Table. Responses to conditions or circumstances identified through the pre-vaccination screening checklist | The Australian Immunisation Handbook

Condition or circumstance of person to be vaccinated	Action	Rationale^3-5
Unwell today: acute febrile illness (current temperature ≥38.5°C) acute systemic illness	Defer all vaccines until not febrile. Vaccinate children who have minor illnesses (without acute systemic symptoms/signs).	To avoid an adverse event in an already unwell person, or to avoid attributing symptoms to vaccination
Disease that lowers immunity Receiving treatment that lowers immunity Infant of a mother who received immunosuppressive therapy during pregnancy	See Vaccination for people who are immunocompromised or Vaccination for women who are planning pregnancy, pregnant or breastfeeding. If necessary, seek expert advice before vaccination. Vaccinate people who live with someone with lowered immunity, including with live viral vaccines.	Vaccine safety and effectiveness may be suboptimal in people who are immunocompromised. Live attenuated vaccines may be contraindicated.
Anaphylaxis following a previous dose of the relevant vaccine	Do not vaccinate. Seek further medical advice to confirm causality and assist with other vaccinations. See also Contraindications to vaccination.	Anaphylaxis to a previous dose of a vaccine is a contraindication to receiving the same vaccine.
Severe allergy to a vaccine component	See Table. Components of vaccines used in Australia. Do not vaccinate, but seek specialist advice. The person may still be able to receive the vaccine, depending on the allergy.	Anaphylaxis to a vaccine component is generally a contraindication to receiving the vaccine.
Received a live attenuated viral parenteral vaccine or vaccine in past 4 weeks	Delay live attenuated viral parenteral vaccines by 4 weeks.	The immune response to a live attenuated viral parenteral vaccine may interfere with the response to a subsequent live viral vaccine given within 4 weeks.
Received any blood product in the past 7 months Received intramuscular or intravenous immunoglobulin in the past year	Check which product the person received and the interval since administration. See Table. Recommended intervals between immunoglobulins or blood products, and measles-mumps-rubella, measles-mumps-rubella-varicella or varicella vaccination in Vaccination for people who have recently received normal human immunoglobulin and other blood products. If the person cannot receive the vaccine now, make a return appointment and send a reminder later.	Antibodies in blood products may interfere with the immune response to , and varicella vaccines. The recommended interval to vaccination depends on the immunoglobulin or blood product received.
Planning a pregnancy or anticipating parenthood	Ensure that women planning pregnancy and their household members have received vaccines recommended for their age group, such as: 2nd dose of if born after 1966 (see Measles, Mumps and Rubella for more details) varicella Ensure that the woman has had appropriate pre-conception serological testing. See Vaccination for women who are planning pregnancy, pregnant or breastfeeding. Advise women not to become pregnant within 28 days of receiving live viral vaccines.	Vaccinating before pregnancy may prevent maternal illness that could affect the infant. It may confer passive immunity to the newborn. There is insufficient evidence to ensure the safety of live vaccines during pregnancy.
Pregnant	See Vaccination for women who are planning pregnancy, pregnant or breastfeeding. Influenza and pertussis vaccines are recommended for all pregnant women. Defer live vaccines until after delivery. Vaccinate household contacts of pregnant women, if required (see recommendations in relevant disease chapter).	There is insufficient evidence to ensure the safety of live vaccines during pregnancy. Inactivated vaccines are generally not contraindicated in pregnancy. Influenza and pertussis vaccines protect the mother and provide passive antibodies to the newborn, to protect them in early infancy.
History of Guillain–Barré syndrome ()	See Vaccination for people who are immunocompromised and Influenza. Assess the risks and benefits of influenza vaccine against the potential risk of recurrence. Seek expert advice if needed.	In people with a history of , the condition may recur after receiving influenza vaccine.
Born preterm	See Vaccination for preterm infants. Preterm infants born at <28 weeks gestation and/or with chronic lung disease need extra pneumococcal vaccinations (see Pneumococcal disease) and annual influenza vaccination (see Influenza). Preterm infants born at <32 weeks gestation and/or <2000 g birth weight may need an extra dose of hepatitis B vaccine (see Hepatitis B).	Preterm infants may be at increased risk of vaccine-preventable diseases (eg invasive pneumococcal disease). They may not mount an optimal immune response to certain vaccines (eg hepatitis B).
Severe or chronic illness	See Vaccination for special risk groups. These people should receive recommended vaccines such as pneumococcal vaccine and annual influenza vaccination. If they have significant immunocompromise, they should not receive live vaccines.	People with a severe or chronic illness may be at increased risk of vaccine-preventable diseases (eg invasive pneumococcal disease). They may not mount an optimal immune response to certain vaccines. Vaccine safety and effectiveness may be suboptimal in people who are immunocompromised.
Bleeding disorder	See Vaccination for people with bleeding disorders. Consider the subcutaneous route as an alternative to the intramuscular route. Seek specialist advice.	Intramuscular injection may lead to haematomas in people with haemostasis disorders.
Aboriginal or Torres Strait Islander person	See Vaccination for Aboriginal and Torres Strait Islander people. See the National Immunisation Program for specific recommendations for Aboriginal and Torres Strait Islander people.	Some Aboriginal and Torres Strait Islander people are at increased risk of some vaccine-preventable diseases, such as influenza, pneumococcal disease and hepatitis A.
No functioning spleen	See People with functional or anatomical asplenia in Vaccination for people who are immunocompromised. Check the person’s vaccination status for pneumococcal, meningococcal, influenza and Hib vaccinations.	People with an absent or dysfunctional spleen are at increased risk of severe bacterial infections, especially invasive pneumococcal disease.
Parent, grandparent or carer of an infant ≤6 months of age	Ensure that parents, grandparents and carers of infants up to 6 months of age have been offered all vaccines recommended for their age group, including (see Diphtheria, Tetanus and Pertussis for more details).	People in close contact with newborns are the most likely sources of vaccine-preventable diseases, especially pertussis, in the newborn.
Lives with someone who is immunocompromised	Ensure that all recommended vaccines (especially , varicella and influenza vaccines) have been offered to household members of people who are immunocompromised. See Vaccination for people who are immunocompromised.	Household members are the most likely sources of vaccine-preventable diseases among people who are immunocompromised. People who are immunocompromised are often unable to be vaccinated, especially with live viral vaccines.
Planning travel	See Vaccination for international travellers.	Travellers may be at increased risk of certain vaccine-preventable diseases.
Occupational or lifestyle factors	See Vaccination for people at occupational risk, Vaccination for other groups, and Table. Catch-up schedule for people ≥10 years of age (for vaccines recommended on a population level in Catch-up vaccination.	Workers in certain occupations (eg healthcare workers, and people working in early childhood education and care) and people with certain lifestyle factors (eg people who inject drugs) may be at increased risk of certain vaccine-preventable diseases.

= bacille Calmette–Guérin; = reduced antigen content diphtheria-tetanus-acellular pertussis; = measles-mumps-rubella; = measles-mumps-rubella-varicella.

Last updated:

8 June 2018

Last reviewed:

8 June 2018

Definitions

BCG: bacille Calmette-Guérin
MMR: measles-mumps-rubella
MMRV: measles-mumps-rubella-varicella
GBS: Guillain-Barré syndrome
dTpa: diphtheria-tetanus-acellular pertussis vaccine, reduced antigen content formulation

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