Clinical Updates

This page contains clinical updates for health professionals.

Page last updated: 20 September 2017

Table of Contents



Pre-vaccination Checklist for Zostavax Administration

Zostavax is a live attenuated vaccine for the prevention of herpes zoster and post herpetic neuralgia. It is contraindicated for use in significantly immunocompromised people.

The Department has developed a template which provides a checklist for immunisation providers to consider before vaccinating a patient with Zostavax (pre-vaccination checklist). This pre-vaccination checklist has been purposely developed to fit into a single page and created for potential incorporation by GPs into their software to screen patients pre-Zostavax. The use of drop down boxes for yes/no answers, and auto populate for Name, DOB, date of completion and provider details (in green) will make the process quicker to complete.

Please note, an additional two pages have been included at the back of the checklist to help providers with their decision making.

The pre-vaccination checklist, was developed in consultation with members of the Therapeutic Goods Administration’s Advisory Committee on Vaccines, members of the Australian Technical Advisory Group on Immunisation, and members of the GP Roundtable.

Public consultation on proposed changes to the infant pneumococcal schedule recommendations in the Australian Immunisation Handbook

Key Points

  • A public consultation is currently open on proposed changes to the infant pneumococcal schedule recommendations in the Australian Immunisation Handbook.
  • The public consultation document can be accessed on Citizen Space.
  • The public consultation will remain open until 11.59 pm on Monday 2 October 2017.
  • Comments from all interested parties are welcomed.


Australian Technical Advisory Group on Immunisation advice on the use hepatitis B vaccines during supply shortages

Key Points

  • There is currently a shortage of the adult formulation of hepatitis B vaccines Engerix-B® (GlaxoSmithKline) and H-B-Vax-II® (Seqirus) in Australia. The shortage has impacted on private market supply.
  • Supply for the National Immunisation Program (NIP) has not been affected at this time, so the adult formulation of hepatitis B vaccines as part of the NIP expansion measure should continue as scheduled for all eligible individuals.
  • The substitute options that ATAGI recommends for adult hepatitis B vaccination in the event of unavailability of Engerix-B® or H-B-Vax-II® are as follows:
    1. Concurrent administration of two doses of the paediatric formulation of a hepatitis B vaccine (0.5mL per dose) – the doses can be administered at adjacent sites (≥2.5cm apart) on the same arm or separately with one dose in each arm; OR
    2. Administration of an adult dose of the combined hepatitis A and hepatitis B vaccine (Twinrix® (GlaxoSmithKline)) – there may be further dose requirements of hepatitis A-containing vaccine if protection against hepatitis A is also desired.

The original vaccination schedule should be maintained. While using the same brand product is preferable, use of the alternative brand product to complete the vaccination course is acceptable.

Please refer to the document below which provides clinical advice to assist in using alternate hepatitis B vaccines during supply shortages.


National Immunisation Program – Expansion (free catch-up vaccines for all individuals aged 10 to 19 years, and refugees and humanitarian entrants aged 20 years and over) from 1 July 2017.

From 1 July 2017, all individuals aged 10 to 19 years and refugees and humanitarian entrants aged 20 years and over are eligible to receive free catch-up vaccinations through an expansion to the National Immunisation Program.

For the eligible cohorts, the NIP expansion measure will enable free access to a nationally consistent catch-up schedule for recommended early childhood vaccines.

Please refer to the vaccination provider factsheets below for further advice on the new access arrangements under this measure. Promotional materials including a poster and consumer flyer can also be accessed through the Immunise Australia Publications & Resources page.


ATAGI Clinical advice to support the introduction of Rotarix® to replace RotaTeq® in specified Australian states (Western Australia, South Australia, Victoria and Queensland) from 1 July 2017.

Key Points

  • The oral rotavirus vaccine Rotarix® (given in a 2-dose schedule) will replace RotaTeq® (given in a 3-dose schedule) in Western Australia, South Australia, Victoria and Queensland from 1 July 2017. After 1 July 2017, Rotarix® will be the only rotavirus vaccine used under the National Immunisation Program in Australia for children commencing their childhood schedule.
  • Both products have equivalent vaccine effectiveness and have led to a marked reduction in severe gastroenteritis cases in all Australian jurisdictions.
  • Rotarix® is administered at approximately 2 months (from 6 weeks) and 4 months of age. The main difference between Rotarix® age restrictions (compared to Rotateq®) is that the 1st dose must be administered prior to 15 weeks of age and the 2nd dose prior to 25 weeks of age.
  • During the brand switch period, some infants may potentially receive fewer doses than routinely scheduled when using the RotaTeq® brand. The specific recommendations will vary depending on the age of the child and rotavirus vaccination history.

Please refer to the document below which provides clinical advice to assist in the switch from RotaTeq® to Rotarix®.


2017 seasonal influenza vaccines

2017 NIP seasonal influenza vaccines will be available from mid-April 2017.

Protection against influenza requires annual vaccination with a vaccine containing the most recent strains.

There is new evidence that the effectiveness of the influenza vaccine wanes over three or four months and it is important to be protected when influenza is most common (around August).

Providers should continue to offer vaccination throughout the influenza season. In particular, those in risk groups can benefit from vaccination at any time of the year.

There are low vaccination rates in Aboriginal and Torres Strait Islander children under five years of age, pregnant women and people who suffer from chronic illnesses. Please consider what you can do to reach at-risk patients in your clinic.

Before administering a flu shot, check you have the correct vaccine for the person’s age.

A range of resources, including posters and factsheets on the 2017 seasonal influenza vaccines are available on the Immunise Australia Publications & Resources website.

For more information on influenza vaccines, refer to influenza (flu).


Zostavax and Individuals who are immunocompromised

Important information on Zostavax and individuals who are immunocompromised:


Pertussis  booster for 18 month olds

A pertussis (whooping cough) booster has been added to the NIP for children at 18 months of age. The booster dose complements pertussis containing vaccinations given at two, four and six months with booster doses given at four years and 10 to 15 years. Supplies of the vaccine will be available from March 2016.

The Australian Technical Advisory Group on Immunisation (ATAGI) considers the re-introduction of a pertussis booster dose at 18 months necessary from a public health perspective to improve pertussis control. This is due to waning immunity following primary immunisation and an increase in the number of infections in the two to nine age group in recent years.

Targeted, enhanced surveillance of adverse events will be undertaken as part of the program roll-out.  Any adverse events following immunisation at any age should be reported to the Therapeutic Goods Administration (TGA). Go to the ‘report a problem’ link via the TGA's website at ( or report adverse events through the usual reporting mechanisms in your state or territory.

In order to maintain a complete immunisation history, all vaccines administered to children should be notified to the Australian Childhood Immunisation Register (ACIR) via usual methods.

Catch-up: Incentives for vaccination providers

From 1 January 2016, an additional $6 incentive payment will be made to vaccination providers and GPs who follow up and vaccinate children who are more than two months overdue for their childhood vaccinations. A fact sheet explaining this payment is available.

Fact sheets addressing commonly held concerns regarding vaccination

These resources can help frame discussion about immunisation with parents and provide evidence-based answers to commonly held concerns and myths surrounding vaccination.

Expansion of Australia’s Immunisation Registers

Expansion of Australia’s Immunisation Registers: Work has begun to expand the scope of Australia’s two existing immunisation registers; the Australian Childhood Immunisation Register and the National HPV Vaccination Program Register, to improve vaccination coverage across the whole community. Further information regarding the scheduled changes can be obtained by referring to the Expansion of Australia’s Immunisation Registers factsheet below.

No Jab, No Pay

The Australian Government is extending childhood immunisation arrangements for family assistance payments to increase immunisation rates of children residing in Australia. As an immunisation provider you will be key to providing catch-up vaccinations to children up to 19 years of age under the Australian Government’s No Jab, No Pay measure.

The list of current early childhood vaccines required for Family Tax Benefit part A Supplement (FTB Part A supplement), Child Care Rebate (CCR) and Child Care Benefit (CCB) is available from the Department of Social Services website.

Vaccines which are not required to receive family assistance payments are still recommended for some age groups. For example, meningococcal C and varicella are clinically recommended and funded by the Government for young individuals between the ages of 10-19 years of age. These vaccines are not linked to family assistance payments.

An overview for health professionals, with initial details is available.

In addition, you may find the following resources helpful for your discussions with parents:

Medical exemptions

From 1 January 2016, notifications of medical contraindications and natural immunity will NOT be accepted on practice/GP letterhead and must be provided on the approved ACIR Immunisation Medical Exemption Form.

The form includes guidance for general practitioners on what is, and is not, considered a valid reason for a medical exemption.

Medical contraindications to vaccination are rare. The medical basis for vaccination exemption is based on guidance in the Australian Immunisation Handbook 10th edition.

Natural immunity to hepatitis B, measles, mumps, rubella and varicella must be confirmed via laboratory testing or physician based clinical diagnosis. Exemption to a combination vaccine on the bases of natural immunity is only valid if immunity is confirmed for all vaccine antigens.

Conscientious objection (vaccination objection on non-medical grounds) is no longer a valid exemption from the immunisation requirements.


Zostavax® has been approved to be placed on the NIP, to be provided free of charge from 1 November 2016 to people aged 70 years, subject to vaccine supply. There will also be a five year catch-up program for people aged 71 – 79 years. The Department is working to progress the provision of the Zostavax® vaccine to all eligible Australians as rapidly as possible.

The implementation of new vaccination programs under the NIP is a major task that takes approximately 12-18 months from receipt of Government funding approval. This time is required for activities such as the procurement of vaccine; vaccine safety surveillance planning; development of appropriate communications; and negotiation with states and territories regarding implementation requirements and timing. In the case of the Zostavax® vaccine, time is also required to develop and roll out an adult vaccination register.

For more information about Zostavax®, refer to the Zoster section of the Australian Immunisation Handbook 10th edition.

Changes to recommendations in the administration of pertussis containing vaccine

The Pertussis Chapter, 4.12, of the 10th Edition of the Australian Immunisation Handbook has been updated and approved by the National Health and Medical Research Council CEO on 27 March 2015.

The Pertussis Chapter includes two changes to recommendations in the administration of pertussis containing vaccine:

  • a DTPa (diphtheria, tetanus, pertussis) booster at age 18 months to reduce pertussis notifications in the 1 - 3 year age group and to reduce transmission to younger siblings; and
  • a preference for pertussis vaccination (the reduced content dTpa formulation) in pregnant women (third trimester) to improve protection against pertussis in young infants.

The chapter also contains amendments which provide updated information and evidence.

Australian Immunisation Handbook Pertussis Chapter 4.12.

Pertussis posters and brochures

Meningococcal B vaccine and clinical advice for immunisation providers regarding the use of Bexsero® (4CMenB)

From 5 March 2014, the recombinant multicomponent meningococcal B vaccine Bexsero® (4CMenB) became available through purchase on the private market. 4CMenB is registered for use in persons ≥two months of age for the prevention of invasive disease caused by serogroup B meningococci.

For infants aged < six months of age, three primary doses of 4CMenB plus a booster at age 12 months are recommended. 4CMenB may be given at the same time as other infant vaccines administered under the National Immunisation Program, but must be given at separate injection sites. The first dose of 4CMenB may be administered as early as six weeks of age to align with the National Immunisation Program infant schedule. For older infants, adolescents and adults who the vaccine is recommended for, the dosing schedule varies based on age of first dose.

In clinical trials systemic reactions, including fever, were more common when 4CMenB was given concurrently with other infant vaccines, compared to when 4CMenB or other routine vaccines were administered alone. Therefore Australian Technical Advisory Group on Immunisation recommends the prophylactic use of paracetamol with every dose of 4CMenB administered to children

More detailed information regarding dosage and administration, recommendations for use and adverse events, including the use of prophylactic paracetamol, are provided in the ATAGI statement.

Australian Technical Advisory Group on Immunisation (ATAGI) advice on non National Immunisation Program vaccines

Information about vaccines that are available in Australia but not included on the National Immunisation Program, such as yellow Fever and rabies, is also available in the Australian Immunisation handbook (10th edition).

In this section