Contents

2 Processes for safe immunisation

2.7 Adult vaccination (aged 18 years and older)

Whenever adults are seen in general practice or by immunisation providers, there is an opportunity to ensure they have been adequately protected against the following diseases and have received at least a primary immunisation course as described in Table 2.10. If the requisite number of doses has not been received, catch-up vaccination is recommended and funded (see Appendix 2).

Women of childbearing age should know whether or not they are immune to rubella (see chapter 18) and varicella (see chapter 21).

Table 2.10: Primary immunisation requirements for adults (aged 18 years and older) (funded)

Disease Number of vaccine doses
Tetanus 3 doses
Diphtheria 3 doses
Poliomyelitis 3 doses
Measles, mumps, rubella 2 doses
HPV (aged 26 years and under) 3 doses*
* Individuals who were under age 27 years when they commenced HPV vaccination are currently funded to complete the 3-dose course, even if they are older than 27 years when they complete it.

See Table 2.11 for a checklist for adult vaccination, including vaccinations recommended for at-risk groups (funded vaccines are in the shaded boxes). See also chapter 4: ‘Immunisation of special groups’ for information about immunisation during pregnancy and lactation, of immune-deficient individuals, of immigrants and refugees, for travel, and for those with occupational and lifestyle risk factors.

Table 2.11: Checklist for adult vaccination, excluding travel requirements

Vaccine (relevant chapter) Recommended and funded for adults ≥18 years Recommended but not funded for adults ≥18 years
Hib 
(chapters 4 and 6)
For (re-)vaccination of patients who are: post-haematopoietic stem cell transplant (HSCT) or chemotherapy; pre- or post-splenectomy or with functional asplenia; pre- or post-solid organ transplant, pre- or post-cochlear implants, renal dialysis and other severely immunosuppressive regimens  
Hepatitis A 
(chapter 7)
Transplant patients

Close contacts of hepatitis A casesa
Patients with chronic hepatitis B or C infection
Hepatitis B 
(chapter 8)
Household or sexual contacts of patients with acute or chronic hepatitis B infection

HIV-positive patients

Hepatitis C-positive patients

Following non-consensual sexual intercourse

Following immunosuppressionb

Transplant patients

Dialysis patients 

Following needle-stick injury
Non-immune adults at risk
HPV 
(chapters 4 and 9)
Individuals aged 15–26 yearsc,d
Individuals aged 9–26 years:c,d
  • with confirmed HIV infection
  • transplant (including stem cell) patients
  • an additional dose post-chemotherapy
Individuals aged 27 yearsc,d,e and older:
  • who have had little previous exposure to HPV and are now likely to be exposed
  • who are men who have sex with men
  • with HIV
Annual influenza vaccine 
(chapter 10)
Individuals aged 65 years and older

Pregnant women

Individuals aged under 65 years who meet the chronically ill criteria
All other adults
MMR 
(chapters 11, 13 and 18)
Any individual susceptible to any one of these three diseases 

(Re-)vaccination following immunosuppression
 
Meningococcal conjugate MenCCV and 
MCV4-D
(chapters 4 and 12)
Patients pre- or post-splenectomy or with functional asplenia
 
Patients with HIV

Patients with complement deficiency (acquired, including monoclonal antibody therapy against C5, or inherited) 

Patients pre- or post-solid organ transplant

Bone marrow transplant patients

Patients following immunosuppressionb

Close contacts of meningococcal casesf
Young adults in communal accommodation

Laboratory personnel routinely exposed to N. meningitidis
Pneumococcal conjugate PCV13 and polysaccharide 23PPV
(chapters 4 and 15)
Patients:
  • with HIV
  • post-haematopoietic stem cell transplant (HSCT) or chemotherapy
  • pre- or post-splenectomy or with functional asplenia
  • pre- or post-solid organ transplant
  • undergoing renal dialysis
  • with complement deficiency (acquired or inherited)
  • with cochlear implants
  • with primary immune deficiency
PCV13 followed by 23PPV for those at increased risk

PCV13 followed by 23PPV for those aged ≥65 years
IPV
(chapter 16)
Any unvaccinated or partially-vaccinated individual

(Re-)vaccination following immunosuppression
 
Td, Tdap vaccine 
(chapters 5, 14 and 19)
Td for susceptible individuals (including following immunosuppression); boosters at 45 and 65 yearsg

Tdap for pregnant women from 28 to 38 weeks’ gestation

Tdap for (re-)vaccination of patients who are post-HSCT or chemotherapy; pre- or post-splenectomy; pre- or post-solid organ transplant, renal dialysis and other severely immunosuppressive regimens
Tdap instead of Td vaccine for individuals who are likely to be in contact with infants aged under 12 months
Varicella 
(chapter 21)
Non-immune patients:
  • with chronic liver disease
  • with deteriorating renal function before transplantation
  • prior to solid organ transplant
  • prior to any elective immunosuppressionb
  • for post-exposure prophylaxis of immune competent in-patients
Patients at least 2 years after bone marrow transplant

Patients at least 6 months after completion of chemotherapy HIV-positive patients who are non-immune to varicella, with mild or moderate immunosuppression

Patients with inborn errors of metabolism at risk of major metabolic decompensation, with no clinical history of varicella

Household contacts of paediatric patients who are immune compromised or undergoing a procedure leading to immune compromise, where the household contact has no clinical history of varicella

Household contacts of adult patients who have no clinical history of varicella and who are severely immune compromised, or undergoing a procedure leading to immune compromise, where the household contact has no clinical history of varicella
Non-immune individuals
Zoster 
​(chapter 22)
  Adults aged 50 years and older

Notes

aOnly 1 dose of hepatitis A vaccine is funded for close contacts of hepatitis A cases.
bNote that the period of immunosuppression due to steroid or other immunosuppressive therapy must be longer than 28 days.
cIndividuals who started with HPV4 may complete their remaining doses with HPV4 or with HPV9 when available.
dIndividuals who were under age 27 years when they commenced HPV vaccination are currently funded to complete the three-dose course, even if they are older than 27 years when they complete it.
eHPV vaccine is registered for use in females aged 9–45 years and in males aged 9–26 years. However, there are no theoretical concerns that the efficacy or safety of HPV vaccine in males up to the age of 45 years will differ significantly from females of the same age or younger males.
fOnly 1 dose of meningococcal conjugate vaccine is funded for close contacts of meningococcal cases.
gThe administration charge for the Td booster is not funded, although the vaccine is free.