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Guidelines for preventive activities in general practice 7th edition

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Full index

Introduction and user guide

Preventive activities before pregnancy

Genetic counselling and testing

Preventive activities in children and young people

Preventive activities in middle age

Preventive activities in older age

Communicable diseases

Prevention of chronic disease

Prevention of vascular and metabolic disease

Early detection of cancers

Psychosocial

Oral hygiene

Glaucoma

Urinary incontinence

Osteoporosis

Screening tests of unproven benefit

References

Appendices

Glossary

Acronyms

Acknowledgements

Disclaimer

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Immunisation

Immunisation age range table
Age 0 - 9 10 - 14 15 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 79 >80
  X X X X X X X X X X X X X X X

Immunisation is recommended for all children and adults at particular ages according to the Australian Immunisation Handbook (A). General practitioners should advocate immunisation and counter the common misunderstandings and antivaccine campaigns.

The National Immunisation Program Schedule (NIPS) provides a schedule of recommended funded vaccines. There may be other vaccines that are not funded but are recommended in the Australian Immunisation Handbook. There may be variability in vaccines recommended/funded (eg. hepatitis A vaccine).

Health inequality

For immunisation to be effective there needs to be high coverage rate. Therefore GPs need to be aware of groups with lower levels of age appropriate immunisation including170:

  • families with young parents (under 25 years of age)171,172
  • single parent families and families with more than one child173
  • migrant families (particularly in the first years of their arrival in Australia or if a language other than English is spoken at home)171-175
  • families where the parents are unemployed,170,174 on low incomes,171,174 or having very high or very low education levels172,173,176
  • families who move frequently175
  • Aboriginal children in rural and urban areas.177-179

The National Immunisation Program Schedule (NIPS)

The National Immunisation Program Schedule (NIPS)
Age Vaccine
Birth
  • Hepatitis B* (hepB)
2 months
  • Hepatitis B* (hepB)
  • Diphtheria, tetanus and acellular pertussis (DTPa)
  • Haemophilus influenzae type b (Hib)**
  • Inactivated poliomyelitis (IPV)***
  • Pneumococcal conjugate (7 vPCV)
  • Rotavirus (first dose must be given before 12 weeks [Rotateq] or 14 weeks [Rotarix] of age, or not at all depending on vaccine used)
4 months
  • Hepatitis B* (hepB)
  • Diphtheria, tetanus and acellular pertussis (DTPa)
  • Haemophilus influenzae type b (Hib)**
  • Inactivated poliomyelitis (IPV)***
  • Pneumococcal conjugate (7 vPCV)
  • Rotavirus (Rotarix, second dose before 24 weeks or not at all, Rotateq second dose before 28 weeks)
6 months
  • Hepatitis B* (hepB)
  • Diphtheria, tetanus and acellular pertussis (DTPa)
  • Hib (extra)**** (only if Hiberix, HibTITER, or ActHIB used at 2 and 4 months)
  • Inactivated poliomyelitis (IPV)***
  • Pneumococcal conjugate (7 vPCV)
  • Rotavirus (only Rotateq has third dose, to be given before 32 weeks or not at all)
12 months
  • Hepatitis B* (fourth dose if Hib-hepB used at 2 and 4 months or fifth dose for those born at <32 weeks or <2000 g birth weight)
  • Haemophilus influenzae type b (Hib)** (may need to use monovalent Hib vaccine)
  • Measles, mumps and rubella (MMR) first dose
  • Measles, mumps rubella and varicella (MMRV) instead of MMR to give at 12 and 18 months (when available)
  • Meningococcal C (MenCCV)
  • Hepatitis A vaccine (for Aboriginal people and Torres Strait Islanders in Northern Territory, Queensland, South Australia and Western Australia only)
12-24 months
  • Pneumococcal conjugate or polysaccharide** (7vPCV booster for high risk groups or 23vPPV for Aboriginal and Torres Strait Islander children, see footnote)
18 months
  • Varicella (VZV) (only if no history of varicella or prior vaccination)
  • Hepatitis A vaccine (for Aboriginal people and Torres Strait Islanders in NT, Qld, SA and WA only)
  • Measles, mumps and rubella (MMR) – second dose at 18 months instead of 4 years (NIPS)
  • Measles, mumps rubella and varicella (MMRV) instead of separate MMR + VZV to give at 12 and 18 months (when available)
4 years
  • Diphtheria, tetanus and acellular pertussis (DTPa)
  • Inactivated poliomyelitis (IPV)**
  • Measles, mumps and rubella (MMR) (second dose funded NIP)
  • Pneumococcal conjugate or polysaccharide† (7vPCV or 23vPPV) (booster for high risk)
10-13 years
  • Hepatitis B (2 adult doses for those born pre-May 2000, or not vaccinated against hepatitis B)
  • Varicella (VZV) (first dose or second dose booster vaccination)
  • Human papillomavirus (HPV) (3 doses over 6 months, for females)
12–13 years
  • Human papillomavirus (HPV) (3 doses over 6 months, for females)
15-17 years
  • Diphtheria, tetanus and acellular pertussis (dTpa is the adult/adolescent vaccine)
15-49 years
  • Influenza (for all Aboriginal people and Torres Strait Islanders)
  • Pneumococcal polysaccharide (23vPPV) (for at risk Aboriginal people and Torres Strait Islanders)
50 years and over
  • Influenza (Aboriginal people and Torres Strait Islanders)
  • Pneumococcal polysaccharide (23vPPV) (Aboriginal people and Torres Strait Islanders)
65 years and over
  • Influenza
  • Pneumococcal polysaccharide (23vPPV)

* 3 hepB doses after birth dose required and extra dose at 12 months if born <32 weeks or birth weight <2000 g, unless immunity proven on serology at 7 months of age
** Use PRP-OMP (Pedvax Hib or Comvax) in areas of higher risk (for Aboriginal and Torres Strait Islander children in NT, Qld, SA, WA). Use PRP-T or PRP-OMP in other children
*** IPV in IPV combination vaccines, eg. DTPa-hepB-IPV, DTPa-IPV, DTPa-IPV-Hib, DTPa-hepB-IPV-Hib (their use may create a need for one dose monovalent Hib vaccine at 12 months)
**** Third dose at 6 months if using PRP-T (ActHib, Hiberix) or HbOC (HibTITER) Hib type vaccines in Aboriginal and Torres Strait Islander children in southern states and other children (lower risk)
† Pneumococcal vaccination (in addition to 7vPCV at 2, 4 and 6 months, 23vPPV or 7vPCV booster doses are recommended and funded for:

  • Aboriginal and Torres Strait Islander children up to 5 years of age in central Australia
  • Booster 23vPPV at 18–24 months in NT, Qld, SA, WA
  • Children under 10 years of age at risk from specified medical conditions; if unimmunised give 2 doses 7vPCV, if immunised give booster 7vPCV at 12 months and 23vPPV at 4–5 years
  • Children up to the age of 10 years who, after their sixth birthday develop asplenia, HIV infection, or a haematological malignancy, or who receive a transplant, should receive 2 doses of 7vPCV 2 months apart, and a dose of 23vPPV 2 months later (refer to http://immunise.health.gov.au Australian Immunisation Handbook. 9th edn, 2008)
  • When using 23vPPV revaccinate after 5 years. Depending on risk for infection a second revaccination is indicated 5 years after second 23vPPV or at 50 or 65 years, whichever is later

Notes

  1. Hepatitis B vaccine should be given to all infants at birth and should not be delayed beyond 7 days after birth. Infants whose mothers are hepatitis B surface antigen positive (HbsAg+ve) should be given hepatitis B immunoglobulin (HBIG) within 12 hours of birth
  2. Diphtheria tetanus (dT) should be given at 50 years of age unless a dT booster dose has been documented in the previous 10 years. Boostrix (dTpa) is preferred instead of dT to protect from pertussis
  3. Vaccine cold chain: to maintain vaccine quality by keeping the temperature of vaccines within 3 degrees of 5 degrees celsius. Temperatures outside this range damage vaccines and render them less effective or useless. Accurate monitoring of refrigerator storage temperatures or use of vaccine storage refrigerators is recommended

Recommended vaccines in the Australian Immunisation Handbook not in NIPS

Recommended vaccines in the Australian Immunisation Handbook not in NIPS
Soon after birth BCG (for Aboriginal people and Torres Strait Islanders in NT, far north Queensland, some regions of SA and WA, as well as children under 5 years of age who will travel to live >3 months in endemic areas or have family with leprosy)
From 6 months Annual influenza vaccination is recommended for any person ≥6 months of age where there is a wish to reduce the likelihood of becoming ill with influenza
From 10–26 years
  • Either 2v or 4v HPV vaccination is recommended to protect against oncogenic HPV 16 and 18 infections. Vaccination has no effect on existing HPV infections but prevents new HPV 18 and 18 infections
  • 4vHPV (Gardasil) is recommended for females aged 14–26 years (in NIPS, age 10–13 years)
  • 2vHPV (Cervarix) is recommended for females aged 14–26 years (in NIPS, aged 10–13 years) and also for women aged
  • 27–45 years, the level of benefit depending on sexual history

No evidence to recommend male vaccination as yet (4vHPV licensed for use in males aged 9–15 years)
50 years Diphtheria, tetanus and acellular pertussis (dTpa) is preferred to diphtheria and tetanus (dT) (This is recommended if no tetanus immunisation was received in the previous 10 years)
From 60 years Zoster virus live vaccine (Zostavax) for prevention of shingles (can be given from age 50 years onward)
All health care workers
  • Hepatitis B (and hepatitis A in some jurisdictions)
  • Annual influenza
  • Pertussis (dTpa)
  • MMR (if not immune)
  • Varicella (if not immune)
Men who have sex with other men
  • Hepatitis A and B
Injecting drug users

Immunisation information resources

  • http://immunise.health.gov.au
  • The ACIR Enquiry Line: 1800 653 809 (this number can be used to obtain information on the vaccination history of individual children from birth to seventh birthday (given since 1/1/1996)
  • www.health.sa.gov.au/immunisationcalculator is a useful resource to work out what catch up immunisations are required; covers most situations in Australia. Expert advice from local public health immunisation experts may still be required
  • www.ncirs.usyd.edu.au.

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