Asplenia and hyposplenia
Background
The spleen plays an important role in preventing infection by removing bacteria (particularly encapsulated bacteria) from the blood stream. Individuals with anatomical asplenia (absent spleen) or functional asplenia/hyposplenia (no function or decreased function) are therefore at an increased risk of infection. In addition to being up to date with National Immunisation Program (NIP) and COVID-19 vaccines, individuals with asplenia or hyposplenia are recommended and funded to receive extra vaccines (outlined below).
The reason for asplenia or hyposplenia may be congenital or due to surgical removal (eg. in the case of trauma). Children with congenital asplenia, cancer related asplenia and those with sickle cell anaemia have a higher risk of infection than those who have had splenectomy for trauma.
Scheduling additional vaccines can be complicated by the cause of asplenia or hyposplenia. Where possible people having a planned splenectomy should ideally receive all additional vaccines at least 2 weeks prior to surgery. This is to ensure optimal protection prior to spleen removal. Those who undergo an unplanned or emergency splenectomy should defer vaccines for at least 7 days following surgery to allow time for recovery.
Individuals with asplenia/hyposplenia have a lifelong risk of infection. In addition to vaccination, patients are also recommended to receive prophylactic antibiotics.
Additional vaccine recommendations for children (< 18 years)
Pneumococcal
WordPress Tables PluginVaccine brand Prevenar 13® (pneumococcal conjugate vaccine 13vPCV) Pneumovax 23® (pneumococcal polysaccharide vaccine 23vPPV) Age at diagnosis ≥ 6 weeks to ≤ 11 months 3 doses (min. 8 weeks apart) + 1 booster¥β§ Single dose at ≥ 4 years^ ≥ 12 months Single doseΩ^β§ Single dose at ≥ 4 years^ Additional booster doses N/A 5 years following completion of initial dose€ ¥ doses as per NIP at 6 weeks, 4 months, 6 months (additional dose for those with a special risk condition) and routinely at 12 months of age.
β booster doses are given at ≥ 12 months of age/8 weeks since previous dose (whichever is later).
§ if not up to date with NIP recommendations refer to the Australian Immunisation Handbook for catch up advice.
^ ideally Prevenar 13® is administered first, followed by Pneumovax 23® at ≥ 4 years of age/minimum of 8 weeks later (whichever is later). If Pneumovax 23® is inadvertently administered first, a minimum of 12 months should elapse before administering Prevenar 13®.
Ω to be given a minimum of 8 weeks following any previous doses.
€ maximum of 2 doses of Pneumovax 23® in a lifetime.
N/A- not recommended.Meningococcal
WordPress Tables PluginVaccine brand Nimenrix® (meningococcal quadrivalent conjugate vaccine 4vMenCV ACWY) Bexsero® (meningococcal B recombinant multicomponent vaccine MenBV) Age at diagnosis ≥ 6 weeks to ≤ 5 months 3 doses (min. 8 weeks apart) + 1 booster^#† 3 doses (minimum 8 weeks apart) + 1 booster dose^¥§ ≥ 6 months to ≤ 11 months 2 doses (min. 8 weeks apart) + 1 booster^#† 2 doses (minimum 8 weeks apart) + 1 booster dose^¥§ ≥ 12 months 2 doses#† 2 doses (minimum 8 weeks apart)^¥§ Additional booster doses Where the primary course was completed at ≤ 6 years of age Give a booster dose 3 years following the completion of the primary course, then further booster doses every 5 years† Give a single booster dose only 3 years after completing the primary course§ Where the primary course was completed at ≥ 7 years of age Give a booster dose every 5 years following the completion of the primary course† Give a single booster dose only 5 years after completing the primary course§ ^ booster doses are given at ≥ 12 months of age/8 weeks since the previous dose (whichever is later).
# a single dose of Nimenrix® is funded on the NIP at 12 months and for year 10 students and adolescents aged 15-19 years who missed receiving the vaccine at school.
¥ administration of prophylactic paracetamol is recommended for those < 4 years of age (15mg/kg per dose) 30 minutes prior to vaccination (or as soon as possible after), as well as 2 subsequent doses (4-6 hours apart) to reduce the likelihood and severity of fever.
† Menveo® may be used interchangeably as an alternate brand to Nimenrix®. Where possible completing a course with the same brand is preferred.
§ Bexsero® is registered for use from 6 weeks of age. Trumenba® is an alternate meningococcal B vaccine available as a 3 dose course for individuals asplenia/hyposplenia aged 10 years or older. Meningococcal B vaccines are not interchangeable.Haemophilus influenzae type B (HIB)
WordPress Tables PluginVaccine brand Infanrix hexa®/ActHIB® Age at diagnosis ≥ 6 weeks As per NIP^§ ^ if < 5 years of age and not up to date with NIP refer to the Australian Immunisation Handbook for catch up recommendations.
§ a single dose is recommended for those aged 5 years or over who have not previously completed a primary course.Influenza
WordPress Tables PluginVaccine brand Variable- refer to MVEC: Influenza for age-appropriate brands and details Age at diagnosis < 6 months N/A£ ≥ 6 months Recommended annually£€ N/A- not recommended in this age group.
£ immunisation of family members recommended.
€ 2 doses, given 4 weeks apart is recommended for those < 9 years of age in the 1st year of receiving the vaccine.
Additional vaccine recommendations for adults (≥ 18 years)
Pneumococcal
WordPress Tables PluginVaccine brand Prevenar 13® (pneumococcal conjugate vaccine 13vPCV) Pneumovax 23® (pneumococcal polysaccharide vaccine 23vPPV) Dose Single dose at diagnosis⧥^ Single dose (min. 8 weeks following completion of Prevenar 13®)⥆ Additional booster doses N/A 5 years following completion of the initial dose⥆ β please note that pneumococcal vaccination for adults is recommended and funded under the NIP. In instances where doses have already been given they do not need to be repeated following a new diagnosis of asplenia/hyposplenia.
§ dose only required if patient has never received a dose of Prevenar 13® before.
¥ ideally Prevenar 13® is administered first, followed by Pneumovax 23® a minimum of 8 weeks later. If Pneumovax 23® is inadvertently administered first, a minimum of 12 months should elapse before administering Prevenar 13®.
^ individuals who previously received Synflorix® or Prevenar 7® are recommended to receive a single dose of Prevenar 13® at diagnosis.
† maximum of 2 doses only of Pneumovax 23® in a lifetime.
N/A- not recommended.Meningococcal
WordPress Tables PluginVaccine brand Nimenrix® (meningococcal quadrivalent conjugate vaccine 4vMenCV ACWY) Bexsero® (meningococcal B recombinant multicomponent vaccine MenBV) Dose 2 doses (min. 8 weeks apart)߆^§ 2 doses (min. 8 weeks apart)ßΩ Additional booster doses Give a booster dose every 5 years following the completion of the primary course†^§¥ Give a single booster dose only 5 years after completing the primary courseΩ ß in instances where a primary course has previously been given there is no need to repeat the course.
† Menveo® may be used interchangeably as an alternate brand to Nimenrix®. Where possible completing a course with the same brand is preferred.
^ individuals who previously received meningococcal C only vaccines (eg NeisVac-C®, Menjugate® or Meningitec®) should be re-immunised with meningococcal ACWY as recommended in these guidelines. There should be a minimum interval of at least 8 weeks between meningococcal vaccine doses.
§ individuals who previously received polysaccharide meningococcal ACWY vaccines (Menomume®or Mencevax®) should be re-immunised with conjugate meningococcal ACWY as recommended in these guidelines. There should be a minimum of 6 months elapse before administering a conjugate meningococcal ACWY vaccine.
¥ there is no maximum number or doses in a lifetime.
Ω Trumenba® is an alternate meningococcal vaccine available as a 3 dose course for individuals asplenia/hyposplenia aged 10 years or older. Meningococcal B vaccines are not interchangeable for primary courses or booster doses.Haemophilus influenzae type B (HIB)
WordPress Tables PluginVaccine brand ActHIB® Dose Single dose at diagnosis^ Additional booster dose N/A ^ dose only required if patient did not previously complete their primary course.
Influenza
WordPress Tables PluginVaccine brand Variable- refer to MVEC: Influenza for age-appropriate brands and details Dose Single dose given annually§^ § immunisation of family members is recommended.
^ people who have received a solid organ transplant/HSCT should be given 2 doses of influenza vaccine, 4 weeks apart in the first year of being vaccinated following their transplant.
Vaccine funding
Some of the recommendations in these guidelines are outside the scope of the National Immunisation Program (NIP). Different jurisdictions and individual hospitals have varying approaches to non-NIP vaccines, which should be clarified with the local health service.
Resources
- MVEC: Meningococcal
- MVEC: Pneumococcal and vaccines
- MVEC: Influenza
- NCIRS: Meningococcal vaccines GRADE assessments
- Spleen Australia
Authors: Rachael McGuire (MVEC Education Nurse Coordinator) and Nigel Crawford (Director SAEFVIC, Murdoch Children’s Research Institute)
Reviewed by: Rachael McGuire (MVEC Education Nurse Coordinator) and Nigel Crawford (Director SAEFVIC, Murdoch Children’s Research Institute)
Date: March 28, 2023
Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.
You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.
AEFI-CAN: Adverse Events Following Immunisation - Clinical Assessment Network
AEFI-CAN (Adverse Events Following Immunisation – Clinical Assessment Network) is a formal collaboration between Australian state and territory-based vaccine safety clinics and their adult and paediatric immunisation/infectious diseases/allergy specialists. It also includes representatives from the Therapeutic Goods Administration (TGA), most state/territory health departments and the immunisation branch of the Australian Government Department of Health (DoH).
As a national network, AEFI-CAN works collaboratively to clinically assess and manage individual patients following serious or unexpected adverse events after immunisation. The network is also involved in:
- developing a consistent robust national approach to serious and/or severe AEFI with the creation of standardised protocols
- standardising AEFI and clinical follow up reporting
- enhancing community and health/vaccine provider knowledge and practice about AEFI
- providing expert advice to health professionals as required.
AEFI-CAN bridges the important link between surveillance and clinical assessment and management. As such, AEFI-CAN assists in determining patient outcomes and supports investigation of possible safety signals in a real-time integrated way.
Authors: Adele Harris (SAEFVIC Research Nurse, Murdoch Children’s Research Institute) and Annette Alafaci (SAEFVIC Research Assistant, Murdoch Children’s Research Institute)
Reviewed by: Annette Alafaci (SAEFVIC Research Assistant, Murdoch Children’s Research Institute)
Date: December 2020
Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.
You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.
Australian Immunisation Register
In 2016, the previously known Australian Childhood Immunisation Register (ACIR) expanded to an all of life register and became known as the Australian Immunisation Register (AIR). It is a national register recording the immunisations of all Australians of all ages.
Why should vaccines be recorded?
The AIR records any vaccine doses administered, the date of administration and the specific brands given. It also identifies any vaccines that are due or overdue according to the National Immunisation Program (NIP). Immunisation history statements (IHS) can also be generated from AIR.
For families accessing Family Tax Benefit Part A payments or childcare subsidies, a child’s AIR record needs to show that immunisations are up to date to ensure that payments are not reduced.
In order to confirm enrolment into early childhood education and care services (including childcare and kindergarten), an up to date IHS from AIR must be produced.
A comprehensive reporting of all vaccinations administered, helps to increase vaccination coverage rates and the effectiveness of the NIP.
Who can record immunisations?
Any recognised immunisation provider can record vaccines onto AIR.
What vaccines should be recorded?
All vaccines administered since January 1 1996 can be recorded onto AIR. This includes all vaccines on the NIP, influenza and travel vaccines, as well as any additional vaccines given to an individual (eg. tetanus vaccines given for tetanus prone wounds, Boostrix® in pregnancy, meningococcal B vaccines etc). Any vaccines given overseas can and should also be recorded.
In 2021, a legislation change came into effect mandating the reporting of all NIP, influenza and COVID-19 vaccines to AIR.
Immunisation exemptions and catch up plans
All approved immunisation exemptions and recognised catch up plans are documented onto AIR to ensure that immunisation records are accurate.
Do patients need to be eligible for medicare in order to have an AIR record?
No. Everyone can have an AIR record. If a person does not have medicare, immunisations can still be recorded based on name, date of birth and address.
Immunisation history statements
An IHS can be used to keep track of vaccines that have been given, that are due or that are overdue. All medical exemptions are noted on an IHS. IHS is the only acceptable form of documentation when enroling into early childhood education and care services.
How do I access my own AIR record?
Statements can be accessed using a Medicare online account through myGov. Alternatively, copies may be obtained from any immunisation provider or the AIR enquiries line.
Resources
- Australian Government Department of Human Services: Australian Immunisation Register (AIR)
- Australian Government Department of Human Services: AIR education for vaccination providers
- Australian Government Department of Human Services: Help using AIR online
- Australian Government Department of Human Services: Immunisation medical exemption form
Author: Rachael McGuire (MVEC, Education Nurse Coordinator)
Reviewed by: Rachael McGuire (MVEC, Education Nurse Coordinator)
Date: February 2021
Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.
You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.
Aboriginal and Torres Strait Islander peoples immunisation recommendations
Background
Aboriginal and Torres Strait Islander peoples, or First Nations Australians, have higher rates of some vaccine-preventable diseases (VPD) than non-Indigenous Australians. This is due to a variety of factors, including access barriers to health care and preventative care, higher burden of chronic medical conditions and social determinants such as overcrowding and socioeconomic factors. For this reason, Aboriginal and Torres Strait Islander peoples are prioritised for additional protection through the funding of further vaccines on the National Immunisation Program (NIP).
Variations to recommendations for additional vaccines vary from state to state, based on local disease burden. In addition to this, individual immunisation providers (e.g. hospital immunisation services) may have varying approaches to additional vaccines; this should be clarified with the local health service.
Recommendations
All First Nations Australians are recommended to receive the same vaccines given to non-Indigenous Australians. Additional vaccines prioritised for First Nations Australians are summarised in the table below.
Table 1: NIP-funded vaccine priorities for Aboriginal and Torres Strait Islander peoples
| Jurisdiction | Disease (vaccine) | Notes |
| ACT NSW Tas Vic | Meningococcal B (Bexsero) | Given at 2, 4 and 12 months (additional dose at 6 months for some underlying medical conditions)^ |
| Influenza (age-appropriate brands) | Given annually from ≥ 6 months (2 doses in the first year of being vaccinated for those < 9 years) | |
| Pneumococcal (Prevenar 13) | Single dose at ≥ 50 years | |
| Pneumococcal (Pneumovax 23) | 2 doses at ≥ 50 years (1st dose 2–12 months after Prevenar 13,# 2nd and final dose ≥ 5 years after 1st dose) | |
| Herpes zoster (Shingrix) | 2 doses at ≥ 50 years (2–6 months apart if immunocompetent, 1–2 months apart if immunocompromised)* | |
| NT | Disease (vaccine) | Notes |
| Meningococcal B (Bexsero) | Given at 2, 4 and 12 months (additional dose at 6 months for some underlying medical conditions)^ | |
| Influenza (age-appropriate brands) | Given annually from ≥ 6 months (2 doses in the first year of being vaccinated for those < 9 years) | |
| Pneumococcal (Prevenar 13) | Single dose at 6 months (to make total of 4 doses in the infant schedule)¥ Single dose at ≥ 50 years | |
| Hepatitis A (Vaqta) | Given at 18 months and 4 years (total 2 doses) | |
| Pneumococcal (Pneumovax 23) | Single dose at ≥ 4 years (minimum 2 months after last Prevenar 13 dose), followed by a second dose ≥ 5 years later (total 2 Pneumovax 23 doses in a lifetime) 2 doses at ≥ 50 years (1st dose 2–12 months after Prevenar 13,# 2nd and final dose ≥ 5 years after the 1st dose) | |
| Herpes zoster (Shingrix) | 2 doses at ≥ 50 years (2–6 months apart if immunocompetent, 1–2 months apart if immunocompromised)* | |
| SA Qld | Disease (vaccine) | Notes |
| Tuberculosis (BCG) | SA: Given at birth to all babies on Anangu Pitjantjara Yankunytjatjara (APY) Lands. Catch-up can be given up to 5 years Qld: Given at birth to all Aboriginal and Torres Strait Islander babies and to all children < 5 years of age living in Aboriginal and Torres Strait Islander communities | |
| Meningococcal B (Bexsero) | Given at 2, 4 and 12 months (additional dose at 6 months for some underlying medical conditions)^ | |
| Influenza (age-appropriate brands) | Given annually from ≥ 6 months (2 doses in the first year of being vaccinated for those < 9 years) | |
| Pneumococcal (Prevenar 13) | Single dose at 6 months (to make total of 4 doses in the infant schedule)¥ ≥ Single dose at 50 years | |
| Hepatitis A (Vaqta) | Given at 18 months and 4 years (total 2 doses) | |
| Pneumococcal (Pneumovax 23) | Single dose at ≥ 4 years (minimum 2 months after last Prevenar 13 dose), followed by a second dose ≥ 5 years later (total 2 Pneumovax 23 doses in a lifetime) 2 doses at ≥ 50 years (1st dose 2–12 months after Prevenar 13,# 2nd and final dose ≥ 5 years after the 1st dose) | |
| Herpes zoster (Shingrix) | 2 doses at ≥ 50 years (2–6 months apart if immunocompetent, 1–2 months apart if immunocompromised)* | |
| WA | Disease (vaccine) | Notes |
| Meningococcal ACWY (Nimenrix) | Given at 2, 4 and 12 months (additional dose at 6 months for some underlying medical conditions)^ | |
| Meningococcal B (Bexsero) | Given at 2, 4 and 12 months (additional dose at 6 months for some underlying medical conditions)^ | |
| Influenza (age-appropriate brands) | Given annually from ≥ 6 months (2 doses in the first year of being vaccinated for those < 9 years) | |
| Pneumococcal (Prevenar 13) | Single dose at 6 months (to make total of 4 doses in the infant schedule)¥ Single dose at ≥ 50 years | |
| Hepatitis A (Vaqta) | Given at 18 months and 4 years (total 2 doses) | |
| Pneumococcal (Pneumovax 23) | Single dose at ≥ 4 years (minimum 8 weeks after last Prevenar 13 dose), followed by a second dose ≥ 5 years later (total 2 Pneumovax 23 doses in a lifetime) 2 doses at ≥ 50 years (1st dose 2–12 months after Prevenar 13,# 2nd and final dose ≥ 5 years after the 1st dose) | |
| Herpes zoster (Shingrix) | 2 doses at ≥ 50 years (2–6 months apart if immunocompetent, 1–2 months apart if immunocompromised)* |
^ Refer to MVEC: Meningococcal for specific medical conditions and vaccination guidance.
# If Pneumovax 23 is inadvertently given before Prevenar 13 dose, wait 12 months before administering Prevenar 13.
* Shingrix vaccination is funded from 18 years of age for those with a history of haematopoietic stem cell transplant, solid organ transplant, blood cancer and advanced/untreated HIV).
¥ If 6-month dose is not given, refer to Australian Immunisation Handbook for catch up advice.
shaded boxes indicate live attenuated vaccines
Vaccine-preventable diseases (VPD) targeted through funding
Hepatitis A
Factors associated with hepatitis A transmission include (but are not limited to) overcrowding and poor sanitation conditions. Before the introduction of the NIP-funded Hepatitis A vaccination program, Hepatitis A was particularly prevalent in Aboriginal and Torres Strait Islander communities. Rates in First Nations children aged under 5 years were over 20 times higher than those in non-Indigenous children in the same age group. This disease burden was most prominent in more remote areas, particularly in northern Australia.
For more information, refer to Australian Immunisation Handbook: Hepatitis A
Herpes zoster (shingles)
Herpes zoster (shingles) is caused by a reactivation of the varicella zoster virus, the same virus that causes varicella (chickenpox) disease. Zoster episodes requiring primary care presentation and/or hospitalisation impact Aboriginal and Torres Strait Islander people at an earlier age than non-Indigenous Australians. In addition, the increased burden of chronic and complex diseases means that First Nations Australians are more likely to develop herpes zoster and its associated complications compared with other Australians.
For more information, refer to MVEC: Zoster
Influenza
First Nations Australians are three times more likely than non-Indigenous people to be admitted to hospital for influenza and pneumonia. Vaccination can offer protection against disease and its complications.
For more information, refer to MVEC: Influenza page
Meningococcal
First Nations Australians have a 10-fold increased incidence of invasive meningococcal disease compared to non-Indigenous people across some age groups. Certain medical conditions further increase the likelihood of experiencing disease (e.g. immunosuppression, asplenia). Protection is offered through vaccination at the ages where disease affects individuals at the highest rates.
For more information, refer to MVEC: Meningococcal
Pneumococcal
Rates of invasive pneumococcal disease (IPD) are 6 to 7 times higher for Aboriginal and Torres Strait Islander peoples compared with non-Indigenous Australians. The risk of invasive pneumococcal disease (IPD) is greatest in young children under 5 and adults over 50 years. Protection is offered through vaccination at the ages where disease affects individuals at the highest rates.
For more information, refer to MVEC: Pneumococcal
Tuberculosis
In most areas of Australia, rates of tuberculosis are similar for First Nations Australians and non-Indigenous Australians. However, there are some specific regions where the burden of disease is higher amongst First Nations people. The reasons for this increased burden are varied; it may be associated with high density living conditions (contributing to ease of transmission) and being in close proximity to other countries with high rates of disease (contributing to imported cases by travellers).
For more information about tuberculosis vaccination (with advice specific to Victoria), refer to MVEC: Tuberculosis
Access
Easy access to vaccines is important. High vaccine coverage and being vaccinated on time are key to reducing the burden of many VPDs among Aboriginal and Torres Strait Islander peoples.
All routine and additional immunisations can be administered via GP services, councils, hospital immunisation services, some pharmacies and local Aboriginal Health Services.
Other considerations
Individuals may also benefit from other vaccines not previously mentioned on this page, depending on other factors, such as:
- vaccination history
- medical conditions
- sexual orientation
- proximity to local outbreaks
- travel plans
- occupational risk.
Resources
National
- Department of Health and Aged Care: Immunisation for Aboriginal and Torres Strait Islander people
- NCIRS: Aboriginal and Torres Strait Islander Immunisation
- HealthInfoNet
- NCIRS: Vaccination for Our Mob
State
Vic
Authors: Rachael McGuire (MVEC Education Nurse Coordinator), Nigel Crawford (Director SAEFVIC, Murdoch Children’s Research Institute) and Rebecca Feore (Immunisation Nurse, The Royal Children’s Hospital)
Reviewed by: Rachael McGuire (MVEC Education Nurse Coordinator) and Katie Butler (MVEC Education Nurse Coordinator)
Date: December 2023
Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.
You should not consider the information on this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.
Background
It is widely recognised that Aboriginal and Torres Strait Islander peoples have higher rates of some vaccine preventable diseases (VPD) than non-Indigenous persons. This is not necessarily due to being of Aboriginal and/or Torres Strait Islander background, but rather due to the higher rates of underlying chronic health conditions and social circumstances that can lead to an increase in disease burden. For this reason, additional vaccines are recommended, some of which are available through the National Immunisation Program (NIP).
The recommendations and funding for additional vaccines for Aboriginal and Torres Strait Islander peoples vary from state to state, based on local disease burden. In addition, individual immunisation providers may have varying approaches to non-NIP vaccines, and this should be clarified with the local health service.
Accessing immunisations
Routine and additional immunisations can be administered via GP services, councils, hospitals, local Aboriginal Health Services and some pharmacies.
Additional funded vaccines for Aboriginal and Torres Strait Islander people living in Victoria
Hepatitis B
Rates of hepatitis B infection in Aboriginal and Torres Strait Islander peoples population are up to 3 times higher than the non-Indigenous with notification rates increasing with age.
Hepatitis B vaccination is funded on the NIP with routine doses given at birth, 6-weeks, 4-months and 6-months of age. A booster dose is also given at 12-months of age for those who were born at < 32-weeks gestation and/or < 2000g birth weight.
In addition to this, hepatitis B vaccination is also funded in Victoria for all non-immune Aboriginal and Torres Strait Islander peoples of any age.
Pneumococcal
The risk of invasive pneumococcal disease (IPD) is greatest in young children and older adults. Rates of IPD are 6–7 times higher in Aboriginal and Torres Strait Islander people.
Aboriginal and Torres Strait Islander children living in Australian Capital Territory (ACT), New South Wales (NSW), Tasmania (Tas) or Victoria (Vic) are funded for 1 dose of Prevenar 13® (13vPCV) at ages 6 weeks, 4-months and 12-months (3 doses in total). For those with a risk condition/< 28-weeks gestation an extra dose of 13vPCV is given at 6-months of age (4 doses in total) as well as a dose of Pneumovax 23® (23vPPV) at 4-years of age.
Aboriginal and Torres Strait Islander children in Northern Territory (NT), Queensland (Qld), South Australia (SA) and Western Australia (WA) are funded to receive an extra dose of pneumococcal vaccine at age 6 months followed by two further doses of 23vPPV at age 4-years and at least 5 years later.
All Aboriginal and Torres Strait Islander individuals aged > 12 months with risk conditions are recommended to receive 1 additional dose of 13vPCV unless they have previously received a total of 4 doses of 13vPCV (according to the routine schedule for Aboriginal and Torres Strait Islander infants in NT, Qld, SA and WA) followed by two doses of 23vPPV. These doses are funded for some but not all risk conditions.
All Aboriginal and Torres Strait Islander adults ≥ 50 years of age are eligible for 1 dose of 13vPCV and two doses of 23vPPV.
The maximum number of doses of 23vPPV received in a lifetime is two.
For more information please refer to MVEC: Pneumococcal.
Influenza
Aboriginal and Torres Strait Islander people are three times more likely than non-Indigenous people to be admitted to hospital for influenza and pneumonia.
Annual influenza vaccination is funded on the NIP for all Aboriginal and Torres Strait Islander peoples from 6 months of age.
Meningococcal B and ACWY
In 2019, Aboriginal and Torres Strait Islander people had a 10-fold increased incidence of meningococcal disease than non-Indigenous people across some age groups. The most common strains causing infection were types B and W. The recommendation for all Aboriginal and Torres Strait Islander peoples is immunisation against meningococcal disease from 6 weeks of age.
Nimenrix® (meningococcal ACWY) is currently funded on the NIP as a single dose at 12-months of age and an adolescent dose at 14-15 years of age (Year 10 equivalent).
Meningococcal B vaccine (Bexsero®) is free and recommended under the NIP for Aboriginal and Torres Strait Islander infants at 2, 4, and 12 months of age. An additional dose at 6 months of age is required for Aboriginal and Torres Strait Islander infants with certain medical risk conditions.
Meningococcal B and meningococcal ACWY vaccines are also funded under the NIP for people of all ages with specified medical risk conditions that increase their risk of IMD.
For more information refer to MVEC: Meningococcal.
COVID-19 vaccines
A primary course of COVID-19 vaccines are recommended for all Aboriginal and Torres Strait Islander person > 5 years of age. Additional booster doses are also recommended for certain age groups. Aboriginal and Torres Strait Islander people are prioritised for immunisation as there is an increased risk of severe COVID-19 disease and death due to a number of factors. This includes a higher prevalence of underlying medical conditions, as well as a greater likelihood of living in communities where other preventative measures (social distancing, mask wearing and hand hygiene) cannot be maintained.
Please refer to COVID-19 vaccination – ATAGI clinical guidance on COVID-19 Vaccine in Australia in 2021 and COVID-19 vaccination information for Aboriginal and Torres Strait Islander people.
Additional funded vaccines for Aboriginal and Torres Strait Islander people living in other states
| Vaccine | Age group | State |
|---|---|---|
| BCG (tuberculosis) | Children < 5 years | QLD |
| Prevenar 13® (13-valent pneumococcal conjugate vaccine) | 6 months | NT, QLD, SA, WA |
| Vaqta® Paediatric (hepatitis A – 2 dose course) | 18 months and 4 years | NT, QLD, SA, WA |
SA Health- Aboriginal and Torres Strait Islander people immunisation recommendations QLD Health- Aboriginal and Torres Strait Islander people immunisation recommendations WA Department of Health – Immunisation schedule ATAGI clinical advice on hepatitis A vaccine
Resources
Aboriginal health services
Other resources
- Australian Immunisation Handbook: Vaccination for Aboriginal and Torres Strait Islander people
- National Aboriginal Community Controlled Health Organisation: COVID-19 Vaccine Updates and Information
- ATAGI clinical advice on vaccination recommendations for Aboriginal and Torres Strait Islander people from 1 July 2020
- ATAGI clinical guidance for COVID-19 vaccine providers
- National Immunisation Program schedule for all Aboriginal and Torres Strait Islander people
- NCIRS: Aboriginal and Torres Strait Islander Immunisation
Authors: Rachael McGuire (MVEC Education Nurse Coordinator), Nigel Crawford (Director SAEFVIC, Murdoch Children’s Research Institute) and Rebecca Feore (Immunisation Nurse, The Royal Children’s Hospital)
Reviewed by: Rachael McGuire (MVEC Education Nurse Coordinator)
Date: February 22, 2024
Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.
You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.
Allergy and immunisation
Hypersensitivity/allergic reactions following immunisation can be classified as:
- urticarial- a red, itchy skin rash often referred to as hives, which characteristically has a central raised white wheal surrounded by an area of redness
- non-urticarial rash- skin changes that don’t involve hives
- angioedema- swelling in the deeper layers of the skin
- generalised allergic reaction- involving symptoms like vomiting and diarrhoea
- anaphylaxis- a sudden onset and rapid progression of symptoms involving the skin, respiratory and/or cardiovascular systems.
Suspected hypersensitivity reactions, particularly non-urticarial skin rashes following immunisation, are common, however true vaccine allergy, where a person is contraindicated from being immunised with the same vaccine in the future, is rare (less than 1 case per million doses).
A true vaccine allergy can only be diagnosed after specialist consultation with a vaccine allergy specialist, often after specific testing is carried out.
For future vaccine advice in the setting of immunisation hypersensitivity/allergic reactions, referrals should be made to SAEFVIC. SAEFVIC staff may direct the referral to an immunisation specialist or alternatively to a vaccine allergy specialist.
Influenza vaccine and egg allergy
Based on prospective and retrospective studies of influenza vaccination in those with and without egg allergy (including egg anaphylaxis), the presence of egg allergy does not increase the risk of allergic reactions to the influenza vaccine.
The influenza vaccine can be administered in community vaccination clinics (which may or may not have direct medical practitioner supervision), General Practitioner surgeries or Immunisation clinics, as a single dose followed by the recommended 15 minute observation period.
MMR vaccine and egg allergy
Although measles and mumps vaccine viruses are cultivated in eggs, these vaccines (MMR or MMR-Varicella vaccines) contain negligible amounts of egg protein/allergen. Therefore individuals with allergy/anaphylaxis to egg can be safely immunised in the community setting without any need for extra monitoring or additional observation.
Yellow fever vaccine and egg allergy
Currently, many guidelines advise that egg anaphylaxis is a contraindication to receiving a yellow fever vaccine (YFV), with the Australian Immunisation Handbook recommending people requiring the vaccine discuss this with an immunologist or allergist due to the YFV containing egg ovalbumin.
Due to the serious nature of the disease, some countries requiring proof of immunisation as an entry requirement and the widely varying guidelines pertaining to YFV in egg-allergic people; researchers from the National Centre for Immunisation Research and Surveillance (NCIRS), and the Royal Children’s Hospital in Melbourne, have published a case series proposing that skin testing may not be required for patients with mild egg allergy, and that a 2-step graded challenge under medical supervision is a safe alternative.
COVID-19 vaccines and allergy
Additional precautions are recommended for individuals with possible allergic reactions to a previous dose of a COVID-19 vaccine; allergic reactions to ingredients in the COVID-19 vaccine to be administered (including Polysorbate 80 in Vaxzevria (AstraZeneca) and Nuvaxovid (Novavax), and PEG in Comirnaty (Pfizer) and Spikevax (Moderna)); prior anaphylactic reactions to other vaccines or medications where PEG or Polysorbate 80 may have been the cause; or a known systemic mast cell activation disorder with raised mast cell tryptase that has required treatment.
In these instances a specialist review by an immunology/allergy/vaccination specialist to undertake a risk/benefit assessment to assess suitability for vaccination should be undertaken.
For all other allergies, including those with a history of anaphylaxis to food, drugs, venom or latex, it is recommended a routine observation period of 15 minutes following COVID-19 vaccination is observed.
Resources
- MVEC: Gelatin allergy and vaccines
- MVEC: COVID-19 vaccines and allergy
- NCIRS fact sheet- Vaccines, allergy and asthma
- The Pediatric Infectious Diseases Journal: Yellow fever vaccination in EGG-allergic children
- MVEC: SAEFVIC
- Australasian Society of Clinical Immunology and Allergy (ASCIA): Vaccination of the egg-allergic individual
- Journal of Allergy and Clinical Immunology: Vocal cord dysfunction/inducible laryngeal obstruction(s) mimicking anaphylaxis during SARS-CoV-2 (COVID-19) vaccination
Author: Kirsten Perrett (Clinician Scientist Fellow, Murdoch Children’s Research Institute)
Reviewed by: Rachael McGuire (MVEC Education Nurse Coordinator)
Date: May 31, 2022
Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.
You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.
Adverse event reporting Australia
Vaccines are medications and like any medication, there are possible side effects or adverse events. Serious adverse events from immunisation are extremely rare. If you or your child has experienced an adverse event it should be reported to your local government health authority for follow up and management.
Please see the list below for the appropriate body to report to, according to your state or territory.
- South Australia Health 1300 232 272 http://www.sahealth.sa.gov.au/
- Tasmania 1800 671 738 www.health.tas.gov.au
- Victoria (SAEFVIC) 1300 882 924 (Option 1) https://www.safevac.org.au/Home/Info/VIC
- Western Australia State Health Department WAVVS (08) 9321 1312 https://www.safevac.org.au/Home/Info/WA
- Australian Capital Territory Health Department (02) 6205 2300 http://www.health.act.gov.au/
- New South Wales Public Health Units 1300 066 055 http://www.health.nsw.gov.au/
- Northern Territory Department of Health (08) 8922 8044 NT AEFI form
- Queensland Health (07) 3328 9888 http://www.health.qld.gov.au/
It is important to note that these services do not provide emergency care and are reporting services only.
If you require medical assistance please see your GP, local emergency department or dial 000 if immediate support is required.
Author: Rachael McGuire (MVEC Education Nurse Coordinator)
Reviewed by: Francesca Machingaifa (MVEC Education Nurse Coordinator)
Date: February 2022
Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.
You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.
ATAGI (Australian Technical Advisory Group on Immunisation)
The Australian Technical Advisory Group on Immunisation (ATAGI) provides independent advice to the Minister for Health on the Immunise Australia Program and other related issues.
In addition to technical experts, ATAGI’s membership includes a consumer representative and general practitioners.
The Terms of Reference of the Australian Technical Advisory Group on Immunisation are to:
- provide technical advice to the Minister for Health on the medical administration of vaccines available in Australia, including those on the National Immunisation Program (NIP)
- through the department, provide advice to research funding bodies regarding the status of current immunisation research and areas where additional research is required
- advise the Pharmaceutical Benefits Advisory Committee (PBAC) on matters relating to the ongoing strength of evidence pertaining to existing, new and emerging vaccines in relation to their effectiveness and use in Australian populations
- consult with relevant organisations to produce the Australian Immunisation Handbook
- consult with the National Immunisation Committee (NIC) on the content and format of the Australian Immunisation Handbook and associated implementation strategies
- consult with the Communicable Diseases Network Australia (CDNA) and the Advisory Committee on Vaccines (ACV) on matters relating to the implementation of immunisation policies, procedures and vaccine safety
- provide advice on COVID-19 immunisation programs and policies, to improve confidence in COVID-19 vaccines and to ensure equitable access to COVID-19 vaccines as they become available in Australia.
ATAGI meet regularly and provide bulletins detailing the important outcomes from meetings. These bulletins, COVID-19 vaccination statements and weekly updates are available via the ATAGI website.
The vaccine PBAC outcomes are also publicly available.
Resources
- ATAGI
- PBAC outcomes
- Advisory Committee on Vaccines
- Advisory Committee on Immunization Practices (ACIP) at the Centers for Disease Control and Prevention (CDC) in USA – meetings and deliberations documents
- Australian Government Department of Health: Australian Technical Advisory Group on Immunisation (ATAGI) COVID-19 Working Group
Author: Nigel Crawford (Director, SAEFVIC, Murdoch Children’s Research Institute)
Reviewed by: Francesca Machingaifa (MVEC Education Nurse Coordinator, Murdoch Children’s Research Institute)
Date: August 2021
Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.
You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.
AusVaxSafety: vaccine safety surveillance in Australia
AusVaxSafety is an active national surveillance system of all vaccines on the National Immunisation Program (NIP), which monitors adverse events following immunisation (AEFI) to detect possible vaccine safety signals. With funding from the Australian Government Department of Health, it commenced in 2014 and is led by the National Centre for Immunisation Research and Surveillance (NCIRS). The Victorian vaccine safety surveillance is coordinated by SAEFVIC, based at the Murdoch Children’s Research Institute (MCRI).
AusVaxSafety monitors de-identified data using three software programs: SmartVax, Vaxtracker and NPS Medicine Insight. Information is gathered directly from patients or their carers via SMS or email. It is used across more than 350 sites including general practices, hospital- and community-based immunisation clinics, and Aboriginal medical services spread throughout all Australian states and territories.
All data is shared with the Therapeutic Goods Administration (TGA), the Australian Government Department of Health and the participating state health departments, all of whom have a shared responsibility for monitoring the safe use of vaccines.
Resources
Author: Annette Alafaci (SAEFVIC Research Assistant, Murdoch Children’s Research Institute)
Reviewed by: Annette Alafaci (SAEFVIC Research Assistant, Murdoch Children’s Research Institute) and Rachael McGuire (SAEFVIC Research Nurse, Murdoch Children’s Research Institute)
Date: July 2020
Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.
You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.
Adolescent immunisation
Adolescence is an important time to consider the risk of vaccine preventable diseases and the benefits of immunisation. By adolescence, immunity previously obtained from childhood vaccines can begin to decline and certain behaviours or risk factors can mean that individuals in this age group are vulnerable to other vaccine preventable diseases. As a result ‘booster’ doses of previous vaccines, as well as additional vaccines, are recommended. Many of these vaccines are offered for free on the National Immunisation Program (NIP) as part of the secondary school immunisation program (SSIP). Other recommended vaccines can be provided at cost.
Where to access vaccines
NIP vaccines are provided to secondary school students at school during school hours. They are also available at council-run immunisation sessions, through GP clinics, as well as some accredited pharmacies.
Consent
Generally speaking, a parent, legal guardian or other medical treatment decision maker of a child (under the age of 18 years) can provide consent for vaccination on their behalf.
In some circumstances a child or adolescent may be determined as mature enough to understand the proposed procedure explained to them by a medical practitioner or experienced immuniser (Gillick competence). In these circumstances they may provide their own consent.
If a child or adolescent refuses a vaccination after valid consent has been provided, it is important to respect their wishes and withhold vaccination.
National Immunisation Program vaccines
Human papillomavirus (HPV)
Up to 90% of the population will be infected with a human papillomavirus (HPV) strain within their lifetime. Most HPV infections have no clinical symptoms. This means that people infected with HPV often do not know they have it and can continue transmitting the virus to others. Strains of HPV are most commonly sexually transmitted. Vaccination against HPV can prevent genital warts and cancers caused by the disease. HPV vaccination (Gardasil®9) is provided as a single dose (for immunocompetent individuals) administered in year 7 (12-14 years of age). Adolescents with immunocompromise are recommended to receive a 3-dose course for optimal protection.
Diptheria-tetanus-pertussis
A primary course of diphtheria–tetanus–pertussis (DTPa) is administered in early childhood with a booster dose of dTpa recommended for adolescents in order to provide ongoing protection into adulthood. A single dose of dTpa (Boostrix®) is administered in year 7 (12-14 years of age).
Meningococcal ACWY
Meningococcal disease is caused by the bacteria Neisseria meningitidis. There are 13 known sub-types (serogroups) and of these, 5 are currently vaccine preventable (B and A, C, W, Y).
Meningococcal disease is most prevalent in children aged ≤ 2 years, however there is another peak in disease among adolescents and young adults aged 15-24 years. A single dose of meningococcal ACWY (Nimenrix®) is funded for adolescents in year 10, with a catch up program available for those who missed this dose (15-19 years). Those with special risk factors (eg. immune suppression or asplenia) are also recommended to receive additional doses of meningococcal ACWY.
Additional recommended vaccines
Meningococcal B
Serogroups B, C, W and Y account for the highest number of cases of invasive meningococcal disease (IMD) in Australia. Whilst a meningococcal ACWY vaccine is funded as part of the school program, meningococcal B vaccines (Bexsero® or Trumenba®) are not currently funded in the adolescent population, but are, however, strongly recommended.
COVID-19
A primary course of COVID-19 vaccination is recommended for all adolescents. Booster doses are recommended for adolescents with medical comorbidities that increase their risk of severe COVID-19 disease, or those who have a disability with significant or complex medical needs.
Whilst adolescents have been shown to experience less severe COVID-19 disease, infection rates in this age group have been shown to be similar to adults. Impacts on adolescents such as mental health harms and disruptions to socialisation and education should also be considered. Vaccinating adolescents against COVID-19 is recommended to prevent infection, severe disease and death, as well as long COVID and paediatric multi-system inflammatory syndrome (PIMS-TS).
Influenza
Annual influenza vaccination is safe and strongly recommended for all adolescents. It is funded on the NIP for some at risk groups such as Aboriginal and Torres Strait Islander adolescents, and those with cardiac disease, severe asthma or diabetes. Those who are not funded to receive influenza vaccines and still wish to be vaccinated can purchase vaccines for a small fee.
Resources
Victorian program information
Other resources
Authors: Nigel Crawford (Director, SAEFVIC, Murdoch Children’s Research Institute), Mel Addison (SAEFVIC Research Nurse, Murdoch Children’s Research Institute), and Rachael McGuire (MVEC Education Nurse Coordinator)
Reviewed by: Rachael McGuire (MVEC Education Nurse Coordinator)
Date: April 11, 2023
Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.
You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.