The Australian Immunisation Handbook 10th Edition

09 April 2018

Page last updated: 01 August 2017

April 2018

Updates to the 10th edition of The Australian Immunisation Handbook

Advice included in the 10th edition of The Australian Immunisation Handbook has been updated since this edition was first published in 2013. A list of updates is provided below by the date they were published. These updates have been made in response to specific issues requiring amendment; amended chapters have not been reviewed in their entirety unless specified.

The most up-to-date version of the 10th edition Handbook is the online version. If you have a hard copy of the 10th edition Handbook this list can be printed for easy reference or used to annotate updates in your hard copy.

Key updates made to the 10th edition Handbook in February 2018 are listed below

Chapter 4.6 Human Papillomavirus

4.6.7 Recommendations

The following replaces the existing Recommendations listed in Chapter 4.6 Human Papillomavirus:

  1. All individuals (males and females) who commence vaccination at the age of 9 to 14 years, except immunocompromised individuals (refer to (b) below), should receive two doses of 9vHPV vaccine given 6–12 months apart (0, 6–12 months).
  2. The following population groups should receive three doses of 9vHPV vaccine given at 0, 2 and 6 months:
    1. immunocompromised individuals (males and females) at any age;
    2. males and females who receive their first dose of 9vHPV after turning 15 years of age.

Table 1Comparison of the ATAGI current and proposed recommendations for HPV vaccination

Recommendation
Vaccine
Cohort
Number of doses
Schedule of doses
Previous
2vHPV vaccine (females only)

4vHPV† vaccine
(males and females)
Commencing vaccination
aged 9–18 years
3 doses
0, 1 and 6 months
(2vHPV vaccine)

0, 2 and 6 months
(4vHPV vaccine)
Immunocompromised
aged 9–45 years
Current
9vHPV vaccine
(males and females)
Commencing vaccination
aged 9–14 years
2 doses
0, 6–12 months§
Immunocompromised
aged 9–45 years
3 doses
0, 2 and 6 months
Commencing vaccination
aged ≥15 years

*HPV vaccine may be administered from 9 years of age, however, the optimal time for vaccination is approximately 12–14 years, as provided under the school-based National Immunisation Program (NIP).
Both 2vHPV and 4vHPV vaccines have been registered in Australia. Only 4vHPV vaccine has been provided under the National Immunisation Program (NIP) since HPV vaccination was funded in 2007.
Immunocompromised individuals include those with primary or secondary immunodeficiencies (B lymphocyte antibody and T lymphocyte complete or partial deficiencies), HIV infection, malignancy, organ transplantation, autoimmune disease, or significant immunosuppressive therapy (but does not include asplenia or hypopsplenia).
§If an individual has received two doses of HPV vaccine with an interval of less than 5 months between dose 1 and dose 2, a third dose is required at least 12 weeks after the second dose, ensuring that the minimum intervals for 3 doses have been met. If the second dose is received at <6 months but ≥5 months after the first dose, a third dose is not required, as clinical trial data support this interval still being sufficiently immunogenic.
Minimum intervals recommended for a 3-dose schedule are at least 4 weeks between dose 1 and dose 2 and at least 5 months between dose 1 and dose 3.

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  1. 9vHPV vaccine can be used to complete an HPV vaccination schedule commenced with either the 4vHPV or 2vHPVvaccine.
  2. No catch up is recommended for individuals who have completed a full schedule (either age and interval appropriate 2- or 3- dose schedules) with either 4vHPV or 2vHPV. Refer to evidence following.

Chapter 4.7 Influenza

Updating the text to reflect the 2018 influenza season (Refer to Chapter 4.7 Influenza)

Chapter 4.13 Pneumococcal disease

4.13.7 Recommendations

The following replaces the existing Recommendations for infant pneumococcal vaccination schedule listed in Chapter 4.6 Pneumococcal disease:

  1. All children, except those specified in (b) below, should receive three doses of 13vPCV at 2, 4 and 12 months of age (called ‘2+1’ schedule) instead of the current schedule with doses at 2, 4 and 6 months of age (called ‘3+0’ schedule).
  2. The following population groups at increased risk of pneumococcal infection should continue to receive four doses of 13vPCV at 2, 4, 6 and 12 months^ of age (called ‘3+1’ schedule): 
    1. Aboriginal and Torres Strait Islander children living in the NT, QLD, SA and WA
    2. Children with underlying medical conditions associated with an increased risk of IPD.

^ Note the preferred schedule point for the fourth (last) 13vPCV dose is age 12 months rather than 18 months.

Table 1: Comparison of current and proposed ATAGI recommendations for 13vPCV schedules in children

Cohort
Schedule in previous recommendation*
Schedule in current recommendation
Children without underlying medical conditions associated with increased risk of IPD All children in ACT, NSW, TAS or VIC
3+0

(2, 4 and 6 months)

2+1

(2, 4 and 12 months)

Non-Indigenous children in NT, QLD, SA or WA
Aboriginal and Torres Strait Islander children in NT, QLD, SA or WA
3+1

(2, 4, 6 and 12–18 months)

3+1

(2, 4, 6 and 12 months)

All children with underlying medical conditions associated with increased risk of IPD (Attachment A)
3+1

(2, 4, 6 and 12 months)

3+1

(2, 4, 6 and 12 months)

* Refer to The Australian Immunisation Handbook Chapter 4.13 Pneumococcal disease, section 4.13.7 ‘Recommendations’.

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  1. Schedules for catch-up doses of 13vPCV for children aged <5 years who have not received any pneumococcal conjugate vaccine (PCV) doses or who have only received incomplete courses of PCVs are covered in Tables 2 (for all children with medical condition(s) increasing IPD risk and Aboriginal and Torres Strait Islander children in NT, QLD, SA or WA) and 3 (for all other children).

Table 2: Catch-up schedule for 13vPCV for Aboriginal and Torres Strait Islander children living in NT, QLD, SA or WA ONLY, and all children with any medical condition(s)* associated with an increased risk of invasive pneumococcal disease (IPD), aged <5 years

Number of doses given previously
Age at presentation
Age when previous dose of any PCV was given
Recommendations‡
1st dose
2nd dose
3rd dose
Number of further dose(s) required
No previous doses <12 months
4§
12–59 months
2
1 previous dose <12 months
Any age
3§
12–59 months
<12 months
2§
≥12 months
1
2 previous doses <12 months
Any age
Any age
2§
12–59 months
<12 months
<12 months
2§
≥12 months
1
≥12 months
≥12 months
None
3 previous doses <12 months
Any age
Any age
Any age
1§
12–59 months
<12 months
<12 months
Any age
1
≥12 months
≥12 months
None

* Recommendations for vaccination of haematopoietic stem cell transplant (HSCT) recipients differ: a separate table for revaccination following HSCT in children and adults will be included in upcoming updates to The Australian Immunisation Handbook.
Prior PCV doses may have been given as 7vPCV (e.g. from overseas), 10vPCV or 13vPCV. Use 13vPCV as the vaccine formulation for catch-up doses, regardless of which formulation of PCV the child received previously.
Where possible, align doses with the standard schedule points at 2, 4 and 6 months of age for infants. The minimum interval between dose(s) is 1 month if aged <12 months, and 2 months if aged ≥12 months.
§ The last dose should be given after the child reaches 12 months of age (as a booster dose) with a minimum interval of 2 months after the previous dose of PCV.

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Table 3: Catch-up schedule for 13vPCV for all other children aged <5 years (not covered in Table 2a)

Number of doses given previously
Age at presentation
Age when previous dose of any PCV* was given
Recommendation
1st dose
2nd dose
3rd dose
Number of further dose(s) required
No previous doses <12 months
3
12–59 months
1
1 previous dose <12 months
<12 months
2
12–59 months
<12 months
1
≥12 months
None
2 previous doses <12 months
<12 months
<12 months
1
12–59 months
<12 months
<12 months
1
≥12 months
None
3 previous doses <12 months
<12 months
<12 months
<12 months
1
12–59 months
Any age
Any age
≥12 months
None

* Prior PCV doses may have been given as 7vPCV (e.g. from overseas), 10vPCV or 13vPCV. Use 13vPCV as the vaccine formulation for catch-up doses, regardless of which formulation of PCV the child received previously.
Where possible, align doses with the standard schedule points at 2 months and 4 months of age for infants aged <5 months. The minimum interval between dose(s) is 1 month if aged <12 months, and 2 months if aged ≥12 months.
The last dose should be given after the child reaches 12 months of age (as a booster dose) with a minimum interval of 2 months after the previous dose of 13vPCV.

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