Australian immunisation schedule: NIP, adult vaccines and catch-up

Vaccination is one of the highest-impact preventive interventions in Australian general practice. The National Immunisation Program (NIP) provides funded vaccines across the lifespan, with clinical guidance from the Australian Immunisation Handbook — the authoritative reference updated by the Australian Technical Advisory Group on Immunisation (ATAGI). All vaccinations must be recorded in the Australian Immunisation Register (AIR) — mandatory by law, and essential for Centrelink No Jab, No Pay compliance and childcare/school enrolment requirements. The GP consultation is the most common point of access for both childhood catch-up and adult NIP vaccines.

A. Core clinical — the AU general-practice framework

Key checks before every vaccination

Before any vaccine:

• Check AIR — review vaccination history; identify gaps and catch-up opportunities
• Severe acute illness with fever — defer vaccination until recovery
• Allergies — egg allergy and influenza (most modern flu vaccines are safe in non-anaphylactic egg allergy; anaphylactic egg allergy → immunology review); latex; specific vaccine components
• Pregnancy — avoid live vaccines (MMR, varicella, Zostavax, BCG, oral typhoid); inactivated vaccines are safe
• Immunosuppression — avoid live vaccines in severe immunocompromise (biologics, JAK/TYK2 inhibitors, oral prednisolone ≥20 mg/day for ≥2 weeks, severe HIV); Shingrix (recombinant, non-live) is safe in immunocompromise
• Recent blood product or immunoglobulin — defer live vaccines (MMR, varicella) 3–11 months depending on product
• 15-minute observation post-vaccination — mandatory; adrenaline and ASCIA Action Plan must be on-hand

Childhood NIP schedule (current 2024–2025; verify Handbook)

Age	Vaccines
Birth	Hepatitis B
6 weeks	DTPa-HepB-IPV-Hib (Infanrix Hexa); Prevenar 13/15; Rotavirus (RotaTeq or Rotarix)
4 months	DTPa-HepB-IPV-Hib; Prevenar 13/15; Rotavirus
6 months	DTPa-HepB-IPV-Hib; Prevenar 13/15; Rotavirus (3rd dose if RotaTeq); annual influenza from 6 months
12 months	MMR; MenACWY (Nimenrix); Pneumococcal catch-up
18 months	MMRV; Hib (Act-HIB); DTPa booster
4 years	DTPa-IPV (Quadracel or Infanrix-IPV)
Adolescent (school-based)	HPV Gardasil 9 — single dose since 2023; MenACWY; dTpa (Boostrix)

Always verify the current schedule via the Australian Immunisation Handbook — the NIP is updated regularly.

Adult NIP — funded for eligible groups

• Annual influenza: ≥65, pregnancy (any trimester), chronic disease (cardiac, respiratory, diabetes, renal, hepatic, immunocompromise), residential aged care residents, Aboriginal and Torres Strait Islander people ≥6 months — recommended for all ≥6 months
• COVID-19 boosters: per current ATAGI recommendations
• Shingrix (herpes zoster): ≥65 funded (2-dose, 2–6 months apart); immunocompromised ≥18 funded since November 2023 — do not substitute Zostavax
• RSV (Arexvy or Abrysvo): adults ≥75 funded; 60–74 with risk factors
• Maternal RSV (Abrysvo): 28–36 weeks pregnancy — protects newborn through first months of life
• Prevenar 20: single dose for adults ≥70; earlier for Aboriginal and Torres Strait Islander ≥50; chronic disease or immunocompromise per Handbook
• dTpa: every pregnancy (20–32 weeks); cocoon strategy for household contacts of newborns; adult booster approximately every 10 years
• MMR catch-up: adults born from 1966 not documented as having 2 doses or seronegative — particularly refugees, healthcare workers, internationally trained health professionals
• HPV catch-up: to age 26; extended for MSM, immunocompromised, Aboriginal and Torres Strait Islander to 25 years
• Hepatitis B: healthcare workers, MSM, injecting drug use, sex industry work, chronic liver disease, renal dialysis — 3-dose series with post-vaccination serology titres

AEFI — adverse events following immunisation

AEFI	Clinical features	Action
Anaphylaxis	Within 15 min; airway compromise, hypotension, angioedema, generalised urticaria	Adrenaline IM thigh; 000; ED
Vasovagal	Pre-syncopal pallor, bradycardia; resolves supine	Lie flat; observe
Local reaction	Redness, swelling, pain at site	Paracetamol, cool compress; settles 24–48h
Fever	Common with childhood vaccines	Paracetamol as needed
Febrile seizure	Post-MMR day 5–12 or post-pertussis; children	Usually benign; reassure and review
Intussusception	Post-rotavirus (rare); abdominal pain, bloody stool	ED urgently
Myocarditis	Post-mRNA COVID; adolescent males, young adult males; chest pain, dyspnoea	Cardiology, ED; very rare

Report serious or unexpected AEFI to the TGA and to the state or territory public health unit. AusVaxSafety operates active text-message-based surveillance for COVID-19 and influenza vaccines.

B. Key NIP evidence: what changed and why

Shingrix replacing Zostavax

ATAGI listed Shingrix on the NIP for adults ≥65 and immunocompromised ≥18 from November 2023. Shingrix (recombinant zoster vaccine AS01B adjuvant, RZV) offers approximately 97% efficacy against herpes zoster in adults ≥50 versus approximately 50% for Zostavax (live attenuated). Crucially, Shingrix is non-live — it is safe and indicated in immunocompromised patients where Zostavax is contraindicated. The 2-dose schedule (0 and 2–6 months apart) is necessary for full protection. Reactogenicity (sore arm, fatigue, myalgia) is common and should be counselled in advance.

Single-dose HPV Gardasil 9

Since 2023, a single dose of Gardasil 9 in adolescents aged 12–13 replaces the previous 2-dose schedule. WHO and ATAGI accepted non-inferiority data for the 1-dose regimen with simpler delivery and comparable immunogenicity to the 2-dose series in this age group. Catch-up for missed doses in those aged up to 26 (extended for MSM, immunocompromised, Aboriginal and Torres Strait Islander to 25) uses a 2-dose schedule.

Maternal RSV and adult RSV

Maternal RSV vaccination with Abrysvo (bivalent prefusion F subunit) at 28–36 weeks pregnancy generates antibody transfer to the newborn, substantially reducing severe RSV lower respiratory tract infection in infants under 6 months. For adults ≥75, and 60–74 with risk factors (cardiac or pulmonary disease, immunocompromise, residential aged care), RSV vaccines (Arexvy or Abrysvo) are NIP-funded — a new category as of 2024–2025.

Prevenar 20 simplifying pneumococcal scheduling

For most adults ≥70, a single dose of Prevenar 20 (20-valent conjugate vaccine) replaces the previous sequential Prevenar 13 (PCV13) then Pneumovax 23 (PPV23) approach. This broader coverage in a single dose reduces scheduling complexity. For adults with chronic disease or immunocompromise, earlier vaccination and revaccination schedules apply — check current Handbook criteria.

C. Cold chain, vaccine hesitancy, and catch-up

Cold chain management

All vaccines require cold chain management at 2–8°C — the “Strive for 5” principle (aim for centre of the 2–8°C range, i.e., 5°C). Specific exceptions: varicella and Zostavax require freezer storage per packaging. On cold chain breach, do not discard immediately — follow the Handbook breach algorithm, consult the state public health unit, and assess whether revaccination is required. Conduct an annual cold chain audit.

Vaccine hesitancy — approach in general practice

The SKAI (Sharing Knowledge About Immunisation) framework recommends motivational interviewing: explore concerns, listen without dismissing, acknowledge emotions, provide balanced evidence, and support autonomy. Avoid confrontation or lecturing — it typically increases resistance. Document the discussion and any refusal clearly. Counsel parents of unvaccinated children regarding No Jab, No Pay (Centrelink) and childcare/school enrolment implications under state and territory legislation.

Catch-up in adults and refugees

Check the AIR at every health assessment. Refugees and humanitarian entrants frequently have incomplete or undocumented vaccination histories — offer catch-up based on individual serology (measles IgG, varicella IgG, hepatitis B serology) rather than assuming prior vaccination. Healthcare workers require documented hepatitis B immunity (post-vaccination anti-HBs ≥10 mIU/mL), MMR or serology (2 doses or seropositive), and annual influenza as occupational requirements.

D. Australian operations

MBS items for vaccination

• Standard GP consultations: Items 23/36/44 — vaccine discussions included in standard consultation billing; no separate vaccination-specific consultation item
• Practice nurse vaccination: Item 10987 — practice nurse administering vaccine on GP’s behalf
• Health assessments as catch-up opportunities: Items 701 (45–49 years), 705 (75+), 715 (Aboriginal and Torres Strait Islander), 699 (Heart Health Check) — review AIR and offer due vaccines at every health assessment
• GPCCMP (Items 965/967): Chronic disease patients frequently have multiple vaccine entitlements — document in the care plan

AIR recording obligations

Recording every vaccination in the AIR is legally required. Errors or omissions can affect Centrelink payments, childcare and school access, and patient safety (risk of over- or under-vaccination on catch-up). Ensure that brand, batch number, date, site, and dose are recorded accurately.

PBS and NIP funding

NIP vaccines are supplied free to eligible patients through the NIP. Travel vaccines (yellow fever, hepatitis A for travel, typhoid, Japanese encephalitis, rabies, cholera) are not NIP-funded and are paid privately. Mpox vaccination is state-funded for at-risk groups (MSM with relevant risk factors) — contact the relevant state sexual health service. Meningococcal B (Bexsero) for infants beyond ATSI-specific NIP funding is private cost.

E. Special populations

Pre-immunosuppression: Patients commencing biologics, JAK inhibitors, TYK2 inhibitors, or high-dose corticosteroids should complete live vaccines at least 4 weeks before starting immunosuppression. Shingrix, Prevenar, and influenza should be given before or soon after initiation. Coordinate with the specialist prescribing immunosuppression.

Solid organ transplant recipients: Comprehensive pre-transplant vaccination is critical — live vaccines contraindicated post-transplant. Annual influenza, Shingrix, Prevenar, and hepatitis B with post-vaccination titre are standard.

Travel: Pre-travel vaccination differs from NIP — see separate travel medicine guidance. Allow 6–8 weeks for full courses. Yellow fever must be administered at designated yellow fever vaccination centres only. Refer to Smartraveller for destination-specific requirements.

HIV: MMR and varicella are generally safe if CD4 ≥200 cells/µL; avoid if severely immunocompromised. Annual influenza and pneumococcal vaccination are standard. Shingrix is indicated and funded from ≥18 years for HIV-positive patients.

Pregnancy: dTpa at 20–32 weeks of every pregnancy, annual influenza at any trimester, COVID-19 boosters per ATAGI, and maternal RSV (Abrysvo) at 28–36 weeks are all recommended. Avoid live vaccines.

When to escalate

Refer or escalate when:

• Post-vaccination anaphylaxis — adrenaline IM then 000 and immediate ED transfer
• Severe or unusual AEFI (Guillain-Barré pattern, suspected myocarditis, intussusception post-rotavirus) — hospital admission and TGA/public health unit notification
• Severe egg allergy and influenza vaccine indication — immunology review for formal challenge
• Complex pre-immunosuppression vaccination planning — coordinate with prescribing specialist
• Cold chain breach requiring revaccination assessment — public health unit for guidance
• Outbreak of vaccine-preventable disease — public health unit for ring vaccination and contact tracing

What this article is and is not

This is general health information based on the Australian Immunisation Handbook, ATAGI statements, NIP, and AMH. It is not personal medical advice and does not create a doctor–patient relationship. The NIP schedule and funded vaccine eligibility are updated regularly — always verify with the current Handbook before prescribing. Decisions about vaccination for individual patients, including those with complex medical histories, require clinical judgement and consultation with the treating team.

For patient-facing information: HealthDirect — Immunisation, SKAI, Department of Health — Immunisation.

---

Sources cited

1. Australian Immunisation Handbook (ATAGI/Department of Health)
2. ATAGI — Australian Technical Advisory Group on Immunisation
3. National Immunisation Program (NIP)
4. Australian Immunisation Register (AIR)
5. MBS Online
6. National Vaccine Storage Guidelines — Strive for 5
7. AusVaxSafety — Active AEFI surveillance
8. SKAI — Sharing Knowledge About Immunisation
9. TGA — Vaccine safety and AEFI reporting
10. Australian Medicines Handbook
11. NPS MedicineWise — Immunisation
12. HealthDirect — Immunisation
13. Smartraveller — Travel vaccinations