The Australian Immunisation Handbook (Handbook) is the national clinical guideline advising health professionals on the safest and most effective use of vaccines. The Australian Technical and Advisory Group on Immunisation (ATAGI) develops all clinical advice and recommendations in the Handbook, which is endorsed by the National Health and Medical Research Council (NHMRC).

NCIRS plays a major role in, and leads the development of, the Handbook: 

  • We monitor and review changes in the immunisation landscape, from vaccine registrations to new scientific evidence, which are relevant to formulating and updating recommendations in the Handbook.

  • We synthesise, interpret and translate the best available scientific evidence to help develop evidence-based clinical recommendations on the use of vaccines in the Handbook. This includes undertaking literature searches, critical appraisal of literature and preparation of evidence summaries. 

  • We review and update all Handbook chapters in collaboration with the lead ATAGI member responsible for the chapter, together with external experts as required.

  • We develop a number of NCIRS resources for immunisation providers that support their understanding of the content, especially recommendations, of the Handbook.

Introducing GRADE to develop Australian Immunisation Handbook recommendations 

The Australian Technical Advisory Group on Immunisation (ATAGI) is moving towards the use of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach for developing Australian Immunisation Handbook recommendations on clinical use of vaccines in Australia. This aligns with the recommendation of the National Health and Medical Research Council (NHMRC) of Australia for the development of its guidelines.

The GRADE approach was developed by the GRADE Working Group. It offers a framework for rating the quality of the available evidence in a systematic review, and developing and grading the strength of healthcare recommendations in guidelines.1 It has since been widely recommended by international guideline development bodies such as the World Health Organization (WHO). The WHO Strategic Advisory Group of Experts (SAGE) on Immunization and the Advisory Committee on Immunization Practices (ACIP) of the USA have used GRADE for developing some of their recommendations on use of vaccines. 

The following tables have been prepared using the GRADE evidence review and decision-making process. The summary of findings (SoF) table details the key findings and an assessment of the certainty of evidence obtained following a systematic review on a particular comparison for each of the critical or important outcomes that were considered. These tables have been prepared by NCIRS and reviewed by ATAGI. The evidence to decision (EtD) table shows the decisions of ATAGI in developing the recommendations according to the GRADE approach to decision-making.

Note: The GRADE approach has been adopted by ATAGI for the development of new or updated recommendations for the Australian Immunisation Handbook from July 2020. The comparison of adjuvanted influenza vaccine with standard influenza vaccine in people aged ≥65 years was selected as the topic for piloting the use of GRADE as it was considered of immediate relevance to current immunisation practice. This page will be continuously updated as more recommendations are developed/updated through the GRADE approach.

1. Guyatt G, Oxman AD, Akl EA, et al. GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables. Journal of clinical epidemiology 2011;64:383-94.

GRADE assessment tables

Influenza vaccines



Last updated March 2021