How to manage adverse events following immunisation (AEFI), including anaphylaxis. How to document the vaccine given and report it to the immunisation register.
Immediately after vaccine administration:
- Dispose of clinical waste, including sharps and vaccine vials, at the point of use. See your state or territory management guidelines for how to safely dispose of clinical waste. Also see the National Health and Medical Research Council’s Australian Guidelines for the Prevention and Control of Infection in Healthcare.1
Cover the injection site quickly with a dry cotton ball and tape as needed.
Gently apply pressure for 1 or 2 minutes. Do not rub the site — rubbing will encourage the vaccine to leak back up the needle track, which can cause pain and local irritation.
To distract the vaccinated person and reduce distress, immediately change their position after completing the vaccination. For example, ask the parent/carer to put the infant over their shoulder and move around.2
Remove the cottonwool after a few minutes and leave the injection site exposed to the air.
Record the relevant details of the vaccines given — see Documenting vaccination.
Keep the person under observation for at least 15 minutes to ensure that they do not experience an immediate adverse event, and to provide rapid medical care if needed. They should not drive or operate machinery during this time.
Inform the vaccinated person or their parent/carer, preferably in writing, of any expected adverse events following immunisation, and of the date of the next scheduled vaccination(s).
Take the opportunity to check the vaccination status of other family members (as appropriate), and discuss any catch-up vaccination requirements and options available. This can also be done earlier in the visit.
Paracetamol may be recommended, as required, for fever or pain after vaccination. Paracetamol is not recommended prophylactically, except for MenB (meningococcal B) vaccine in infants <2 years of age (see Meningococcal disease). See Common adverse events following immunisation and how to manage them.
Immunisation providers must document all vaccinations. This includes:
- documenting the vaccination in the person’s medical record
- notifying the vaccination to the relevant immunisation register
Document all vaccines administered to children in the child’s clinical file and the individual child health record. The parent or carer keeps this record and presents it every time the child sees a health professional.
See also Reporting to immunisation registers.
Adolescents and adults
Record vaccines administered to adolescents and adults in both the vaccinated person’s clinical file and the personal health record, or individual record of vaccination. Record the following details:
- the person’s full name and date of birth
- details of the vaccine given, including the brand name, batch number and dose number
- date and time of vaccination
- site of administration
- name of the person providing the vaccination
- date the next vaccination is due
See also Reporting to immunisation registers.
Healthcare workers or students
Healthcare workers or healthcare students doing work or clinical placement in state or territory health facilities may have specific requirements for documenting their vaccinations. Contact your state or territory health department for specific requirements.
See also Reporting to immunisation registers.
Reporting to immunisation registers
The Australian Immunisation Register (AIR) captures all the vaccines a person receives throughout their life. This includes vaccines received in general practice and in community clinics.
All people of all ages who are enrolled in Medicare are automatically included on the AIR. People not enrolled in Medicare are included when an immunisation provider sends details of a vaccination to the register. Immunisation providers other than general practitioners need to register with the AIR before they can send data to it.
The Australian Immunisation Register Act 2015 came into effect on 1 January 2016, and provides the legal authority for the expansion and ongoing administration and keeping of immunisation registers. Before 2016, Australia had 2 national immunisation registers:
- The Australian Childhood Immunisation Register (ACIR) started on 1 January 1996 and recorded details of vaccines given to children <7 years of age who live in Australia. The ACIR expanded in 2016 to become the AIR.
- The National Human Papillomavirus Vaccination Program Register (HPV Register) started in 2007 to record information about HPV vaccine doses administered in Australia.
Why report to the registers?
National immunisation registers provide an important means of ensuring accountability of, and evaluating, Australia’s funded National Immunisation Program. They are the primary means of determining vaccination coverage at national, state and territory, and local levels.
Registers provide a central record of the vaccination history of every Australian. They are accessible by Australian immunisation providers to assess a person’s vaccination history and plan vaccination needs.
AIR data are used to determine a family’s entitlement to government family assistance payments, including:
- the Child Care Benefit and Child Care Rebate
- the Family Tax Benefit Part A supplement
Immunisation requirements for eligibility for these payments include all people up to 20 years of age.
It is therefore important that immunisation providers promptly submit vaccination data to the AIR.
The Australian Government Department of Human Services website has more details about immunisation requirements for family assistance payments.
Australian Immunisation Register
Immunisation providers should send details of all National Immunisation Program and private vaccinations to the AIR. Vaccination details can be submitted to the AIR:
- using Practice Management Software
- through Health Professional Online Services (HPOS)
- manually using a paper form (either an immunisation encounter form or an immunisation history form)
More details about reporting to the AIR for health professionals can be found on the Australian Government Department of Human Services website.
When required, exemptions to immunisation can be given for medical contraindications or natural immunity to certain diseases. Immunisation medical exemptions can only be given by:
- general practitioners
- general practice registrars on an approved training placement
- public health physicians
- infectious diseases physicians
- clinical immunologists
The medical exemption form is available on the Australian Government Department of Human Services website.
An individual’s vaccination record can be updated with vaccination details where there is documentation that the vaccination was given by another immunisation provider (including vaccines given while the child, adolescent or young adult was overseas) by completing and sending an immunisation history form, available on the Australian Government Department of Human Services website.
Resources on the AIR website
The Australian Government Department of Human Services website has information and resources about the AIR. The website has:
- a general information area for individuals and families
- a general information area for health professionals
- a secure area for immunisation providers only
The AIR secure site, which is within HPOS, allows immunisation providers to obtain a range of statistical and identified reports. Depending on the provider’s access level, they can view a child’s, adolescent’s or young adult’s vaccination details; record vaccination information; and access a range of other reports.
All general practitioners with access to HPOS can access the AIR secure site through this platform. Other immunisation providers can register for access to the AIR secure site by completing the online request form, available from the Australian Government Department of Human Services website.
For more details or for assistance on any reporting issues, call the AIR Internet Helpline on 1300 650 039.
Immunisation History Statement
Immunisation History Statements contain details of vaccines included in the National Immunisation Program and most privately purchased vaccines. These statements are automatically generated when a child completes the childhood vaccination schedule (usually at around 4 years of age). Statements are mailed to the address most recently recorded by Medicare for that person.
Parents and carers of children <14 years of age, adolescents ≥14 years of age and adults can get a copy of their immunisation history at any time:
- using their Medicare online account through myGov
- through the Medicare Express Plus mobile app
- by calling 1800 653 809 (free call)
Immunisation History Statements can help people recall vaccination history when required, including:
- for childcare and school enrolment
- to determine eligibility for the Child Care Benefit, the Child Care Rebate and the Family Tax Benefit Part A supplement — this requires that children are assessed as fully immunised
Recording details of a deceased person
Medicare notifies the AIR of the death of a child or young individual <20 years of age. Immunisation providers no longer need to provide this information to the AIR.
Children who moved overseas
If a child, adolescent or young adult <20 years of age has moved overseas, their immunisation provider can inform the AIR by telephone or secure-site email. This prevents their name continuing to appear on AIR reports of overdue individuals.
People born overseas who have moved to Australia permanently
A person born overseas who has moved permanently to Australia will be automatically added to the AIR when they enrol with Medicare. Individuals residing temporarily in Australia are not included on the AIR until an immunisation provider notifies the register of a vaccine administered to that person.
The National Human Papillomavirus Vaccination Program Register (HPV Register) was introduced in 2007. It records information about HPV vaccine doses administered in Australia. This fulfils an essential role in monitoring and evaluating the HPV Vaccination Program.
Some states and territories also maintain records of vaccines delivered through school-based programs. Contact your state or territory government health department for details on how to obtain these records.
Reporting to the HPV Register
Details of HPV vaccines given in the community are provided to the HPV Register by the immunisation provider who administers the vaccine. Vaccination details may be submitted electronically, in data uploads or direct entry using the secure website, or in hard copy, using one of the approved notification forms.
Immunisation providers need to be approved and registered with the HPV Register to electronically notify administered doses.
More details about registration and notification procedures are available from the HPV Register website or by calling 1800 478 734 (1800 HPV REG).
HPV vaccination coverage and other reports
Overdue HPV vaccine dose reports are available on the HPV Register secure website for immunisation providers. De-identified HPV vaccination coverage data and other reports have also been developed to inform policy-making, and support program delivery and approved research. National coverage data are made publicly available on the HPV Register website.
HPV Register statements
The HPV Register sends Completion Statements and History/Reminder Statements. Immunisation History Statements, containing details of the vaccinations recorded on the HPV Register, are sent to people who are overdue for HPV vaccination within the school-based program. Completion Statements are sent to people who have completed the 2- or 3-dose HPV vaccination course.
Vaccinated people and parents or carers can request a statement at any time by calling 1800 478 734 (1800 HPV REG). If booster doses are needed in future, all eligible people will be notified by the HPV Register.
HPV vaccination status
Immunisation providers can also request a person’s vaccination status by telephone or view it online if they are registered with the HPV Register.
HPV Register secure website
The HPV Register secure website allows registered and approved immunisation providers to view a person’s vaccination history and access overdue dose reports. More details on how to request access to the HPV Register secure website are on the health professionals page of the HPV Register website or by calling 1800 478 734 (1800 HPV REG).
Australian Q Fever Register
The Australian Q Fever Register records information about people who have received Q fever vaccine. Registered users can access this information.
See Q fever.
Adverse events following immunisation
An adverse event following immunisation (AEFI) is any negative reaction that follows vaccination. It does not necessarily have a causal relationship with the vaccine.
The adverse event may be any:3
- unfavourable or unintended sign
- unfavourable or unintended symptom
- abnormal laboratory finding
These events may be caused by the vaccine(s) or may occur by chance (that is, the event would have occurred regardless of vaccination).
Frequency of AEFIs
The frequency of adverse events is classified by regulatory agencies and often reported in clinical trials as:4
- very common (>10% of people vaccinated)
- common (1–10%)
- uncommon (0.1 to <1%)
- rare (0.01% to <0.1%)
- very rare (<0.01%)
Minimising the risk of AEFIs
Screen each person to be vaccinated using the pre-vaccination screening checklist in Preparing for vaccination. This helps ensure that the person does not have a condition that increases the risk of an AEFI or is a contraindication to vaccination.
- the disease-specific chapters of this Handbook, including the variations from product information
- any other relevant sources, such as state or territory guidelines
Always use correct injection procedures to help minimise adverse events. See Administration of vaccines.
Informing the person being vaccinated about possible adverse events
Advise the person, or their parent or carer about what common adverse events are likely or expected and what they should do about them. This should be part of the consent procedure.
It is preferable to give people written advice, such as Table. Common side effects following immunisation for vaccines used in the National Immunisation Program schedule.
See also Preparing for vaccination.
Immediate AEFIs and how to manage them
The most serious immediate AEFI is anaphylaxis. Severe anaphylactic reactions usually happen rapidly, within 15 minutes of vaccination.
Anaphylaxis after routine vaccination is very rare, but can be fatal.5
All immunisation providers must be able to:
- recognise all the symptoms and signs of anaphylaxis
- distinguish between anaphylaxis, convulsions and fainting
- Table. Clinical features that may help differentiate between a vasovagal episode and anaphylaxis
- Table. Recognition and treatment of anaphylaxis
- Infographic. Managing anaphylaxis after vaccination
- Infographic. Preparing an anaphylaxis response kit
Signs and symptoms of anaphylaxis
Anaphylaxis is characterised by sudden respiratory compromise and/or circulatory collapse.6
Early signs involve the skin — for example:
- generalised erythema
Early signs can also involve the gastrointestinal tract — for example:
Severe cases may have:
- circulatory collapse
- altered level of consciousness
- weak or absent pulse
- marked respiratory compromise from upper airway oedema or bronchospasm
Rapid intramuscular administration of adrenaline is the cornerstone of anaphylaxis treatment. Adrenaline is lifesaving and must be used promptly.7
Antihistamines or hydrocortisone are not recommended to manage anaphylaxis in an emergency.
Every time vaccines are given, these things must be immediately to hand:
- a protocol for managing anaphylaxis
- 1 mL syringes
Protocol for managing anaphylaxis
- If the person is unconscious, lie them on their left side and position them to keep the airway clear.
- If the person is conscious, lie them on their back in ‘head-down and feet-up’ position, unless this causes breathing difficulties.
- If the person has respiratory or cardiovascular symptoms or signs of anaphylaxis, give adrenaline by intramuscular injection into the anterolateral thigh. See Using adrenaline for dosage.
- Call for help. Never leave the patient alone.
- If oxygen is available, give it to the person by facemask at a high flow rate.
- If the person’s condition does not improve within 5 minutes, give another dose of adrenaline. Keep giving doses every 5 minutes until the person improves.
- Check the person’s breathing. If they are not breathing, start basic life support or cardiopulmonary resuscitation (CPR), according to the Australian Resuscitation Council Guidelines.8
- In all cases, transfer the person to hospital for more observation and treatment.
- Fully document the event, including the time and dose(s) of adrenaline given.
Adrenaline 1:1000 is recommended to treat anaphylaxis because it is universally available. Adrenaline 1:1000 contains 1 mg of adrenaline per mL of solution in a 1 mL glass vial.
Adrenaline 1:10,000 is not recommended to treat anaphylaxis.
Adrenaline is not needed for generalised non-anaphylactic reactions (such as skin rash or angioedema). If in doubt, give intramuscular adrenaline. No serious or permanent harm is likely to occur from administering adrenaline to a person who is not experiencing anaphylaxis.9
Use a 1 mL syringe to improve measurement accuracy when drawing up small doses of adrenaline.
Dosage and administration of adrenaline
The recommended dose of 1:1000 adrenaline is:
- 0.01 mL per kg body weight (equivalent to 0.01 mg per kg or 10 µg per kg)
- up to a maximum of 0.5 mL
- given by deep intramuscular injection, preferably in the anterolateral (upper outer) thigh
Repeat the dose of 1:1000 adrenaline every 5 minutes until there is clinical improvement.
The anterolateral thigh is the preferred site because adrenaline disperses more predictably from this site.10 This also aligns with recommendations from various professional bodies in:11
- emergency medicine
Do not give adrenaline 1:1000 intravenously.
Table. Doses of intramuscular 1:1000 adrenaline for anaphylaxis lists the dose of 1:1000 adrenaline to use if you do not know the person’s exact weight.
Approximate age and weight
<1 year (approx. 5–10 kg)
1–2 years (approx. 10 kg)
2–3 years (approx. 15 kg)
4–6 years (approx. 20 kg)
7–10 years (approx. 30 kg)
10–12 years (approx. 40 kg)
|>12 years and adults, including pregnant women (over 50 kg)||
Source: Modified from Australasian Society of Clinical Immunology and Allergy12
Using adrenaline autoinjectors
Adrenaline autoinjectors (EpiPen) are devices that administer a single, pre-measured dose of adrenaline.
They are designed for use by anyone, whether medically trained or not. Clear instructions on correct use are on the device’s barrel and in the packaging.
Autoinjectors are usually recommended or prescribed for:
- people who are at risk of anaphylaxis due to an existing allergy
- people for whom skin testing indicates a high risk of an allergic reaction on exposure to an allergen
If a person who carries an autoinjector device develops anaphylaxis after vaccination, it is appropriate to use their autoinjector to administer adrenaline.
Administer autoinjectors in the mid-outer thigh.
Autoinjectors are dose-specific:
- EpiPen Jr contains 150 µg adrenaline and is recommended for children weighing between 10 kg and 20 kg.
- EpiPen contains 300 µg adrenaline and is recommended for children and adults weighing more than 20 kg.
Autoinjectors are not recommended for use in children weighing less than 10 kg.
Autoinjectors are usually not appropriate to include in first aid kits for general use. This is because:
- they are single use only
- they are dose-specific
- multiple pens would be needed to allow for repeat dosing and varying ages/weights of patients
- shelf-life is 1–2 years maximum
The most common immediate adverse event in adults and older children is a vasovagal episode (fainting). This can occur either immediately or soon after vaccination.
Fainting after vaccination can be serious. If a person feels giddy or light-headed before or after vaccination, advise them to lie down until they feel better.
Infants and children rarely faint. Assume that any sudden loss of consciousness in young children is anaphylaxis, particularly if there is no strong central pulse.
A key difference between anaphylaxis and vasovagal episodes is that:
- a central pulse is weak or absent in anaphylaxis
- a central pulse is strong in a vasovagal episode or convulsion
If anaphylaxis is suspected, give the person adrenaline as quickly as possible7 (see Managing anaphylaxis). Undertreatment of anaphylaxis is more harmful, and potentially life-threatening, than overtreatment of a mild or moderate allergic reaction.11
Respiratory symptoms or signs
Cardiovascular symptoms or signs
Skin symptoms or signs
Gastrointestinal symptoms or signs
Neurologic symptoms or signs
Note: Anaphylaxis features are modified from The Brighton Collaboration Case Definition Criteria for Anaphylaxis.5 Neurologic symptoms are not listed in this case definition.5 However, symptoms of anxiety and distress, including feelings of impending doom, are reported in people experiencing anaphylaxis.6
Common AEFIs and how to manage them
Most vaccine adverse events are minor. The most common adverse events are injection site reactions, such as: 13
These are to be expected, are generally mild and usually last for 1–2 days.
Injection site nodules are also fairly common. They are fibrous remnants of the body’s interaction with vaccine components (usually an adjuvant) in the muscle. Nodules may last for many weeks after vaccination and do not need any specific treatment.
Low-grade fever and tiredness (malaise) are also common after many vaccines. These responses are usually mild and self-limiting, and generally do not need specific treatment.
Commonly occurring AEFIs are described in Table. Comparison of the effects of diseases and the side effects of National Immunisation Program vaccines.
Details about the adverse events that are known to occur after vaccination are in the ‘Adverse events’ section of each disease-specific chapter.
Using paracetamol to manage pain or fever
Using paracetamol at the time of, or immediately after, vaccination to reduce the risk of fever is not recommended.
An exception is the specific recommendation to give prophylactic paracetamol with Men B vaccine in infants <2 years of age (see Meningococcal disease).
Infants, children or adults can receive paracetamol if they have:
- fever of >38.5°C following vaccination
- pain at the injection site
The dose of paracetamol for an infant or child up to 12 years of age is 15 mg per kg per dose, up to a maximum dose of 60 mg per kg per day in 4 divided doses.
Adults and children aged ≥12 years can receive 500–1000 mg every 4–6 hours. The dose must not exceed 4 g in 24 hours.
People should not take paracetamol for more than 48 hours without seeking medical advice.14
Seeking medical advice for adverse events
People should seek medical advice if they have unexpected, serious or prolonged adverse symptoms or signs after vaccination.
The symptoms and signs from illness that is unrelated to vaccination can sometimes be attributed to a recent vaccination. These should be investigated and managed.
Uncommon and rare AEFIs
Some vaccines can cause uncommon or rare serious adverse events. The rate of vaccine adverse events is usually hundreds to thousands times less than the rate of disease complications.
The benefits and risks of immunisation are always taken into account when making recommendations for vaccine use.
It is important to advise the person being vaccinated or their parent/carer about known, but rare, AEFIs. Place the advice in the context of the benefits of vaccination. See Vaccination for people who have had an adverse event following immunisation.
If a person has had a serious, uncommon or rare AEFI, it is important that they or their immunisation provider seek advice from a specialist immunisation clinic, or contact their state or territory health authorities for more details. This advice is important to:
- determine the relationship of the adverse event to vaccination
- consider the benefits and risks of further vaccination
- plan for receiving additional doses of that vaccine or other vaccines, as appropriate
People who have had a serious AEFI can usually still receive vaccines under close medical supervision. This does not include people who have a contraindication, such as anaphylaxis to a vaccine component whose identity has been confirmed. For more details, see Vaccination for people who have had an adverse event following immunisation.
Examples of uncommon and rare adverse events are below. Although uncommon or rare, these events are not necessarily causally related to vaccination, even if they occur after vaccination.
Febrile convulsions are a fairly common response to fever of any cause in young children, particularly in those aged <3 years. Incidence peaks at 14–18 months of age. Overall, by the age of 5 years, around 3% of all children will have had a febrile convulsion, regardless of vaccination.
Febrile convulsions are rare after vaccination. They do occur more commonly after some vaccines, but still at a low rate.
For example, MMR (measles-mumps-rubella) and MMRV (measles-mumps-rubella-varicella) vaccines are associated with an increased risk of febrile convulsions around 7–12 days after the 1st vaccine dose (see Measles for more details).
Co-administration of inactivated influenza vaccine and 13vPCV (13-valent pneumococcal conjugate vaccine) may also be associated with an increased risk of febrile convulsions. See Influenza and Pneumococcal disease.
In 2010, 1 brand of seasonal influenza vaccine (bioCSL Fluvax and Fluvax Junior) was associated with high fevers and febrile convulsions in children aged <5 years in Australia. Incidence was estimated at 4.4 per 1000 doses in Western Australia.15 This vaccine is no longer registered for use in this age group. Other influenza vaccines for children have not been associated with an excess risk of fever and febrile convulsions.15,16
Brachial neuritis is inflammation of a nerve in the arm, causing weakness or numbness. It can occur after receiving a tetanus toxoid–containing vaccine. The estimated excess risk is around 0.5–1 in 100,000 doses in adults.4,17
Case reports of brachial neuritis following administration of other vaccines are rare, and a causal relationship has not been established.18 This includes HPV (human papillomavirus) vaccines.19
Oral rotavirus vaccines are associated with a small increased risk of intussusception. This a rare form of bowel blockage caused when the intestine telescopes into itself. The risk appears to be particularly in the 7 days following the 1st vaccine dose. However, a smaller increased risk in the week after the 2nd dose has also been reported.20-22
The increased risk represents around 6 additional cases of intussusception for every 100,000 infants vaccinated, or 14 additional cases per year in Australia.22
Anaphylaxis after immunisation has been reported, but is very rare.23
For example, the estimated incidence rate of anaphylaxis after receiving 4vHPV (4-valent HPV) vaccine in Australia as at June 2015 was 2.8 anaphylaxis episodes per million doses of vaccine distributed.24 This is within the same rate range as for other vaccines given to children and adolescents in international studies, such as hepatitis B vaccine, which is associated with anaphylaxis in approximately 1 in 1.1 million doses distributed.25
A hypotonic-hyporesponsive episode (HHE) is the sudden onset of:
- pallor or cyanosis
- limpness (muscle hypotonia)
- reduced responsiveness or unresponsiveness
This can occur after vaccination where no other cause is evident, such as a vasovagal episode or anaphylaxis.
The episode usually occurs 1–48 hours after vaccination and resolves spontaneously.
There are no known long-term side effects from an HHE.26,27
In Australia during 2011, 3 HHEs were reported per 100,000 doses of DTPa (diphtheria-tetanus-acellular pertussis)–containing vaccine given to children <1 year of age.28
Guillain–Barré syndrome (GBS) is a rare autoimmune condition. It involves acute onset of flaccid paralysis that is:
- rapidly progressive
It may or may not involve sensory loss.
Diagnosis of GBS is complex. Only a physician can diagnose GBS.
A small increased risk of GBS was associated with an influenza vaccine in the United States in 1976. Since then, close surveillance has shown that GBS occurs at a very low rate of up to 1 in 1 million doses of influenza vaccine, if at all.29
Complex regional pain syndrome
Complex regional pain syndrome is an uncommon and poorly understood condition. It is characterised by chronic pain in one or more of the extremities, along with autonomic dysfunction in the affected limb(s). It occurs in response to trauma such as: 30
- medical procedures
Rare cases of complex regional pain syndrome after vaccination have been reported. However, this may be a non-specific reaction to the minor trauma of the injection and not specific to the vaccine(s) used.18
Events where evidence demonstrates no causal link with immunisation
Because vaccines are usually given to healthy people, conditions that occur after a vaccine dose may be attributed to vaccination. This is particularly so for illnesses that are complex and have an unknown or unclear cause.
Many of these illnesses are rare or manifest months to years after vaccination. This means that they are difficult to study in randomised controlled clinical trials, which are usually conducted before vaccine registration.
However, strong epidemiological evidence indicates that there is no causal association between vaccination and many diseases or conditions that were suggested to relate to vaccines. This evidence usually comes from multiple well-conducted post-marketing studies.
Examples of events unrelated to vaccination include:
- sudden infant death syndrome (SIDS) and any vaccine31-33
- autism and MMR vaccine34-37
- multiple sclerosis and hepatitis B vaccine38-41
- inflammatory bowel disease and MMR vaccine34
- diabetes and Hib (Haemophilus influenzae type b) vaccine42-44
- asthma and any vaccine45
People who want advice about links between vaccination and certain conditions can speak to:
- their immunisation provider
- a specialist immunisation clinic
- their state or territory health authority
Promptly report any serious or unexpected AEFI
Providers should use clinical judgement to decide which adverse events to report.
Parents and carers should be encouraged to notify their immunisation provider or health authorities of any AEFI.
Surveillance for AEFIs is an integral part of Australia’s National Immunisation Program. It underpins the safe use of all vaccines in Australia.
Surveillance of AEFIs aims to detect:
- changes in the rates of known adverse events
- any unrecognised or unexpected adverse events
- adverse events that result from program errors, such as incorrect vaccine schedule, delivery or storage
Australia has a vaccine safety surveillance initiative called AusVaxSafety. AusVaxSafety collects reports of AEFIs directly from the public. Software programs installed in sentinel surveillance sites (such as general practices and community immunisation clinics) send SMSs after a vaccination asking about the person’s experience. The system monitors de-identified information to detect possible safety signals for vaccines.
What to report
All immunisation providers should report AEFIs, particularly serious or unexpected AEFIs. This allows any vaccine safety issues to be identified and managed as soon as possible.
Any event that is suspected of being related to vaccination can be reported. All identifying information relating to the reporter and patient is kept strictly confidential.
For details on how to report AEFIs, see How to report AEFIs.
Notifying an adverse event does not imply a causal association with vaccination. Some events may occur coincidentally after vaccination.
When to report AEFIs
Timely notification of adverse events — particularly rapid reporting of serious events — is important to identify any potential concerns.
However, there is no time limit for reporting AEFIs.
Who can report AEFIs
Anyone can report an AEFI, whether they are health professionals or consumers.
An immunisation provider who did not give the vaccine can report an AEFI. Include as much detail as possible in all reports.
Patients and parents should be encouraged to contact their healthcare provider if they are concerned about an adverse event occurring after vaccination, particularly if the reaction is:
As well as reporting AEFIs, immunisation providers may need to advise the person about clinical management and future vaccination. They may need expert advice. Information about specialist immunisation clinics, or the contact details for paediatricians or medical specialists with experience in managing patients with AEFIs, are usually available from state or territory health authorities. Also see Vaccination for people who have had an adverse event following immunisation.
How to report AEFIs
Details of how to report AEFIs in each state and territory are in Table. Contact information for notifying adverse events following immunisation.
Immunisation providers can also report directly to the Therapeutic Goods Administration (TGA) using the Australian Adverse Drug Reaction Reporting System.
Anyone can report adverse events directly to the TGA using the National Adverse Events Following Immunisation (AEFI) reporting form.
State or territory
Report adverse events to
Australian Capital Territory
ACT Health Department
Complete an adverse event reporting form and contact 02 6205 2300.
New South Wales
NSW public health units
Complete an AEFI reporting form and contact your local public health unit on 1300 066 055.
NT Department of Health
Complete an AEFI form and contact your local Centre for Disease Control unit:
Complete the online vaccine reaction report form or telephone 1300 232 272.
Therapeutic Goods Administration
Complete the online reporting form on the TGA website or telephone 1800 020 653
Surveillance of Adverse Events Following Vaccination In the Community (SAEFVIC)
Report to SAEFVIC online or telephone 1300 882 924 (choose option 1).
Western Australian Vaccine Safety Surveillance System (WAVSS)
Report to WAVSS online or telephone 08 9321 1312.
What happens to the reports and data
State and territory health departments forward AEFI notifications to the TGA. The TGA enters the notification into the Adverse Drug Reactions System database. This database includes all adverse reaction reports related to medicines and vaccines.
The TGA forwards copies of AEFI reports it receives from other channels to state and territory health departments.
The TGA aggregates vaccine AEFI reports from all sources. Details on rates and trends in AEFIs are published in the journal Communicable Diseases Intelligence.46
The TGA also transfers reports of adverse events to all medicines, including vaccines, to a publicly accessible search facility, the Database of Adverse Event Notifications.
- National Health and Medical Research Council (NHMRC). Australian guidelines for the prevention and control of infection in healthcare. Canberra: NHMRC; 2010.
- Sparks L. Taking the "ouch" out of injections for children: using distraction to decrease pain. MCN The American Journal of Maternal/Child Nursing 2001;26:72-8.
- Definition and application of terms for vaccine pharmacovigilance. Report of CIOMS/WHO Working Group on Vaccine Pharmacovigilance. Geneva: Council for International Organizations of Medical Sciences, World Health Organization; 2012.
- Institute of Medicine. Stratton KR, Howe CJ, Johnston RB, Jr., eds. Adverse events associated with childhood vaccines: evidence bearing on causality. Washington, DC: National Academy Press; 1994.
- Rüggeberg JU, Gold MS, Bayas JM, et al. Anaphylaxis: case definition and guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2007;25:5675-84.
- Ewan PW. Anaphylaxis. BMJ 1998;316:1442-5.
- Sheikh A, Shehata YA, Brown SG, Simons FE. Adrenaline (epinephrine) for the treatment of anaphylaxis with and without shock. Cochrane Database of Systematic Reviews 2008;(4):CD006312. doi:10.1002/14651858.CD006312.pub2.
- Australian Resuscitation Council, New Zealand Resuscitation Council. Guideline 8. Cardiopulmonary resuscitation. 2016 (accessed Apr 2018).
- Australasian Society of Clinical Immunology and Allergy (ASCIA). Anaphylaxis emergency medication (adrenaline [epinephrine] autoinjectors) for general use. 2017 (accessed Apr 2018).
- Simons FE, Gu X, Simons KJ. Epinephrine absorption in adults: intramuscular versus subcutaneous injection. Journal of Allergy and Clinical Immunology 2001;108:871-3.
- Australasian Society of Clinical Immunology and Allergy (ASCIA). Adrenaline (epinephrine) autoinjectors FAQ. 2018 (accessed Apr 2018).
- Australasian Society of Clinical Immunology and Allergy (ASCIA). Guidelines: acute management of anaphylaxis. Sydney: ASCIA; 2017.
- 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.
- Australian Government Department of Health, Therapeutic Goods Administration (TGA). Paracetamol: practitioner fact sheet. 2003 (accessed Apr 2018).
- Armstrong PK, Dowse GK, Effler PV, et al. Epidemiological study of severe febrile reactions in young children in Western Australia caused by a 2010 trivalent inactivated influenza vaccine. BMJ Open 2011;1:e000016.
- Australian Government Department of Health, Therapeutic Goods Administration. Seasonal flu vaccine: investigation into febrile reactions in young children following 2010 seasonal trivalent influenza vaccination. Status report as at 2 July 2010 (updated 24 September 2010) (accessed Apr 2018).
- Hamati-Haddad A, Fenichel GM. Brachial neuritis following routine childhood immunization for diphtheria, tetanus, and pertussis (DTP): report of two cases and review of the literature. Pediatrics 1997;99:602-3.
- Institute of Medicine. Stratton K, Ford A, Rusch E, Wright Clayton E, eds. Adverse effects of vaccines: evidence and causality. Washington, DC: The National Academies Press; 2012.
- Debeer P, De Munter P, Bruyninckx F, Devlieger R. Brachial plexus neuritis following HPV vaccination. Vaccine 2008;26:4417-9.
- Buttery JP, Danchin MH, Lee KJ, et al. Intussusception following rotavirus vaccine administration: post-marketing surveillance in the National Immunization Program in Australia. Vaccine 2011;29:3061-6.
- Patel MM, López-Collada VR, Bulhões MM, et al. Intussusception risk and health benefits of rotavirus vaccination in Mexico and Brazil. New England Journal of Medicine 2011;364:2283-92.
- Carlin JB, Macartney KK, Lee KJ, et al. Intussusception risk and disease prevention associated with rotavirus vaccines in Australia's national immunization program. Clinical Infectious Diseases 2013;57:1427-34.
- Mahajan D, Cook J, McIntyre PB, Macartney K, Menzies RI. Annual report: surveillance of adverse events following immunisation in Australia, 2010. Communicable Diseases Intelligence 2011;35:263-80.
- Australian Government Department of Health, Therapeutic Goods Administration. Gardasil (quadrivalent human papillomavirus vaccine), update 2. Update – adverse event monitoring: 13 May 2015 (accessed May 2018).
- Bohlke K, Davis RL, Marcy SM, et al. Risk of anaphylaxis after vaccination of children and adolescents. Pediatrics 2003;112:815-20.
- Goodwin H, Nash M, Gold M, Heath TC, Burgess MA. Vaccination of children following a previous hypotonic–hyporesponsive episode. Journal of Paediatrics and Child Health 1999;35:549-52.
- Baraff LJ, Shields WD, Beckwith L, et al. Infants and children with convulsions and hypotonic-hyporesponsive episodes following diphtheria-tetanus-pertussis immunization: follow-up evaluation. Pediatrics 1988;81:789-94.
- Mahajan D, Cook J, McIntyre P, Macartney K, Menzies R. Supplementary report: surveillance of adverse events following immunisation among children aged less than seven years in Australia, 1 January to 30 June 2011. Communicable Diseases Intelligence 2012;36:114-9.
- Nelson KE. Invited commentary: influenza vaccine and Guillain-Barré syndrome – is there a risk? American Journal of Epidemiology 2012;175:1129-32.
- Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR. Proposed new diagnostic criteria for complex regional pain syndrome. Pain Medicine 2007;8:326-31.
- Jonville-Bera AP, Autret E, Laugier J. Sudden infant death syndrome and diphtheria-tetanus-pertussis-poliomyelitis vaccination status. Fundamental and Clinical Pharmacology 1995;9:263-70.
- Mitchell EA, Stewart AW, Clements M, Ford RP, New Zealand Cot Death Study Group. Immunisation and the sudden infant death syndrome. Archives of Disease in Childhood 1995;73:498-501.
- Fleming PJ, Blair PS, Platt MW, et al. The UK accelerated immunisation programme and sudden unexpected death in infancy: case-control study. BMJ 2001;322:822-5.
- MacIntyre CR, McIntyre PB. MMR, autism and inflammatory bowel disease: responding to patient concerns using an evidence-based framework [editorial]. Medical Journal of Australia 2001;175:127-8.
- Madsen KM, Hviid A, Vestergaard M, et al. A population-based study of measles, mumps, and rubella vaccination and autism. New England Journal of Medicine 2002;347:1477-82.
- Taylor B, Miller E, Lingam R, et al. Measles, mumps, and rubella vaccination and bowel problems or developmental regression in children with autism: population study. BMJ 2002;324:393-6.
- Peltola H, Patja A, Leinikki P, et al. No evidence for measles, mumps, and rubella vaccine-associated inflammatory bowel disease or autism in a 14-year prospective study. The Lancet 1998;351:1327-8.
- Monteyne P, André FE. Is there a causal link between hepatitis B vaccination and multiple sclerosis? Vaccine 2000;18:1994-2001.
- Ascherio A, Zhang SM, Hernán MA, et al. Hepatitis B vaccination and the risk of multiple sclerosis. New England Journal of Medicine 2001;344:327-32.
- Demicheli V, Rivetti A, Di Pietrantonj C, Clements CJ, Jefferson T. Hepatitis B vaccination and multiple sclerosis: evidence from a systematic review. Journal of Viral Hepatitis 2003;10:343-4.
- World Health Organization (WHO). The Global Advisory Committee on Vaccine Safety rejects association between hepatitis B vaccination and multiple sclerosis (MS). 2002 (accessed Apr 2018).
- DeStefano F, Mullooly JP, Okoro CA, et al. Childhood vaccinations, vaccination timing, and risk of type 1 diabetes mellitus. Pediatrics 2001;108:e112.
- Classen JB, Classen DC. Clustering of cases of insulin dependent diabetes (IDDM) occurring three years after Hemophilus influenza B (HiB) immunization support causal relationship between immunization and IDDM. Autoimmunity 2002;35:247-53.
- Karvonen M, Cepaitis Z, Tuomilehto J. Association between type 1 diabetes and Haemophilus influenzae type b vaccination: birth cohort study. BMJ 1999;318:1169-72.
- Anderson HR, Poloniecki JD, Strachan DP, et al. Immunization and symptoms of atopic disease in children: results from the International Study of Asthma and Allergies in Childhood. American Journal of Public Health 2001;91:1126-9.
- Dey A, Wang H, Quinn H, Cook J, Macartney K. Surveillance of adverse events following immunisation in Australia annual report, 2015. Communicable Diseases Intelligence 2017;41:E264-78.
- 13-valent pneumococcal conjugate vaccine
- quadrivalent HPV vaccine
- diphtheria-tetanus-acellular pertussis vaccine
- Guillain-Barré syndrome
- sudden infant death syndrome
- National Health and Medical Research Council
- World Health Organization
- Australasian Society of Clinical Immunology and Allergy
This document was printed on: 23/02/2019. Printed content may be out of date. For up to date information, always refer to the digital version: https://immunisationhandbook.health.gov.au/vaccination-procedures/after-vaccination.