Contents

Introduction

The purpose of the Immunisation Handbook 2014 (the Handbook) is to provide clinical guidelines for health professionals on the safest and most effective use of vaccines in their practice. These guidelines are based on the best scientific evidence available at the time of publication, from published and unpublished literature.

The information contained within the Handbook was correct at the time of publication. This edition of the Handbook will remain current unless amended electronically via the Ministry of Health website (www.health.govt.nz/immunisation) or until the next edition or update is published.

The National Immunisation Schedule

The National Immunisation Schedule (the Schedule) is the series of publicly funded vaccines available in New Zealand (see Table 1). Some vaccines are also offered as targeted programmes in response to a recognised need (see Table 2). See also section 2.7 for a summary of the primary immunisation requirements for adults (funded) and other funded and unfunded recommendations for this age group.

On 1 July 2012 the management and purchasing of vaccines transferred from the Ministry of Health to PHARMAC. All publicly funded vaccines are now listed on PHARMAC’s Pharmaceutical Schedule (see www.pharmac.govt.nz), and the district health boards (DHBs) are responsible for funding these once PHARMAC has listed them.

PHARMAC considers medicine and vaccine funding applications from pharmaceutical suppliers, health professionals, consumer groups and patients. Usually, manufacturers/suppliers decide whether to make an application for funding. Normally this will follow registration and approval of the medicine or vaccine by Medsafe. PHARMAC will generally only consider an application for a medicine or vaccine to be funded once it has been registered and approved by Medsafe.

Following a vaccine funding application, PHARMAC will assess the vaccine, seek clinical input (for vaccines this may be from the immunisation subcommittee of the Pharmaceutical and Therapeutics Advisory Committee [PTAC] or from PTAC itself), and conduct an economic analysis. The recommendations from the immunisation subcommittee are then considered by PTAC, who will provide advice to PHARMAC. PHARMAC then decides what priority the application has for funding, and consults with the Ministry of Health on capacity and implementation issues that may be associated with introducing a new vaccine. Depending on the outcome of that process, PHARMAC may then negotiate with the supplier. If an agreement is reached, PHARMAC will consult with the health sector on a funding proposal.

The Ministry of Health remains responsible for the National Immunisation Programme. The National Immunisation Programme:

The Ministry of Health works with PHARMAC to ensure there is a strong link between vaccine decisions, management and the National Immunisation Programme.

Although funding decisions will be communicated to the sector, vaccinators are advised to regularly check the Pharmaceutical Schedule and any online updates (www.pharmac.govt.nz) for changes to funding decisions, and the online edition of the Immunisation Handbook (www.health.govt.nz/immunisation) for the latest immunisation information. There may also be locally funded immunisation programmes in response to a specific need.

Changes to vaccine funding from 1 January 2017Top

Table 1 shows the 2017 National Immunisation Schedule and Table 2 the vaccines funded for special groups at higher risk of some diseases.

Changes to vaccine funding from 1 January 2017 are as follows.

  1. HPV vaccine will be funded for males and females aged 26 years and under (see chapter 9: ‘Human papillomavirus’).
  2. Initially, HPV9 (Gardasil 9) will be used in school-based programmes only. HPV4 (Gardasil) will continue to be used in primary and secondary care until existing stocks are used up, and then HPV9 will be used. Those who started with HPV4 may complete the course with HPV4 or with HPV9 when available.
  3. Two doses of HPV vaccine, at 0 and 6–12 months, will be funded for children aged 14 years and under. The vaccine may be offered from age 9 years; but the usual Schedule will be at age 11 or 12 years (school years 7 or 8).
  4. Three doses of HPV vaccine, at 0, 2 and 6 months, will be funded for:
    • individuals aged 15 to 26 years inclusive
    • individuals aged 9 to 26 years inclusive:
      • with confirmed HIV infection
      • transplant (including stems cell) patients.
  5. An additional dose of HPV vaccine for individuals aged 9 to 26 years post-chemotherapy.

Table 1: National Immunisation Schedule, commencing 1 January 2017

Antigen(s) DTaP-IPV-HepB/Hib PCV13 RV5 MMR Hib DTaP-IPV Tdap HPV4 or HPV9 Td Influenza
Brand Infanrix-hexa Prevenar 13 RotaTeq MMR II Act-HIB Infanrix-IPV Boostrix Gardasil/ Gardasil9 ADT Booster Influvac and Fluarix
Manufacturer GSK Pfizer MSD MSD Sanofi-aventis GSK GSK Seqirus / MSD Seqirus Mylan and GSK
6 weeks              
3 months              
5 months              
15 months              
4 years                
11 years                  
11/12 years*              
2 doses
   
45 years                  
65 years                
annually

Key: D = diphtheria; T = tetanus; aP = acellular pertussis; IPV = inactivated polio vaccine; Hib = Haemophilus influenzae type b; Hep B = hepatitis B; PCV13 = 13-valent pneumococcal conjugate; RV5 = rotavirus vaccine (pentavalent); MMR = measles, mumps and rubella; d = adult diphtheria; ap = adult acellular pertussis; HPV = human papillomavirus; Td = adult tetanus and diphtheria vaccine.

* HPV is funded for individuals aged 26 years and under: 2 doses for those aged 14 years and under; 3 doses for those aged 15–26 years; 3 doses for those aged 9–26 years with certain medical conditions, plus an additional dose post-chemotherapy.

Table 2: Funded vaccines for special groups

Note: Vaccinators are advised to regularly check the Pharmaceutical Schedule and any online updates (www.pharmac.govt.nz) for changes to funding decisions for special groups.

Vaccine Individuals eligible for funded vaccine
Hepatitis A vaccine (see chapter 7) Transplant patients

Children with chronic liver disease

​Close contacts of hepatitis A cases
Hepatitis B vaccine and hepatitis B immunoglobulin (HBIG) (see chapter 8) Household or sexual contacts of patients with acute or chronic hepatitis B infection

Babies of mothers with chronic hepatitis B infection need both hepatitis B vaccine and HBIG at birth

Children aged under 18 yearswho have not achieved positive serology and who require additional vaccination

HIV-positive patients

Hepatitis C-positive patients

Following non-consensual sexual intercourse

Patients following immunosuppression*

Transplant patients

Dialysis patients

Following needle-stick injury 
Hib (see chapter 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
HPV (see chapter 9) Individuals aged 9 to 26 years inclusive:
  • with confirmed HIV infection
  • transplant (including stem cell) patients
  • an additional dose post-chemotherapy.
Annual influenza vaccine (see chapter 10) Patients aged under 65 years (including infants and children aged 6 months and older) with certain medical conditions

Pregnant women 
Measles-mumps-rubella (MMR) vaccine 
(see chapter 11)
MMR vaccine for patients following immunosuppression (seek specialist advice)
Meningococcal conjugate vaccines – MenCCV and 
MCV4-D (see chapter 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 immunosuppression*

Close contacts of meningococcal cases
Pertussis vaccine (see chapter 14) Tdap for women during pregnancy from 28 to 38 weeks’ gestation

DTaP-IPV-HepB/Hib, DTaP-IPV or 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
Pneumococcal conjugate (PCV13) and pneumococcal polysaccharide (23PPV) vaccines (see chapter 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
Poliomyelitis vaccine (IPV) 
(see chapter 16)
IPV for patients following immunosuppression
Tetanus-diphtheria vaccine (Td) 
(see chapter 19)
Td for patients following immunosuppression
BCG (Bacillus Calmette-Guérin) (see chapter 20) Neonatal BCG is recommended for infants at increased risk of tuberculosis (TB). Other children aged under 5 years at risk of TB exposure are also eligible
Varicella vaccine (see chapter 21) Non-immune patients:
  • with chronic liver disease who may in future be candidates for transplantation
  • with deteriorating renal function before transplantation
  • prior to solid organ transplant
  • prior to any elective immunosuppression*
  • for post-exposure prophylaxis of immune competent in-patients
Patients at least 2 years after bone marrow transplantation, on advice of their specialist

Patients at least 6 months after completion of chemotherapy, on advice of their specialist

HIV-positive patients with mild or moderate immunosuppression who are non-immune to varicella, on advice of their HIV specialist

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 immunocompromised or undergoing a procedure leading to immune compromise, where the household contact has no clinical history of varicella

* Note that the period of immunosuppression due to steroid or other immunosuppressive therapy must be longer than 28 days.

For more information, see section 2.7 (adult vaccination), chapter 4: ‘Immunisation of Special Groups’ and the individual disease chapters.

Eligibility for publicly funded vaccinesTop

Only vaccines given according to the Schedule are available free of charge, unless there is a specific funded programme in response to a recognised need (see Table 2). The immunisation benefit is paid by DHBs to providers for the administration of:

Currently there is no funding provided for the administration of Td boosters given at ages 45 and 65 years, although the vaccine is free.

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.

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. All children are also eligible for Well Child Tamariki Ora Services.

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.

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