Catch-up vaccination

Catch-up vaccination aims to provide optimal protection against disease as quickly as possible by completing a person’s recommended vaccination schedule in the shortest but most effective time frame.

Take every opportunity to review a person’s vaccination history and give them appropriate catch-up vaccines, as needed. If a person has not received the vaccines scheduled in the National Immunisation Program appropriate for their age:

• plan and document a catch-up schedule
• discuss this planned schedule with the person who needs the vaccine or their parent/carer

Assess vaccination status based on the schedule for the National Immunisation Program, as well as for the state or territory that the person lives in. If a person has recently moved from interstate, they may need catch-up vaccination.

See Infographic. Catch-up vaccination for children <10 years old and Infographic. Catch-up vaccination for adolescents and adults.

Confirming a person’s vaccination history

Written documentation of vaccination is important to assess a person’s vaccination status. Make every effort to confirm previous vaccination and obtain documentation.

How immunisation service providers manage inadequate records should be based on: 

• the age of the person being vaccinated
• whether they received previous vaccines in Australia or overseas 
• the vaccines being considered for catch-up

Immunisation registers

Details of a person’s immunisation history (an Immunisation History Statement) can be obtained from the Australian Immunisation Register (AIR) site within Health Professional Online Services (HPOS) or the AIR enquiries line (1800 653 809). If it is possible that a vaccine may have been given but not recorded on the AIR, every effort should be made to contact the relevant immunisation provider for that vaccine.

If the nominated provider or the AIR cannot confirm the vaccination, and no written records are available, the vaccine should be considered as not received, and the person should be offered catch-up vaccination appropriate for their age.

Certain vaccines received during adolescence may be recorded by registers other than the AIR. Some states and territories also maintain records of vaccines delivered through school-based programs. State and territory government health authorities can advise on how to obtain these records.

For adults ≥20 years of age, historical records of vaccines received before September 2016 may not be reported to the AIR. Information for certain vaccines may be available from other sources, such as states and territories, and the Australian Q Fever Register.

Reporting to immunisation registers in After vaccination has more details on the immunisation registers used in Australia and how to obtain vaccination records.

Incomplete documentation of previous vaccination

If previous vaccination cannot be confirmed, assume that the person has not received the vaccine(s) they need.

For most vaccines (except Q fever), there are no adverse events associated with additional doses in people who are already immune. 

Injection site reactions may increase after frequent additional doses of:

• diphtheria-containing vaccines
• pertussis-containing vaccines
• tetanus-containing vaccines
• pneumococcal polysaccharide vaccines

However, in most cases, the benefits of protection from the vaccine will outweigh the risk of an adverse reaction.

Significant adverse events are rarely associated with additional (potentially repeated) doses of:

• MMR (measles-mumps-rubella) vaccine
• VV (varicella vaccine)
• IPV (inactivated poliovirus) vaccine
• hepatitis B vaccine

Laboratory testing to guide catch-up vaccination

In some cases, laboratory testing can determine whether the person has immunity from previous vaccination or infection, and may be useful to guide the need for catch-up vaccination. 

Laboratory testing can include: 

• serology — used to detect antibodies from recent or past infection for certain diseases, or vaccination
• antigen detection 
• PCR — used to detect current or recent infection for certain diseases (or, in some cases, recent vaccination with live vaccines)

Laboratory testing to determine immunity as a result of previous vaccination or infection is only reliable for certain diseases:

• hepatitis A
• hepatitis B
• measles
• mumps
• rubella 
• varicella (but does not always detect vaccine-induced immunity)

For other diseases, laboratory testing is not routinely recommended to guide the need for catch-up vaccination. This is either because it is not reliable or because previous infection does not protect against subsequent disease. For example, for pneumococcal disease or influenza, infection with 1 serotype or strain does not protect against disease from the multiple other serotypes or strains that are in the vaccine.

See recommendations about serological testing before and after vaccination in relevant disease-specific chapters.

If serological testing is performed, it may be helpful to discuss the results with the laboratory that did the test to help interpret the results and ensure that relevant clinical information has been included.

Previous infection is not a contraindication to vaccination against the same disease, in most circumstances and for most vaccines. This means that it is more practical to offer vaccination than laboratory testing. However, the national due and overdue rules state natural immunity to a disease as a valid exemption to vaccination for certain antigens. More details about reporting to the AIR for health professionals can be found on the Australian Government Department of Human Services website.

Determining when a vaccine dose is valid according to age and interval since last dose

A ‘valid’ vaccine dose is one that is considered immunogenic (and safe) given the age and health status of the recipient, and the interval since the recipient’s last dose of the same vaccine.

Children may have received the 1st dose of a vaccine at a younger age than routinely recommended. See Table. Minimum acceptable age for the 1st dose of scheduled vaccines in infants to determine whether their vaccine was valid, and whether they need additional doses or catch-up.

For children and adults in whom the interval between vaccine doses is shorter than recommended, use the Catch-up resources that list the minimum acceptable intervals between vaccine doses to determine whether they need additional doses or catch-up. In some cases, minimum ages apply for subsequent doses in the schedule, as well as the 1st dose.

Apply these principles when planning catch-up vaccination:

• The scheduled interval between doses may be shorter or longer than the standard interval, and the number of doses needed may decrease with age at starting vaccination. For example, if starting vaccination against Haemophilus influenzae type b at 15 months of age, children need only 1 dose of (any) Hib (Haemophilus influenzae type b) vaccine.
• As a child gets older, the recommended number of vaccine doses may change, or the child may not need any doses. This is because they become less vulnerable to specific diseases as they get older.
• For incomplete or overdue vaccinations, always build a catch-up schedule based on the previous documented doses the person has received. In almost all cases, do not start the schedule again, regardless of the interval since the last dose. Count previous doses as part of the schedule. One exception to this rule is for oral cholera vaccine (see Cholera).
• If more than 1 vaccine is overdue, give 1 dose of each due or overdue vaccine at the first catch-up visit. Do not defer due or overdue vaccines (see Giving multiple vaccine injections at the same visit in Administration of vaccines). Schedule further required doses after the appropriate minimum interval (see Table. Minimum acceptable dose intervals for children <10 years of age).
• Use the standard intervals and ages recommended in the National Immunisation Program schedule once the child or adult is up to date with the schedule.
• As a general rule, healthy individuals can receive inactivated vaccines at any time before or after, or at the same time as, all other vaccines registered in Australia. Please refer to disease-specific chapters for exceptions. People can receive multiple live parenteral vaccines either at the same time or at least 4 weeks apart.^1,2
• Co-administration of 2 combination vaccines containing the same antigen is not routinely recommended. But this may be acceptable if no alternative vaccines or schedules are available. 
• Some people need further doses of antigens that are only available in combination vaccines. In general, it is acceptable to use combination vaccines, even if this means that the number of doses of another antigen exceeds the number required in a schedule.
• For some vaccines, catch-up vaccination is not recommended. For example, rotavirus vaccination is not recommended if the child cannot receive the 1st (and subsequent) vaccine doses within the prescribed upper age limits (see Catch-up guidelines for individual vaccines for children <10 years of age).

Use these resources to help plan a catch-up schedule:

• online catch-up calculator
• World Health Organization online list of overseas immunisation schedules
• Catch-up worksheet for children <10 years of age for National Immunisation Program vaccines
• Table. Minimum acceptable age for the 1st dose of scheduled vaccines in infants
• Table. Number of vaccine doses the child should have received by their current age
• Table. Minimum acceptable dose intervals for children <10 years of age
• Table. Catch-up schedule for Haemophilus influenzae type b (Hib) vaccination for children <5 years of age
• Table. MenACWY vaccine catch-up for healthy children aged <2 years
• Table. MenACWY vaccine primary catch-up for children with specified medical conditions
• Table. MenB vaccine catch-up for healthy children aged <2 years
• Table. MenB vaccine catch-up for children with specified medical conditions
• Table. Catch-up schedule for pneumococcal conjugate vaccines for Aboriginal and Torres Strait Islander children living in NT, Qld, SA or WA ONLY, and children from all states/territories with any risk condition(s) associated with an increased risk of invasive pneumococcal disease, aged <5 years
• Table. Catch-up schedule for pneumococcal conjugate vaccines for Aboriginal and Torres Strait Islander children living in NSW, Vic, Tas or ACT, and children from all states/territories who do not have risk condition(s) associated with an increased risk of invasive pneumococcal disease, aged <5 years
• Table. Catch-up schedule for people ≥10 years of age (for vaccines recommended on a population level)

If you are not sure how to plan the catch-up schedule, or if the catch-up is complicated, seek further advice from your state or territory health authority. 

See Infographic. Catch-up vaccination for children <10 years old.

Catch-up calculator

Health hosts an online catch-up calculator which provides catch-up vaccination recommendations for all infants, children, and adolescents under 20 years of age including those with one or more medical at-risk conditions. This helps immunisation providers plan appropriate catch-up schedules for children and adolescents <20 years of age across Australia.

When using the calculator, check the accuracy of information by referring to:

• your current state or territory immunisation schedule
• the current online edition of this Handbook

Overseas immunisation schedules

The World Health Organization website lists immunisation schedules in other countries. Use this to help interpret documentation from overseas vaccination to confirm which vaccines a person arriving from overseas may have received. Note that vaccines received overseas may have different brand names, contain different antigens in combination or be given in a different schedule. Also see Vaccination of migrants, refugees and people seeking asylum in Australia.

Catch-up worksheet for children aged <10 years

Resource: Catch-up worksheet for children <10 years of age for National Immunisation Program vaccines is a worksheet for calculating and recording:

• which vaccines are required in children aged <10 years
• the number of doses outstanding
• the timing of these doses

See Using the catch-up worksheet for children <10 years of age.

Minimum age for 1st dose

Table. Minimum acceptable age for the 1st dose of scheduled vaccines in infants lists the minimum acceptable ages for the 1st dose of scheduled vaccines in infants.

Number of doses a child should have received

Use Table. Number of vaccine doses the child should have received by their current age to assess the number of doses a child should have received if they were on a standard schedule.

Check under the child’s current age to find how many doses they should have already received. Use that number of doses as the starting point for calculating a catch-up schedule.

For example, a child who is 18 months old now should have received 3 doses of DTPa (diphtheria-tetanus-acellular pertussis), 3 doses of IPV vaccine, and so on.

Minimum intervals

Table. Minimum acceptable dose intervals for children <10 years of age lists the minimum acceptable interval between doses under special circumstances, such as catch-up vaccination. Children should not receive vaccine doses at less than the minimum acceptable interval.¹

In most cases, doses received earlier than the minimum acceptable interval should not be considered as valid doses and should be repeated, as appropriate, using Table. Number of vaccine doses the child should have received by their current age.

Catch-up for Hib vaccine in children aged <5 years

Table. Catch-up schedule for Haemophilus influenzae type b (Hib) vaccination for children <5 years of age can help calculate the number and timing of doses needed for catch-up for Hib vaccination of children.

Catch-up for meningococcal vaccine in children

Resources to plan meningococcal vaccine catch-up include:

• Table. MenACWY vaccine catch-up for healthy children aged <2 years
• Table. MenACWY vaccine primary catch-up for children with specified medical conditions
• Table. MenB vaccine catch-up for healthy children aged <2 years
• Table. MenB vaccine catch-up for children with specified medical conditions

Catch-up for pneumococcal vaccine in children

Resources to plan pneumococcal vaccine catch-up include:

• Table. Catch-up schedule for pneumococcal conjugate vaccines for Aboriginal and Torres Strait Islander children living in NT, Qld, SA or WA ONLY, and children from all states/territories with any risk condition(s) associated with an increased risk of invasive pneumococcal disease, aged <5 years
• Table. Catch-up schedule for pneumococcal conjugate vaccines for Aboriginal and Torres Strait Islander children living in NSW, Vic, Tas or ACT, and children from all states/territories who do not have risk condition(s) associated with an increased risk of invasive pneumococcal disease, aged <5 years

Catch-up for people aged ≥10 years

Use Table. Catch-up schedule for people ≥10 years of age (for vaccines recommended on a population level) to calculate a catch-up schedule for people aged ≥10 years.

Use the catch-up resources to plan a catch-up schedule for a child <10 years of age. The catch-up worksheet can help record these steps.

To use the catch-up worksheet:

1. Record the child’s details, including date of birth and current age, at the top of the worksheet.
2. For each vaccine, determine how many doses the child has received and the date of the last dose. Record this in the ‘Last dose given’ column of the worksheet. Include previous vaccinations given in another country if documentation is adequate, and enter overseas vaccination onto the Australian Immunisation Register (see Immunisation registers in Assessing immunisation status).
3. Check how many doses of each vaccine are required for the child’s current age in Table. Number of vaccine doses the child should have received by their current age. Enter this number in the ‘Number of doses needed at current age’ column of the worksheet.
4. Assess other factors identified during pre-vaccination screening that may affect the type or number of vaccines needed. Record any factors that affect the schedule in the ‘Comments’ column beside the relevant vaccine. These may include
   • anaphylaxis to any vaccine or one of its components (this is a contraindication to vaccination)
   • immunocompromising condition(s) due to disease or treatment (see Vaccination for people who are immunocompromised)
   • children identifying as Aboriginal or Torres Strait Islander people (see Vaccination for Aboriginal and Torres Strait Islander people)
   • children with an underlying medical condition(s) that predisposes them to invasive pneumococcal disease (see Pneumococcal disease) or meningococcal disease (see Meningococcal disease) 
   • preterm infants born at <32 weeks gestation (see Hepatitis B vaccine and Pneumococcal vaccines.
5. If the schedule needs to vary because of recorded factors (for example, a child who is immunocompromised may need different vaccines), adjust the ‘number of doses required’ accordingly.
6. For each vaccine, compare the number of doses received (as recorded in the ‘Last dose given’ column) with the number of doses required for the child’s current age.
7. If the child has already received all valid vaccine doses for protection against that disease, cross through the relevant ‘Dose number due now’ and ‘Further doses’ columns. Ensure that the minimum acceptable interval has been met for all previous doses, particularly if the child started their vaccination program overseas.
8. If the number of doses received (as recorded in the ‘Last dose given’ column) is less than the number of doses needed, give the child a dose of the relevant vaccine now, and record this in the ‘Dose number due now’ column. If this dose still does not complete the required doses, enter the further doses number in the ‘Further doses’ column.
9. Schedule the next dose at the most appropriate time (usually at the earliest opportunity), referring to Table. Minimum acceptable dose intervals for children <10 years of age. Record when the next dose is due in the ‘Further doses’ column.
10. Convert this information into a list of proposed appointment dates, with details of the vaccines and dose numbers needed at each visit, in the ‘Catch-up appointments’ section of the worksheet.
11. Record this catch-up schedule in your provider records and give a copy to the child’s parent or carer.
12. Once a child has received relevant catch-up vaccines, give the remaining scheduled vaccines according to the recommended National Immunisation Program schedule. For example, a 12-month-old child who is brought up to date with all vaccines, including the 12-month vaccination, should receive the 2nd dose of MMR-containing vaccine at 18 months of age, not 4 weeks after the last dose.

See also Infographic. Catch-up vaccination for children <10 years old.

Consider this advice on catch-up for individual vaccines alongside the general principles of catch-up vaccination.

For each vaccine in this section, the minimum acceptable age is listed for the 1st dose of scheduled vaccines in infants. However, there may be special circumstances where children may need to be vaccinated earlier than routinely recommended. Special circumstances may include infants or children being vaccinated:

• during an outbreak of a certain disease or after exposure to someone with the disease
• before overseas travel
• opportunistically if they see a provider early 

The ages for vaccination in these circumstances can differ from routinely recommended ages for vaccination under the National Immunisation Program schedule.

In some cases, these ages will also result in the dose not being considered by the Australian Immunisation Register as ‘valid’ for calculating immunisation status. This is noted under the relevant vaccines in this section.

See also:

• Table. Minimum acceptable age for the 1st dose of scheduled vaccines in infants
• Table. Minimum acceptable dose intervals for children <10 years of age

DTPa vaccine

Recommended doses

Monovalent pertussis vaccine is not available in Australia.

DTPa-containing vaccines can be used for catch-up of primary or booster doses in children aged <10 years.

Children <10 years of age should receive a total of 5 doses of DTPa-containing vaccine:

• 3 doses as part of the primary schedule for infants (recommended at 2, 4 and 6 months of age)
• 2 booster doses (recommended at 18 months and 4 years of age)

However, if the child received dose 4 of DTPa-containing vaccine (1st booster dose, routinely recommended at 18 months of age) after the age of 3.5 years, they do not need a 5th dose of DTPa-containing vaccine (2nd booster dose, routinely recommended at 4 years of age) to be given before 10 years of age. In this case, the next vaccine dose would be recommended at 12–13 years of age (the scheduled early adolescent booster dose).

In children aged <10 years, the number of doses administered is influenced by:

• the age at which they start catch-up vaccination
• the number of doses needed
• the minimum intervals between doses

For complex catch-up schedule advice, contact your state or territory health department.

See Diphtheria, Tetanus and Pertussis.

Minimum age for 1st dose

6 weeks

Action if a vaccine dose is inadvertently given before the recommended minimum age

If a child receives their 1st dose of DTPa-containing vaccine at ≤28 days of age, it is recommended that the dose is repeated. This repeat dose should be given at 2 months of age. Follow the National Immunisation Program schedule for future doses, with the next dose of DTPa-containing vaccine given at 4 months of age.

If a child receives their 1st dose of DTPa-containing vaccine between >28 days and <42 days (6 weeks) of age, it does not necessarily need to be repeated. Limited data suggest that receiving the vaccine at this age will still be safe and immunogenic. Follow the National Immunisation Program schedule for future doses, with the next dose of DTPa-containing vaccine given at 4 months of age.

The need to repeat the 1st dose of vaccine may not be recognised until the infant is older. For example, a 4-month-old infant may present for vaccination and has only previously received 1 dose of DTPa-hepB (hepatitis B)-IPV-Hib at age ≤28 days. In this case: 

• repeat the dose now (and count this as dose 1) 
• proceed with the schedule as per the National Immunisation Program or catch-up recommendations

Minimum interval between doses

Minimum intervals between:

• doses 1 and 2 — 4 weeks
• doses 2 and 3 — 4 weeks
• doses 3 and 4 — 6 months
• doses 4 and 5 — 6 months (unless the child received dose 4 at >3.5 years of age, then dose 5 is not needed)

Children who did not receive an 18-month booster dose

The 18-month booster dose was not routinely recommended between 2003 and 2015. This means that some children will have only had 3 primary doses of DTPa-containing vaccine and a booster dose at 4 years of age.

If the child received their 4th dose of DTPa-containing vaccine after 3.5 years of age, they do not need another childhood dose. Their next dose will be the booster dose recommended during adolescence.

If the child is aged ≥18 months to ≤3.5 years and did not receive a booster dose of DTPa-containing vaccine at 18 months of age, they should receive:

• their 1st booster dose (dose 4) now
• a 2nd booster dose at 4 years of age (with a minimum interval of 6 months between these doses)
• their next booster dose during adolescence, as routinely recommended

See Pertussis for more details.

Hepatitis A vaccine for Aboriginal and Torres Strait Islander children in the Northern Territory, Queensland, South Australia and Western Australia only

Recommended doses

Aboriginal and Torres Strait Islander children in the Northern Territory, Queensland, South Australia and Western Australia are recommended to receive 2 doses of hepatitis A vaccine:

• dose 1 at 18 months of age 
• dose 2 at 4 years of age

Contact your state or territory health authority for advice about catch-up vaccination in children ≥5 years of age.

See Hepatitis A.

Minimum age for 1st dose

12 months

Action if a vaccine dose is inadvertently given before the recommended minimum age

If a child receives their 1st dose of hepatitis A vaccine at <12 months of age, and they need ongoing protection against hepatitis A, repeat the 1st dose.

Minimum interval between doses

Minimum interval between doses 1 and 2 is 6 months.

Hepatitis B vaccine

Recommended doses

Australian-born infants typically receive:

• a monovalent hepatitis B vaccine dose at birth
• a 3-dose primary course of hepatitis B–containing vaccine at 2, 4 and 6 months of age (usually given as DTPa-hepB-IPV-Hib)

See Hepatitis B.

Minimum age for 1st dose

6 weeks (excluding the birth dose of hepatitis B vaccine)

Action if a vaccine dose is inadvertently given before the recommended minimum age

If a hepatitis B–containing combination vaccine is inadvertently given before 6 weeks of age, follow the recommended action for DTPa-containing vaccines.

See DTPa vaccine.

Minimum interval between doses

Minimum intervals between:

• doses 1 and 2 — 1 month
• doses 2 and 3 — 2 months

In addition, the minimum recommended interval between dose 1 and dose 3 is 4 months (see Hepatitis B).

The Australian Immunisation Register accepts a minimum interval of 4 weeks between any hepatitis B vaccine dose. This allows children who have been immunised using 3-dose schedules (typically provided overseas) to be considered as fully immunised.³

Birth dose

The birth dose of hepatitis B vaccine is only scheduled for infants up to 7 days of age. If the child did not receive this dose, they do not need a catch-up birth dose. They should receive their primary 3-dose course of a hepatitis B–containing combination vaccine as scheduled at 2, 4 and 6 months of age.

Final dose of primary course

All infants should receive the final dose of the primary hepatitis B vaccine course (with or without a birth dose) at ≥24 weeks of age. If the final dose is given at <24 weeks but ≥16 weeks (approximately 4 months) of age, the dose does not need to be repeated.

Catch-up using monovalent hepatitis B vaccine

If a child needs catch-up vaccination for hepatitis B only, and not any other antigens in the hepatitis B–containing combination vaccines, they can receive the standard schedule of monovalent hepatitis B vaccine (0, 1, 6 months) for the remaining dose(s), if needed. Check the minimum intervals specified in Table. Minimum acceptable dose intervals for children <10 years of age.

Preterm infants

Preterm (<32 weeks gestation) or low-birthweight infants (<2000 g birth weight) are recommended to receive:

• doses of hepatitis B vaccine at birth, and at 2, 4 and 6 months of age
• either serological testing for antibody to hepatitis B surface antigen or a hepatitis B booster dose at 12 months of age

For details, see Vaccination for preterm infants and Hepatitis B.

Hib vaccine

Recommended doses

Hib-containing vaccine is routinely recommended in a 4-dose schedule for infants at 2, 4, 6 and 18 months of age.

See Haemophilus influenzae type b.

Minimum age for 1st dose

6 weeks

Action if a vaccine dose is inadvertently given before the recommended minimum age

If a Hib-containing combination vaccine is inadvertently given before 6 weeks of age, follow the recommended action for DTPa-containing vaccines. See DTPa vaccine.

Doses and intervals for catch-up

The recommended number of doses and intervals for catch-up Hib vaccines vary with the child’s age.

See Table. Catch-up schedule for Haemophilus influenzae type b (Hib) vaccination for children <5 years of age. See also Haemophilus influenzae type b. 

The recommended minimum interval between primary doses for catch-up is 4 weeks. 

Children should receive booster doses at 18 months of age, or 2 months after the last dose of Hib vaccine, whichever is later. Children do not need a booster dose if they received their previous dose at ≥18 months of age.

MMR and MMRV vaccines

Recommended doses

All children aged ≥12 months are recommended to receive 2 doses of MMR-containing vaccine:

• the 1st dose at 12 months of age as MMR vaccine
• the 2nd dose at 18 months of age as MMRV vaccine

See Measles, Mumps and Rubella.

Minimum age for 1st dose

12 months

Action if a vaccine dose is inadvertently given before the recommended minimum age

Children can receive MMR vaccine from 6 months of age in certain circumstances, such as for post-exposure prophylaxis for measles (see Measles). It is recommended that the 1st dose be repeated if it was given at <11 months of age.

The Australian Immunisation Register will record MMR vaccine given at ≥11 months of age as a valid dose to calculate immunisation status. A dose provided at ≥11 months (but before 12 months) of age may be sufficiently immunogenic, especially in infants born to mothers with measles antibody derived from vaccination rather than natural infection. As such, doses given at ≥11 months but <12 months may not need to be repeated.³

MMRV vaccine is recommended as the 2nd (not 1st) dose of MMR-containing vaccine in children <4 years of age. If a child was inadvertently given MMRV as the 1st dose of MMR-containing vaccine, that MMR-containing dose does not need to be repeated, unless it was given at <12 months of age.

Minimum interval between doses

The minimum interval between doses 1 and 2 is 4 weeks.

Catch-up recommendations

MMR is recommended as the 1st dose of MMR-containing vaccine in children <4 years of age.

If a child has not received any documented doses of MMR vaccine, the catch-up schedule is 2 doses of MMR-containing vaccine, given at least 4 weeks apart. See Measles. Children aged >12 months to <4 years can receive the 1st dose as MMR vaccine, and the 2nd dose as MMRV vaccine.

If a child receives varicella vaccine at <12 months of age, they should receive a further dose at 18 months of age. If the 2nd dose of MMR vaccine and a dose of varicella vaccine are both needed, the child can receive MMRV vaccine. See Varicella.

Only give MMRV vaccine as the 2nd dose of MMR-containing vaccine in children <4 years of age. 

Children aged ≥4 years to 14 years can receive MMRV as their 1st dose of MMR-containing vaccine. See Measles and Varicella.

Meningococcal vaccines

Recommended doses

The recommended schedule for meningococcal vaccines varies for different formulations (see Meningococcal disease). Generally, the earlier the vaccination schedule starts, the more doses are needed.

People with medical conditions that increase their risk of invasive meningococcal disease need extra doses.

Children aged 12-23 months are recommended to receive a single dose (Nimenrix or MenQuadfi) or 2 doses (Menveo) of MenACWY vaccine.

Minimum age for 1st dose

6 weeks for either MenACWY or MenB vaccine

Action if a vaccine dose is inadvertently given before the recommended minimum age

If a child receives their 1st dose of MenB vaccine at ≤28 days of age, it is recommended that the dose is repeated. This repeat dose should be given at 2 months of age. Follow the National Immunisation Program schedule for future doses.

If a child receives their 1st dose of MenACWY or MenB vaccine between >28 days and <42 days (6 weeks) of age, the dose does not necessarily need to be repeated. Seek expert advice.

The Australian Immunisation Register will record MenACWY given at ≥11 months of age as a valid dose to calculate immunisation status.

Minimum intervals between doses

The minimum acceptable interval between MenACWY vaccines is 8 weeks. There are no clinical trial data in older children for minimum intervals less than the routinely recommended interval of 8 weeks.

The minimum acceptable interval between primary doses of MenB vaccine is 6 weeks for infants aged <6 months, for a 2+1 schedule. The minimum acceptable interval between doses of MenB vaccine is 8 weeks for infants and children aged 6–23 months. The minimum acceptable interval between primary doses of MenB vaccine is 4 weeks for children aged ≥2 years and adults.

In circumstances where MenB and MenACWY vaccines are indicated, the vaccines can be administered concurrently based on first principles. See Meningococcal disease.

Catch-up recommendations

If a child aged ≥12 months has not received a dose, they are recommended to receive a single dose (Nimenrix or MenQuadfi) or 2 doses (Menveo) of MenACWY vaccine. See Meningococcal disease.

Doses and intervals for catch-up 

The number of doses and recommended intervals for meningococcal vaccines needed for catch-up vaccination depend on:

• the child’s age
• their health status

See:

• Meningococcal disease
• Table. MenACWY vaccine catch-up for healthy children aged <2 years
• Table. MenACWY vaccine primary catch-up for children with specified medical conditions
• Table. MenB vaccine catch-up for healthy children aged <2 years
• Table. MenB vaccine catch-up for children with specified medical conditions

Specified medical conditions for which additional doses of MenB vaccine are scheduled include:

• functional or anatomical asplenia, including sickle cell disease or other haemoglobinopathies
• defects in, or deficiency of, complement components, including factor H, factor D or properdin deficiency
• current or planned future treatment with eculizumab
• HIV infection

Pneumococcal vaccines (13vPCV, 15vPCV, 20vPCV and 23vPPV)

Recommended doses

All infants are routinely recommended to receive 3 doses of a pneumococcal conjugate vaccine (PCV) (13vPCV, 15vPCV or 20vPCV) at 2, 4 and 12 months of age.

An additional dose of a conjugate vaccine (13vPCV, 15vPCV or 20vPCV) at 6 months of age is recommended for:

• Aboriginal and Torres Strait Islander children living in the Northern Territory, Queensland, South Australia and Western Australia
• children with risk conditions for pneumococcal disease

These children are also recommended to receive 2 doses of 23vPPV:

• 1st dose at 4 years of age
• 2nd dose at least 5 years later

See Pneumococcal disease.

Minimum age for 1st dose

6 weeks

Action if a vaccine dose is inadvertently given before the recommended minimum age

If a child receives their 1st dose of PCV at ≤28 days of age, it is recommended that the dose is repeated. This repeat dose should be given at 2 months of age. Follow the National Immunisation Program schedule for future doses, with the next dose of PCV given at 4 months of age.

If a child receives their 1st dose of PCV between >28 days and <42 days (6 weeks) of age, it does not necessarily need to be repeated. Limited data suggest that administration at this age will still be safe and immunogenic. Follow the National Immunisation Program schedule for future doses, with the next dose of PCV given at 4 months of age.

The need to repeat the 1st dose of vaccine may not be recognised until the infant is older. For example, a 4-month-old infant may present for vaccination and has only previously received 1 dose of PCV at age ≤28 days. In this case:

• repeat the dose now (and count this as dose 1)
• proceed with the schedule as per the National Immunisation Program or catch-up recommendations

Doses and intervals for catch-up

The number of doses and recommended intervals for PCV needed for catch-up vaccination depend on:

• the child’s age
• their health status
• their Aboriginal and Torres Strait Islander status
• the state or territory they live in

See:

• Pneumococcal disease
• Table. Catch-up schedule for pneumococcal conjugate vaccines for Aboriginal and Torres Strait Islander children living in NSW, Vic, Tas or ACT, and children from all states/territories who do not have risk condition(s) for pneumococcal disease, aged <5 years
• Table. Catch-up schedule for pneumococcal conjugate vaccines for Aboriginal and Torres Strait Islander children living in NT, Qld, SA or WA ONLY, and children from all states/territories with risk condition(s) for pneumococcal disease, aged <5 years

Children may have received previous PCV doses as 7vPCV (for example, if they received vaccines overseas), 10vPCV or 13vPCV. It is acceptable to complete the course with a higher valency vaccine. However, infants and children who receive lower valency pneumococcal conjugate vaccines do not need catch-up doses with higher valency vaccines for doses already received.

Healthy children do not need catch up doses of pneumococcal conjugate vaccine after age ≥5 years.

Preterm infants born at <28 weeks gestation should receive extra doses of pneumococcal vaccines, in accordance with the schedule for children at increased risk of pneumococcal disease. See Pneumococcal disease and Vaccination for preterm infants.

Where possible, align catch-up doses with the standard schedule points for infants (2 and 4 months of age, and 6 months of age for Aboriginal and Torres Strait Islander children and children with risk conditions for pneumococcal disease).

The minimum interval between doses of PCV is 1 month if aged <12 months, and 2 months if aged ≥12 months. In any PCV catch-up schedule, children should receive their last dose after they reach 12 months of age (as a booster dose), with a minimum interval of 2 months after the previous dose.

The minimum interval between a dose of 23vPPV that follows a dose of PCV is 2 months.

The minimum interval between doses of 23vPPV is 5 years.

Polio vaccine

Recommended doses

If a child has not received any doses of polio vaccine, give 3 doses of IPV or IPV-containing vaccines at least 4 weeks apart (see Poliomyelitis). 

Previous doses of oral polio vaccine are interchangeable with IPV.

If a child receives their 3rd dose of IPV at >4 years of age, they do not need a 4th (booster) dose to be given. 

Minimum age for 1st dose

6 weeks

Action if a vaccine dose is inadvertently given before the recommended minimum age

If an IPV-containing combination vaccine is inadvertently given before 6 weeks of age, follow the recommended action for DTPa-containing vaccines. See DTPa vaccine.

Minimum interval between doses

Minimum intervals between:

• doses 1 and 2 — 4 weeks
• doses 2 and 3 — 4 weeks
• doses 3 and 4 — 4 weeks (unless the child received dose 3 at >4 years of age, then dose 4 is not needed)

Rotavirus vaccine

Recommended doses

Catch-up rotavirus vaccination of older infants or children is not recommended.

Infants should start the course of rotavirus vaccination within the recommended age limits for the 1st dose:

• the 1st dose of RotaTeq should be given between 6 and 12 weeks of age (before turning 13 weeks old)
• the 1st dose of Rotarix should be given between 6 and 14 weeks of age (before turning 15 weeks old)

Children should not receive vaccine doses beyond the upper age limits specified Table. Upper age limits for dosing of oral rotavirus vaccines in Rotavirus.

See Rotavirus.

Minimum age for 1st dose

6 weeks

Action if a vaccine dose is inadvertently given before the recommended minimum age

If a child received their 1st dose of rotavirus vaccine at ≤28 days of age, it is recommended that the dose is repeated. This repeat dose should be given at 2 months of age. Follow the National Immunisation Program schedule for future doses, with the next dose of rotavirus vaccine given at 4 months of age.

If a child received their 1st dose of rotavirus vaccine between >28 days and <42 days (6 weeks) of age, it does not necessarily need to be repeated. Limited data suggest that administration at this age will still be safe and immunogenic. Follow the National Immunisation Program schedule for future doses, with the next dose of rotavirus vaccine given at 4 months of age.

Minimum interval between doses

For all doses of rotavirus vaccine, do not exceed the upper age limits for dose administration. See Rotavirus.

The minimum interval between each dose of rotavirus vaccine is 4 weeks.

Varicella vaccine

Recommended doses

1 dose of varicella-containing vaccine is routinely recommended in children <10 years of age, with a preference for 2 doses (see Varicella).

Minimum age for 1st dose

9 months for Varilrix monovalent varicella vaccine.

12 months for other varicella-containing vaccines.

Action if a vaccine dose is inadvertently given before the recommended minimum age

If a child receives a varicella-containing vaccine at <12 months of age, the dose should be repeated, preferably at 18 months of age.

Varilrix (monovalent varicella vaccine) is registered for use from 9 months of age. Children can receive this vaccine from ≥9 months of age in special circumstances, such as before travelling. However, a dose received at <12 months of age should be repeated.

MMRV vaccine is recommended as the 2nd (not 1st) dose of MMR-containing vaccine in children <4 years of age. If a child is inadvertently given MMRV as the 1st dose of MMR-containing vaccine, that MMR-containing dose does not need to be repeated, unless it was given at <12 months of age.

Catch-up recommendations

If a child has not received any documented doses of varicella vaccine, the catch-up schedule is a single dose of varicella-containing vaccine for children aged <14 years. See Varicella.

If a child receives varicella vaccine at <12 months of age, they should receive a further dose at 18 months of age. If the 2nd dose of MMR vaccine and a dose of varicella vaccine are both needed, the child can receive MMRV vaccine. See MMR and MMRV vaccines.

Only give MMRV vaccines as the 2nd dose of MMR-containing vaccine in children <4 years of age. Children aged ≥4 years to 14 years can receive MMRV as their 1st dose of MMR-containing vaccine.

Catch-up is much more common for young children than it is for people ≥10 years of age. However, sometimes adolescents and adults missed doses earlier in their life and need to catch up. They may also need booster doses or revaccination. People who did not have natural infection as children and were not vaccinated remain at unnecessary risk of vaccine-preventable diseases.

In general, the same principles for catch-up vaccination apply as for younger children. For example, if a vaccine course is incomplete, do not start the course again, regardless of the interval since the last dose. One exception to this rule is for oral cholera vaccine (see Cholera).

Catch-up vaccination for adults may not be as straightforward as for children and adolescents.

See Infographic. Catch-up vaccination for adolescents and adults.

Do not use certain childhood combination vaccines for adolescents or adults

Certain childhood combination vaccines are not registered for use in children aged ≥10 years, adolescents or adults. The exception is MMR vaccine, which is available for use at all ages. MMRV vaccine is only recommended for use up to 14 years of age.

Combination vaccines should not be used for adolescents or adults who need vaccines for several antigens. The antigen content of combination vaccines is different from that of adult formulations. There may be a higher risk of adverse events, such as injection site reactions.

HALO principle

When planning which vaccines to give to adults, consider the HALO principle. This helps assess which vaccines adults need based on risk factors:

• Health
• Age
• Lifestyle
• Occupation

The schedule for each individual adult may differ because of the risk factors identified when applying the HALO principle.

Examples of how the HALO principle can be used:

• Health — the person has a medical condition(s) that increases their risk of acquiring a particular vaccine-preventable disease or experiencing complications from that disease. Examples are influenza, pneumococcal and meningococcal disease.
• Age — older age groups may need extra vaccines, such as influenza or pneumococcal vaccination. Certain age groups may be targeted for immunisation against a particular disease, such as HPV. Young to middle-aged adults may have missed out on vaccine doses as a result of schedule changes, such as the 2nd dose of MMR vaccine.
• Lifestyle — the person may have missed vaccines because they changed where they live. They may need extra vaccines because they travel frequently. They may have other lifestyle risk factors that increase their risk of acquiring a vaccine-preventable disease, such as smoking or injecting drugs.
• Occupation — the person may work in a job for which certain vaccines are recommended because of the increased risk of acquiring a vaccine-preventable disease or transmitting it to others. Examples are people who work in health care or early childhood education and care, and people who work with animals.

The pre-vaccination screening checklist and Table. Responses to conditions or circumstances identified through the pre-vaccination screening checklist in Preparing for vaccination also incorporate the HALO principle to some extent.

Planning catch-up vaccines for people aged ≥10 years

Table. Catch-up schedule for people ≥10 years of age (for vaccines recommended on a population level) contains information on vaccine doses and intervals between doses for people aged ≥10 years who need catch-up vaccination for a particular antigen.

This table only includes diseases for which vaccination is recommended at a population level, and for which catch-up is needed if vaccine doses were missed earlier in life.

The table does not include information on all diseases that adults may need vaccines for. Vaccination for special risk groups includes more details.

The table shows the number of vaccine doses required for a person who has not previously received any vaccine doses for that antigen. If a person has received previous doses, deduct the number of previous doses from the number in the ‘Doses needed’ column. 

To use Table. Catch-up schedule for people ≥10 years of age (for vaccines recommended on a population level):

• determine how many vaccine doses for a particular antigen a person should have received to be considered completely vaccinated (see ‘Doses needed’ column)
• deduct any previous vaccine doses received for that antigen from the number in the ‘Doses needed’ column
• check the ‘Minimum interval between doses’ column to schedule further doses

For more recommendations, see the following, as required: 

• the relevant disease-specific chapter(s) in this Handbook
• Vaccination for special risk group

Example of catch-up requirements

For example, a 32-year-old woman (Age) is returning to nursing (Occupation) but has only ever had:

• 1 dose of hepatitis B vaccine
• 4 doses of oral poliomyelitis vaccine
• 1 dose of MMR vaccine
• 2 doses of DTPw (whole-cell) vaccine as a child

She recently had a splenectomy (Health) after an accident.

This person would need:

• 1 dose of dTpa
• 2 adult doses of hepatitis B — 1 dose now and another dose in 2 months
• no further doses of polio vaccine (she is fully vaccinated against polio)
• 1 dose of MMR vaccine
• 2 doses of varicella vaccine if non-immune — 1 dose now and another dose in 4 weeks
• 1 dose of influenza vaccine (and 1 dose every year)
• pneumococcal vaccine (because of splenectomy) — 1 dose of pneumococcal conjugate vaccine (13vPCV, 15vPCV or 20vPCV) now, 1 dose of 23vPPV (23-valent pneumococcal polysaccharide vaccine) 2 months later and a second dose of 23vPPV at least 5 years after the 1st dose of 23vPPV
• 1 dose of Hib vaccine (because of splenectomy)
• 2 doses of MenACWY vaccine (because of splenectomy) — 1 dose now and another dose in 8 weeks, plus booster doses every 5 years
• 2 doses of MenB vaccine (because of splenectomy) — 1 dose now and another dose in 8 weeks

For more details, see: 

• Vaccination for people at occupational risk
• People with functional or anatomical asplenia in Vaccination for people who are immunocompromised
• relevant disease-specific chapters

1. Kroger AT, Duchin J, Vázquez M. General best practice guidelines for immunization. Best practices guidance of the Advisory Committee on Immunization Practices (ACIP). Atlanta, GA: Centers for Disease Control and Prevention; 2017.
2. Kroger AT, Atkinson WL, Pickering LK. General immunization practices. In: Plotkin SA, Orenstein WA, Offit PA, Edwards KM, eds. Plotkin's vaccines. 7th ed. Philadelphia, PA: Elsevier; 2018. 
3. Australian Government Department of Human Services. The Australian Immunisation Register. National due and overdue rules for immunisation. (Accessed Apr 2018). https://www.humanservices.gov.au/organisations/health-professionals/services/medicare/australian-immunisation-register-health-professionals#enabler-2021