is recommended in a 4-dose schedule. (Refer also to 4.13 Pneumococcal disease.) If catch-up is required for 10vPCV, vaccination can be done according to the information provided in Table 2.1.10.

Children aged ≥5 years who are not at increased risk of invasive pneumococcal disease (including Indigenous children aged ≥5 years) do not require catch-up doses of PCV.

Preterm infants born at <28 weeks gestation should receive extra doses of pneumococcal vaccines, in accordance with the schedule for those at increased risk of IPD (refer to 4.13 Pneumococcal disease and 3.3.2 Vaccination of women who are planning pregnancy, pregnant or breastfeeding, and preterm infants).

Poliomyelitis vaccine

If no previous doses of poliomyelitis vaccine have been given, give 3 doses of IPV or IPV-containing vaccines at least 4 weeks apart (refer to 4.14 Poliomyelitis). (Previous doses of OPV are interchangeable with IPV.)

If the 3rd dose of IPV is administered at ≤3.5 years of age, give the 4th (booster) dose at the 4th birthday. If the 3rd dose is given after 3.5 years, the 4th dose is not required. However, if the use of combination vaccines is necessary, a further IPV-containing dose may be given.

Rotavirus vaccine

Catch-up rotavirus vaccination of older infants or children is not recommended. Infants should commence the course of rotavirus vaccination within the recommended age limits for the 1st dose; that is, the 1st dose of RotaTeq should be given between 6 and 12 weeks of age (i.e. before turning 13 weeks old), and the 1st dose of Rotarix should be given between 6 and 14 weeks of age (i.e. before turning 15 weeks old). It is recommended that vaccine doses are not given beyond the upper age limits specified in Table 4.17.1 (refer to 4.17 Rotavirus).

Table 2.1.8: Catch-up schedule for Haemophilus influenzae type b (Hib) vaccination for children <5 years of age*
Number of Hib doses given previously
Current age
Age when previous dose(s) of Hib vaccine given
Recommendations
1st dose
2nd dose
3rd dose
Number of further primary dose(s) required
Number of booster doses required at age ≥12 months
No previous doses <7 months
3 §
1
7–11 months
2
1
12–15 months
1
1
16–59 months
1
Not needed
1 previous dose <7 months <7 months
2 §
1
7–11 months <7 months
2 §
1
7–11 months
1
1
12–15 months <12 months
1
1
≥12 months
Not needed
1
16–59 months <16 months
Not needed
1
≥16 months
Not needed
Not needed
2 previous doses <12 months <7 months <12 months
1 §
1
7–11 months 7–11 months
Not needed
1
12–59 months <7 months <12 months
1 §
1
12–15 months
Not needed
1
7–11 months 7–15 months
Not needed
1
12–15 months 12–15 months
Not needed
Not needed
Any age ≥16 months
Not needed
Not needed
3 previous doses 7–11 months Any age Any age Any age
Not needed
1
12–59 months <7 months <12 months <12 months
Not needed
1
12–15 months
Not needed
1 #
12–15 months 12–15 months
Not needed
Not needed
7–11 months 7–15 months 12–15 months
Not needed
Not needed
Any age Any age ≥16 months
Not needed
Not needed

* Recommendations for vaccination of haematopoietic stem cell transplant (HSCT) recipients differ; refer to Table 3.3.3 Recommendations for revaccination following haematopoietic stem cell transplant (HSCT) in children and adults, irrespective of previous immunisation history.

† This column lists the number of further primary doses that should be scheduled for the child, based on their current age. The recommended interval between primary doses for catch-up is 1 month. Where possible, it is recommended to schedule the required remaining primary doses to be given prior to 12 months of age. If there are further delays in the scheduled catch-up primary dose(s), the number of doses required should be checked again against the child’s age at each presentation.

‡ This column lists the number of booster doses that should be scheduled for the child, based on their current age. Booster doses are to be given at age 12 months or 2 months after the last dose of Hib vaccine, whichever is later.

§ One less dose is required if PRP-OMP is to be used for the entire primary course, or if PRP-OMP has already been given for all previous doses. If v has been given as one or more of the doses in the primary course, plan for the number of doses as specified in this table. PRP-OMP is the Hib formulation contained in Liquid PedvaxHIB. PRP-T is the Hib formulation contained in the other Hib-containing vaccines: ACT-Hib, Hiberix, Infanrix hexa, Menitorix and Pediacel.

¶ A booster dose is not needed if the last previous dose was given at ≥16 months of age.
# This booster dose is not required if PRP-OMP was used for both the 1st and the 2nd (primary) doses of Hib vaccine in infancy, since the 3rd dose of Hib vaccine received at age 12–15 months would have served as the booster dose for these children.

Table 2.1.9: Catch-up schedule for 13vPCV(Prevenar 13) for non-Indigenous children, and Indigenous children residing in the Australian Capital Territory, New South Wales, Tasmania and Victoria, who do not have any medical condition(s) associated with an increased risk of invasive pneumococcal disease (IPD), aged <5 years
Number of doses given previously Age at presentation Age when previous dose of any PCV* was given Number of further dose(s) required
1st dose 2nd dose 3rd dose
No previous doses <7 months 3
7–11 months 2
12–59 months 1
1 previous dose <7 months <7 months 2
7–11 months <7 months 2
7–11 months 1
12–59 months <12 months 1
≥12 months Not needed
2 previous doses <12 months <7 months <12 months 1
7–11 months 7–11 months Not needed
12–23 months <7 months <12 months 1
≥12 months Not needed
≥7 months Any age Not needed
24–59 months Any age Any age Not needed
3 previous doses 7–59 months Any age Any age Any age Not needed

* Prior PCV doses may have been given as 7vPCV (e.g. from overseas), 10vPCV or 13vPCV. Use 13vPCV as the vaccine formulation for further catch-up doses required, regardless of which formulation of PCV the child received previously.
† Recommended interval between primary doses for catch-up is 1–2 months. Where possible, it is recommended to align doses with the standard schedule points at 4 months and 6 months of age for infants aged <7 months. The minimum interval between dose(s) is 1 month if aged <12 months, and 2 months if aged ≥12 months.

Table 2.1.10: Catch-up schedule for 13vPCV* (Prevenar 13) for Indigenous children residing in the Northern Territory, Queensland, South Australia or Western Australia ONLY, who do not have any medical condition(s) associated with an increased risk of invasive pneumococcal disease (IPD), aged <5 years
Number of doses given previously Age at presentation Age when previous dose of any PCV was given Recommendations
1st dose 2nd dose 3rd dose Number of further primary dose(s) required Number of booster 13vPCV doses required §
No previous doses <7 months 3 1
7–11 months 2 1
12–23 months 1 1
24–59 months 1 Not needed
1 previous dose <7 months <7 months 2 1
7–11 months <7 months 2 1
7–11 months 1 1
12–23 months <12 months 1 1
≥12 months Not needed 1
24–59 months <12 months 1 Not needed
≥12 months Not needed Not needed
2 previous doses <12 months <7 months <12 months 1 1
7–11 months 7–11 months Not needed 1
12–23 months <7 months <12 months 1 1
≥12 months Not needed 1
7–11 months Any age Not needed 1
≥12 months ≥12 months Not needed Not needed
24–59 months Any age Any age Not needed Not needed
3 previous doses 7–11 months Any age Any age Any age Not needed 1
12–23 months <7 months <12 months Any age Not needed 1
≥12 months ≥12 months Not needed Not needed
7–11 months 7–11 months ≥12 months Not needed Not needed
24–59 months Any age Any age Any age Not needed Not needed

* If 13vPCV is not available, and 10vPCV is being used for all/any children, 10vPCV is recommended in a 4-dose schedule for infants (i.e. at ages 2, 4, 6 and 12–18 months). If catch-up is required for 10vPCV, vaccination can be done according to the information provided in this Table. (Refer also to 4.13 Pneumococcal disease.)
† Prior PCV doses may have been given as 7vPCV (e.g. from overseas), 10vPCV or v. 13vPCV should be used as the vaccine formulation for further catch-up doses required, regardless of which formulation of PCV the child received previously.
‡ Recommended interval between primary doses for catch-up is 1–2 months. Where possible, it is recommended to align doses with the standard schedule points at 4 months and 6 months of age for infants aged <7 months. The minimum interval between dose(s) is 1 month if aged <12 months, and 2 months if aged ≥12 months.
§ A minimum interval of 2 months is required after the last dose of 13vPCV in the primary course.

Table 2.1.11: Catch-up schedule for 13vPCV (Prevenar 13) and 23vPPV (Pneumovax 23) in children with a medical condition(s) associated with an increased risk of invasive pneumococcal disease (IPD),* presenting at age <2 years

For children with a medical condition(s) associated with an increased risk of IPD presenting at age 2 years, refer to recommendations in 4.13 Pneumococcal disease and Table 4.13.2.

Table 2.1.11: Catch-up schedule for 13vPCV (Prevenar 13) and 23vPPV (Pneumovax 23) in children with a medical condition(s) associated with an increased risk of invasive pneumococcal disease (IPD),* presenting at age <2 years
Number of doses given previously Age at presentation Age when previous dose of any PCV was given Recommendations
1st dose 2nd dose 3rd dose Number of further primary dose(s) of 13vPCV required § Number of booster doses of 13vPCV required at
age ≥12months
Number of doses of 23vPPV required at
age 4–5 years
No previous doses <7 months 3 1 1
7–11 months 2 1 1
12–23 months 1 1 1
1 previous dose <7 months <7 months 2 1 1
7–11 months <7 months 2 1 1
7–11 months 1 1 1
12–23 months <12 months 1 1 1
≥12 months Not needed 1 1
2 previous doses <12 months <7 months <12 months 1 1 1
7–11 months 7–11 months Not needed 1 1
12–23 months <7 months <12 months 1 1 1
≥12 months Not needed 1 1
7–11 months Any age Not needed 1 1
≥12 months ≥12 months Not needed Not needed 1
3 previous doses 7–11 months Any age Any age Any age Not needed 1 1
12–23 months <7 months <12 months Any age Not needed 1 1
≥12 months ≥12 months Not needed Not needed 1
7–11 months 7–11 months ≥12 months Not needed Not needed 1

* Refer to List 4.13.1 in 4.13 Pneumococcal disease for the list of specified conditions.
† Recommendations for vaccination of haematopoietic stem cell transplant (HSCT) recipients differ; refer to Table 3.3.3 Recommendations for revaccination following HSCT in children and adults, irrespective of previous immunisation history.
‡ Prior PCV doses may have been given as 7vPCV (e.g. from overseas), 10vPCV or 13vPCV. 13vPCV should be used as the vaccine formulation for further catch-up doses required, regardless of which formulation of PCV the child received previously.
§ Recommended interval between primary doses for catch-up is 1–2 months. Where possible, it is recommended to align doses with the standard schedule points at 4 months and 6 months of age for infants aged <7 months. The minimum interval between dose(s) is 1 month if age <12 months, and 2 months if age ≥12 months.
¶ The booster dose of 13vPCV should be given at the earliest opportunity after the child reaches 12 months of age, but a minimum interval of 2 months is required after the last dose of 13vPCV in the primary course.

Catch-up schedules for persons ≥10 years of age

Catch-up is much less commonly required for this age group than for young children. Nevertheless, issues surrounding booster doses or revaccinations are common, particularly in adults. Persons who did not have natural infection as children but were not vaccinated remain at unnecessary risk of vaccine-preventable diseases.

In general, the same principles for catch-up vaccination apply as for younger children. For example, if a vaccine course is incomplete, do not start the course again, regardless of the interval since the last dose. One exception to this rule is for oral cholera vaccine (refer to 4.1 Cholera).

Catch-up vaccination for adults can be less straightforward than for children and adolescents. A useful principle to consider when planning which vaccines to give to adults is the HALO principle, which allows for assessment of vaccines needed depending on risk factors:

  • Health
  • Age
  • Lifestyle
  • Occupation

The schedule for each individual adult may differ because of the risk factors identified when applying the HALO principle. Some examples of how the HALO principle can be used:

  • Health: the person to be vaccinated has a medical condition(s) that places them at increased risk of acquiring a particular vaccine-preventable disease or experiencing complications from that disease, for example, influenza.
  • Age: older age groups may require extra vaccines, such as influenza or pneumococcal vaccination, or certain age groups may be targeted for immunisation against a particular vaccine-preventable disease, such as HPV. Another example is young to middle-aged adults who may have missed out on vaccine doses due to schedule changes, such as the 2nd dose of MMR vaccine.
  • Lifestyle: the person may have missed vaccines because they moved location of residence, may require extra vaccines because they travel frequently, or have other lifestyle risk factors that increase their risk of acquiring a vaccine-preventable disease, for example, smoking or injecting drugs.
  • Occupation: the person may be employed in an occupation for which certain vaccines are recommended because of the increased risk of acquiring a vaccine-preventable disease and/or transmitting it to others, such as in healthcare or early childhood education and care.

The HALO principle is also incorporated, to some extent, into questions used in the pre-vaccination screening checklist (refer to Tables 2.1.1 and 2.1.2).

Table 2.1.12 contains information on vaccine doses and intervals between doses for persons aged ≥10 years in whom catch-up vaccination for a particular disease antigen is required. This table only contains information on diseases for which vaccination is recommended at a population level, and for which catch-up is required if doses have been missed earlier in life. The table does not include information on all diseases for which vaccines are required for adults. Recommended vaccines and catch-up vaccination that might be required when assessed using the HALO principle above and/or by using the pre-vaccination screening checklist (refer to Tables 2.1.1 and 2.1.2) are discussed in 3.3 Groups with special vaccination requirements.

Table 2.1.12 can be used as follows:

For example, a 32-year-old woman (Age) is returning to nursing (Occupation) but has only ever had 1 dose of hepatitis B vaccine, 4 doses of the oral poliomyelitis vaccine, 1 dose of MMR vaccine and 2 doses of DTPw vaccine as a child and recently had a splenectomy (Health) following an accident. This person would require:

  • 1 dose of dTpa
  • 2 adult doses of hepatitis B; 1 dose given now and a further dose in 2 months
  • no further doses of poliomyelitis vaccine (is fully vaccinated against poliomyelitis)
  • 1 dose of MMR vaccine
  • 2 doses of varicella vaccine if non-immune; 1 dose given now and a further dose in 4 weeks
  • 1 dose of influenza vaccine, and 1 dose annually thereafter
  • pneumococcal vaccine: 1 dose of 13vPCV, followed by 23vPPV approximately 2 months later (because of splenectomy)
  • 1 dose of Hib vaccine (because of splenectomy)
  • 2 doses of 4vMenCV; 1 dose given now and a further dose in 8 weeks (because of splenectomy).
  • 2 doses of MenBV; 1 dose given now and a further dose in 8 weeks (because of splenectomy).

For additional details on these recommendations, refer to 3.3.7 Vaccination of persons at occupational risk; ‘Persons with functional or anatomical asplenia’ in 3.3.3 Vaccination of immunocompromised persons, and relevant disease-specific chapters in Part 4.

Where several vaccines are required for an adolescent or adult – for example, dTpa, hepatitis B and poliomyelitis vaccines – childhood combination vaccines (recommended for use in those <10 years of age) should not be used as their antigen content differs and there may be an increased risk of adverse event(s), such as injection site reactions. The childhood combination vaccines are not registered for use in children aged 10 years, adolescents or adults.

Table 2.1.12: Catch-up schedule for persons ≥10 years of age (for vaccines recommended on a population level)

This table is to be used to guide catch-up vaccination for persons ≥10 years of age in conjunction with the guidance provided in the section ‘Catch-up schedules for persons ≥10 years of age’ above.
Antigen Doses required* Minimum interval between 
dose 1 and 2
Minimum interval between 
dose 2 and 3
Diphtheria and tetanus† 3 doses† 4 weeks 4 weeks
Pertussis‡ 1 dose‡ Not required Not required
Hepatitis B - Aged 10–19 years 3 paediatric doses 1 month 2 months §

Hepatitis B - Aged 11–15 years only

2 adult doses 4 months Not required
Hepatitis B - Aged ≥20 years 3 adult doses 1 month 2 months §
Poliomyelitis 3 doses 4 weeks 4 weeks
Human papillomavirus 3 doses 4 weeks 12 weeks
Measles, mumps and rubella 2 doses 4 weeks Not required
Meningococcal¶ 1 dose Not required Not required
Pneumococcal Depends on age of person, Indigenous status and if they have medical condition(s) associated with an increased risk of invasive pneumococcal disease (refer to Table 4.13.3 in 4.13 Pneumococcal disease,and 3.3 Groups with special vaccination requirements)
Varicella #** At least 
1 dose if aged <14 years
If 2nd dose given, a 4-week interval is required # Not required
2 doses if aged ≥14 years 4 weeks Not required
Zoster 1 dose if aged ≥60 years †† Not required Not required

* This column outlines the number of vaccine doses required for a person who has not previously received any vaccine doses for that antigen. To determine how many further doses are required for a person who has received previous vaccine doses, the number of previous doses should be deducted from the number in this column. Refer to footnote ‡ below for specific guidance on using this table for catch-up vaccinations for pertussis.
† One of the doses should be given as dTpa -containing vaccine and the course completed with dT. This dose would also provide the single catch-up dose for pertussis (refer to footnote ‡ below). In the unlikely event that dT is not available, dTpa or dTpa-IPV may be used for all 3 primary doses.17
‡ If a person ≥10 years of age has not received the number of pertussis vaccine doses recommended prior to 10 years of age, they only require 1 dose to be considered up-to-date (irrespective of the number of previous doses of pertussis-containing vaccine they received prior to 10 years of age). A single booster dose of pertussis-containing vaccine is routinely recommended for all adolescents, optimally delivered between 11 and 13 years of age, which should be taken into account when planning catch-up for pertussis (refer to 4.12 Pertussis).
§ For hepatitis B vaccine, the minimum interval between dose 1 and dose 3 is 4 months (refer to 4.5 Hepatitis B).
¶ The required catch-up dose for meningococcal disease is specific to meningococcal C conjugate vaccine (MenCCV). 4vMenCV and MenBV are indicated for those at increased risk of meningococcal disease; refer to recommendations in 4.10 Meningococcal disease and 3.3 Groups with special vaccination requirements.
# Varicella vaccine is recommended for all non-immune persons. At least 1 dose should be given to those aged <14 years, and all persons aged ≥14 years should receive 2 doses. (Refer also to 4.22 Varicella.)
** MMRV is suitable to provide varicella vaccination in children aged <14 years. This vaccine is not recommended for use in persons ≥14 years of age. (Refer also to 4.22 Varicella.)
†† Routine vaccination of persons aged 70–79 years is expected to obtain the greatest benefits against HZ and its complications. However, vaccination is also recommended for persons aged 60–69 years and ≥80 years (refer to 4.24 Zoster).

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