Australian Government Department of Health and Ageing Immunisation HandbookAustralian Government Department of Health and Ageing crest. Link to the Immunise Australia Program homepage.

1.3 Pre-vaccination Procedures

1.3.4 Pre-vaccination Screening

Please note: due to continuous updates being made to the Immunisation Handbook, the page number on the electronic version will not always match the hard copy version.


Immunisation service providers should perform a pre-vaccination health screen of all recipients to determine:

  • if there are any contraindications or precautions to the vaccines that are to be administered, and
  • whether alternative or additional vaccines should be considered.
For some individuals, alterations to the routinely recommended vaccines may be necessary to either eliminate or minimise the risk of adverse events, to optimise an individual’s immune response, or to enhance the protection of a household contact against vaccine-preventable diseases.

Such changes to the recommended vaccines may require discussion with an immunisation expert such as the local immunisation coordinator or a medical practitioner with expertise in vaccination.

Steps for pre-vaccination screening


A comprehensive pre-vaccination health screening is necessary to assess a person’s medical fitness for vaccination and to determine whether a different vaccine schedule may be recommended.

Follow these steps to complete the screening process:
  1. Provide the person to be vaccinated or the parent/carer with the Prevaccination screening checklist (Table 1.3.1). NB. Some of the questions in this checklist are deliberately non-specific so as to elicit as much important information as possible.
    • The pre-vaccination screening checklist may be photocopied and handed to the parent/carer or person to be vaccinated just before vaccination.
    • It may also be photocopied and displayed in the clinic/surgery for easy reference for the immunisation service provider.
  2. When any of the conditions or circumstances are identified by using the pre-vaccination screening checklist, refer then to Table 1.3.2 which lists the specific issues pertaining to these conditions or circumstances and provides the appropriate action with a rationale.
  3. Where necessary, further expert advice should be sought from a medical practitioner with expertise in vaccination, the immunisation section within your State or Territory health authority, or your local Public Health Unit (see Appendix 1, Contact details for Australian, State and Territory Government health authorities and communicable disease control).
  4. No one should be denied the benefits of vaccination by withholding vaccines for inappropriate reasons (see Table 1.3.4 False contraindications to vaccination).

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Table 1.3.1: Pre-vaccination screening checklist

Pre-vaccination screening checklist


This checklist helps your doctor/nurse decide about vaccinating you or your child. Please tell your doctor/nurse if the person about to be vaccinated:
  • is unwell today
  • has a disease which lowers immunity (eg. leukaemia, cancer, HIV/AIDS)or is having treatment which lowers immunity (eg. oral steroid medicines such as cortisone and prednisone, radiotherapy, chemotherapy)
  • has had a severe reaction following any vaccine
  • has any severe allergies (to anything)
  • has had any vaccine in the past month
  • has had an injection of immunoglobulin, or received any blood products or a whole blood transfusion within the past year is pregnant
  • has a past history of Guillain-Barré syndrome
  • was a preterm infant
  • has a chronic illness
  • has a bleeding disorder

A different vaccine schedule may be recommended if the person to be vaccinated:
  • identifies as an Aboriginal or Torres Strait Islander
  • does not have a functioning spleen
  • is planning a pregnancy or anticipating parenthood
  • is a parent, grandparent or carer of a newborn
  • lives with someone who has a disease which lowers immunity (eg. leukaemia, cancer, HIV/AIDS), or lives with someone who is having treatment which lowers immunity (eg. oral steroid medicines such as cortisone and prednisone, radiotherapy, chemotherapy)

Note: Please ask your doctor/nurse questions about this information or any other matter relating to vaccination before the vaccines are given.
Before any vaccination takes place, the immunisation service provider will ask you:
  • Did you understand the information provided to you about immunisation?
  • Do you need more information to decide whether to proceed?
  • Did you bring your/your child’s vaccination record card with you?

It is important for you to receive a personal record of your or your child’s injections. If you do not have a record, ask your immunisation service provider to give you one. Bring this record with you every time you or your child visit for vaccination. Make sure your doctor/nurse records all vaccinations on it.
Your child may need this record to enter childcare, preschool or school.

Conditions or circumstances identified using the pre-vaccination screening checklist


The recommended responses for immunisation service providers to any conditions or circumstances identified by the pre-screening checklist is summarised in Table 1.3.2. NB. Only vaccines recommended on the National Immunisation Program schedule are included in Table 1.3.2. For information on other vaccines, refer to the relevant chapter within this Handbook (Part 3) or to vaccine product information. For reference, Table 1.3.3 provides a classification of live attenuated vaccines.
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Table 1.3.2: Responses to relevant conditions or circumstances identified by the pre-vaccination screening checklist


Condition or circumstance Action Rationale13-15

Unwell today:

  • Acute febrile illness
    (current T ≥38.5°C).
  • Acute systemic illness.
 Defer all vaccines
until afebrile.
NB. Children with minor
illnesses (without acute
systemic symptoms/signs)
should be vaccinated. 		To avoid an adverse event
in an already unwell child,
or to avoid attributing
symptoms to vaccination.
Has a disease which
lowers immunity or
receiving treatment which
lowers immunity.
See Section 2.3.3,
Vaccination of individuals
with impaired immunity
due to disease or treatment.		 Seek expert advice
before vaccination
(see Appendix 1).
NB. People living with
someone with lowered
immunity should be
vaccinated, including
with live viral vaccines.		 The safety and effectiveness
of the vaccine may be
suboptimal in people with
impaired immunity.
Anaphylaxis following
a previous dose of the
relevant vaccine.		 Do not vaccinate.
See also ‘Contraindications
to vaccination’ below.		 Anaphylaxis to a
previous dose of vaccine
is a contraindication to
receiving the vaccine.
A severe (anaphylactic)
allergy to a vaccine
component.
Refer to Appendix 4
for vaccine component
checklist.		 Do not vaccinate (seek
specialist advice as
per Appendix 1).
See also ‘Contraindications
to vaccination’ below.		 Anaphylaxis to a
vaccine component is
a contraindication to
receiving the vaccine.
Received live parenteral
vaccine or BCG vaccine
in past 4 weeks.		 Delay live vaccines
by 4 weeks.		 The immune response to a
live viral vaccine may interfere
with the response to a second
live viral vaccine if given
within 4 weeks of the first.
Has had any blood
product in the past
7 months, or has had IM
or IV immunoglobulin
in the past 11 months.
Refer to Table 2.3.5
Recommended
intervals between either
immunoglobulins or blood
products and MMR, MMRV
or varicella vaccination.		 Make a return appointment
for this vaccination,
and send a reminder
later if necessary.		 Antibodies within these
products may interfere
with the immune response
to these vaccines.
Is pregnant.
Refer to Table 2.3.1
Vaccinations in pregnancy.		 Live vaccines* should be
deferred until after delivery.
Conception should
be deferred until at
least 28 days after
administration of live
viral vaccines. Inactivated
vaccines are generally
not contraindicated
in pregnancy.		 There is insufficient evidence
to ensure the safety of
administering live vaccines
during pregnancy or within
28 days before conception.
NB. Influenza vaccine
is recommended for
pregnant women.
Vaccination of household
contacts of pregnant
women should be
completed according to
the NIP schedule.
History of Guillain-Barré
syndrome (GBS).
See Chapter 3.9, Influenza.		 Risks and benefits of
influenza vaccine should
be weighed against the
potential risk of GBS
recurrence (seek specialist
advice as per Appendix 1).		 People with a history of
GBS may be at risk of
recurrence of the condition
following influenza vaccine.
Was born preterm.
See Section 2.3.2,
Vaccination of women
planning pregnancy,
pregnant or breastfeeding
women, and preterm infants.		 Preterm infants born at
<28 weeks’ gestation or
<1500 g birth weight
require an extra dose of
PRP-OMP Hib vaccine
at 6 months of age.
Preterm infants born
at <28 weeks’ gestation
and/or with chronic lung
disease require extra
pneumococcal vaccinations.
Preterm infants born at
<32 weeks’ gestation or
<2000 g birth weight may
require an extra dose of
hepatitis B vaccine.		 Preterm infants may be at
increased risk of vaccinepreventable
diseases (eg.
invasive pneumococcal
disease (IPD)), and may not
mount an optimal immune
response to certain vaccines
(eg. hepatitis B, PRP-OMP).
Has a severe or
chronic illness.
See Chapter 2.3, Groups
with special vaccination
requirements.		 These people should
receive pneumococcal
vaccine and annual
influenza vaccination.
If there is significantly
impaired immunity,
they should not receive
live vaccines, but
inactivated vaccines
should be considered
(seek expert advice).		 People with a severe or
chronic illness may be at
increased risk of vaccinepreventable
diseases (eg.
IPD) but may not mount an
optimal immune response
to certain vaccines.
Has a bleeding disorder.
See Section 2.3.6,
Vaccination of patients
with bleeding disorders.		 The subcutaneous route
could be considered as
an alternative to the
intramuscular route
(seek specialist advice
as per Appendix 1).		 Intramuscular injection
may lead to haematomas
in patients with disorders
of haemostasis.
Identifies as an Aboriginal
or Torres Strait Islander.
See Chapter 2.1, Vaccination
for Aboriginal and Torres
Strait Islander people.		 See the National
Immunisation Program
Indigenous schedules.		 Some groups of Indigenous
people are at increased risk
of some of the vaccinepreventable
diseases.
Does not have a
functioning spleen.
See Section 2.3.3,
Subsection 2.3.3.5,
Individuals with functional
or anatomical asplenia.		 Check vaccination status
for pneumococcal,
meningococcal and
Hib vaccinations.		 Individuals with an absent
or dysfunctional spleen
are at an increased risk of
severe bacterial infections,
most notably IPD.
Is planning a pregnancy or
anticipating parenthood.		 Ensure prospective parents
have been offered vaccines
recommended for their agegroup
including 2nd dose of
MMR if born after 1966, and
dTpa† (unless they have had
a previous dose of dTpa).		 Vaccinating before pregnancy
may prevent maternal illness
which could affect the infant,
and may confer passive
immunity to the newborn.
NB. Advise women not to
become pregnant within
28 days of receiving
live viral vaccines.
Is a parent, grandparent
or carer of a newborn.		 Ensure parents,
grandparents and carers
of a newborn have been
offered all vaccines
recommended for their
age-group including dTpa
(unless they have had a
previous dose of dTpa).		 People in close contact are
the most likely sources
of vaccine-preventable
diseases, in particular
pertussis, in the newborn.
Lives with someone who
has impaired immunity.		 Ensure all vaccines (in
particular MMR, varicella
and influenza vaccines)
recommended for their
age-group have been
offered to household
members of people with
impaired immunity.		 Household members are
the most likely sources
of vaccine-preventable
diseases among people
with impaired immunity
(who often are unable to
be vaccinated, especially
with live viral vaccines).

* Live attenuated vaccines are classified in Table 1.3.3 below.
† See Chapter 3.3, Diphtheria, Chapter 3.14, Pertussis or Chapter 3.21, Tetanus for further information.


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Table 1.3.3: Live attenuated parenteral and oral vaccines


Live attenuated parenteral vaccines Live attenuated oral vaccines
Viral Bacterial Viral Bacterial
MMR
MMRV
Varicella vaccine (VV)
Monovalent
rubella vaccine
Yellow fever
Zoster vaccine		 BCG Oral rotavirus vaccine Oral typhoid vaccine

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Contraindications to vaccination


There are only 2 absolute contraindications applicable to all vaccines:
(i) anaphylaxis following a previous dose of the relevant vaccine, and
(ii) anaphylaxis following any component of the relevant vaccine.

There are 2 further contraindications applicable to live (both parenteral and oral) vaccines:

(iii) Live vaccines should not be administered to individuals with impaired immunity, regardless of whether the impairment is caused by disease or treatment. The exception is that, with specialist advice, MMR can be administered to HIV-infected individuals in whom impaired immunity is mild. (See Section 2.3.3, Vaccination of individuals with impaired immunity due to disease or treatment, and individual vaccine chapters.)
(iv) In general, live vaccines should not be administered during pregnancy, and women should be advised not to become pregnant within 4 weeks of receiving a live vaccine (see Table 2.3.1 Vaccinations in pregnancy).

False contraindications to vaccination


Conditions listed in Table 1.3.4 below are not contraindications to vaccination.

People with these conditions should be vaccinated with all recommended vaccines.

Table 1.3.4: False contraindications to vaccination


The following conditions are not contraindications to any of the
vaccines in the National Immunisation Program schedule:
  • mild illness without fever (T <38.5°C),
  • family history of any adverse events following immunisation,
  • past history of convulsions,
  • treatment with antibiotics,
  • treatment with locally acting (inhaled or low-dose topical) steroids,
  • replacement corticosteroids,
  • asthma, eczema, atopy, hay fever or ‘snuffles’,
  • previous pertussis-like illness, measles, rubella, mumps, varicella, herpes zoster or meningococcal disease,
  • prematurity (vaccination should not be postponed),
  • history of neonatal jaundice,
  • low weight in an otherwise healthy child,
  • any neurological conditions including cerebral palsy and Down syndrome,
  • contact with an infectious disease,
  • child’s mother is pregnant,
  • child to be vaccinated is being breastfed,
  • woman to be vaccinated is breastfeeding,
  • recent or imminent surgery,
  • poorly documented vaccination history.

References


13. Centers for Disease Control and Prevention (CDC). General recommendations on immunization. In: Atkinson W, Hamborsky J, McIntyre L, Wolfe C, eds. Epidemiology and prevention of vaccine-preventable diseases. 9th ed. Washington, D.C.: Public Health Foundation, 2006.

14. Lane L, Reynolds A, Ramsay M. When should vaccination be contraindicated in children? Drug Safety 2005;28:743-52.

15. Pickering LK, Baker CJ, Long SS, McMillan JA, eds. Red Book: 2006 report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2006.

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