Table. Risk conditions and immunosuppressive therapies for zoster vaccination and eligibility for NIP funding
ATAGI recommends all people aged ≥18 years who are immunocompromised are recommended to receive a zoster vaccine, with consideration given on the optimal timing for vaccination.
Some people with higher risk of zoster are funded under the National Immunisation Program (NIP) to receive Shingrix.
Those who are funded, as indicated in the table below, are at greatest risk of herpes zoster either due to certain underlying conditions or because they are about to, are currently or have previously received certain immunosuppressive therapies.
Please note the following:
- Not all conditions or therapies that increase the risk of herpes zoster are listed.
- Immunosuppressive therapies have been categorized by class rather than specific medication to allow for new drugs that fall into these therapeutic classes to be funded.
- If a person has commenced their schedule for Shingrix within the funded interval (where applicable) the second dose will be funded, even if the second dose occurs beyond the funded interval time.
See also Vaccination for people who are immunocompromised for recommendations for immunocompromised people including specific revaccination recommendations and recommendations regarding timing of vaccination for immunocompromised people.
| Risk category | Details or example conditions | Funded |
|---|---|---|
| Acute haematological malignancies | Acute leukaemia | Yes |
| Aggressive lymphomas | ||
| Chronic haematological malignancies | Myelodysplastic syndromes/chronic myeloproliferative disorders | Yes |
| Lymphoproliferative malignancies and plasma cell dyscrasias (e.g. myeloproliferative neoplasms) | ||
| Chronic lymphocytic leukaemia | ||
| Indolent non-Hodgkin lymphoma | ||
| Multiple myeloma | ||
| Human immunodeficiency virus infection | CD4+ cell count < 200/µL | Yes |
| CD4+ cell count > 200/µL | No | |
| Inborn errors of immunity with ongoing functional deficits | Humoral e.g., X-linked agammaglobulinemia | Yes |
| Combined defects e.g., severe combined immunodeficiency (SCID) | ||
| Phagocytic disorders e.g., chronic granulomatous disease (CGD) | ||
| Other inborn errors of immunity | ||
| Complement disorders, hereditary angioedema (HAE) | No | |
| IgA deficiency | ||
| Chronic kidney disease | Stage 5 or on dialysis | Yes |
| Stage 4 and below | No | |
| Cellular therapies and stem cell transplantation | Autologous haematopoietic stem cell transplant | Yes - currently receiving or within the previous 24 months |
| Chimeric antigen receptor T-cell therapy | ||
| Allogeneic haematopoietic stem cell transplant | ||
| Allogeneic haematopoietic stem cell transplant with ongoing graft vs host disease with immunosuppressive therapy (where they remain at high risk beyond 24 months) | Yes | |
| B and T-cell targeted monoclonal antibody therapies | Anti-CD20 (e.g. Rituximab) | Yes – if currently receiving or received within the last 6 months |
| Anti B-cell activating factor (BAFF) (e.g. tabalumab) | ||
| Anti-CD52 (e.g. Alemtuzumab) | ||
| Anti-thymocyte globulin (e.g. Thymoglobulin) | ||
| Cancer therapies | Chemotherapy treatment of haematological malignancy | Yes |
| Chemotherapy treatment of solid organ tumours | Yes - currently or within the last 6 months | |
| Immune checkpoint inhibitors | No | |
| Kinase inhibitors (including ALK, CDK inhibitors) | ||
| Radiotherapy (alone, without concurrent or sequential chemotherapy) | ||
| Conventional immunosuppressive agents | High dose methotrexate ≥20mg per week (oral and subcutaneous) | Yes – if currently receiving or received within the last 6 months |
| Azathioprine ≥3.0mg/kg/day | ||
| 6-mercaptopurine ≥1.5mg/kg/day | ||
| Mycophenolate ≥1g/day | ||
| Cyclophosphamide | ||
| Systemic calcineurin inhibitors (e.g. tacrolimus, cyclosporin) | ||
| mTOR inhibitors (e.g. everolimus) | ||
| Purine analogues (e.g. cladribine) | ||
| Aminosalicylates | No | |
| Auranofin | ||
| Hydroxychloroquine | ||
| Leflunomide | ||
| Penicillamine | ||
| Biologic therapies | Tumour necrosis factor inhibitors (TNFi) (e.g. adalimumab) | Yes – if received in the last 6 months |
| Soluble TNF receptors (e.g. etanercept) | ||
| T-cell co-stimulation modulators (e.g., Abatacept) | ||
| Type I interferon receptor inhibitors (IFNAR1) (e.g. anifrolumab) | ||
| Proteasome inhibitors (e.g., bortezomib) | ||
| Anti-integrins (e.g., natalizumab and vedolizumab) | No | |
| Anti-IgE antibodies (e.g., omalizumab) | ||
| Anti-complement antibodies (e.g., eculizumab) | ||
| Immunomodulatory drugs | Sphingosine-1-phosphate receptor modulators (e.g., fingolimod) | Yes – if received in the last 6 months |
| Oral small molecule targeted therapies | Bruton’s tyrosine kinase (BTK) inhibitors (e.g. Ibrutinib) | Yes - currently or within the last 6 months |
| Janus kinase (JAK) inhibitors (e.g. Upadacitinib) | ||
| BCR-ABL inhibitors (e.g. Imatinib) | ||
| Immunosuppressive therapy to prevent organ rejection | Any therapy to prevent organ rejection | Yes – if prior to or following solid organ transplantation, currently, or within the last 6 months |
| Interleukin (IL) inhibitors | Anti-IL1 antibodies (e.g., canakinumab or anakinra) | Yes – if currently receiving or received within the last 6 months |
| AntiIL4/13 antibodies (e.g., dupilumab) | ||
| Anti-IL5 antibodies (e.g., mepolizumab) | ||
| Anti-IL6 antibodies and IL-6 receptor inhibitors (e.g., tocilizumab) | ||
| Anti-IL17 antibodies (e.g., secukinumab) | No | |
| Anti-IL 12/23 antibodies (e.g., ustekinumab) | ||
| Anti-IL23 antibodies (e.g., guselkumab) | ||
| Anti-IL31 antibodies (e.g., nemolizumab) |
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