Australia’s trusted independent immunisation experts
NCIRS Seminar/Webinar Series

From 1 July 2020 some important changes to the National Immunisation Program (NIP) and recommendations for pneumococcal, meningococcal and hepatitis A vaccination took effect. 

The pneumococcal vaccination recommendations and schedule changed to reflect the current best clinical evidence in preventing pneumococcal disease in adults and in people with conditions that increase their risk of disease. The changes aim to simplify vaccination advice by making it easier to understand who should get vaccinated, and when and which vaccine they should get. 

The meningococcal vaccinations funded through the NIP changed to better protect Aboriginal and Torres Strait Islander children and people of all ages with medical conditions that increase their risk of invasive meningococcal disease. The NIP schedule for hepatitis A vaccination for Aboriginal and Torres Strait Islander children in the Northern Territory, Queensland, South Australia and Western Australia was also modified.

This NCIRS webinar provided information about these NIP changes. 

Resources:

Presentation slides - Meningococcal, Hib and Hepatitis A vaccines and case studies - Dr Clayton Chiu [PDF - 1183kB]

Presentation slides - Pneumococcal vaccines - Associate Professor Christopher Blyth  [PDF - 799kB]

Q&A from webinar

  • General questions about pneumococcal vaccines and recommendations

    Q: What is the difference between 13vPCV and 23vPPV?

    A: 13vPCV and 23vPPV vary in the number of pneumococcal serotypes they protect against, that is, valency (v).  23vPPV contains 23 variant types of antigens in the form of polysaccharides (sugars). These polysaccharides occur on the surface of the pneumococcal bacteria. 13vPCV contains 13 variant types of polysaccharide antigens.  In conjugate vaccines like 13vPCV these polysaccharides are conjugated (linked) to a protein carrier. This conjugation enhances the immune response, particularly in young children, and results in immune memory that prolongs protection.

    Q: Is the formulation of 13vPCV given to adults the same as that given to children?

    A: Yes. There is currently only one formulation of 13vPCV (Prevenar 13) and this is registered for use in all people 6 weeks of age and older. Refer to the pneumococcal chapter of the Australian Immunisation Handbook for further details.

    Q: Where can I find the list of risk conditions for pneumococcal disease for which pneumococcal vaccines are recommended?

    A: The updated list of risk conditions for pneumococcal disease for which pneumococcal vaccination is recommended can be found in the Australian Immunisation Handbook, the ATAGI clinical advice on changes to recommendations for pneumococcal vaccines from 1 July 2020 and NCIRS fact sheet on pneumococcal vaccines for Australians. This list also outlines the eligibility of some of these risk conditions for funding under the National Immunisation Program (NIP). 

    Q: Is there an upper age limit for receiving pneumococcal vaccines?    

    Q: What happens if you and your baby move to another state with a different schedule?

    A: All individuals are recommended to receive vaccines according to the recommendations for their state or territory of current residence. Catch-up vaccinations may be required.

    Q: What is the maximum number of doses of 23vPPV a person is allowed to have in their lifetime?

    A: All individuals are now recommended to receive no more than 2 doses of 23vPPV in their lifetime. Please refer to the NCIRS Pneumococcal vaccines FAQs for further details. 

    Q: I understand that the number of recommended lifetime doses of 23vPPV is now limited to 2 doses for all people. Does this include the doses of 23vPPV given in childhood?

    A: Yes, the 2 doses include the doses of 23vPPV received in childhood. For previous 23vPPV doses, count only the documented doses; if no 23vPPV doses are documented as received, consider as not given.

    Q: What are the recommendations for non-Indigenous adults who do not have risk factors?

    A: All non-Indigenous adults who do not have any of the conditions in the list of risk factors for pneumococcal disease are recommended to receive one dose of 13vPCV at ≥70 years of age. This will replace the previously recommended single dose of 23vPPV at 65 years of age.

    Q: After the childhood schedule is complete, do we then vaccinate again from aged 50 years for Indigenous individuals and age 70 years for non-Indigenous individuals?

    A: The 13vPCV was first recommended and funded for use in the routine childhood NIP schedule in mid-2011. At the present time, individuals who remain well would not require another pneumococcal vaccine until they are 50 years old (for Indigenous people) or 70 years old (for non-Indigenous people).  

    Some people may develop risk factors for pneumococcal disease after they have already completed the infant schedule and may require further doses of pneumococcal vaccines prior to reaching late adulthood (50 years or 70 years). Children diagnosed with risk conditions at age >12 months who have previously received 13vPCV in a 3-dose schedule at 2, 4 and 12 months should receive 1 dose of 13vPCV at diagnosis followed by 2 doses of 23vPPV, at the intervals described in the Australian Immunisation Handbook. Children who have previously received 13vPCV in a 4-dose schedule at 2, 4, 6 and 12 months followed by two doses of  23vPPV are currently not recommended to receive further doses of pneumococcal vaccines.

    Q: For people with a prior diagnosis of invasive pneumococcal disease (IPD), how soon after diagnosis can they receive the recommended pneumococcal vaccines?

    A: The best time to begin vaccination will be a clinical decision, but will generally be when the patient has clinically recovered and is stable. Ideally the 13vPCV (the first recommended dose) should be given without undue delay or a missed opportunity for vaccination. This should be followed by a dose of 23vPPV given at an interval of 12 months (an interval of 2-12 months is acceptable). The person should then receive a second dose of 23vPPV at least 5 years after the first 23vPPV dose. 

    Q: For patients who have recently undergone organ transplant, how soon after the transplant can they receive the recommended pneumococcal vaccines?

    A: Six months. People who have undergone haematopoietic stem cell transplant (HSCT) are recommended 3 doses of 13vPCV after transplantation, followed by 2 doses of 23vPPV at the intervals described in the Australian Immunisation Handbook. The first dose of 13vPCV can be given 6 months after HSCT. People who have undergone a solid organ transplant are recommended 1 dose of 13vPCV after transplantation, followed by 2 doses of 23vPPV. The 13vPCV dose can be given 6 months after transplantation. 

    Q: Are adults aged ≥70years without risk factors for pneumococcal disease recommended to receive booster doses of pneumococcal vaccines?

    A: Booster doses of pneumococcal vaccines (either 13vPCV or 23vPPV) are currently not recommended for adults who do not have risk factors for pneumococcal disease.

    Q: Can 13vPCV and Zostavax be given together?

    A: 13vPCV can be given at the same time as Zostavax (herpes zoster vaccine) for eligible individuals, and this is encouraged to reduce the need for multiple visits.

  • Questions about transitioning from previous recommendations for pneumococcal vaccines

    Q: My patient has a risk condition for pneumococcal disease and has previously received ≥2 doses of 23vPPV. What further doses of pneumococcal vaccine should they receive?

    A: The patient is not recommended to receive any further doses of 23vPPV. This is because the number of recommended lifetime doses of 23vPPV is now limited to 2 doses for all people. Any doses of 23vPPV received in the past are counted when deciding how many more are required.

    People with risk factors for pneumococcal disease who have previously received 2 or more doses of 23vPPV but have never received 13vPCV are recommended to receive a single dose of 13vPCV.  The dose of 13vPCV should be given at least 12 months after their last 23vPPV dose.

    Q: Is the category “people over 65 years” on the NIP being replaced with “people aged >12months who have a risk factor for pneumococcal disease”? 

    A: No, the ≥65 years and >12months categories refer to recommendations for two distinct population groups and are therefore unrelated. 

    The ≥65 years category refers to previous recommendations; this was the recommended age of vaccination for a dose of 23vPPV for older non-Indigenous adults who do not have risk factors for pneumococcal disease. From 1 July 2020, this recommendation has been replaced with the recommendation that older non-Indigenous adults who do not have risk factors should receive 1 dose of 13vPCV at age ≥70 years. (A dose of 23vPPV at age 65 years is no longer recommended for older non-Indigenous adults who do not have risk factors for pneumococcal disease.)

    The >12 months category refers to current recommendations for people with risk factors for pneumococcal disease. From 1 July 2020, these people are now recommended to receive 1 dose of 13vPCV followed by 2 doses of 23vPPV, following appropriate intervals. Refer to the Australian Immunisation Handbook for detailed guidance.

    Q: For adults or older children with newly identified pneumococcal risk conditions, are the doses of 13vPCV given in childhood counted when deciding the number of further doses required?

    A: As 13vPCV was available in Australia only from 2010 and so most adults or older children would not have previously received 13vPCV. However, all doses of 13vPCV previously received are considered when determining the number of further doses required.  For people who have received 13vPCV as part of the infant schedule, the number of doses required will depend on the infant schedule followed. Children newly diagnosed with  risk conditions at age >12 months who have previously received 13vPCV in a 3-dose schedule at either 2, 4 and 6 months  or 2, 4 and 12 months are recommended to receive 1 dose of 13vPCV at diagnosis followed by 2 doses of 23vPPV. Refer to the Australian Immunisation Handbook for information on dosage intervals.

    Many Aboriginal and Torres Strait Islander children born since mid-2011 who live in the Northern Territory, Queensland, South Australia and Western Australia would have received 4 doses of 13vPCV as part of their routine schedule. Please check their vaccination record. If these children are diagnosed with a risk condition, they would not need an extra dose of 13vPCV. They would still require the 2 recommended doses of 23vPPV though.

    Q: If an Aboriginal and Torres Strait Islander child has received 4 doses of 13vPCV and 1 dose of 23vPPV and is then diagnosed with a medical condition at 5 years – what does this child receive?

    A: Children and adolescents with newly identified risk conditions who have previously received 4 doses of 13vPCV and 1 dose of 23vPPV are recommended to receive 1 more dose of 23vPPV. This dose should be given at least five years after the last 23vPPV dose. 

    Q: Are kids aged 0–5 years in NSW not included in the new at-risk changes?

    A: There are no changes to the NIP Schedule and recommendations for pneumococcal vaccination in all children aged ≤12 months. However, the recommendations for children diagnosed with risk factors at age >12 months have changed. Children residing in NSW who are diagnosed with risk factor(s) at age >12 months are now recommended to receive 1 dose of 13vPCV at diagnosis followed by 2 doses of 23vPPV. 

    Q: An adult has previously received 23vPPV at 65 years and has now been diagnosed with a risk condition for pneumococcal disease. What pneumococcal vaccines should they receive?

    A: An adult who had received 23vPPV at age 65 years as part of the universal recommendation for all adults, who is now diagnosed with a risk condition, should receive a dose of 13vPCV. The recommended interval between the previous 23vPPV dose and the current 13vPCV dose is 12 months. This adult should receive another dose of 23vPPV with an interval of 5 years after the previous 23vPPV dose. No further doses of pneumococcal vaccines (13vPCV or 23vPPV) are recommended for this adult.

    Also all adults with pre-existing risk factors who have previously received 2 or more doses of 23vPPV but have never received 13vPCV are recommended to receive 1 dose of 13vPCV. This 13vPCV dose should be given at least 12 months after the last dose of 23vPPV. No more doses of 23vPPV are required for these individuals.

    Q: A 70-year-old man has previously received 2 doses of 23vPPV. What pneumococcal vaccine is he  recommended to receive now?

    A: All non-Indigenous adults who have never received 13vPCV should be given a dose of 13vPCV at ≥70 years of age. This single dose of 13vPCV is NIP-funded for all adults aged ≥70 years of age on or after 1 July 2020, regardless of whether the person has received 23vPPV previously.

  • Questions about dose timing and intervals for pneumococcal vaccines

    Q: What is the minimal interval between a dose of 13vPCV and a subsequent dose of 23vPPV?

    A: Two months. The recommended interval between the last dose of 13vPCV and a subsequent dose of 23vPPV is 12 months, but 2–12 months is acceptable. For young children, the minimum age recommended for the first dose of 23vPPV, following the primary series of 13vPCV, is  4 years.

    Q: What is the minimal interval between a dose of 23vPPV and a subsequent dose of 13vPCV? Is the minimum interval different for people aged ≥70 years?

    A: Twelve months. The recommended interval between the last dose of 23vPPV and a subsequent dose of 13vPCV is 12 months, regardless of the age of the person being vaccinated. 

    Q: For children with risk conditions, including those living in high-risk states and territories, what is the minimal interval between the 3rd dose of 13vPCV (scheduled at 6 months) and the 4th dose of 13vPCV?

    A: The minimum interval between the 3rd dose of 13vPCV and the 4th dose of 13vPCV is 2 months and it should not be given before 12 months of age.

    Q: A non-Indigenous adult has received a dose of 23vPPV at 65–69 years as part of the previous recommendations. When should they get the age-based dose of 13vPCV?

    A: If the individual has never received 13vPCV, they should receive 1 dose of 13vPCV as soon as possible after the following criteria are fulfilled:

    • the individual has turned 70 years of age and 
    • at least 12 months have passed since they received the last dose of 23vPPV.

    Q: My patient has a risk condition for pneumococcal disease and has received 23vPPV but not 13vPCV in the past. When should I give them the dose of 13vPCV?

    A: The patient should be given 13vPCV as soon as possible after satisfying the minimum interval requirements, that is, 12 months. The minimum interval between a dose of 23vPPV and a subsequent dose of 13vPCV is 12 months.

    Q: For older adults (≥65 years) with newly identified medical conditions, what is the minimal interval between the 2 doses of 23vPPV that they are recommended to receive?

    A: The minimum interval between 2 doses of 23vPPV doses is 5 years. This applies to all individuals recommended to receive 23vPPV, regardless of their age.

    Q: A dose of 13vPCV was inadvertently given less than 12 months after 23vPPV. What should I do?

    A. Whether this 13vPCV should be repeated would need to be considered on a case-by-case basis. Among other factors, the decision would need to take into account the person’s risk of pneumococcal disease, current epidemiology of pneumococcal disease and the interval between the dose of 13vPCV and the last dose of 23vPPV received. For advice on how to proceed, please contact your local public health unit or immunisation specialist service.

  • Questions about rationale/policy for pneumococcal vaccination recommendations

    Q: Were the recommendations for the use of pneumococcal vaccines updated because of the COVID-19 outbreak?

    A: No, the changes to the pneumococcal vaccine recommendations from 1 July 2020 are unrelated to the COVID-19 outbreak. Pneumococcal vaccines will not provide protection against COVID-19.

    Q: When can we start offering 13vPCV doses to people aged ≥70 years?

    A: 1 July 2020. This is when the new pneumococcal vaccination program commenced.

    Q: Why has the recommended age for vaccination for older adults changed?

    A: From 1 July 2020, the recommended age for pneumococcal vaccination for non-Indigenous adults is 70 years of age, replacing the previous recommendation at ≥65years of age. The incidence of IPD is much greater from 70 years of age than between 65 and 69 years of age. Because the effectiveness of pneumococcal vaccine reduces over time, moving the age of pneumococcal vaccination from 65 years of age to 70 years of age is expected to provide better protection as people move into older age groups with increasing pneumococcal disease risk.

    Q: Why has the recommended pneumococcal vaccine for non-Indigenous older adults changed from 23vPPV to 13vPCV?

    A: From 1 July 2020, all non-Indigenous older adults aged 70 years or older with no risk conditions are recommended to receive 1 dose of 13vPCV, replacing the previously recommended dose of 23vPPV at 65 years of age.  The dose of 13vPCV will provide more assured protection against community acquired pneumonia because of vaccine serotypes contained in 13vPCV, compared to 23vPPV, and will also further reduce remaining 13vPCV-type IPD among older adults. 

    Q: If the rationale for giving the third dose of 13vPCV at 12 months is to attain maximum protection in the second year of life, why is the dose not given at 18 months instead?

    A: The decision to recommend a booster dose of 13vPCV at 12 months of age takes into consideration the pneumococcal disease epidemiology among Australian children and the schedule for other vaccines on the NIP.

  • Questions about pneumococcal risk factors

    Q: Are neurodegenerative diseases such as Parkinson's disease, risk factors for pneumococcal disease for which pneumococcal vaccine is indicated? 

    A: At present Parkinson's disease is not considered a risk condition for pneumococcal disease for which vaccination is indicated. Refer to the pneumococcal chapter of the Australian Immunisation Handbook for the full list of pneumococcal risk factors for which pneumococcal vaccination is recommended.

    Q: Is rheumatic heart disease a risk factor for pneumococcal disease for which pneumococcal vaccine is indicated?

    A: Rheumatic heart disease, a cardiac condition, is a risk condition for pneumococcal disease for which vaccination is indicated. People with this condition are recommended to receive pneumococcal vaccines based on the recommendations for people with risk factors, but these doses are not funded under the NIP. Refer to the pneumococcal chapter of the Australian Immunisation Handbook for the full list of pneumococcal risk factors for which pneumococcal vaccination is recommended, and for pneumococcal vaccine recommendations for people with risk factors.

    Q: Is hypertension a risk factor for pneumococcal disease for which pneumococcal vaccine is indicated?

    A: At present hypertension is not considered a risk condition for pneumococcal disease for which vaccination is indicated. Refer to the pneumococcal chapter of the Australian Immunisation Handbook for the full list of pneumococcal risk factors for which pneumococcal vaccination is recommended.

  • Questions about funding/eligibility for pneumococcal vaccinations

    Q: Are adults aged ≥70years who have previously received 13vPCV as part of the childhood program also eligible for a dose of 13vPCV?

    A: The 13vPCV vaccine was first recommended and funded for use in children in 2011. Therefore currently no adults aged ≥70 years would have received 13vPCV during infancy. The recommendations for the use of pneumococcal vaccines in adults are continually reviewed and may change with time as new evidence and vaccines are introduced. 

    Q: Are diabetics eligible to receive extra doses of pneumococcal vaccine?  

    A: Diabetes is a risk condition for which pneumococcal vaccines are recommended. People with this condition are recommended to receive pneumococcal vaccines based on the recommendations for people with risk factors, but these doses are not funded under the NIP. Refer to the pneumococcal chapter of the Australian Immunisation Handbook for the full list of pneumococcal risk factors for which pneumococcal vaccination is recommended and the eligibility to NIP-funded doses.

    Q: Do people with risk factors for which pneumococcal vaccines are recommended but not funded under the NIP (e.g. COPD and diabetes) need to purchase the recommended vaccines privately? 

    A: Yes, individuals recommended to receive pneumococcal vaccines that are not funded under the NIP need to obtain and purchase the vaccines by private prescription.

    Q: Are people with risk factors for pneumococcal disease eligible to receive funded pneumococcal vaccines at any age?

    A: Individuals of all ages with risk factors for pneumococcal disease are recommended to receive pneumococcal vaccine doses. 13vPCV can be given as early as 6 weeks of age, and 23vPPV is given from 4 years of age. People with some, but not all, of the risk conditions are eligible to receive NIP-funded pneumococcal vaccines. All people with risk conditions for which pneumococcal vaccines are funded under the NIP are eligible to receive their recommended doses free under the NIP, regardless of their age. Please refer to of the Australian Immunisation Handbook for the list of pneumococcal risk factors for which pneumococcal vaccination is recommended and funded under the NIP.

    Q: Are non-Indigenous adults aged ≥70 years who have previously received 23vPPV eligible for a free dose of 13vPCV under the NIP?

    A: All non-Indigenous adults who have never received 13vPCV should be given a dose of 13vPCV at ≥70 years of age. This single dose of 13vPCV is NIP-funded for all adults aged ≥70 years of age on or after 1 July 2020, regardless of whether the person has received 23vPPV previously. 

    Q: Will 23vPPV still be available under the PBS?

    A: 23vPPV will no longer be available under the Pharmaceutical Benefits Scheme (PBS). In July 2019, the PBAC considered the listing of the 23vPPV was no longer required, and recommended delisting the vaccine from the PBS.
    The PBAC Secretariat has advised that there will likely be an advanced notice issued of the delisting either 1 August or 1 September 2020, for deletion 1 month later.

  • Other questions about pneumococcal vaccines and resources

    Q: What year did the immunisation register start registering adults - especially for information regarding past history of 23vPPV?

    A: The Australian Immunisation Register became a whole of life register in September 2016 and records all vaccines given to all people in Australia.  

    Q: We are unable to order (Pneumovax) 23vPPV from the government funded supplier due to lack of stock. Will this change any time soon?

    Q: Given the current shortage of 23vPPV, should adults aged ≥65years old who are on the waiting list for 23vPPV be told to wait until they are eligible for the 13vPCV (at age 70) instead?

    Q: Given the current shortage of 23vPPV, should adults aged ≥65years old who are on the waiting list for 23vPPV be told to wait until they are eligible for the 13vPCV (at age 70) instead?

    Q: I have had 65yr old waiting for 23vPPV for 6 months do I now ask them to step down and wait until they are 70yrs or do I give them the choice of purchasing privately.

    A: One of the two pneumococcal vaccines supplied in Australia, Pneumovax 23 is currently listed as being in shortage on the Therapeutic Goods Administration (TGA) website - click on ‘medicine shortages’ on the right side of the homepage and search for ‘pneumovax’ under ‘all shortages’. 

    Pneumovax 23 sponsor Merck Sharp & Dohme (Australia) Pty Ltd, has advised the Department of Health that the anticipated return to stock date was 29 June 2020. 

    The shortage affected the private market only. There is no current impact to supply for the NIP, and any patients who meet NIP eligibility criteria should still be able to access it. 

    Adults aged <65 years who are not medically at risk should speak with their doctor or immunisation provider for further information about the vaccine and its associated costs.

    Q: Will guidance be provided for providers on how they can best explain these changes to 65-year-old patients who are worried about missing out on the vaccine?

    A: The Commonwealth Chief Medical Officer has written to all GPs and Aboriginal Medical Services providing resources to assist vaccination providers in the implementation of the 1 July 2020 scheduled changes.  The resources, including clinical fact sheets, new schedule cards and consumer resources for meningococcal B are also available on the Department of Health website. In addition, the program changes have been communicated to all peak groups, speciality organisations and societies who might be interested in the changes, as well as Primary Health Networks. States and territories have also communicated about the changes by reaching out to local groups in their individual jurisdiction.

    Q: I have started using the pneumococcal vaccine calculation tool from the immunisation coalition. It is recommended by HNEPHU. Do you at NCIRS recommend it?

    A: The PneumoSmart Vaccination Tool has been created by the Immunisation Coalition based on the pneumococcal disease vaccination recommendations in the online Australian Immunisation Handbook. The tool may be useful in assisting with determining catch-ups, if it is updated to reflect all the updated recommendations according to the current online Australian Immunisation Handbook. However, providers should always exercise their own independent skill or judgment, and seek additional professional advice if required.

    Q: Is there a catch-up calculator app available?

    A: The National Immunisation Catch up Calculator is now available via the online Australian Immunisation Handbook website. 

    There is no feature available at the present time to perform immunisation schedule catch-up calculations via a mobile app. This is a feature the project team is reviewing in the upcoming Financial Year.

    In the meantime, the inaugural National Immunisation Catch-up Calculator (NICC V1.0) is now available from the official Australian Immunisation Handbook.

    You will be able to use the NICC V1.0 for immunisation schedule catch-up calculations for children up to the age of 10 years.

    While you will need an internet connection to use this calculator, you can use from a mobile phone, tablet or PC.

    Q: Will the Handbook provide guidance on funded versus unfunded risk factors, and on dose intervals between 23vPPV and 13vPCV?

    A: Yes, the Handbook outlines the list of risk conditions for pneumococcal vaccine recommendations and their eligibility for funding under the NIP. Please see List. Risk conditions for pneumococcal disease in the pneumococcal chapter of the Australian Immunisation Handbook. Also refer to the pneumococcal chapter of the Australian Immunisation Handbook for information on the recommended dose intervals.

    Q: Will the new pneumococcal recommendations reflect on this site - https://immunisationcoalition.org.au/pvt/?

    A: Please refer to the administrator of that website.

  • Questions about meningococcal vaccinations

    Q: Which non-Indigenous children are eligible for a catch-up program for NIP-funded Bexsero?

    A: From 1 July 2020 Bexsero will be funded under the NIP for people of all ages with some medical conditions that increase their risk of IMD.  These risk conditions include defects in, or deficiency of, complement components, including factor H, factor D or properdin deficiency; current or future treatment with eculizumab; functional or anatomical asplenia, including sickle cell disease or other haemoglobinopathies, and congenital or acquired asplenia. Refer to Meningococcal vaccination: Clinical advice for vaccination providers for detailed information.

    Q: What is the recommended schedule for Bexsero in Aboriginal and Torres Strait Islander children?

    A: The schedule for Bexsero for the routine infant program:

    • 2, 4 and 12 months of age for those with no medical risk conditions (3 doses)
    • 2, 4, 6 and 12 months of age for those with risk conditions for IMD (4 doses)

    Meningococcal B vaccine (Bexsero) catch-up is available for all Aboriginal and Torres Strait Islander children <2 years of age (up to 23 months), for 3 years - until 30 June 2023. The number and spacing of doses required depend on the age when vaccination starts and the presence of risk conditions. Details are available in the Australian Immunisation Handbook. 

    Q: What is the recommended schedule for Bexsero in children with an at-risk condition?

    A: The number of doses required will depend on age. 

    Age at start of vaccine course Dose requirements for people with a specified medical condition
    6 weeks to 5 months 4 doses (8 weeks between doses; 4th dose at 12 months of age or 8 weeks after 3rd dose, whichever is later)
    6-11 months 3 doses (8 weeks between 1st and 2nd doses; 3rd dose at 12 months of age or 8 weeks after 2nd dose, whichever is later)
    ≥12 months 2 doses (8 weeks between doses)

    Details are available in the Australian Immunisation Handbook.

    Q:Can Bexsero be co-administered with other vaccines and in the same limb as other vaccinations?

    A: Yes, Bexsero can be safely administered with other NIP vaccines. Both Bexsero and Prevenar 13 vaccines cause a higher frequency of injection site reaction, so avoid giving these two vaccines in the same limb. Ensure a 2.5 cm distance between any co-administered vaccines on the same limb. For age 12 months, the upper limb is preferred to the lower limb for administration of Bexsero or Prevenar 13. The site option will depend on the child’s deltoid muscle mass. Refer to the Administration of vaccines section in the Australian Immunisation Handbook. 

    Q: Is Bexsero licenced and can it be given at 6 weeks of age at the same time as other vaccinations?

    A: Yes, Bexsero is licenced, and it can be safely given at 6 weeks of age and can be safely administered with other NIP vaccines. Refer to question above regarding site administration. 

    Q: Are Aboriginal and Torres Strait Islander children aged over 2 years eligible for free catch-up for Bexsero? 

    A: No, the first dose must commence <2 years of age and the recommended number of doses can be given.

    Q: If a child has their first dose of Bexsero at 23 months is the second dose still funded?

    A: Yes, if the child is Aboriginal or Torres Strait Islander or meets the at-risk conditions. 

    Q: Is the provider to give paracetamol on presentation before administering Bexsero for all eligible children under 2 years?

    A: The Australian Immunisation Handbook recommends that children <2 years of age have an increased risk of fever if Bexsero is co-administered with other routine vaccines, compared with when these vaccines are given separately. However, this is not a contraindication to co-administration of Bexsero with other vaccines. Children <2 years of age are recommended to receive prophylactic paracetamol if they are receiving Bexsero. Children <2 years of age can receive Bexsero separately from other routine infant vaccines, with a minimum interval of 3 days, to minimise the risk of fever. Prophylactic paracetamol should still be used. The recommendation for prophylactic paracetamol has also be advised in the ATAGI clinical advice on the changes to recommendations for the use and funding of meningococcal vaccines from 1 July 2020. Given that each state and territory has their own legislation and provides their own authority for vaccine providers in accordance with the Medicines, Poison’s and Therapeutic Goods Act 2008, providers will need to contact their own state health department for further information regarding this.

    Q: Is meningococcal B (MenB) vaccine indicated in individuals who are on immunosuppressive drugs, for example, methotrexate and azithromycin?

    A: While any person who wants to protect themselves against invasive meningococcal disease is recommended to receive MenACWY and MenB vaccines, the Australian Immunisation handbook only strongly recommends these vaccines for people with specified risks. The specified medical conditions for which these vaccines are strongly recommended are inherited defects or deficiency of properdin or complement components, receiving treatment with eculizumab, functional or anatomical asplenia, HIV infection and haematopoietic stem cell transplant.

    Refer to ATAGI clinical advice on vaccination recommendations for people with risk conditions from 1 July 2020

    Those on immunosuppressive drugs without any of these conditions are not specifically strongly recommended to receive MenACWY or MenB vaccine.

    Q: Are any children aged over 2 years funded for a catch up for Bexsero? 

    A: Bexsero is funded for people of all ages from 6 weeks with a specified medical condition that put them at an increased risk of invasive meningococcal disease. These specified medical conditions consist of inherited defects or deficiency of properdin or complement components, receiving treatment with eculizumab, and functional or anatomical asplenia. Individuals with other conditions with increased risk of invasive meningococcal disease or those without any at-risk medical conditions are not funded for Bexsero.

    Q: Are all people at increased risk of invasive meningococcal disease funded for Bexsero or just Aboriginal and Torres Strait Islander persons?

    A: MenB and MenACWY vaccines will be NIP-funded for all people (from 6 weeks of age) with the following specific health conditions: functional or anatomical asplenia; defects in, or deficiency of, complement components; current or future treatment with eculizumab (monoclonal anti-complement antibody).

  • Questions about other related topics

    Q: What is the recommendation for giving hepatitis A vaccine for Children in SA turning 18 months after July 1 2020? Should it be at 4 years and what about children turning 4 years next month who have completed 2 doses of Hep A?

    A: Children turning 18 months after 1 July 2020 who have received a previous dose of Hepatitis A vaccine should receive the second dose at 4 years of age. If no previous doses of Hepatitis A vaccine have been received, then the child should receive dose 1 of hepatitis A vaccine at 18 months and dose 2 at 4 years of age. If a child has received 2 previous doses of hepatitis A vaccine no more doses are required. (Minimum interval between the two hepatitis A doses is 6 months.)

    Q: When will the new schedules be available and when will practices receive hard copies?

    A: The National Immunisation Program schedules are now available online: 

    National Immunisation Program schedule for all non-Indigenous people

    National Immunisation Program schedule for all Aboriginal and Torres Strait Islander people 

    The Commonwealth Chief Medical Officer has written to all GPs and Aboriginal Medical Services providing resources to assist vaccination providers in the implementation of the 1 July 2020 scheduled changes.  The resources, including clinical fact sheets, new schedule cards, and consumer resources for meningococcal B are available on the Department of Health’s website here.  In addition, the program changes have been communicated to all peak groups, speciality organisations and societies who might be interested in the changes, as well as Primary Health Networks.

    States and territories have also communicated about the changes by reaching out to local groups in their individual jurisdiction.

    State and territory schedules are available on the state and territory websites.

    Q: Is there a catch-up calculator available as an app?

    A: The National Immunisation Catch up calculator is now available via the online Australian Immunisation Handbook website. 

    There is no feature available at the present time to perform immunisation schedule catch-up calculations via a mobile app. This is a feature the project team is reviewing in the upcoming Financial Year.

    In the meantime, the inaugural National Immunisation Catch-up Calculator (NICC V1.0) is now available from the official Australian Immunisation Handbook.

    You will be able to use the NICC V1.0 for immunisation schedule catch-up calculations for children up to the age of 10 years.

    While you will need an internet connection to use this calculator, you can use from a mobile phone, tablet or PC.

    Q: Has the Australian Immunisation Handbook been updated to reflect these new recommendations?

    A: Yes, the Handbook has been updated and the changes are detailed in the ‘What’s new’ section of each relevant disease. 

    Q: Can you give more than 2 vaccines in a deltoid area where it may be difficult to create adequate space?

    A: Infants aged <12 months

    The vastus lateralis muscle in the anterolateral thigh is the recommended site for intramuscular vaccination in infants <12 months of age. This is because it is a large muscle and is free of neurovascular structures that could be harmed by vaccine administration. The ventrogluteal area is an alternative site for intramuscular vaccination of infants. Immunisation providers who choose to use this site must be familiar with the landmarks used to identify it. Further information available in the Administration section of the Australian Immunisation Handbook.

    Children aged ≥12 months

    The deltoid muscle is the recommended site for intramuscular vaccination in children ≥12 months of age. Ensure a 2.5 cm distance between any co-administered vaccines on the same limb. The site option will depend on the child’s deltoid muscle mass and the reactogenicity of the vaccine being administered. The ventrogluteal area is an alternative site for intramuscular vaccination of children ≥12 months of age. Immunisation providers should be familiar with the landmarks used to identify this site. The vastus lateralis in the anterolateral thigh may also be used in children ≥12 months of age. Further information available in the Administration section of the Australian Immunisation Handbook. 

    Q: What are the recommended vaccination sites for multiple injections, especially at 12 months and what are the recommended vaccination sites for the 12 months immunisations?

    A: All NIP vaccines scheduled for age 12 months can be co-administered at the 12 months visit, especially if the provider is unsure that the parents/carers will return with the child for a follow-up visit. Alternatively, children <2 years of age can receive Bexsero separately from other routine infant vaccines, with a minimum interval of 3 days, to minimise the risk of fever. Prophylactic paracetamol should still be used. Refer to Contraindications and precautions section of the Meningococcal disease chapter in the Handbook. In this case, give other routinely recommended vaccines first. 

    Both Bexsero and Prevenar 13 vaccines cause a higher frequency of injection site reaction so avoid giving these two vaccines in the same limb. Ensure a 2.5 cm distance between any co-administered vaccines on the same limb. For age 12 months, the upper limb is preferred to the lower limb for administration of Bexsero or Prevenar 13. The site option will depend on the child’s deltoid muscle mass. Refer to the Administration of vaccines section in the Australian Immunisation Handbook.

    Q: Are refugees or asylum seekers eligible for funding for additional vaccines such as Bexsero?

    A: Vaccination is a priority for all migrants, refugees and people seeking asylum after arriving in Australia. All age groups should receive catch-up vaccination.

    Only individuals eligible for Medicare are able to access vaccines at no cost through the National Immunisation Program (NIP). GPs and health centres should sight patient’s Medicare cards ahead of providing NIP funded vaccines, including Bexsero. Meningococcal B is funded under the NIP for people of all ages with specified medical risk conditions that increase their risk of IMD.

    Q: Is the meningococcal B vaccine included under the Australian Government’s ‘No Jab, No Pay’ immunisation requirements policy? 

    A: No Jab No Play (entry to childcare) is managed by individual states and territories; however, there has been no indication the additional vaccines will be required for entry. 

    The meningococcal B vaccine is not assessed as part of the eligibility requirements for family assistance payments under the Australian Government’s No Jab, No Pay policy.  

    The vaccines required as part of the “No Jab, No Pay’ policy are dependent on the age and vaccination status of the individual. Further information is available on the Department of Health fact sheet.

    Q: Is multiple sclerosis classified as at risk?

    A: Multiple sclerosis is not one of the specific conditions with demonstrated evidence of increased risk of meningococcal or pneumococcal disease for which additional vaccines are recommended. However, those who are receiving immunosuppressive treatment for this condition are recommended to receive influenza and pneumococcal vaccines, as per the Australian Immunisation Handbook.

    Multiple questions/comments regarding equitable access and use of prophylactic paracetamol

    Q: We have a high ATSI population who will be commencing the Bexsero additions on their schedule as at July 1. As an S2 drug, we understand that paracetamol may be administered by VSP's as a one off dose prophylactically. Many families will not be reliable to purchase paracetamol for the further does required, and our VSP's are restricted in 'supplying' this drug.  I understand that this situation would be unchanged if added to our DTP, as it remains a 'supply' issue. Do you have any advice in this circumstance, especially if the VSP's are able to cover the expense and 'supply' the future doses?

    Q: I have a query about Bexsero coming on to the NIP schedule. A lot of our service providers are nurse only clinics in areas with a high Indigenous population. We are concerned that some of our clients will not have paracetamol at home or even be able to afford it. Our community health clinics are nurse only clinics and they do not store or administer paracetamol. There are not doctors to prescribe paracetamol if it hasn't been given by the parent or carer. I'd like to know what is the advice about giving Bexsero immunisation if the client has not received paracetamol prior or post vaccination? We are currently looking at producing a standing order for paracetamol prior to administering the vaccination if it hasn't been given at home - but we are unsure what to recommend or do post vaccination.

    Q: Will providers be responsible for administering paracetamol if parents don’t? Many of the vaccination encounters are opportunistic so there is no advanced appointment where parents can be told about the recommendation to give paracetamol, and some families may not have paracetamol.

    Q: Will the onus be on the provider to give paracetamol on presentation before administering Bexsero for ATSI children aged <2 years?

    Summarised Q: Who is responsible for administering paracetamol prior to administering Bexsero (providers, parents/carers)? A lot of service providers who look after indigenous populations are nurse only clinics and as it is an S2 drug, there are restrictions with its supply. What if patients cannot provide the drug or cover its expense? What is the advice for giving Bexsero if the patient has not received paracetamol prior or post vaccination?

    A: Providers will need to discuss this issue with their local Public Health Units and/or state and territory health Departments.

  • Questions about policy and eligibility decisions 

    Q: At-risk – do you include other islanders such as Samoans?  

    A: People from other islands, such as Samoa, are not considered to be Aboriginal and Torres Strait Islanders.
    Only individuals eligible for Medicare are able to access vaccines at no cost through the National Immunisation Program (NIP). 

    Q: Has there been any discussion about funding for refugee and asylum seekers - another high-risk groups?

    A: Vaccination is a priority for all migrants, refugees and people seeking asylum after arriving in Australia. All age groups should receive catch-up vaccination. Refer to the Australian Immunisation Handbook.

    Only individuals eligible for Medicare are able to access vaccines at no cost through the NIP. 
    GPs and health centres should sight patient’s Medicare cards ahead of providing NIP-funded vaccines, including Bexsero.

    Meningococcal B will be funded under the NIP for people of all ages with specified medical risk conditions that increase their risk of IMD.

    Q: Have they taken into consideration the amount of non-Indigenous parents who have paid for coverage of MenB?

    A: The PBAC did not recommend listing for a broader population of infants or for adolescents due to the remaining uncertainties regarding the magnitude of clinical effectiveness of 4CMenB, and the lack of any herd protective effects, which inform the cost effectiveness. Details of the decision can be found at www.pbs.gov.au, using the search term ‘PBAC meetings’.

    Q: If an Aboriginal or Torres Strait Islander person declines additional vaccines (but still has standard vaccines) will their childcare or Centrelink status be affected?

    A: No, the additional vaccines implemented under the NIP on 1 July 2020 for special risk groups will not affect Centrelink payments. 

    Q: Multiple questions regarding whether and/or when NIP-funded doses of either Bexsero or pneumococcal vaccines will be available for other high-risk age or population groups or with certain medical risk conditions recommended but not funded with the change in July. The recurring ones are regarding:

    • non-Indigenous infants for Bexsero
    • children age ≥2 years for Bexsero
    • diabetes for pneumococcal vaccines
    • other common chronic conditions for pneumococcal vaccines

    A: No further changes to NIP-funded vaccine for meningococcal or pneumococcal disease are being considered at this time.

    Further information regarding these changes, including a range of resources to support providers, can be found on the Department of Health website

  • Questions about reporting to AIR and program operation

    Q: AIR at present does not recognise the extra vaccines for Aboriginal clients - having to enter the extra vaccines under "other". Will AIR recognise the change in scheduled doses due post July this year?

    A: While all vaccines (with the exception of Q fever) can be recorded on AIR, no changes will be made to the AIR site age schedule boxes at this stage. 

    As the vaccines implemented under the NIP on 1 July 2020 are for special risk groups, AIR does not have due and overdue rules for them. Vaccination providers will need to continue to select the drop down of “Other” on the AIR site Record Encounter screen to record the vaccines.

    Q: Do you think providing financial incentive can improve notification. We used to get $18 per notification in the past.

    A: Reporting to AIR is more important than ever to ensure people don’t receive unnecessary repeat vaccinations, to monitor the effectiveness of vaccines and vaccination programs, to inform immunisation policy and research and to monitor vaccination coverage across Australia. The majority of health professionals understand the importance of having a complete and accurate immunisation register and use software that automatically submits the immunisation details to AIR. The payment of $18 was made many years ago to assist health professionals move from paper to electronic reporting.

    Q: As a new nurse immuniser, does it have to be a medical practitioner who decides a patient at risk from the at risk medical risk list or can the nurse immuniser decide and be funded?

    A: Nurse immunisers must practice within their scope of practice and within the legal requirements. Further advice should be sought from their state and territory health departments’ areas they are employed within. Further information is available on the Department of Health website

    Q: Any work towards unifying state-based schedules, since we have a more mobile population (until COVID)?

    A: There is a national schedule and in some states and territories, where there is a greater risk of particular vaccine preventable diseases, additional vaccines are required.

    Q: When and how can we order Prevenar-13 for aged care residents/consumers? Same as for Pneumovax? By fax?

    A: Ordering processes for NIP vaccines remain the same. Please contact the Jurisdictional Immunisation Coordinator in your state or territory.

    Q: We are unable to order Pneumovax 23 from the government funded supplier due to lack of stock. Will this change any time soon?

    A: One of the two pneumococcal vaccines supplied in Australia, Pneumovax 23, is currently listed as being in shortage on the Therapeutic Goods Administration (TGA) website - click on ‘medicine shortages’ on the right side of the homepage and search for ‘pneumovax’ under ‘all shortages’. 

    The sponsor of Pneumovax 23, Merck Sharp & Dohme (Australia) Pty Ltd has advised the Department of Health that the anticipated return to stock date is 28 August 2020. 

    This shortage affects the private market only. There is no current impact to supply for the National Immunisation Program (NIP), and any patients who meet NIP eligibility criteria should still be able to access it.

    Adults aged <65 years who are not medically at risk should speak with their doctor or immunisation provider for further information about the vaccine and its associated costs.

    Q: When will practices receive paperwork- updated schedules etc?

    Q: When will the new NIP landscape/portrait documents be released?

    A: The resources, including clinical fact sheets, new schedule cards and consumer resources for meningococcal B are available on the Department of Health website. In addition, the program changes have been communicated to all peak groups, speciality organisations and societies who might be interested in the changes, as well as Primary Health Networks. States and territories have also communicated about the changes by reaching out to local groups in their individual jurisdiction.

Speakers:

Dr Clayton ChiuDr Clayton Chiu 
Associate Director, Immunisation Policy Support and Guideline Development, NCIRS, Public Health Physician

Clayton Chiu is a public health physician, trained in adult internal medicine and public health. He is also a conjoint lecturer of The Children’s Hospital at Westmead Clinical School, The University of Sydney. His main interests are in the epidemiology and control of communicable diseases; immunisation for prevention and control of vaccine preventable diseases; and knowledge translation to support development of population vaccination policies. Dr Chiu leads the Research to inform policy program at NCIRS providing scientific research support to the Immunisation Branch of the Australian Government Department of Health and ATAGI, particularly for the development and implementation of national immunisation policies.

Associate Professor Christopher BlythAssociate Professor Christopher Blyth 
Co-Director, Wesfarmers Centre of Vaccines and Infectious Diseases, Paediatric Infectious Diseases Physician and Clinical Microbiologist
Dr Chris Blyth is a clinical academic and NHMRC Emerging Leadership Fellow. He is Associate Professor of Paediatrics, University of Western Australia and Co-director of Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute. He leads the Department of Paediatric Infectious Diseases at Perth Children's Hospital. The majority of his research is in influenza, vaccine-preventable respiratory tract infection, pneumonia and vaccine safety. 

Dr Blyth was appointed as a sitting member of the Australian Technical Advisory Group on Immunisation (ATAGI) in 2012, Australia’s peak immunisation advisory group to Government, assuming the role of deputy chair in 2014 and co-chair in 2018. He is part of the Expert Leadership Group of AusVaxSafety, the Scientific Steering Committee of the Human Vaccines Program and was recently appointed as an Associate Member of the Australian Academy of Health and Medical Science.