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Clinical guidelines

Guidelines for preventive activities in general practice 9th edition

6.1 Immunisation

Age Birth <2 2-3 4-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 >65

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

Consent

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

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

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

Vaccination for special high-risk groups

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

Health inequity

What are the key equity issues and who is at risk?

GPs need to be aware of groups with lower levels of age-appropriate immunisation.3 Socioeconomic characteristics associated with lower immunisation rates at 12 months4 include:

  • being Aboriginal or Torres Strait Islander
  • being born overseas
  • no private health insurance
  • being in the highest or lowest socioeconomic quintile
  • being of low birth weight and singleton birth.

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

What can GPs do?

Evidence supports a number of strategies in improving immunisation rates that could reduce inequities if efforts were focused on at-risk groups:

  • audit of immunisation coverage of at-risk groups in the practice
  • use of recall-and-reminder systems and catch-up plans, with a focus on at-risk groups
  • integrating vaccination status checks into routine health assessments for those target population groups.
Table 6.1.1. Summary of the main requirements from the National Immunisation Program Schedule
AgeVaccine
Birth* Hepatitis B (hep B)
6–8 weeks Hepatitis B, diphtheria, tetanus, acellular pertussis (whooping cough), haemophilus influenzae type b, inactivated poliomyelitis (polio; hepB-DTPa-Hib-IPV)

Pneumococcal conjugate (13vPCV)

Rotavirus (dose 1 of Rotarix or RotaTeq)†
4 months Hepatitis B, diphtheria, tetanus, acellular pertussis (whooping cough), haemophilus influenzae type b, inactivated poliomyelitis (polio; hepB-DTPa-Hib-IPV) Pneumococcal conjugate (13vPCV) Rotavirus (dose 2 Rotarix or RotaTeq)†
6 months Hepatitis B, diphtheria, tetanus, acellular pertussis (whooping cough), haemophilus influenzae type b, inactivated poliomyelitis (polio; hepB-DTPa-Hib-IPV)

Pneumococcal conjugate (13vPCV)

Rotavirus (dose 3 for RotaTeq recipients only)†
≥6 months Influenza annually (for those at risk of serious complications of influenza – eg Aboriginal and Torres Strait Islander peoples)
12 months Haemophilus influenzae type b and meningococcal C (Hib-MenC)

Measles, mumps and rubella (MMR)

Pneumococcal conjugate (13vPCV) booster (only for medically at-risk groups)
12–18 months Hepatitis A (for Aboriginal and Torres Strait Islander peoples in the Northern Territory, Queensland, South Australia and Western Australia only)

Pneumococcal conjugate (13vPCV; for Aboriginal and Torres Strait Islander peoples in the Northern Territory, Queensland, South Australia and Western Australia only)
18 months Measles, mumps, rubella and varicella (chickenpox; MMRV)

Diphtheria, tetanus, acellular pertussis (whooping cough; DTPa)
18–24 months Hepatitis A (for Aboriginal and Torres Strait Islander peoples in the Northern Territory, Queensland, South Australia and Western Australia only)
4 years‡ Diphtheria, tetanus, acellular pertussis (whooping cough) and inactivated poliomyelitis (polio; DTPa-IPV)

Measles, mumps and rubella (MMR; if MMRV vaccine was not given at 18 months of age)

Pneumococcal polysaccharide (23vPPV; only for medically high-risk groups)
10–15 years

School-based programs +/– GP catch-up
Hepatitis B (two adult doses for those not vaccinated against hepatitis B)

Varicella (catch up until all immunised)

Human papillomavirus (HPV; three doses over six months)

Diphtheria, tetanus and acellular pertussis (dTpa is the adult/adolescent vaccine)
15–49 years Influenza annually (for Aboriginal and Torres Strait Islander peoples)

Pneumococcal polysaccharide (23vPPV; for Aboriginal and Torres Strait Islander people who are medically at risk)
Pregnant women Influenza

Diphtheria, tetanus and acellular pertussis (dTpa) from 28 weeks (up to 38 weeks acceptable). Note that this is recommended for all but funding is variable
50 years and over Influenza (for Aboriginal and Torres Strait Islander peoples)

Pneumococcal polysaccharide (23vPPV; for Aboriginal and Torres Strait Islander peoples)
65 years and over Influenza

Pneumococcal polysaccharide (23vPPV)
*Hep B vaccine (dose 1 or 0) should ideally be given to all infants within 24 hours of birth, but at most within seven days of birth. Infants born to hepatitis B surface antigen (HBsAg)–positive mothers should be given hepatitis B immune globulin (HBIG) and a dose of monovalent hepatitis B vaccine on the day of birth (preferably within 12 hours of birth and certainly within 48 hours). Further information at Australian Immunisation Handbook

†Rotavirus vaccines are contraindicated in infants with a history of intussusception (IS), or predisposing abnormality to IS, or severe combined immunodeficiency. Rotavirus vaccines are time limited and differ in number of doses and timing: catch-up may not be possible

‡MMR dose 2 remains at 4 years of age for children not immunised with MMRV at 18 months
Table 6.1.2 Vaccines recommended but not funded in National Immunisation Program
AgeVaccine
Soon after birth Bacillus Calmette–Guérin (BCG; Aboriginal and Torres Strait Islander peoples in higher risk areas of the Northern Territory, Queensland, and parts of northern South Australia). Infants born to migrants from country with high risk of tuberculosis (TB) – look up individual state and territory guidelines
<2 years and between 15 and 19 years of age Meningococcal B vaccine recommended for highest incidence age groups from 6 weeks of age
Any age from 12 months Varicella – A second dose of vaccine, at least one month after first dose, provides improved protection from varicella
Parents and carers of infants aged <6 months Diphtheria, tetanus and acellular pertussis (dTpa) is recommended to protect the infant from pertussis. To maximise the protection of infants, parents and carers should get immunised before the birth. The dTpa vaccine can be given at any time after vaccination with diphtheria, tetanus (DT), and may be given again five years after previous dTpa
50 years and >65 years

Travellers of any age
dTpa should be used in place of DT when providing booster tetanus immunisations ≥50 years of age. This booster dose is recommended if no tetanus immunisation was received in the previous 10 years, or no previous dTpa
>60 years A single dose of zoster vaccine is recommended for prevention of shingles
All healthcare workers dTpa

Hepatitis B (and hepatitis A in some jurisdictions)

Annual influenza

Measles, mumps and rubella (MMR; if not immune)

Varicella (if not immune)
Men who have sex with men

People who inject drugs
Hepatitis A and B

Immunisation information resources include:

Notification of adverse events

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

References

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