Contents

Appendices

Appendix 2: Planning immunisation catch-ups

It is essential that vaccinators have a sound understanding of the number of antigens and the most effective spacing of doses required for a primary course and subsequent boosters in order to assess an individual’s immunisation requirements. The principles described below will help vaccinators in this process. Section A2.1 discusses catch-up requirements for children aged under 18 years, and section A2.2 discusses the requirements for adults.

Plan and document your complete catch-up schedule in the patient notes and recall system to ensure continuity of care.

Vaccinators should always check the manufacturer’s recommendations for age-appropriate vaccine recommendations and the interval(s) required between dose(s). It is important to give all the required doses of each antigen, even if this necessitates an extra dose of another antigen.

For assistance with planning catch-up schedules, contact your immunisation coordinator, the Immunisation Advisory Centre freephone line on 0800 466 863, or discuss with an experienced colleague.

Eligibility for publicly funded vaccines

The Health and Disability Services Eligibility Direction 2011 (the Eligibility Direction) issued by the Minister of Health sets out the eligibility criteria for publicly funded health and disability services in New Zealand. Only people who meet the eligibility criteria defined in the Eligibility Direction can receive publicly funded (ie, free or subsidised) health and disability services.

Note that regardless of their immigration and citizenship status, all children aged under 18 years are eligible to receive Schedule vaccines, and providers can claim the immunisation benefit for administering the vaccines.

Further information on eligibility can be found on the Ministry of Health website (www.health.govt.nz/eligibility).

A2.1 For infants, children and adolescents aged under 18 years who start their vaccinations late or who are more than one month behind a due vaccination date

When planning a catch-up schedule, start by focusing on the antigens already received and the additional antigens required, not the vaccine combinations available or trade names. There is no need to think in terms of events missed, (eg, the 6-week, 3-month, 5-month, 15-month vaccination event). It is important to note the age of the child when the antigens were received.

In the past, catch-up tables were provided, but children seldom fitted these unless they were completely unvaccinated, or there was no documented history and they were assumed to be unvaccinated. Trying to fit a child’s vaccine requirements to a table can result in too many or not enough antigens being administered. Use the following principles to establish what antigens the child requires.

A2.1.1 Principles of catch-up for infants and children aged under 10 years

  1. The best approach is to ascertain the antigens required for their current age, subtract any already given and then develop the individual’s catch up schedule.
  2. There is considerable flexibility when planning catch-up schedules. To offer the best protection in the shortest time possible, vaccines may be given simultaneously and the catch-up schedule shortened to four-weekly intervals (unless otherwise stated by the manufacturer) to ensure the required number of doses are administered.
  3. If the Schedule has been interrupted, do not repeat prior doses, regardless of how long ago the previous doses were given.
  4. If the immunisation status of a child is uncertain or unknown, plan the catch-up schedule assuming the vaccines have not been given.
  5. If a child infrequently attends general practice and failure to return for future immunisation is a concern, it is prudent to administer as many antigens as possible at every visit.
  6. For infants and children aged under 10 years, use DTaP-IPV-HepB/Hib or DTaP-IPV for primary immunisation. Tdap may be used for primary immunisation of children aged 7 to under 18 years (note that Tdap is not registered for children aged under 10 years or for primary immunisation, but there are not expected to be any safety concerns).
  7. The first dose of rotavirus vaccine (RV5, RotaTeq) should be given before age 15 weeks (ie, 14 weeks and 6 days), with subsequent doses administered at a minimum dose interval of four weeks. All three doses must be given by age 8 months and 0 days. Where the first dose is inadvertently given at age 15 weeks or older, the remainder of the series should be completed, but all three doses must be given by age 8 months and 0 days.
  8. The first dose of MMR is scheduled at age 15 months, but may be given to children from age 12 months at the parents’/guardians’ request. If there are concerns about the child returning for follow-up visits, give MMR at the first visit from age 12 months. MMR or any single-antigen measles vaccine given before age 12 months is not counted as part of the two-dose MMR schedule.
  9. A single dose of Hib is required for all children aged 12 months to under 5 years, regardless of the number of doses given in their first year. Healthy children aged 5 years and older do not need Hib.
  10. For infants commencing PCV13 vaccination at ages 7–11 months, a primary course is two doses, with a minimum of four weeks between doses. A booster dose is given after age 12 months, at least four months after the completion of the primary course. Unimmunised children aged 12–23 months require two PCV13 doses, eight weeks apart. Unimmunised children aged 2 to under 5 years require one dose of PCV13.
  11. Remember to check whether the infant/child has any specific health conditions that may make them eligible for additional vaccines or additional doses of vaccine (see chapter 4 and the relevant disease chapters).
  12. Once the child has received the appropriate vaccines for their age, they should continue on the Schedule as usual.

Table A2.1: Minimum number of antigens required, by age at time of presentation, for infants and children aged under 10 years

<12 months 12 months to <5 years 5 years to <10 years
3 DTaPa 3 or 4 DTaPe, f 4 DTaPf
3 Polio (IPV)a 3 or 4 Polio (IPV)e, f, g 3 or 4 Polio (IPV)g
3 Hep Bb 3 Hep Bb 3 Hep Bb
3 Hib 1 Hibh 2 MMR
3 PCVc 1 or 2 PCVi, j  
3 RVd 1 or 2 MMRk  
a Use DTaP-IPV-HepB/Hib or DTaP-IPV for the 3-dose primary series (at a minimum of 4-weekly intervals). They then continue on the usual childhood Schedule with a booster dose of DTaP-IPV given at age 4 years, and at least 6 months after the 3rd dose of the primary series.
b If the child received Hep B at birth, they will require a total of 4 Hep B doses.
c Ideally, the primary course of PCV should be completed with the same manufacturer’s vaccine. Where this is not possible, it is acceptable to use the available PCV vaccine. For infants commencing PCV vaccination at ages 7–11 months, a primary course is 2 doses with a minimum of 4 weeks between doses. A booster dose is given after 12 months of age, at least 4 months after the completion of the primary course.
d The 1st dose of rotavirus vaccine should be given before age 15 weeks (ie, 14 weeks and 6 days), with subsequent doses administered at a minimum dose interval of 4 weeks. All 3 doses must be given by age 8 months and 0 days. Where the 1st dose is inadvertently given at age 15 weeks or older, the remainder of the series should be completed but all 3 doses must be given by age 8 months and 0 days.
e Children commencing immunisation at age 12 months to under 4 years require 3 doses of DTaP- and IPV-containing vaccines – use DTaP-IPV-HepB/Hib or DTaP-IPV (at a minimum of 4-weekly intervals). They then continue on the usual childhood Schedule with a booster dose of DTaP-IPV given at age 4 years, and at least 6 months after the 3rd dose.
f Children commencing immunisation from age 4 years require 4 doses of DTaP. Use DTaP-IPV-HepB/Hib or DTaP-IPV for the 3-dose primary series (at a minimum of 4-weekly intervals). The 4th DTaP-containing dose is given at least 6 months after the 3rd dose.
g A minimum of 3 polio doses are required for the primary series for children aged under 10 years, but 4 doses may be given when combination vaccines are used (eg, DTaP-IPV-HepB/Hib or DTaP-IPV). The minimum recommended interval between IPV doses 1 and 2 is 4 weeks; the 3rd IPV dose should be given at least 6 months after dose 2. If the 3rd dose is given in a shorter time interval than this (eg, if used with a DTaP catch-up) then a 4th IPV dose should be given at least 6 months after the 3rd dose.
h A single dose of Hib is required for all children from age 12 months to under 5 years, regardless of the number of doses given before age 12 months.
i For children commencing immunisation at age 12–23 months, 2 PCV doses are required, a minimum of 8 weeks apart. If vaccination commences at age 24 months (2 years) or older, only 1 PCV dose is required.
j If a full primary course (ie, 3 doses) of PCV7 or PCV10 has been given, only 1 further PCV13 dose is required if the age at presentation is 12 months to under 5 years. A minimum interval of 4 months is required between the primary course and this booster dose. If the child has completed all 4 doses of PCV10 (the primary series and the 15-month booster), no further dose of PCV13 is required.
k Children commencing immunisation at age 12 months to under 4 years require 1 dose of MMR. They then continue on the usual childhood Schedule with a 2nd dose of MMR given at age 4 years, and four weeks after the 1st dose. Children commencing immunisation at age 4 years require 2 doses of MMR 4 weeks apart.

A2.1.2 Principles of catch-up for children and adolescents aged 10 to under 18 years

  1. The best approach is to ascertain the antigens required for current age, subtract any already given and then develop the individual’s catch-up schedule.
  2. There is considerable flexibility when planning catch-up schedules. Vaccines may be given simultaneously and the catch-up schedule shortened to four-weekly intervals (unless otherwise stated by the manufacturer) to ensure the required number of doses are administered to offer the best protection in the shortest time possible.
  3. If the Schedule has been interrupted, do not repeat prior doses regardless of how long ago the previous doses were given.
  4. If the immunisation status of an individual is uncertain or unknown, plan the catch-up schedule assuming the vaccine has not been given.
  5. If an individual infrequently attends general practice and failure to return for future immunisation is a concern, it is prudent to administer as many antigens as possible at every visit.
  6. For individuals from age 10 years to under 18, Tdap is recommended and funded for primary and booster immunisation. While Tdap is not approved for use (registered) as a primary course, there are expected to be no safety concerns in using Tdap for primary immunisation in children aged 10 to under 18 years. Therefore, using Tdap should be considered for all catch-up schedules for primary and booster immunisations.
  7. For individuals aged 11–15 years, an alternative two-dose hepatitis B catch-up schedule may be considered using the monovalent hepatitis B vaccine (HBvaxPRO 10 µg), with the second dose given four to six months after the first.
  8. Individuals aged 14 years and under receive two doses of HPV, at 0 and 6–12 months. Individuals aged 15 years and older receive three doses of HPV, at 0, 2 and 6 months or 0, 1 and 4 months. Those who started with HPV4 may complete their remaining doses with HPV4 or with HPV9 when available. Non-residents who were under age 18 years when they commenced HPV vaccination are currently funded to complete the course, even if they are aged 18 years or older when they complete it. See Table A2.9 for HPV catch-up schedules.
  9. Remember to also check whether the individual has any specific health conditions that may make them eligible for additional vaccines or additional doses of vaccine (see chapter 4: ‘Immunisation of special groups; and the relevant disease chapters).
  10. Once the individual has received the appropriate vaccines for their age they should continue on the Schedule as usual.

Table A2.2: Minimum number of antigens required by individuals aged 10 to under 18 years at the time of presentation

10 years to <18 years
4 Tdapa
3 Polio (IPV)b
3 Hep B (5 µg) for children aged 10 to <18 years; or 2 Hep B doses (10 µg) for children aged 11–15 yearsc
2 MMR
2 HPVd,e,f for those aged 11–14 years, or 3 HPVd,g for those aged 15 years and older
a If aged 10 years to under 18 years, use Tdap for the primary series and the booster dose, with a minimum interval of 6 months between doses 3 and 4 (the primary series and the booster dose).
b The minimum recommended interval between IPV doses 1 and 2 is 4 weeks; the 3rd IPV dose should be given at least 6 months after dose 2. If the 3rd dose is given in a shorter time interval than this, a 4th IPV dose should be given at least 6 months after the 3rd dose.
c If aged 10 years to under 18 years, 3 doses of Hep B (5 µg) are required. An alternative 2-dose schedule of Hep B (10 µg; HBvaxPRO) may be used for children aged 11–15 years, with the 2nd dose given 4–6 months after the 1st.
dIndividuals who started with HPV4 may complete their remaining doses with HPV4 or with HPV9 when available.
eFor those aged 11–14 years, the 2nd HPV dose is preferably given at least 6 months after the 1st. If the 2nd dose is given earlier than 5 months after the 1st, a 3rd HPV dose is recommended and funded. . Give the 3rd dose at least 6 months after the 1st dose.
fRegardless of the age at the 1st dose, if the 2nd HPV dose is given at age 15 years or older a 3rd HPV dose is recommended and funded. Give the 3rd dose at least 4 months after the 2nd dose.
gFor those aged 15 years and older, give a 3-dose HPV course at 0, 2 and 6 months. If a shortened schedule is required for these older individuals, give the 2nd dose at least 1 month after the 1st dose and the 3rd dose at least 3 months after the 2nd dose.

A2.1.3 National Immunisation Schedule catch-up guides for infants, children and adolescents aged under 18 years

Note, these are a guide only. The vaccinator must subtract any previous doses given. It is important to note the age at which the antigens have been given.

Table A2.3: Age at presentation: 3–6 months

Note: subtract previous doses given.

Dose Vaccines
First dose* DTaP-IPV-HepB/Hib PCV RV*
4 weeks later DTaP-IPV-HepB/Hib PCV RV*
4 weeks later DTaP-IPV-HepB/Hib PCV RV*
Once the child has received the appropriate vaccines for their age, continue on the Schedule as usual.
* Only eligible for RV if the 1st dose is given before age 15 weeks (ie, 14 weeks and 6 days). The 3rd dose must be given before age 8 months and 0 days.

Table A2.4: Age at presentation: 7–11 months

Note: subtract previous doses given.

Dose Vaccines
First dose DTaP-IPV-HepB/Hib PCV*
4 weeks later DTaP-IPV-HepB/Hib PCV
4 weeks later DTaP-IPV-HepB/Hib  
Once the child has received the appropriate vaccines for their age, continue on the Schedule as usual.
* Infants commencing PCV vaccination at age 7–11 months require a primary course of 2 PCV doses. Those who received 1 PCV dose before age 7 months should also receive 2 further doses of PCV to complete the primary course.

Table A2.5: Age at presentation: 12–23 months

Note: subtract previous doses given.

Dose Vaccines
First dose DTaP-IPV-HepB/Hiba PCVb, c MMRd
4 weeks later DTaP-IPV-HepB/Hibe    
4 weeks later or at age 15 months, whichever is applicable DTaP-IPV-HepB/Hibe PCVb, c  
Once the child has received the appropriate vaccines for their age, continue on the Schedule as usual.
a One dose of Hib is required from age 12 months to under 5 years, regardless of previous doses.
b A child commencing PCV vaccination at age 12–23 months requires 2 doses with a minimum interval of 8 weeks between doses.
c If the child has had a primary course of PCV in their 1st year, they only require 1 dose in their 2nd year. A minimum interval of 8 weeks is required between the primary course in the 1st year and the booster dose in the 2nd year.
d The 1st dose of MMR is scheduled at age 15 months, but may be given to children from age 12 months at the parents’/guardians’ request. If there are concerns about the child returning for follow-up visits, give MMR at the 1st visit from age 12 months.
e Parents/guardians should be informed that their child will receive extra doses of Hib but there are no safety concerns with these extra doses. If the parents/guardians prefer, vaccinators may administer the DTaP-IPV and Hep B vaccines as 2 separate injections instead of the combination DTaP-IPV-HepB/Hib vaccine.

Table A2.6: Age at presentation: 2 years to under 5 years

Note: subtract previous doses given.

Dose Vaccines
First dose DTaP-IPV-HepB/Hiba PCV MMR
4 weeks later DTaP-IPV-HepB/Hibb   MMRc
4 weeks later DTaP-IPV-HepB/Hibb    
6 months later DTaP-IPVd    
Once the child has received the appropriate vaccines for their age, continue on the Schedule as usual.
a One dose of Hib is required from age 12 months to under 5 years, regardless of previous doses.
b Parents/guardians should be informed that their child will receive extra doses of Hib but there are no safety concerns with these extra doses. If the parents/guardians prefer, vaccinators may administer the DTaP-IPV and Hep B vaccines as 2 separate injections instead of the combination DTaP-IPV-HepB/Hib vaccine.
c Administer the 2nd MMR dose at age 4 years. If the child is older than age 4 years, administer the 2nd MMR dose a minimum of 4 weeks after the 1st dose.
d Administer DTaP-IPV at age 4 years, but note the ideal interval is 6 months after the final DTaP-IPV-HepB/Hib dose. If the child is older than age 4 years, administer DTaP-IPV a minimum of 6 months after the final DTaP-IPV-HepB/Hib dose.

Table A2.7: Age at presentation: 5 years to under 10 years

Note: subtract previous doses given.

Dose Vaccines
First dose DTaP-IPV-HepB/Hiba or DTaP-IPVb Hep Bc MMR
4 weeks later DTaP-IPV-HepB/Hiba,d or DTaP-IPVb,d Hep Bc MMR
4 weeks later DTaP-IPV-HepB/Hiba,d or DTaP-IPVb,d Hep Bc  
6 months later DTaP-IPVd    
Once the child has received the appropriate vaccines for their age, continue on the Schedule as usual.
a Parents/guardians should be informed that their child will receive extra doses of Hib but there are no safety concerns with these extra doses.
b If the parents/guardians prefer, vaccinators may administer the DTaP-IPV and Hep B vaccines as 2 separate injections instead of the combination DTaP-IPV-HepB/Hib vaccine.
c Hep B is not required if DTaP-IPV-HepB/Hib is given.
d If a child turns 10 years before completing their catch-up programme, they should continue on the 10 to under 18 years catch-up schedule (refer to Table A2.8).

 Table A2.8: Age at presentation: 10 years to under 18 years excluding HPV

Note: subtract previous doses given.

Dose Vaccines
First dose Tdapa IPV Hep Bb MMR  
4 weeks later Tdapa IPV Hep B MMR  
4 weeks later Tdapa   Hep B    
6 months later,
or at age 11 years
Tdap IPV      
a Use Tdap for the primary series and the booster dose, with a 6-month interval between the primary series and the booster (doses 3 and 4).
b A two-dose hepatitis B catch-up may be considered for children aged 11–15 years (use HBvaxPRO 10 µg), with the 2nd dose given 4–6 months after the 1st.

Table A2.9: Age at presentation: 11 years to under 18 years – HPV only

Note: subtract previous doses given.

Dose Vaccine
Age 11–14 yearsa,b at presentation  
First dose HPV
6–12 months laterc,d HPV
Age 15 years and olderb,e at presentation  
First dose HPV
2 months later HPV
4 months later HPV
aAlthough the usual Schedule is at age 11 or 12 years (school year 7 or 8), HPV vaccine may be given from age 9 years.
bIndividuals who started with HPV4 may complete their remaining doses with HPV4 or with HPV9 when available.
cFor those aged 11–14 years, the 2nd dose is preferably given at least 6 months after the 1st. However, if the 2nd dose is given less than 5 months after the 1st, a 3rd HPV dose is recommended and funded. Give the 3rd dose at least 6 months after the 1st.
dRegardless of the age at the 1st dose, if the 2nd HPV dose is given at age 15 years or older a 3rd HPV dose is recommended and funded. Give the 3rd HPV dose at least 4 months after the 2nd.
eIf a shortened schedule is required for those aged 15 years and older, give the 2nd dose at least 1 month after the 1st dose and the 3rd dose at least 3 months after the 2nd dose.

A2.2 Immunisation catch-up for eligible adults aged 18 years and olderTop

When seen at general practice or by vaccination providers, adults should be checked to see that they have received protection against the following diseases and have received a primary immunisation course as in Table A2.10 below.

  1. If the requisite number of doses has not been received, catch-up vaccination is recommended. There is flexibility when planning catch-up schedules. To offer the best protection in the shortest time possible, vaccines may be given simultaneously and the catch-up schedule shortened to four-weekly intervals (unless otherwise stated by the manufacturer) to ensure the required number of doses are administered.
  2. Do not repeat prior doses regardless of how long ago the previous doses were given.
  3. All adults should be reminded of the necessity for age-appropriate boosters for tetanus and diphtheria at 45 and 65 years of age.
  4. Pertussis vaccination (Tdap) is currently recommended and funded between 28 and 38 weeks’ gestation in every pregnancy. A single dose of unfunded Tdap may be considered for adults requesting pertussis protection, especially for those in close contact with young babies.
  5. Women of childbearing age should know whether they are immune to rubella. If the patient does not have proof of immunity or two documented doses of MMR, two doses of funded MMR should be offered four weeks apart (MMR cannot be given in pregnancy and pregnancy should be avoided for four weeks following vaccination). Refer to chapter 18: ‘Rubella’. If they have received one documented dose of MMR, a second dose should be administered.
  6. Previously unvaccinated males and females aged 15 years to 26 years inclusive may receive three doses of HPV vaccine. Those who started with HPV4 may complete their remaining doses with HPV4 or with HPV9 when available. Those who were under age 27 years when they commenced, but did not complete, HPV vaccination are currently funded to complete the three-dose course, even if they are aged 27 years or older when they complete it. Non-residents who were under age 18 years when they commenced HPV vaccination are currently funded to complete the course, even if they are aged 18 years or older when they complete it.
  7. Check whether the individual has any additional immunisation requirements, such as certain medical conditions or occupational risk (see chapter 4: ‘Immunisation of special groups’).

Table A2.10: Primary immunisation requirements for adults aged 18 years and older

Antigens and number of doses required
3 Tda
3 Polio (IPV)b
2 MMRc
3 HPVd,e (aged 26 years and under)
a A primary course of 3 doses of adult Td vaccine is recommended and funded for unimmunised or partially-immunised adults. Unfunded Tdap may be offered as an alternative to Td for pertussis protection. At ages 45 and 65 years, the Td booster immunisation administration (the immunisation benefit) is not funded, although the vaccine is free.
b A primary course of 3 doses of IPV is recommended and funded for unimmunised or partially-immunised adults. The minimum recommended interval between IPV doses 1 and 2 is 4 weeks; the 3rd IPV dose should be given at least 6 months after dose 2. If necessary, the interval may be shortened to 4 weeks between doses, but this is not the preferred schedule.
c Two doses of MMR (4 weeks apart) are recommended and funded for unimmunised adults who are susceptible to any one of the three diseases. Those born in New Zealand before 1969 are considered to be immune to measles due to circulating wild disease at that time.
d HPV vaccine is recommended and funded for all individuals aged 26 years and under. Give the 3-dose course at 0, 2 and 6-months. If a shortened schedule is required, give the 2nd dose at least 1 month after the 1st dose and the 3rd dose at least 3 months after the 2nd dose.
e Those who were under age 27 years when they commenced HPV vaccination are currently funded to complete the 3-dose course, even if they are aged 27 years or older when they complete it. Non-residents who were under age 18 years when they commenced HPV vaccination are currently funded to complete the course, even if they are aged 18 years or older when they complete it.