Immunisation / Vaccination

Australian immunisation is based on the National Immunisation Program, with additional recommendations according to age, pregnancy, Aboriginal and Torres Strait Islander status, medical risk, occupation, travel and other exposure risks. This page presents the schedule in two ways: first by age, then by vaccine, with additional Aboriginal and Torres Strait Islander recommendations highlighted in red and additional risk-based recommendations highlighted in blue.

ATSI Extra Vaccines

  1. BCG @ birth (NT, Queensland and northern South Australia)
  2. Meningococcal B @ 2, 4, 12 months (+6 months for specified medical risk)
  3. Meningococcal ACWY and B recommended from 2 months to 19 years (age-specific schedule)
  4. Pneumococcal 20V (Extra) @ 6/12
  5. Influenza yearly indefinitely from 6/12
  6. Hep A @ 18/12 and 4 years (NT, Queensland, SA and WA)
  7. Hep B for non-vaccinated, non-immune adults
  8. Pneumococcal 21V once @ ≥25 years
  9. Shingrix @ ≥50 years (2 doses 2–6 months apart)
  10. RSV @ ≥60 years (1 dose)

Extra Vaccines for At Risk Populations

We classify patients into risk groups. This makes remembering who gets what easier. The risk groups are:

  • Respiratory
    • COPD / emphysema
    • Bronchiectasis / cystic fibrosis / suppurative lung disease
    • Severe asthma
    • Interstitial / fibrotic lung disease
  • Cardiac
    • Congenital heart disease
    • Coronary artery disease
    • Heart failure
  • Immunocompromise
    • HIV
    • Malignancy / chemotherapy / radiotherapy
    • Biologics / immunosuppressants
    • Solid organ / haematopoietic stem cell transplant
    • Asplenia / hyposplenia
    • Complement deficiency / complement inhibitor therapy
  • CKD
    • Chronic kidney disease
    • Nephrotic syndrome
    • Dialysis
  • CSF
    • CSF leak
    • Cochlear implant
  • Miscellaneous
    • T2DM / metabolic disease
    • Chronic liver disease
    • Neurological / neuromuscular disease
    • Haemoglobinopathy
    • Smoking
    • Alcoholism
    • Obesity where relevant

The core risk group is: Respiratory + Cardiac + Immunocompromise + CKD.

  1. Pneumococcal 20V – Extra Dose
    • @ 6/12 if risk recognised in infancy
    • Single dose if risk diagnosed >12 months to <18 years after routine schedule
    • Core
    • CSF
    • Misc: T2DM, CLD, haemoglobinopathy, smoking, alcoholism
  2. Pneumococcal 21V once @ ≥18 years
    • Core
    • CSF
    • Misc: T2DM, CLD, haemoglobinopathy, smoking, alcoholism
  3. Influenza yearly from ≥6/12
    • Core
    • Misc: T2DM, CLD, neurological / neuromuscular disease, haemoglobinopathy
  4. Meningococcal ACWY and B – extra primary doses / boosters
    • Immunocompromise
  5. Shingrix @ ≥18 years
    • Immunocompromise
  6. RSV @ ≥60 years; consider @ 50–59 years
    • Core
    • Misc: T2DM, CLD, neurological / neuromuscular disease, obesity

Birth

  • Hep B (Engerix-B Paediatric)
  • TB / BCG (live) – NT, Queensland and northern South Australia

2 months

  • Diphtheria, Tetanus, Pertussis, Hep B, Hib, Polio (Infanrix Hexa, Vaxelis)
  • Pneumococcal 20V (Prevenar 20)
  • Rotavirus (live) (Rotarix)
  • Meningococcal B (Bexsero)

4 months (same as 2 months)

  • Diphtheria, Tetanus, Pertussis, Hep B, Hib, Polio (Infanrix Hexa, Vaxelis)
  • Pneumococcal 20V (Prevenar 20)
  • Rotavirus (live) (Rotarix)
  • Meningococcal B (Bexsero)

6 months

  • Diphtheria, Tetanus, Pertussis, Hep B, Hib, Polio (Infanrix Hexa, Vaxelis)
  • Influenza yearly from 6 months to <5 years
  • Pneumococcal 20V (Prevenar 20) – specified medical risk
  • Pneumococcal 20V (Prevenar 20)
  • Meningococcal B (Bexsero) – specified medical risk

Influenza – first season

  • Children aged 6 months to <9 years receiving influenza vaccine for the first time require 2 doses ≥4 weeks apart
  • One dose annually thereafter

12 months

  • Measles, Mumps, Rubella (Priorix, M-M-R II)
  • Pneumococcal 20V (Prevenar 20)
  • Meningococcal ACWY (Nimenrix)
  • Meningococcal B (Bexsero)

18 months

  • Measles, Mumps, Rubella, Varicella (Priorix-Tetra, ProQuad)
  • Diphtheria, Tetanus, Pertussis (DTPa) (Infanrix, Tripacel)
  • Hib (ActHIB)
  • Influenza yearly to <5 years
  • Hepatitis A (NT, Queensland, SA, WA) (Vaqta Paediatric)

4 years

  • Diphtheria, Tetanus, Pertussis, Polio (Infanrix IPV, Quadracel)
  • Hepatitis A (NT, Queensland, SA, WA) (Vaqta Paediatric)

≥5 years

  • Influenza yearly for specified medical risk conditions
  • Influenza yearly for all Aboriginal and Torres Strait Islander people

12–13 years (Year 7)

  • Human papilloma virus (Gardasil 9)
    • Single dose for immunocompetent people starting vaccination aged 9–25 years
    • 3 doses @ 0, 2, 6 months if immunocompromised
    • Catch-up funded through age 25
  • dTpa (Boostrix, Adacel)

14–16 years (Year 10)

  • Meningococcal ACWY (MenQuadfi)

≥25 years

  • Pneumococcal 21V once (Capvaxive)

≥50 years

  • Shingles (Shingrix) recommended – 2 doses 2–6 months apart
  • Shingrix NIP-funded from 50 years
  • Shingrix from ≥18 years for specified moderate or severe immunocompromise – 2 doses generally 1–2 months apart
  • RSV may be considered @ 50–59 years with medical risk factors (Arexvy)

≥60 years

  • RSV recommended and NIP-funded (Arexvy)
  • RSV recommended with medical risk factors
  • RSV may be considered from 60–74 years without a risk factor

≥65 years

  • Influenza – yearly
  • Pneumococcal 21V once (Capvaxive)
  • Shingles (Shingrix) – NIP-funded, 2 doses 2–6 months apart

≥75 years

  • RSV recommended and NIP-funded – 1 dose
  • COVID-19 – further dose every 6 months

Pregnant

  • dTpa in every pregnancy, preferably @ 20–32/40 (Boostrix, Adacel)
  • Influenza in every pregnancy at any gestation
  • RSV in every pregnancy from 28/40 (Abrysvo)
  • If not immune / indicated:
    • HBV if at risk
    • Varicella vaccine before pregnancy or after delivery – live vaccine, contraindicated during pregnancy
    • MMR before pregnancy or after delivery – live vaccine, contraindicated during pregnancy

Asplenia, hyposplenia, complement deficiency or complement inhibitor treatment

  • Pneumococcal
  • Meningococcal ACWY
  • Meningococcal B
  • Hib
  • Influenza yearly

COVID-19

  • Healthy children and adolescents <18 years – not routinely recommended
  • 18–64 years – primary dose recommended; further dose every 12 months may be considered
  • 65–74 years – further dose every 12 months; every 6 months may be considered
  • ≥75 years – further dose every 6 months
  • Severe immunocompromise – additional primary and further doses according to age and current guidance

MSM (Men who have sex with men)

  • Meningococcal B and ACWY
  • Hepatitis A
  • Hepatitis B if non-immune
  • HPV if not previously vaccinated
  • Mpox – 2 doses ≥4 weeks apart

Vaccine Coverage

  • BCG
    • Birth – ATSI neonates in NT, Queensland and northern South Australia
  • DTPa
    • 2, 4, 6 months (Infanrix Hexa, Vaxelis)
    • 18 months (Infanrix, Tripacel)
    • 4 years (Infanrix IPV, Quadracel)
    • 12–13 years / Year 7 – dTpa (Boostrix, Adacel)
    • Every pregnancy @ 20–32 weeks
  • HAV (Hepatitis A)
    • 18 months – ATSI children in NT, Queensland, SA and WA
    • 4 years – ATSI children in NT, Queensland, SA and WA
  • HBV (Hepatitis B)
    • Birth (Engerix-B Paediatric)
    • 2, 4, 6 months (Infanrix Hexa, Vaxelis)
    • Non-vaccinated, non-immune Aboriginal and Torres Strait Islander adults
  • Hib
    • 2, 4, 6 months (Infanrix Hexa, Vaxelis)
    • 18 months (ActHIB)
    • Additional vaccination for asplenia / hyposplenia and selected immunocompromising conditions
  • HPV
    • 12–13 years / Year 7 (Gardasil 9)
    • 1 dose for immunocompetent people starting aged 9–25 years
    • 3 doses @ 0, 2, 6 months if starting ≥26 years
    • 3 doses @ 0, 2, 6 months if immunocompromised
  • Influenza
    • Annual from 6 months to <5 years
    • 2 doses ≥4 weeks apart in the first year if aged 6 months to <9 years
    • Annual ≥6 months for specified medical risk conditions
    • Annual ≥6 months for all Aboriginal and Torres Strait Islander people
    • Annual ≥65 years
    • Every pregnancy at any gestation
  • Meningococcal ACWY
    • 12 months (Nimenrix)
    • 14–16 years / Year 10 (MenQuadfi)
    • Recommended for Aboriginal and Torres Strait Islander people aged 2 months–19 years
    • Additional doses for specified medical risk conditions
  • Meningococcal B
    • 2, 4, 12 months (Bexsero)
    • Recommended for Aboriginal and Torres Strait Islander people aged 2 months–19 years
    • Additional dose @ 6 months for specified medical risk
    • Recommended for specified medical risk conditions
  • MMR
    • 12 months (Priorix, M-M-R II)
    • 18 months as MMRV (Priorix-Tetra, ProQuad)
    • Adults born during or since 1966 – 2 documented doses or evidence of immunity
    • Live vaccine
  • Pneumococcal 20V (Prevenar 20)
    • 2 months
    • 4 months
    • 6 months – specified medical risk
    • 6 months – ATSI
    • 12 months
    • >12 months to <18 years – one additional dose when a specified risk condition is diagnosed after completion of the routine schedule
  • Pneumococcal 21V (Capvaxive)
    • ≥18 years – specified medical risk condition
    • ≥25 years – Aboriginal and Torres Strait Islander adults
    • ≥65 years – all other adults
    • Single dose
  • Polio
    • 2, 4, 6 months (Infanrix Hexa, Vaxelis)
    • 4 years (Infanrix IPV, Quadracel)
  • Rotavirus
    • 2, 4 months (Rotarix)
    • Live oral vaccine
    • First Rotarix dose by 14 weeks
    • Second Rotarix dose by 24 weeks
  • RSV
    • Pregnancy from 28 weeks – Abrysvo
    • 50–59 years with medical risk – Arexvy may be considered
    • ≥60 years – Aboriginal and Torres Strait Islander adults
    • ≥60 years with medical risk factors
    • 60–74 years without risk factors – may consider
    • ≥75 years – recommended
  • Varicella
    • 18 months as MMRV (Priorix-Tetra, ProQuad)
    • Catch-up for non-immune people
    • Live vaccine – contraindicated during pregnancy
  • Zoster (Shingrix)
    • Recommended ≥50 years
    • NIP-funded ≥50 years – ATSI
    • NIP-funded ≥65 years – non-Indigenous
    • Recommended ≥18 years if immunocompromised; NIP-funded for specified moderate or severe immunocompromise
    • 2 doses 2–6 months apart if immunocompetent
    • 2 doses generally 1–2 months apart if immunocompromised
    • Non-live vaccine

Vaccination – Practical Exam Points

  • Minor illness:
    • Mild intercurrent illness without significant fever is not usually a reason to defer vaccination.
    • Defer routine vaccination during significant acute febrile illness until recovery.
  • Paracetamol:
    • Routine prophylactic paracetamol is not recommended for most vaccines.
    • Exception: prophylactic paracetamol with MenB (Bexsero) in young children.
    • Paracetamol may be used for post-vaccination fever or discomfort.
  • Egg allergy:
    • Egg allergy, including previous egg anaphylaxis, is not a contraindication to an age-appropriate influenza vaccine.
    • MMR and MMRV can be given to people with egg allergy.
    • Severe egg allergy is a contraindication to yellow fever and Q fever vaccines without specialist assessment.
  • Administration:
    • Most routine vaccines are administered IM.
    • MMR and MMRV can be given IM or subcutaneously.
    • Rotavirus vaccine is oral.
    • Use the route specified for the individual vaccine.
  • Immunisation records:
    • Check the Australian Immunisation Register (AIR).
    • AIR records vaccinations across the lifespan.
    • If reliable vaccination documentation cannot be found, use an appropriate catch-up schedule.
    • Interrupted vaccine courses generally do not need to be restarted.
  • Live vaccines:
    • Generally contraindicated in pregnancy and severe immunocompromise.
    • MMR / MMRV
    • Varicella
    • Rotavirus
    • BCG
    • Live attenuated influenza vaccine
    • Yellow fever
    • Oral typhoid
    • Japanese encephalitis (Imojev)
    • Shingrix is not live.
  • Systemic corticosteroids:
    • High-dose systemic corticosteroid treatment can contraindicate live vaccines.
    • A commonly used adult threshold is prednisolone ≥20 mg/day for ≥14 days.

Vaccine Hesitancy

  • Give a clear professional recommendation.
  • Identify the patient’s specific concern rather than assuming the reason for hesitancy.
  • Correct misinformation clearly without ridicule.
  • Discuss benefits and risks honestly.
  • Use reminder and recall systems.
  • Address practical barriers to vaccination.
  • Maintain the therapeutic relationship and leave the opportunity for further discussion.

RULE

  • R – Resist the righting reflex
  • U – Understand the patient’s own motivation
  • L – Listen with empathy
  • E – Empower the patient

Anaphylaxis Following Vaccination

  1. Call for help / ambulance.
  2. Lie the patient flat. Do not allow them to stand or walk.
  3. If breathing is difficult, allow the patient to sit with legs extended.
  4. Give high-flow oxygen if available.
  5. Give IM adrenaline 1:1000 (1 mg/mL) @ 0.01 mg/kg into the anterolateral thigh, maximum 0.5 mg per dose.
    • 10 kg – 0.1 mg = 0.1 mL
    • 20 kg – 0.2 mg = 0.2 mL
    • 30 kg – 0.3 mg = 0.3 mL
    • 40 kg – 0.4 mg = 0.4 mL
    • ≥50 kg – 0.5 mg = 0.5 mL
  6. Repeat adrenaline every 5 minutes if required.
  7. Arrange ambulance transfer and ongoing monitoring.
  • Adrenaline is the first-line treatment.
  • There is no absolute contraindication to adrenaline in anaphylaxis.
  • Antihistamines do not treat airway obstruction, respiratory compromise or shock.
  • Corticosteroids do not provide immediate treatment of anaphylaxis and must not delay adrenaline.
  • Adrenaline and oxygen must be immediately available wherever vaccines are administered.

Current Key Resources