The Australian Immunisation Handbook 10th Edition

1.4 What's new

Page last updated: 30 August 2016

PDF printable version of 1.4 What's new (PDF 311 KB)

All chapters have been updated and revised, where necessary, from the 9th edition. The 10th edition introduces new vaccines, changes to the schedules and recommendations, and changes to the presentation of the Handbook.

1.4.1 New chapters and chapters that no longer appear in the Handbook

  • Layout of the Handbook differs from the previous edition. The Handbook is now in 5 parts: Part 1 Introduction to The Australian Immunisation Handbook; Part 2 Vaccination procedures; Part 3 Vaccination for special risk groups; Part 4 Vaccine-preventable diseases; and Part 5 Passive immunisation.
  • Part 1 now includes the development process for the Handbook (previously in Appendix 2) and information on the fundamentals of immunisation, including passive and active immunisation, vaccine efficacy and vaccine safety.
  • The new Part 5 Passive immunisation contains information previously contained in Chapter 3.8 of the 9th edition, Immunoglobulin preparations.
  • The chapter on Australian bat lyssavirus and rabies is now listed under Rabies and other lyssaviruses (including Australian bat lyssavirus) in the alphabetical list of diseases in Part 4.
  • The chapter on zoster (herpes zoster) is now included as a disease chapter in Part 4 in this printed version of the 10th edition. It had previously been available as an online update to the 9th edition.
  • The chapter on smallpox has been deleted. For information on smallpox, see the Guidelines for smallpox outbreak, preparedness, response and management on the Department of Health website.
  • Some appendices contained in the 9th edition have been deleted:
    • Products registered in Australia but not currently available (previously Appendix 3); information regarding such products can be sought from the Therapeutic Goods Administration website
    • Definitions of adverse events following immunisation (previously Appendix 6); some common adverse events are now defined in the glossary of technical terms and an expanded section on adverse events following immunisation is now provided in Part 2 (2.3.2)
    • Summary table – procedures for a vaccination encounter (previously Appendix 10); this information is now incorporated throughout Part 2.

1.4.2 Changes to the format of disease chapters in Part 4

  • Where relevant, information on reconstitution and stability of reconstituted vaccines has been included in the ‘Transport, storage and handling’ section of disease chapters.
  • Where relevant, information on co-administration with other vaccines and interchangeability of vaccines is now included in the ‘Dosage and administration’ section of disease chapters.
  • A ‘Pregnancy and breastfeeding’ section has been added to all disease chapters.
  • Information on the public health management of each disease is only given in detail where there are specific additional recommendations for vaccine use in the context of disease control and/or post-exposure prophylaxis. The reader is referred to published guidelines from the Communicable Diseases Network Australia (CDNA), where available.
  • The Evidence Grades assigned in the 9th edition to recommendations contained within three chapters – Human papillomavirus, Rotavirus and Zoster (online only) – have been removed (see discussion in 1.2 Development of the 10th edition of the Handbook regarding Handbook development).

1.4.3 Overview of major changes to recommendations

The following list summarises major changes to recommendations and other important information that have occurred in each part of the 10th edition of the Handbook.

Part 2 Vaccination procedures

2.1 Pre-vaccination

  • The checklist summarising activities required for optimal storage of vaccines has been deleted; readers are referred to the National vaccine storage guidelines: Strive for 5.
  • The table (Table 2.1.5) containing information on the minimum acceptable age for the 1st vaccine doses in infants now provides advice on action required in case of early administration.
  • Catch-up recommendations and tables are now for children aged <10 years (previously <8 years).
  • Catch-up guidelines have been included for new vaccines (MMRV, Hib-MenCCV, 13vPCV and 10vPCV).
  • Updated pneumococcal catch-up tables (Tables 2.1.9, 2.1.10 and 2.1.11) provide recommendations for use of pneumococcal vaccines up to the age of 5 years.
  • Information is provided on the HALO (health, age, lifestyle, occupation) principle for use when considering catch-up vaccination for adults.
  • Additional vaccines (MenCCV, 13vPCV, 23vPPV, zoster) have been added to the catch-up table (Table 2.1.12) for adolescents and adults and this table now applies to persons ≥10 years of age (previously 8 years).

2.2 Administration of vaccines

  • Advice is now provided on the use of vaccines in multi-dose vials.
  • Advice is provided on what to do if a vaccine is inadvertently administered via a route (e.g. intramuscular (IM) or subcutaneous (SC)) other than for which it is recommended.
  • Information is now provided on vaccinating children with congenital limb malformation, children in spica casts, patients undergoing treatment for breast cancer, and patients with lymphoedema.
  • The section on administration of multiple vaccine injections at the same visit now includes advice on the order in which to give sequential vaccines and advice on simultaneous injections by two providers.

2.3 Post-vaccination

  • The section on adverse events following immunisation has been enhanced and expanded, including use of adrenaline autoinjectors for anaphylaxis treatment and more information on reporting of adverse events following immunisation.
  • Contact details are provided for obtaining HPV vaccination history from the National HPV Vaccination Program Register (NHVPR, or the ‘HPV Register’).
  • The section on documentation of vaccination has been expanded to include updated details for reporting to the ACIR, and information on the National HPV Vaccination Program Register and other registers.

Part 3 Vaccination for special risk groups

3.1 Vaccination for Aboriginal and Torres Strait Islander people

  • Information on the burden of influenza in Indigenous children, and the rationale for vaccination of those, especially ≥6 months to <5 years of age, has been included.
  • It is now recommended that Aboriginal and Torres Strait Islander people have their risks and vaccination status for hepatitis B reviewed, be offered testing for previous hepatitis B infection, and be offered vaccination if non-immune.
  • Information on the importance of ensuring immunity to rubella, especially among rural and remote Indigenous women of child-bearing age, has been added.
  • A new table (Table 3.1.1) has been added summarising additional vaccines recommended for Aboriginal and Torres Strait Islander people.

3.2 Vaccination for international travel

  • This section has been updated and expanded and information on recommended vaccines is now divided into routinely recommended vaccines (that are not specifically related to travelling overseas) and selected vaccines that are recommended based on travel itinerary, activities and likely risk of disease exposure.
  • Information on more vaccines, including new vaccines, has been added to the tables outlining the dose and routes of administration (Table 3.2.1) and recommended lower age limits (Table 3.2.2) for vaccines for travellers.

3.3 Groups with special vaccination requirements

  • The section on vaccination of persons with a prior adverse event following immunisation has been expanded. Advice is provided on vaccination of persons with allergies, including egg allergy.
  • The section on vaccination of women who are planning pregnancy, pregnant or breastfeeding, and preterm infants has been updated and expanded.
  • The table of recommendations for vaccination in pregnancy (Table 3.3.1) has been updated to include new vaccines.
  • dTpa vaccine can be given during the third trimester of pregnancy as an alternative to post-partum or pre-conception vaccination.
  • The section on vaccination of immunocompromised persons, including transplant recipients and oncology patients, has been updated and expanded.
  • All immunocompromised persons, irrespective of age, who receive influenza vaccine for the first time are now recommended to receive 2 vaccine doses, at least 4 weeks apart, and 1 dose annually thereafter.
  • The tables of recommendations for vaccinations in solid organ transplant (Table 3.3.2) and haematopoietic stem cell transplant (Table 3.3.3) recipients have been updated to include new vaccines.
  • Information on recommendations for persons infected with human immunodeficiency virus (HIV) now discusses both children and adults and includes rotavirus, HPV, varicella and zoster vaccines.
  • The section on vaccination of persons with functional and anatomical asplenia has been updated to include new vaccines, and now includes a table (Table 3.3.5) summarising vaccine recommendations in this group.
  • The section on vaccination of persons with autoimmune diseases has been expanded to include those undergoing treatment with immunosuppressive agents and those with Guillain-Barré syndrome and other chronic conditions (hypopituitarism and metabolic diseases).
  • The section on vaccination of recent recipients of normal human immunoglobulin and other blood products has been expanded.
  • The section on vaccination of persons with bleeding disorders has been updated to include new recommendations for when IM injections should be deferred and advice regarding vaccination of persons with haemophilia.
  • The table of recommended vaccinations for persons at risk of occupationally acquired vaccine-preventable diseases (Table 3.3.7) has been updated to include new occupational groups and recommendations.
  • The section on vaccination of migrants to Australia has been expanded.
  • A new section has been added to provide recommendations for vaccination for sex industry workers.

Part 4 Vaccine-preventable diseases

4.1 Cholera

  • If the interval between primary immunisation and booster dose is more than 6 months in children aged 2–6 years, or more than 2 years in adults and children aged >6 years, primary immunisation must be repeated.

4.2 Diphtheria, 4.19 Tetanus and 4.12 Pertussis

  • The 1st dose of DTPa-containing vaccines due at 2 months of age can be given as early as 6 weeks of age.
  • Advice is provided that an additional dose of pertussis-containing vaccine can be given in the 2nd year of life (e.g. at 18 months of age) if parents wish to minimise the likelihood of their child developing pertussis.
  • The booster dose of DTPa-containing vaccine recommended at 4 years of age can be given as early as 3.5 years.
  • DTPa-containing vaccines can be used for primary or booster doses in children aged <10 years (previously 8 years). Unvaccinated or partially vaccinated contacts of pertussis cases should be offered DTPa-containing vaccines up to their 10th birthday (previously 8th); dTpa should be offered to those aged ≥10 years.
  • The 2nd booster dose recommended for adolescents (using dTpa) should preferably be given between 11 and 13 years of age.
  • Adults aged ≥65 years should be offered a single dTpa booster if they have not received one in the previous 10 years.
  • For adults who are in certain risk categories for acquiring pertussis, or transmitting it to vulnerable persons, revaccination with dTpa is recommended 10 years after receipt of a prior pertussis-containing vaccine. This interval can be shortened to 5 years in the context of pregnancy.
  • Information is provided on maternal vaccination with dTpa during the third trimester of pregnancy as an alternative to post-partum or pre-conception vaccination.
  • For persons undertaking high-risk travel, a 5-yearly booster dose with dT or dTpa should be considered for protection against tetanus. In other travellers, a booster dose of tetanus-containing vaccine should be provided if 10 years have elapsed since the previous dose.
  • More information on the definition of ‘tetanus-prone wounds’ is provided, and the table (Table 4.19.1) on wound management has been updated to include recommendations for use of tetanus immunoglobulin (TIG) in immunocompromised persons.
  • Information on diphtheria antitoxin is now contained in Part 5 of the Handbook.

4.3 Haemophilus influenzae type b

  • Combination Hib-meningococcal C vaccine (Hib-MenCCV) included.
  • Hib vaccination recommendations apply to all children, including Aboriginal and Torres Strait Islander children, as only PRP-T Hib vaccines have been in use in recent years.

4.4 Hepatitis A

  • The section on serological testing for hepatitis A prior to vaccination has been expanded, and more detail provided as to rationale for vaccination of certain groups.
  • Hepatitis A vaccination is recommended in preference to NHIG for use in post-exposure prophylaxis in immunocompetent persons ≥12 months of age.

4.5 Hepatitis B

  • Different schedules for hepatitis B vaccination, including minimum intervals between doses, have been described in more detail.
  • Advice is provided regarding the validity of a hepatitis B vaccine schedule used for children born overseas, who were vaccinated at birth, 1 month and 6 months of age.
  • Information is provided on checking for infection/immunity to hepatitis B in infants born to mothers with chronic hepatitis B infection 3 to 12 months after the primary vaccine course.
  • It is now recommended that Aboriginal and Torres Strait Islander people have their risks and vaccination status for hepatitis B reviewed, be offered testing for previous hepatitis B infection, and be offered vaccination if non-immune.
  • Migrants from hepatitis B endemic countries should be offered testing for hepatitis B, and vaccination if appropriate.
  • The section on serological testing for hepatitis B prior to vaccination has been expanded, and more detail provided as to rationale for testing and/or vaccination of certain groups, including hepatitis B vaccine non-responders.

4.6 Human papillomavirus

  • HPV vaccination is now recommended for girls at the optimal age for vaccination of 11–13 years.
  • HPV vaccination is now not routinely recommended for women aged 19–26 years. A risk-benefit assessment should be conducted when contemplating vaccination of women in this and older age groups.
  • Recommendations for use of HPV in males have been included. HPV vaccination is recommended for males aged 9–18 years, with the optimal age for vaccination being 11–13 years.
  • Specific recommendations regarding the use of HPV vaccine in immunocompromised persons and men who have sex with men are now included.

4.7 Influenza

  • Intradermal influenza vaccines are included.
  • Ages for which different brands of influenza vaccine are registered have been specified.
  • Readers are referred to the Immunise Australia website to check annual statements on influenza vaccine availability and recommendations for use.
  • Information on the disease burden and benefits of influenza vaccination in pregnancy and in children aged ≥6 months and <5 years has been expanded.
  • The list of persons at increased risk of complications from influenza infection has been expanded to include persons with significant obesity and persons with Down syndrome. Alcoholism has been added to the list of chronic illnesses increasing the risk of complications from influenza infection.
  • Immunocompromised persons, irrespective of age, who receive influenza vaccine for the first time are now recommended to receive 2 vaccine doses, at least 4 weeks apart, and 1 dose annually thereafter.
  • Influenza vaccination is now also recommended for staff working in early childhood education and care and for persons working in the pork industry.

4.8 Japanese encephalitis

  • Two new JE vaccines are included.
  • Advice on booster doses and information on adverse events have been updated.

4.9 Measles, 4.11 Mumps, 4.18 Rubella and 4.22 Varicella

  • Recommendations for MMRV vaccines are updated, and changed from the recommendations provided in the 9th edition. It is stated that MMRV vaccines will be available in Australia from July 2013.
  • MMR vaccine is to be used for the 1st dose at 12 months of age. MMRV is not recommended for use as the 1st dose of MMR-containing vaccine in children <4 years of age.
  • The recommended age for administration of the 2nd dose of measles-containing vaccine will be moved from 4 years of age to 18 months of age (from July 2013).
  • MMRV vaccine can be used as the 2nd dose of MMR-containing vaccine and to provide a single dose of varicella vaccine at 18 months of age (from July 2013).
  • MMRV vaccines are not recommended in persons ≥14 years of age.
  • A new table has been included in the Measles (Table 4.9.1) and Varicella (Table 4.22.1) chapters summarising the different recommendations before and after the introduction of MMRV vaccines in July 2013.
  • The table describing post-exposure prophylaxis for measles (Table 4.9.2) has been revised and expanded to include more specific age ranges, MMR vaccination history and advice regarding persons who are immunocompromised.
  • More information on serological testing and revaccination of women of child-bearing age who are non-immune to rubella is included.

4.10 Meningococcal disease

  • Combination Hib-meningococcal C vaccine (Hib-MenCCV) has been included.
  • Quadrivalent meningococcal conjugate vaccines (4vMenCV) have been included.
  • 4vMenCV is preferred over the quadrivalent meningococcal polysaccharide vaccine (4vMenPV) for use in persons aged ≥9 months who are at increased risk of meningococcal disease.
  • For young children with medical risk factors for meningococcal disease, meningococcal C conjugate vaccine (MenCCV) is recommended in those aged 6 weeks to <12 months; thereafter 4vMenCV is recommended in a 2-dose schedule at approximately 12 and 18 months of age.
  • 5-yearly booster doses of 4vMenCV are recommended for persons at ongoing high risk of meningococcal infection.
  • For persons at ongoing risk of meningococcal infection who have previously received 4vMenPV, a booster dose of 4vMenCV should be given 3 years after the 4vMenPV and then every 5 years.

4.13 Pneumococcal disease

  • 10-valent (10vPCV) and 13-valent (13vPCV) pneumococcal conjugate vaccines are included.
  • For Aboriginal and Torres Strait Islander children living in the Northern Territory, Queensland, South Australia or Western Australia, a booster dose of 13vPCV at 12–18 months of age replaces the booster dose of 23vPPV at 18–24 months of age.
  • The list of conditions associated with increased risks of invasive pneumococcal disease (IPD) (List 4.13.1) has been revised to include both adults and children, and is now divided into two categories: those conditions posing the highest increased risk of developing IPD and those associated with an increased risk of IPD.
  • The table (Table 4.13.3) summarising recommendations for vaccination of adults with 23vPPV has been revised.
  • Recommendations for the use of a single dose of 13vPCV in adults and children >5 years of age with conditions associated with the highest increased risk of IPD (and who have not previously received a 13vPCV dose) are included.
  • Information on the use of 23vPPV in persons >5 years of age at increased risk of IPD has also been more clearly presented.

4.14 Poliomyelitis

  • The 1st dose of IPV-containing combination vaccine due at 2 months of age can be given as early as 6 weeks of age.
  • A booster dose of IPV-containing vaccine is recommended at 4 years of age, but can be given as early as 3.5 years.

4.15 Q fever

  • Q fever vaccination and skin testing training is now undertaken via an educational module available online.
  • Information on the Australian Q Fever Register, which lists Q fever immunisation service providers and records of Q fever vaccinations given to some persons, is included.
  • Q fever vaccination is now also recommended for professional dog and cat breeders, and wildlife and zoo workers who have contact with at-risk animals, including kangaroos and bandicoots.

4.16 Rabies and other lyssaviruses (including Australian bat lyssavirus)

  • The terms PEP (post-exposure prophylaxis) and PreP (pre-exposure prophylaxis) are used throughout the chapter.
  • Information and recommendations on management of all potential lyssavirus exposures, including lyssavirus infection from exposure to bats in non-rabies-enzootic countries, is now included.
  • A 4-dose PEP schedule is now recommended for immunocompetent persons. A 5-dose schedule is only recommended for persons who are immunocompromised.
  • A table (Table 4.16.1) summarising World Health Organization (WHO) categories of lyssavirus exposure, for guidance in use of post-exposure prophylaxis, has been added.
  • Algorithms are provided with details of the recommended management pathways for post-exposure prophylaxis for rabies and other lyssaviruses (including Australian bat lyssavirus), and for booster doses for persons at ongoing risk of exposure to rabies and other lyssaviruses.
  • Advice regarding the completion of post-exposure prophylaxis commenced overseas has been expanded, including the addition of a summary table (Table 4.16.2).
  • Persons who have completed a primary course of a currently available cell culture-derived rabies vaccine no longer routinely require booster doses if travelling or living in an area of high risk.
  • Information on the role of serological testing has been more clearly presented.

4.17 Rotavirus

  • The upper age limits for each dose of rotavirus vaccines are more clearly defined.
  • Contraindications to rotavirus vaccination now include previous history of intussusception (IS) and severe combined immunodeficiency in infants.
  • Information on the safety of rotavirus vaccines in infants with underlying conditions and infants who are immunocompromised has been updated.
  • Information on adverse events following rotavirus vaccination has been updated and expanded, including new information on the low, but increased, risk of IS occurring following the 1st or 2nd dose of either rotavirus vaccine.

4.20 Tuberculosis

  • Bacille Calmette-Guérin (BCG) vaccination is no longer routinely recommended for neonates weighing <2.5 kg.
  • Generalised septic skin disease, skin conditions such as eczema, dermatitis and psoriasis, and significant febrile illness are no longer contraindications to BCG vaccination but, if present, vaccination should be deferred.

4.23 Yellow fever

  • Yellow fever vaccine is not recommended in women who are breastfeeding infants aged <9 months.
  • More detail is provided on how to access the WHO information regarding areas of high yellow fever activity and requirements for travel.

4.24 Zoster

  • Information on the efficacy of vaccination in persons aged 50–59 years has been included.

Part 5 Passive immunisation

  • Information regarding the use of intravenous immunoglobulins as treatment for disease conditions (such as Kawasaki disease) or as replacement therapy for immunodeficient individuals is no longer included in the Handbook. Readers are referred to National Blood Authority guidelines.