Table. Responses to conditions or circumstances identified through the pre-vaccination screening checklist

Unwell today:

• acute febrile illness (current temperature ≥38.5°C)
• acute systemic illness 

• Defer all vaccines until not febrile.
• Vaccinate individuals who have minor illnesses (without acute systemic symptoms/signs).

• 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.

• Do not vaccinate.
• Seek further medical advice to confirm causality and assist with other vaccinations.
• See also Contraindications to vaccination.

• 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. However, some people may still be able to receive the vaccine. Seek specialist advice, if appropriate.

See Vaccination for people who have had an adverse event following immunisation

• 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 MMR, MMRV and varicella vaccines.
• The recommended interval to vaccination depends on the immunoglobulin or blood product received.

• Ensure that women planning pregnancy and their household members have received vaccines recommended for their age group, such as:
  • 2nd dose of MMR 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.

• See Vaccination for women who are planning pregnancy, pregnant or breastfeeding.
• Influenza, pertussis, and RSV vaccines are recommended for all pregnant women. COVID-19 vaccine is recommended for unvaccinated 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.
• Vaccines can protect the mother and importantly, provide passive antibodies to the newborn, to protect them in early infancy.

• See After vaccination, Zoster and Influenza.
• Assess the risks and benefits of influenza vaccine against the potential risk of GBS recurrence. Seek expert advice if needed.

• 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 born at <32 weeks gestation are recommended to receive monoclonal antibody soon after birth (see RSV).

• 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.

• See Vaccination for people with bleeding disorders.
• Consider the subcutaneous route as an alternative to the intramuscular route. Seek specialist advice.

• See Vaccination for Aboriginal and Torres Strait Islander people.
• See the National Immunisation Program for specific recommendations for Aboriginal and Torres Strait Islander people.

• 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.

• Ensure that all recommended vaccines (especially MMR, varicella, influenza and COVID-19 vaccines) have been offered to household members of people who are immunocompromised.
• See Vaccination for people who are immunocompromised.

Acronyms used:

• BCG = bacille Calmette–Guérin;
• dTpa = reduced antigen content diphtheria-tetanus-acellular pertussis;
• MMR = measles-mumps-rubella;
• MMRV = measles-mumps-rubella-varicella.