From July 1 2018 the National Immunisation Program (NIP) will change with the addition of Nimenrix® vaccine (meningococcal ACWY) to be given at 12-months of age. There will also be a shift in the time points for conjugate pneumococcal vaccine (Prevenar 13®) dose 3 and haemophilus influenzae type b (ActHIB®) dose 4. Below are a selection of frequently asked questions (FAQ’s) adapted from the Q and A segment of our recent Clinical Vaccinology Update, regarding the schedule changes. For further information about the new schedule please refer to the presentations located on our Event page.

Meningococcal disease and vaccines

1. What would be the catch-up period for those who have turned 12-months before July 1 2018 and received their 12-month vaccines?

There is no catch-up for meningococcal ACWY. If a person has previously had a meningococcal C containing vaccine at/over 12-months of age and wishes to have a meningococcal ACWY vaccine they will need to purchase the vaccine privately. meningococcal C containing vaccines should be separated by a minimum of 8 weeks.

2. If a child has previously received a meningococcal ACWY at less than 12-months of age (purchased privately) are they required to have another dose at 12-months of age and at what interval?

A dose of meningococcal ACWY in the second year of life is clinically recommended and required as per the Australian Immunisation Register (AIR) for those who are born after July 1 2017. This 12-month dose would be funded on the NIP (Nimenrix®) and should be separated from previous meningococcal ACWY doses by a minimum of 8 weeks.
MVEC: Meningococcal disease and vaccines

3. For those who have previously received NeisVacC® or Menitorix® what is the recommended interval before they can receive meningococcal ACWY?

The recommended interval between doses would be 8 weeks. Those who have previously received a meningococcal C vaccine from 12-months of age or as part of funded catch-up are not eligible for a free meningococcal ACWY and would be required to purchase it privately.

4. When did conjugate meningococcal ACWY vaccines become available in Australia?

Menactra® was registered in Australia in 2011, Menveo® in 2012, and Nimenrix® in 2013.

5. Are booster doses of meningococcal ACWY recommended?

There is currently no recommendation for additional/booster doses of meningococcal ACWY except in those medically at-risk individuals (e.g asplenia/hyposplenia, complement deficiency, Eculizumab therapy). Note there is currently a state based program for meningococcal ACWY @ 15-16 years of age (Menactra®), which will provide a booster dose in adolescence, another high risk period for invasive meningococcal disease (IMD).
MVEC: Asplenia

6. Can Nimenrix be given earlier than 12-months of age?

Yes, Nimenrix® can be given from 6 weeks of age. The number of doses required to complete a meningococcal ACWY vaccine course varies depending on the age in which the course is commenced. Doses given prior to 12-months of age will be at a private cost. If any doses are given prior to 12-months of age, a booster dose after 12-months of age (in the second year of life) is recommended ensuring an 8 week interval from the previous dose. A dose of meningococcal ACWY is clinically indicated and funded in the second year of life. For further information regarding meningococcal vaccine schedules please refer to the following link:
MVEC: Meningococcal disease and vaccines

7. What do we do for children who have already received a full course of meningococcal ACWY prior to 12-months of age?

Administration of any meningococcal ACWY prior to 12-months of age still requires a booster dose at ≥ 12-months of age to complete the course and therefore this can be given as the NIP funded Nimenrix® dose. Always ensure that the booster dose is given a minimum of 8 weeks since the previous dose. For further information regarding meningococcal vaccine schedules please refer to the following link:
MVEC: Meningococcal disease and vaccines

8. If a child has started a course of meningococcal ACWY with Menveo® prior to 12 months of age (purchased privately) can they switch brands to Nimenrix® to complete the course?

Completing the course with the same vaccine brand is preferred however in certain scenarios the use of alternate brands may be more practical. The NIP funded Nimenrix® may be used as the 12-month booster dose for those who have commenced a meningococcal ACWY course < 12-months of age with a different brand (Menveo® or Menactra®).

9. Up to what age can Nimenrix® be used?

Nimenrix® is registered for use up to the age of 55 years.

10. Why Nimenrix® at 12-months of age and not Menveo® or Menactra®?

Only 1 dose of Nimenrix® is required for meningococcal ACWY protection when commencing the course at ≥ 12-months of age. Menactra® and Menveo® require the administration of 2 doses when the course is commenced at ≥ 12-months -2-years of age. For further information of meningococcal schedule and the different vaccine brands please refer to:
MVEC: Meningococcal disease and vaccines

11. Do you recommend meningococcal ACWY or meningococcal B vaccination for health care workers?

All people wishing to be protected against meningococcal disease may consider immunisation. This can be discussed with their treating health professional and if not eligible for free vaccines on the NIP it can be purchased privately. As per the Australian Immunisation Handbook, meningococcal ACWY and meningococcal B vaccination is clinically recommended for laboratory personnel.

Pneumococcal disease and vaccines

1. Do all 12-month old’s receive a Prevenar 13® even if they’ve previously received 3 doses in their infant schedule?

All children 12-months of age from July 1 2018 will be offered a Prevenar 13®. If a child has previously received 3 doses in their infant schedule they are not required on the AIR to have a 4th dose at 12-months, but to reduce the risk of invasive pneumococcal disease it is clinically recommended and safe to do so. 

2. What is the recommendation for children medically at risk of invasive pneumococcal disease (IPD)?

Children who are currently recommended to receive 4 doses, including Aboriginal and Torres Strait Islander children living in QLD, NT, WA and SA or children at increased risk of invasive pneumococcal disease (IPD) will continue to receive a total of 4 doses of Prevenar 13® at 2, 4, 6 and 12-months of age. For details of those at higher risk of IPD see the Australian Immunisation Handbook.

Haemophilus influenzae type b (hib) disease and vaccines

1. If a child presents for 12-month vaccines late should they follow the new schedule? Will they be overdue for hib dose 4 on AIR?

All children presenting for 12-month vaccines from July 1 2018 should receive Nimenrix®. All those born before July 1 2017 will be due on AIR for hib dose 4 at 12-months of age. This will be given as ActHIB®. If any child, regardless of their date of birth has not received hib dose 4 by the time they turn 19-months of age, they will then become overdue on AIR.

General questions

1. Are new vaccines funded for children who do not have Medicare cards?

All people under 20 years of age are eligible for free routine and catch-up vaccines. This includes non-Medicare card holders. For further information regarding eligibility for free vaccines please refer to the following link:
DHHS: Eligibility criteria for free vaccines

2. Is it still advisable to recommend a 2nd booster dose of varicella?

Receipt of 2 doses of varicella-containing vaccine provides increased protection and minimises the chance of breakthrough varicella in children < 14 years of age. This may be given on the same day as other live vaccines or at a minimum interval of 4 weeks. The funded varicella vaccine is given as MMRV at 18-months of age and any additional dose of varicella-containing vaccine would be at private cost.

3. Will influenza vaccine for children aged 6-months – less than 5-years of age continue to be provided for free in the future?

Influenza vaccine is strongly recommended for all those wishing to be protected against influenza disease. At this stage there is no decision as to whether funding will continue in 2019, noting that it is currently state funded, and not on the NIP.
MVEC: Free influenza vaccine in 2018 for children aged 6 months to less than 5 years

4. What if I have a child requiring dose 4 hepatitis B (e.g. low birth weight, prematurity) – can I give them an Infanrix hexa® at 18-months?

Infants born at < 32 weeks gestation and/or < 2000g require a 4th dose of hepatitis B vaccine at 12 months of age. If this dose is inadvertently missed it could be administered with the 18-month scheduled vaccines as part of an Infanrix hexa® (DTPa-polio-hib-hepatitis B). In general, the use of the combination vaccine(s) is acceptable, even if this means the number of doses of another antigen exceeds the required number. In this scenario an extra polio antigen would be administered as part of the Infanrix hexa®. However by doing this, the number of injections for the child is reduced. In this case the child would just be given Infanrix hexa® and Priorix tetra®/ProQuad® at 18-months. ActHIB® and Infanrix®/Tripacel® do not need to be given since these antigens are present in Infanrix hexa® .
MVEC: Preterm infant immunisation

5. What if parents insist on a maximum of 2 vaccines at a time?

There is no clinical indication to delay vaccines. If a family wishes to alter or delay the schedule they should discuss this with their healthcare professional.

6. For multiple injections at 12 and 18-months of age, what are the recommended injection sites?

For children aged ≥ 12-months of age the deltoid is the preferred site for IM injection. The anterolateral thigh may also be used in children ≥ 12-months of age. Clinical judgement is recommended when assessing appropriate sites and utilising the least reactogenic vaccine if using the anterolateral thigh. Documentation of injection sites must be recorded in the child health book or record card. Please refer to the following resource from the Department of Health for further information:
DHHS: Where should I inject vaccines?- poster
MVEC: Administration of injected vaccines- correct technique

7. What if children requiring 2 doses cannot access a second dose of Influenza vaccine? Are they protected?

Children less than 9 years of age are recommended to receive 2 doses of influenza vaccine in their first year of being immunised. We would strongly encourage families to source the vaccine from alternate providers if possible. A single dose of influenza vaccine in this patient group will still provide some protection.

8. What is the earliest age AIR will accept 12-month vaccines as valid doses?

Vaccine brand Dose given <11-months Dose given ≥11-months – <12-months Best practice recommendation
Priorix®/MMR II® 

Not accepted by AIR as a valid dose.

 

Accepted by AIR as a valid dose.

There is some evidence suggesting that a dose provided at ≥11 months (but prior to 12 months) of age is sufficiently immunogenic, especially in infants born to mothers with measles antibodies due to vaccination as opposed to natural infection. As such, doses given in this timeframe may not need repeating.

Nimenrix®

Not accepted by AIR as a valid dose.º

 

Accepted by AIR as a valid dose. *Please refer to best practice recommendation Children should receive a dose of meningococcal ACWY vaccine at 12 months of age, even if they have received doses earlier in infancy. A minimum interval of 8 weeks is required between meningococcal ACWY doses. A dose of meningococcal ACWY in the second year of life (≥12-months of age) is preferred and clinically recommended to ensure optimal protection against disease.  There is some evidence to suggest that a dose given at ≥11-months but <12-months may be sufficiently immunogenic and therefore a repeat dose is not required when given in this timeframe for the purposes of being up to date on the AIR.
Prevenar 13® Transition period from July 1 2018. Accepted by AIR as a valid dose 3. A dose of Prevenar 13® in the second year of life (≥12-months of age) is clinically recommended to reduce the disease prevalence in this age group. Children born between July 1 2017 and December 31 2017 may safely receive a total of 4 doses (2, 4, 6 and 12-months of age) during the transition to the new NIP from July 1 2018.

º Doses of meningococcal ACWY purchased privately and given in infancy still require a booster dose at ≥12-months of age with a minimum interval of 8 weeks [MVEC: Meningococcal disease and vaccines]

9. Can 12-month vaccines be given early in the case of travel?

Patients travelling should seek specialist travel advice regarding immunisation requirements that are specific for their travel destination. In regards to the 12-month vaccines please refer to the above table outlining the earliest age the AIR will accept the 12-month vaccines as a valid dose noting best practice recommendations. 

10. Will there be new “yellow stickers” for children at increased risk (e.g. preterm infants < 32 weeks; < 2000 grams)?

New updated orange stickers will be available to order online from mid-July.
DHHS: Immunisation resources order form

11. Will meningococcal B be funded anytime soon?

Funding a vaccine on the NIP undergoes a complex process of approval via the Pharmaceutical Benefits Advisory Committee (PBAC). The Australian Technical Advisory Group on Immunisation (ATAGI) reviews where a vaccine may be considered on the NIP schedule, but a positive PBAC recommendation is required before an NIP decision can be made at a Commonwealth level. States can make vaccine policy decisions separately for their jurisdiction (e.g. Current Adolescent meningococcal ACWY vaccine program). At this stage none of the meningococcal B vaccines (Bexsero® nor Trumenba®) have PBAC approval, so at this stage are not on the NIP schedule but can be purchased privately.

12. How will the NIP changes affect payments?

Children are still required to be up to date with their immunisations as per the AIR for the purposes of child care subsidies and family assistance payments.
All children, despite their date of birth, are required to receive a 4th dose of hib prior to turning 19-months of age.
All children born before July 1 2017 are not required to have a Prevenar 13® as a 4th dose at 12-months of age to be considered up to date on AIR. However, a dose in the second year of life is clinically recommended and will be funded as a 4th dose during this transition period.

13. Will there be schedule change flyers and information sheets?

There are various online and written resources available outlining the changes to the schedule. Please refer to the links below:

DHHS: Childhood national immunisation schedule changes 2018 – fact sheet
Australian Government Department of Health: Resources
DHHS: NIP schedule changes 1 July 2018
DHHS: Where should I inject vaccines? – poster

14. Is there any safety concern surrounding the co-administration of ActHIB® and Infanrix®/Tripacel® (DTPa) at 18-months of age, given that ActHIB® is conjugated to a tetanus toxoid?

ActHIB® contains hib capsular polysaccharide conjugated with a tetanus toxoid carrier protein. There is no safety concern with administering ActHIB® and DTPa-containing vaccines on the same day. Co-administration would not be considered a “double dose” of tetanus vaccination. Under no circumstances should the tetanus carrier protein component of ActHIB® be substituted for the routine tetanus vaccination.
NCIRS fact sheet: haemophilus influenzae type B

Catch-up scenarios

1. Why is there no catch-up program with meningococcal ACWY or Prevenar 13® for children aged up to 4 years?

There is no funded catch-up program in place for meningococcal ACWY for those who have previously received meningococcal C vaccine at ≥ 12-months of age. Anyone wishing to receive meningococcal ACWY protection and does not meet the NIP requirements may purchase the vaccine privately.

It is clinically recommended that all children receive a dose of Prevenar 13® at 12-months of age even if they have received 3 doses previously in their infant schedule. Parents should be reassured that this is safe. For this small cohort, the 12-month vaccine will be funded, but is not required to be considered fully immunised for the purposes of child care subsidies and family assistance payments.

2. In catch up scenarios do we use Nimenrix® or NeisVacC®?

Nimenrix® is the preferred vaccine for meningococcal catch-up immunisation to ensure protection for the individual against A, W and Y strains of meningococcal disease.

3. Can a 5-year-old presenting for catch-up vaccines receive meningococal ACWY for the overdue meningococcal C?

Yes. Nimenrix® is the vaccine available for meningococcal C catch up (excluding those aged 15-16 years who will receive Menactra® as part of the school based program).

4. If a child presents at 14-months for the 12-month vaccines after July 1 2018, what schedule should they receive?

This child is due for 12-month immunisations- Priorix®/MMR II®, Nimenrix®, Prevenar 13® and ActHIB®. 

This will be the 4th dose of Prevenar 13® and while there is no requirement for a 4th dose on AIR it is clinically recommended and safe. Payments will not be affected if families choose not to have this dose.
Nimenrix® is recommended in this scenario as it has replaced Menitorix®.

This child will appear due for hib dose 4 at 12-months of age, however AIR will not recognise them as overdue until they turn 19-months of age. Payments will not be affected until a child is overdue.

5. When a child (dob- 30/05/2017) presents for their 18-month vaccines after July 1 2018, what should they be given?

This child is due Priorix tetra®/Proquad® and Infanrix®/Tripacel®.

This child does not require a dose of ActHIB® as they already received a 4th dose at 12-months of age.

6. A 10-month old child presents for catch-up and has only ever had 6-week immunisations. What is their recommended catch up schedule when they present on July 1 2018?

This catch up plan will require multiple visits. Please refer to the resources below for further information.

Visit One
Infanrix hexa®
Prevenar 13®

Visit Two (8 weeks after visit one AND ≥ 12-months of age)
Infanrix hexa®
Nimenrix®
Priorix®/MMR II®
Prevenar 13®

Visit Three (at 18-months of age)
Infanrix®/Tripacel®
Priorix tetra®/Proquad®
ActHIB®

MVEC: Catch-up immunisations
Australian Immunisation Handbook: Hib catch-up table < 5-years
Australian Immunisation Handbook: Pneumococcal catch-up table < 5-years for those who do not have a condition associated with increased risk of IPD
Australian Immunisation Handbook: Pneumococcal catch-up table < 5-years for those who have a condition associated with increased risk of IPD

7. My 8-month old patient has missed their 6-month immunisations- what are they due now?

This patient is due Infanrix hexa® only. As per the AIR they will be due for their third Prevenar 13® at 12-months of age as per the new schedule. If a third dose is inadvertently given now as part of catch-up, the patient should still be offered another dose at 12-months of age. This fourth dose would be funded. It is clinically recommended that children receive a dose of Prevenar 13® in the second year of life (< 12-months of age).

Reviewed by: Georgie Lewis (Clinical Manager, SAEFVIC, Murdoch Children’s Research Institute), Nigel Crawford (Director, SAEFVIC, Murdoch Children’s Research Institute),Mel Addison (SAEFVIC Research Nurse, Murdoch Children’s Research Institute), Rachael McGuire (SAEFVIC Research Nurse, Murdoch Children’s Research Institute), Rosemary Morey (Immunisation Section, Department of Health and Human Services) and Michelle Wills (Immunisation Section, Department of Health and Human Services)

Date: September 2018

Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.

You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.