Table. Indications for serological testing to guide the decision to vaccinate
| Vaccine preventable disease | General population | Immunocompromised people | Pregnant women/people and women/people planning to become pregnant | People without clear documentation of vaccination, including migrants or refugees | Healthcare workers and others at occupational risk |
|---|---|---|---|---|---|
| Diphtheria | Not routinely recommended | Not routinely recommended | Not routinely recommended | Not routinely recommended | Serological testing every 10 years is recommended for laboratory workers who may be exposed to toxigenic Corynebacterium diphtheriae in their jobs. See recommendation: People who may be exposed to diphtheria in their jobs are recommended to receive a dose of either dT or dTpa vaccine if their last dose of diphtheria-toxoid vaccine was more than 10 years ago. |
| Hepatitis A |
Pre-vaccination serological testing can be considered to confirm natural immunity in:
If serological testing is positive, vaccination is not needed. See recommendation: serological testing for hepatitis A immunity is not recommended before or after receiving hepatitis A-containing vaccine, with rare exceptions |
Follow guidance for general population | Follow guidance for general population | Follow guidance for general population | Follow guidance for general population |
| Hepatitis B |
Pre-vaccination serological testing is recommended in people at higher risk of hepatitis B, including people who inject drugs, sex industry workers and people living in communities with higher prevalence of hepatitis B. See recommendation People at higher risk of hepatitis B are recommended to have serological testing for hepatitis B before vaccination. Post-vaccination serological testing is recommended 4–8 weeks after completing the vaccine course for people at risk of hepatitis B infection. For details on who testing is recommended for, see recommendation: People at risk of hepatitis B are recommended to have serological testing 4–8 weeks after they complete the hepatitis B vaccine course. Pre-vaccination serological testing is recommended in people at higher risk of hepatitis B, including people who inject drugs, sex industry workers and people living in communities with higher prevalence of hepatitis B. See recommendation People at higher risk of hepatitis B are recommended to have serological testing for hepatitis B before vaccination. Post-vaccination serological testing is recommended 4–8 weeks after completing the vaccine course for people at risk of hepatitis B infection. For details on who testing is recommended for, see recommendation: People at risk of hepatitis B are recommended to have serological testing 4–8 weeks after they complete the hepatitis B vaccine course.
Post-vaccination serological testing is recommended for infants born to mothers with chronic hepatitis B, 3–12 months after completing the infant hepatitis B vaccine course. See recommendation: Infants born to mothers with chronic hepatitis B are recommended to have serological testing 3–12 months after they complete the infant hepatitis B vaccine course. |
Post-vaccination serological testing is recommended for immunocompromised people and others at risk of severe or complicated hepatitis B infection including people with pre-existing liver disease, haemodialysis patients or people with bleeding disorders who received the vaccine subcutaneously. Testing should be conducted 4–8 weeks after completing the vaccine course. For details on testing requirements and clinical management, see recommendation People at risk of hepatitis B are recommended to have serological testing 4–8 weeks after they complete the hepatitis B vaccine course. Pre-vaccination serological testing can be considered for immunocompromised people. See recommendation People at higher risk of hepatitis B are recommended to have serological testing for hepatitis B before vaccination. |
Routine antenatal screening of all pregnant women for hepatitis B surface antigen (HBsAg) is recommended to detect hepatitis B infection. See recommendation: Pregnant women are recommended to be screened for HBsAg |
Follow guidance for general population Serological testing may be considered if there is a possibility that the individual is not immune (ie vaccination is not documented). |
Serological testing is recommended for healthcare workers and those with frequent exposure to human tissue, blood or fluids if they have never been tested after finishing a complete course of hepatitis B immunisation. For details on testing requirements and clinical management, see recommendation: People at risk of hepatitis B are recommended to have serological testing 4–8 weeks after they complete the hepatitis B vaccine course. |
| MMR (measles, mumps and rubella) |
Serological testing for measles, mumps and/or rubella immunity may be helpful if:
See recommendation: Serological testing for immunity to measles is not recommended before or after receiving measles-containing vaccine, with rare exceptions. |
Follow guidance for the general population. Where confirmation of protection against measles after a complete course of MMR vaccination is desirable, serological testing may be conducted 4–6 weeks after the 2nd dose of MMR vaccine. Note: MMR vaccine is a live attenuated vaccine and is contraindicated for most moderately and severely immunocompromised people. |
Follow guidance for general population for measles and mumps. All women who are planning pregnancy or have recently become pregnant should be screened for rubella antibodies, irrespective of documentation of vaccination with rubella-containing vaccine and/or a previous positive rubella antibody result. See recommendation: Serological testing for immunity to rubella is recommended before or after receiving rubella-containing vaccine in certain circumstances. See recommendation: Women of child-bearing age who are seronegative for rubella are recommended to receive rubella-containing vaccine |
Follow guidance for the general population. Women of child-bearing age: Serological testing for rubella may be recommended for certain women of child-bearing age, including women born overseas, Aboriginal and Torres Strait Islander women living in rural and remote regions, and non-English speaking women. Serological testing in these populations is useful to help identify seronegative women of child-bearing age. See recommendation: Women of child-bearing age who are seronegative for rubella are recommended to receive rubella-containing vaccine |
Follow guidance for the general population. |
| Q fever | People who are being considered for Q fever vaccination are recommended to have both serum antibody testing and a Q-Vax skin test before Q fever vaccination. See recommendation: People are recommended to have both serological and skin tests before Q fever vaccination. | Not required – Q fever vaccination is contraindicated in immunocompromised people | Not required – Q fever vaccine is not routinely recommended for pregnant or breastfeeding women. | Follow guidance for the general population. | Follow guidance for the general population. |
| Rabies |
Not routinely recommended after pre-exposure prophylaxis administered intramuscularly. Serological testing is recommended in people who received pre-exposure prophylaxis by the intradermal route. The recommended timing of serological testing varies depending on the specific circumstances, including patient characteristics, level of exposure risk, vaccination history and exposure type (for post-exposure prophylaxis). See recommendations for immunisation against rabies and other lyssaviruses to determine when serological testing is needed. |
Serological testing after rabies vaccination is recommended, both after pre-exposure prophylaxis and after post-exposure prophylaxis. See recommendations for immunisation against rabies and other lyssaviruses. | Follow guidance for the general population. | Follow guidance for the general population. |
Serological testing for rabies immunity is recommended among people who have occupational risk of exposure to bat lyssaviruses in Australia or overseas. See recommendation: People with ongoing occupational exposure to lyssaviruses are recommended to receive booster doses of rabies vaccine |
| Varicella | Not routinely recommended. | Serological testing may be helpful to guide post-exposure management of immunocompromised people. |
Women who are planning pregnancy or pregnant are recommended to receive screening for varicella immunity. Serological testing should only be conducted in women without a clear history of varicella vaccination and/or varicella or zoster infection. See recommendation: Serological testing for immunity to varicella is not recommended before or after receiving varicella-containing vaccine. |
Serological testing to determine the need for vaccination may be considered if:
See recommendation: Serological testing for immunity to varicella is not recommended before or after receiving varicella-containing vaccine. |
Serological testing can be conducted to demonstrate immunity against varicella if there is an absence of evidence of immunity, ie:
See recommendation: Healthcare workers are recommended to receive 2 doses of varicella vaccine if they are not immune. |
| Yellow fever |
Not routinely recommended. Serological testing may be considered for people who may not have responded optimally to previous yellow fever vaccination (eg women who were pregnant or due to potential immunosuppression at the time of vaccination). See recommendation: People aged ≥9 months travelling to an area with a risk of yellow fever virus transmission are recommended to receive yellow fever vaccine |
Serological testing may be considered to guide decisions on the need for booster doses among certain immunocompromised people who have previously received vaccination, particularly people with HIV. See recommendation: People aged ≥9 months travelling to an area with a risk of yellow fever virus transmission are recommended to receive yellow fever vaccine Note: Yellow fever is contraindicated in people who are severely immunocompromised, with some exceptions. |
Follow guidance for the general population. Note: Yellow fever is usually contraindicated in pregnant people, other than in exceptional circumstances. |
Follow guidance for the general population. | Serological testing is recommended every 10 years for laboratory workers who may be exposed to yellow fever virus. See recommendation: Laboratory workers who may be exposed to yellow fever virus are recommended to receive yellow fever vaccine |
| Zoster (herpes zoster) | Not routinely recommended. | Serological testing before vaccination may be considered if the immunocompromised person’s previous exposure to varicella vaccination or natural infection is unknown. Testing may be useful in determining the type of vaccine required ie varicella or zoster vaccine; eg prior to HSCT. However, the poor sensitivity of the test may limit interpretation.8 | Not routinely recommended. | Not routinely recommended. | Not routinely recommended. |
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Acronyms used: |
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