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Appendix 2: Planning immunisation catch-ups

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 A2.2 discusses catch-up requirements for children aged under 18 years, and section A2.3 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.

For assistance with planning catch-up schedules, contact your immunisation coordinator, call the IMAC freephone line on 0800 IMMUNE/0800 466 863, or discuss with an experienced colleague.

A2.1. 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, including National Immunisation Schedule vaccines, in New Zealand. Only people who meet the eligibility criteria defined in the Eligibility Direction can receive publicly funded health and disability services.

However, 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.

A2.2. Planning catch-ups for infants, children and adolescents aged under 18 years

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, 12-month or 15-month vaccination events). It is important to note the age of the child when the antigens were received.

Although catch-up tables are provided in this appendix, children may not fit these unless they are completely unvaccinated, or there is no documented history and they are 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 infant, child or adolescent requires.

A2.2.1. Principles of catch-up for infants and children aged under 10 years

If the immunisation status of a child is uncertain or unknown, plan the catch-up schedule assuming the vaccines have not been given.
Administer catch-up immunisations as per the New Zealand Schedule, not an overseas immunisation schedule.
The best approach is to ascertain the antigens required for the child’s current age, subtract any already given and then develop the individual’s catch-up schedule.
There is considerable ﬂexibility when planning catch-up schedules. To offer the best protection in the shortest time possible, most vaccines can be given at the same visit, and the catch-up schedule shortened to four-weekly intervals to ensure the required number of doses are administered.
If the schedule has been interrupted, do not repeat prior doses regardless of how long ago the previous doses were given. Exceptions to this principle are the following vaccines given to children aged under 12 months: MMR or measles-containing vaccine (see point 10 below), Hib vaccine (see point 11), PCV (see point 12), and varicella vaccine (see point 13).
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.
For infants and children aged under 10 years, use DTaP-IPV-HepB/Hib or DTaP-IPV for primary immunisation. Tdap may be used as an alternative for primary immunisation of children aged 7 to under 18 years (note that Tdap (Boostrix) is not registered for primary immunisation, but there is no evidence of safety concerns).
Where the combination vaccine DTaP-IPV-HepB/Hib is used, there are no safety concerns around receiving extra doses of Hib or HepB. If there is parental concern, then separate DTaP-IPV and Hep B or Hib can be used but would require an extra injection. If single antigen HepB is used, give as 0-1-6-month schedule.
The first dose of rotavirus vaccine (RV1, Rotarix) should be given before age 15 weeks (ie, the latest age is 14 weeks and 6 days), and the second dose administered a minimum of four weeks later. An infant who has not had the first dose before age 15 weeks will not be eligible to commence the rotavirus course. Where the first dose is inadvertently given at age 15 weeks or older, the remaining dose should be given, but both doses should be given before age 25 weeks (ie, by age 24 weeks and 6 days).
The first dose of MMR is scheduled at 12 months and the second dose of MMR at 15 months, or at least four weeks after the first MMR. MMR or any single-antigen measles vaccine given before age 12 months is not counted as part of the two-dose MMR schedule.
A single dose of Hib-PRP is required for all children aged 12 months to under 5 years regardless of the number of doses given in their first year. Children who receive catch up DTaP-IPV-HepB/Hib between ages 12 months to under 5 years do not require a single antigen Hib vaccine (Hib-PRP) as this is covered by the combination vaccine. Healthy children aged 5 years and older do not need Hib vaccination.
For healthy infants commencing PCV vaccination under 12 months of age, a primary course is two doses with a minimum of eight weeks between doses. A booster dose is given eight weeks after the completion of the primary course from age 12 months. To get them back on schedule, if the booster dose is not given after 8 weeks, it can be given at the 15-months event. Unimmunised healthy children aged 12 months to under 5 years require two PCV doses given at least eight weeks apart. For a child who did not complete their primary course when under 12 months of age, do not count doses given prior to age 12 months when determining the number of PCV catch up doses required– give two doses as for unvaccinated healthy children. Healthy children aged 5 years and older do not need PCV. See chapter 17 ‘Pneumococcal disease’ for PCV13 schedules for high-risk children.
All children eligible for meningococcal B catch-up should be vaccinated at the earliest opportunity (see Table 13.4). If MenB was started before the age 5 years, then the funded course can be completed. The recommended number (two or three doses) is based on the age at which the child receives their first dose.
- For children aged under 12 months at the time of first dose, give two doses eight weeks apart, followed by a booster from 12 months of age or a minimum of six months after the second dose, whichever is later.
- For children aged 12 months to under 24 months at time of first dose, give two doses eight weeks apart followed by a booster dose given 12–23 months after dose two. The spacing between dose one and two can be reduced to six weeks if indicated, with a prescription.
- For children aged 24 months or over, give just two doses eight weeks apart (see ‎Table A2.7). This can be reduced to four weeks if clinically indicated.
One dose of varicella vaccine is funded at age 15 months for children who were born on or after 1 April 2016. A child who has received a non-funded varicella vaccine prior to age 12 months is still eligible to receive the 15-month funded vaccine. A child who has had varicella disease does not require the varicella vaccine.
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 ‘Immunisation of special groups’).
Once the child has received the appropriate vaccines for their age, they should continue with the Schedule as usual.

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

<12 months	12 months to <5 years	5 years to <10 years
3 DTaP^a	3 or 4 DTaP^a	4 DTaP^a
3 IPV^a,e	3 or 4 IPV^a,e	3 or 4 IPV^e
3 HepB^a,b	3 HepB^a,b	3 HepB^a,b
2 or 3 Hib-PRP^a	1 Hib-PRP^f	2 MMR
2 PCV^c	2 PCV^c	1 VV^h
2 RV^d	2 MMR^g
2 MenBⁱ	1 VV^h 2 or 3 MenBⁱ
a. Use DTaP-IPV-HepB/Hib (or DTaP-IPV) for the 3-dose primary series (at a minimum of 4 weekly intervals), then continue with the usual childhood schedule with a booster dose of DTaP-IPV-HepB/Hib given at age 4 years to ensure longer term HepB protection. (Note, if there is at least a 5-month gap between doses two and three, DTaP-IPV can be used for the 4-year-old vaccination event). If the child commences immunisation at age 4 years or older, give the booster dose at least 6 months after the third dose of the primary series. A fourth DTP given earlier than 3 years of age on an overseas schedule is not counted as the 4-year dose. For infants requiring Hib-PRP only, the primary series consists of 3 doses for those starting under 6 months of age; for those starting from age 6 months and over, 2 primary doses are required. b. If the child received HepB at birth, they require a total of four HepB doses as the birth dose does not count as part of the primary course. Infants born to HBsAg-positive mothers require serological testing at age 9 months – see section 9.5.2. c. For healthy infants commencing PCV vaccination under 12 months of age, a primary course is 2 doses with a minimum of 8 weeks between doses. A booster dose is given 8 weeks after the completion of the primary course. To get them back on schedule, if the booster dose is not given after 8 weeks, it can be given at the 15-months event. Infants who commenced vaccination with PCV10 can complete the course with PCV13. For healthy children aged 12 months to under 5 years who are commencing immunisation or with an incomplete course, give 2 doses of PCV13 at least 8 weeks apart. (See chapter 17 ‘Pneumococcal disease’ for PCV13 schedules for high-risk children.) d. The first dose of rotavirus vaccine should be given before age 15 weeks (ie, the latest is 14 weeks and 6 days) and the second dose given a minimum of 4 weeks later. Both doses must be given before age 25 weeks (ie, the latest is 24 weeks and 6 days). Where the first dose is inadvertently given at age 15 weeks or older, the second dose should be given, but both doses must be given before age 25 weeks (ie, latest age 24 weeks and 6 days). e. A minimum of 3 polio doses are required for the primary series (at a minimum of 4-weekly intervals) 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). For all infants and children who have had OPV (ie, either OPV or bOPV) a further dose of IPV should be administered even if they have completed a full OPV/bOPV course. Those who received a dose of OPV at birth require a minimum of 3 further doses of polio vaccine – do not count the birth dose. f. A single dose of Hib-PRP is required for all children from age 12 months to under 5 years, regardless of the number of doses given before age 12 months. Children who receive catch-up DTaP-IPV-HepB/Hib between 12 months to under 5 years do not require a single antigen Hib-PRP vaccine as this is covered by the combination vaccine. g. Children commencing immunisation at age 12 months or older require 1 dose of MMR, then continue the usual childhood schedule with a second dose of MMR given at age 15 months, or at least 4 weeks after the first MMR dose. h. One dose of varicella vaccine is funded for children at 15 months born on or after 1 April 2016. Children who received a non-funded varicella vaccine prior to age 12 months are still eligible to receive the funded 15-month varicella vaccine. A child who has had varicella disease does not require the varicella vaccine. i. Three doses of MenB are funded for all infants up to age 12 months (inclusive). A catch-up programme is available until 31 August 2025 for children aged under 5 years. If MenB was started before age 5 years, then the funded course can be completed. The required number (two or three) of doses is based on the age at which the child receives their first dose: For children aged under 12 months at the time of first dose, give two doses eight weeks apart, followed by a booster from 12 months of age or a minimum of six months after the second dose, whichever is later. For children aged 12 months to under 24 months at time of first dose, give two doses eight weeks apart followed by a booster dose given 12–23 months after dose two. The spacing between doses one and two can be reduced to six weeks if indicated, with a prescription. For children aged 24 months or over, give just two doses eight weeks apart. This can be reduced to four weeks if clinically indicated. See also Table A2.7.

A2.2.2. Principles of catch-up for children and adolescents aged 10 to under 18 years

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.
There is considerable ﬂexibility when planning catch-up schedules. To offer the best protection in the shortest time possible, most vaccines can be given at the same visit and the catch-up schedule shortened to four-weekly intervals to ensure the required number of doses are administered.
If the Schedule has been interrupted, do not repeat prior doses regardless of how long ago the previous doses were given.
If the immunisation status of an individual is uncertain or unknown, plan the catch-up schedule assuming the vaccine has not been given.
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. MMR should be recommended at the first visit.
For individuals aged 10 years to under 18 years, Tdap is recommended and funded for primary and booster immunisation. While Tdap is not approved for use (registered) as a primary course, no safety concerns are expected when using Tdap for primary immunisation in individuals aged 10 to under 18 years.
For individuals aged 10 years to under 18 years, give HepB (Engerix B 20µg) at 0, 1 and 6 months. An alternative two-dose HepB catch-up schedule may be considered for individuals aged 10–15 years with the second dose given six months after the first.
A two-dose schedule of HPV at least 6–12 months apart is recommended for individuals who receive their first dose before their 15th birthday, even if they are 15 years or older at the time of the second dose. Individuals who start their HPV schedule from age 15 years and older receive three doses of HPV at 0, 2 and 6 months. If required, a shortened schedule of three doses can be given with a minimum of four weeks between doses one and two, and the third dose given at least 12 weeks after dose two. 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 A2.10 for HPV catch-up schedules.
One dose of varicella vaccine is funded for children turning age 11 years on or after 1 July 2017, who have not previously had varicella vaccination or infection. The appropriate varicella schedule for those aged 13 years or older when starting is two doses with a minimum of a four-week gap; however, only one dose is currently funded for those turning 11 years on or after 1 July 2017.
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’).
Once the individual has received the appropriate vaccines for their age, they should continue with 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 Tdap^a
3 IPV^b
3 HepB for children aged 10 to <18 years; or alternatively 2 HepB doses for children aged 10–15 years^c
2 MMR
2 HPV^{d, e, f} for those aged 11–14 years, or 3 HPV^{d, g} for those aged 15 years and older
1 VV^h
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. A minimum of 3 polio doses are required for the primary series (at a minimum of 4-weekly intervals). c. If aged 10 years to under 18 years, 3 doses of HepB are required at 0, 1 and 6 months. An alternative 2-dose schedule may be used for children aged 10–15 years with the second dose given 6 months after the first. d. Individuals who started with HPV4 may complete their remaining doses with HPV9. e. For those aged 11–14 years, the second HPV dose is preferably given at least 6 months after the first. If the second dose is given earlier than 5 months after the first, a third HPV dose is recommended and funded — give the third dose at least 5 months after the first dose. f. A two-dose schedule of HPV at least 6–12 months apart is recommended for individuals who receive the first dose before their 15th birthday, even if they are 15 years or older at the time of the second dose. g. For 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, the three doses can be given with a minimum of 4 weeks between doses one and two, and the third dose given at least 12 weeks after dose two. h. One dose of varicella vaccine is funded for children turning 11 on or after 1 July 2017, who have not previously had varicella vaccination or infection.

A2.2.3. National Immunisation Schedule catch-up guides for infants, children and adolescents aged under 18 years

Note: the following tables are guides only, and the principles described in sections A2.2.1 and A2.2.2 should be followed. The vaccinator must subtract any previous doses given. It is important to note the age at which the antigens have been given.