Introduction

The purpose of the Immunisation Handbook 2024 (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 These guidelines are based on the best scientific evidence available at the time of publication, from published and unpublished literature.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 Health New Zealand | Te Whatu Ora website until the next edition or update is published.

Changes to the Handbook since 2024

The following changes have been made for the 2024 edition.

In the notifiable disease chapters, public health measures have been edited and where relevant referred to the Communicable Disease Control Manual website.
Chapter 4 Immunisation of special groups – continues to be updated as funded indications change
Chapter 5 Coronavirus disease (COVID-19) continues to be updated.
Chapter 9 Hepatitis B, changes to non-responder protocol recommendations to give additional doses of HepB via intradermal administration
Chapter 12 Measles, infants vaccinated given a first dose of MMR at the age of 11 months (ie from 11 months to under 12 months) are considered to have received MMR dose 1.
Chapter 13 Meningococcal, access to broader protection for infants aged under 12 months.
Chapter 14 Mpox - addition of new chapter
Chapter 19 Respiratory syncytial virus - addition of new chapter
Chapter 25 Zoster - eligibility for funded vaccine for certain special group

The National Immunisation Schedule

Although funding decisions will be communicated to the sector, vaccinators are advised to regularly check the Pharmaceutical Schedule and any online updates for changes to funding decisions, and the Handbook for the latest immunisation information.

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 part of an extended immunisation programme for targeted special groups in response to a recognised need (see Table 2). See also section 2.1.7 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, and the districts 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 Pharmacology 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, which will provide advice to PHARMAC. PHARMAC then decides what priority the application has for funding and consults with Health New Zealand | Te Whatu Ora 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.

Health New Zealand | Te Whatu Ora remains responsible for and manages the National Immunisation Programme, which:

aims to prevent disease through vaccination and to achieve coverage that prevents outbreaks and epidemics
is accountable for achieving the Immunisation Coverage targets
monitors disease burden and those at risk
provides guidance to the sector on immunisation, cold chain and resources
ensures immunisation providers deliver services that meet the needs of their population
implements the National Immunisation Schedule
delivers trusted and effective vaccine programmes
provides immunisation resources, including the Immunisation Handbook
improves information and data systems
manages the Aotearoa Immunisation Register (AIR) (see section 2.3.5).

Health New Zealand | Te Whatu Ora works with PHARMAC to ensure there is a strong link between vaccine purchasing decisions and the management and implementation of the National Immunisation Programme.

Changes to the National Immunisation Schedule in 2024

Table 1 shows the 2024 National Immunisation Schedule, and Table 2 shows the vaccines funded for special groups at higher risk of some diseases.

Changes to vaccine funding in 2024 are as follows:

The quadrivalent inactivated influenza vaccine (Influvac Tetra; see chapter 11 ‘Influenza’) will be the Schedule vaccine for eligible individuals, including pregnant women and adults aged 65 years and older.

Table 1: National Immunisation Schedule, commencing 1 October 2020 (revised 1 March 2023)

Table 1: National Immunisation Schedule, commencing 1 October 2020 (revised 1 March 2023)
Antigen(s)	DTaP-IPV-HepB/Hib	PCV13	MenB	RV1	MMR	Hib-PRP	VV	DTaP-IPV	Tdap	HPV9	Influenza	rZV
Brand	Infanrix-hexa	Prevenar 13	Bexsero	Rotarix	Priorix	Act-HIB	Varilrix	Infanrix-IPV	Boostrix	Gardasil 9	Influvac Tetra	Shingrix
Manufacturer	GSK	Pfizer	GSK	GSK	GSK	Sanofi	GSK	GSK	GSK	Seqirus/MSD	Viatris	GSK
Pregnancy									●^a		●
6 weeks	●	●^b		●
3 months	●		●^c	●
5 months	●	●	●
12 months		●	●		●
15 months					●	●	●^d
4 years								●
11 or 12 years^e									●	● 2 doses^e
45 years									●^f
65 years									●		● annually	● 2 doses
a. Tdap is for women during every pregnancy, from 16 weeks’ gestation, preferably in the second trimester. b. For infants at high risk of pneumococcal disease, an additional dose of PCV13 is given at age 3 months. c. An alternative approved schedule for MenB can be offered at ages 8 weeks, 4 months and 12 months. d. VV is funded for children born on or after 1 April 2016. e. HPV is funded for individuals aged 26 years and under: 2 doses are 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; 3 doses are recommended for those aged 9–26 years with certain medical conditions, plus an additional dose post-chemotherapy. f. Funded for adults from 45 years who have not received 4 previous doses of tetanus vaccine. All individuals aged from 5 years are eligible to receive a primary course of a COVID-19 vaccine. Additional doses are also available to certain groups (see Chapter 5).

Changes to extended immunisation programme for special groups

Vaccines funded for special groups are described in Table 2 below. Changes to existing programmes in 2024 are as follows.

A single dose of meningococcal ACWY vaccine (MenACWY) and two doses of meningococcal B vaccine (MenB) are funded for individuals aged between 13 and 25 years entering or in their first year of living in boarding school hostels, tertiary education halls of residence, military barracks, youth justice residences or prisons. This includes children who turn 13 years while living in boarding school hostels.
Meningococcal B vaccine (MenB) and quadrivalent meningococcal vaccine (MenACWY) are funded for certain special groups at increased risk of meningococcal disease, including those who have previously had meningococcal disease of any group. MenC vaccine has been replaced with MenACWY vaccine for certain infants aged 6 weeks to under 12 months.
Zoster vaccine, certain individuals aged from 18 years with severe immunocompromise are eligible for funded vaccine.
DTaP-IPV-HepB/Hib is funded for the revaccination of children up to age 18 years post-haematopoietic stem cell transplantation.

Table 2: Extended immunisation programme for special groups – vaccines funded in addition to the routine schedule

Note: Vaccinators are advised to regularly check the Pharmaceutical Schedule and any online updates for changes to funding decisions for special groups. See also chapter 4 ‘Immunisation of special groups’.

Vaccine	Individuals eligible for funded vaccine
Haemophilus inﬂuenzae type b (Hib-PRP) (chapter 7)	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 undergoing renal dialysis and other severely immunosuppressive regimens For use in testing for primary immune deficiency^a
Hepatitis A (HepA) (chapter 8)	Transplant patients Children with chronic liver disease Close contacts of hepatitis A cases
Hepatitis B (HepB) (chapter 9)	Household or sexual contacts of patients with acute or chronic hepatitis B virus (HBV) infection Babies of mothers with chronic HBV infection need both hepatitis B vaccine (HepB) and hepatitis B immunoglobulin (HBIG) at birth Children aged under 18 years who have not achieved positive serology and who require additional vaccination HIV-positive patients Hepatitis C-positive patients Following non-consensual sexual intercourse Prior to any planned immunosuppression^b Patients following immunosuppression^b Solid organ transplant patients, including liver or kidney transplant Post-HSCT patients Following needle-stick injury Dialysis patients
Human papillomavirus (HPV) (chapter 10)	People aged 9 to 26 years inclusive who are: confirmed with HIV infection transplant (including stem cell) patients post-chemotherapy
Annual inﬂuenza vaccine (chapter 11)	Patients aged 6 months to <65 years who: have any of the following cardiovascular diseases: ischaemic heart disease congestive heart failure rheumatic heart disease congenital heart disease cerebrovascular disease have either of the following chronic respiratory diseases: asthma, if on a regular preventative therapy other chronic respiratory disease with impaired lung function have diabetes have chronic renal disease have any cancer, excluding basal and squamous skin cancers if not invasive have any of the following other conditions: autoimmune disease immune suppression or immune deficiency HIV transplant recipients neuromuscular and central nervous system diseases/disorders haemoglobinopathies are children on long-term aspirin have a cochlear implant errors of metabolism at risk of major metabolic decompensation pre- and post-splenectomy Down syndrome are pregnant are children aged 4 years and under who have been hospitalised for respiratory illness or have a history of significant respiratory illness, including children age under 5 who were hospitalised with measles are currently accessing secondary or tertiary mental health and addiction services have any of the following serious mental health conditions: schizophrenia major depressive disorder bipolar disorder schizoaffective disorder
Measles, mumps and rubella (MMR) (chapters 12, 14 and 21)	(Re)vaccination of patients prior to planned or following immunosuppression^b
Meningococcal conjugate quadrivalent vaccine (MenACWY) and meningococcal B vaccine (MenB) (chapter 13)	Pre- and post-splenectomy or with functional or anatomical asplenia HIV Complement deficiency (acquired or inherited) Pre- or post-solid organ transplant Close contacts of meningococcal case HSCT (bone marrow transplant) patients Prior to any planned immunosuppression^b Following immunosuppression^b Individuals who have had previous meningococcal disease (any group) Individuals aged between 13 and 25 years entering or in their first year of living in boarding school hostels, tertiary education halls of residence, military barracks, youth justice residences or prisons. This includes children who turn 13 years while living in boarding school hostels.
Pertussis-containing vaccines (chapter 16)	Pregnant women – recommended to be given from 16 weeks’ gestation of every pregnancy, preferably in the second trimester. (Funded when given any time in second or third trimester) Tdap is funded for parents or primary caregivers of infants admitted to a neonatal intensive care unit or special care baby unit for more than 3 days, who had not been exposed to maternal vaccination at least 14 days prior to birth (Re)vaccination of patients who are: post-HSCT or chemotherapy pre- or post-splenectomy pre- or post-solid organ transplant undergoing renal dialysis or other severely immunosuppressive regimens
13-valent pneumococcal conjugate vaccine (PCV13) and 23‑valent pneumococcal polysaccharide vaccine (23PPV) (chapter 17)	For (re)vaccination of high-risk children, PCV13 for patients aged under 5 years and 23PPV for patients aged under 18 years: prior to planned or on immunosuppressive therapy or radiotherapy (vaccinate when there is expected to be a sufficient immune response) with primary immune deficiencies with HIV infection with renal failure or nephrotic syndrome who are immune-suppressed following organ transplantation (including HSCT) with cochlear implants or intracranial shunts with cerebrospinal fluid leak receiving corticosteroid therapy for more than 2 weeks, and who are on an equivalent daily dosage of prednisone of 2 mg/kg per day or greater, or children who weigh more than 10 kg on a total daily dosage of 20 mg or greater with chronic pulmonary disease (including asthma treated with high-dose corticosteroid therapy) preterm infants, born before 28 weeks’ gestation with cardiac disease, with cyanosis or failure with diabetes with Down syndrome who are pre- or post-splenectomy, or with functional asplenia PCV13 and 23PPV for (re)vaccination of patients aged 5 years and older: with HIV infection pre- or post-HSCT^c or chemotherapy^c 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, intracranial shunts^d or cerebrospinal fluid leaks^d with primary immune deficiency PCV13 and 23PPV for use in testing for primary immune deficiency.^a
Inactivated polio vaccine (IPV) (chapter 18)	(Re)vaccination of patients prior to planned or following immunosuppression^b
Tetanus, diphtheria and pertussis (Tdap) (chapter 22)	(Re)vaccination of patients prior to planned or following immunosuppression^b Boosting of patients with tetanus-prone wounds For use in testing for primary immune deficiency^a
Bacillus Calmette–Guérin (BCG) (chapter 23)	For infants at increased risk of tuberculosis (TB): living in a house or family with a person with current or past history of TB; or having one or more household members or carers who within the last 5 years lived in a country with a rate of TB ≥40 per 100,000 for 6 months or longer; or who, during their first 5 years, will be living 3 months or longer in a country with a rate of TB ≥40 per 100,000
Varicella vaccine (VV) (chapter 24)	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 planned immunosuppression^b for post-exposure prophylaxis of immune-competent hospital 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 members of paediatric patients who are immunocompromised, or undergoing a procedure leading to immunocompromise, where the household member has no clinical history of varicella. Household members of adult patients who have no clinical history of varicella and who are severely immunocompromised or undergoing a procedure leading to immunocompromise, where the household contact has no clinical history of varicella.
Zoster (rZV) (chapter 25)	Individuals aged from 18 years, including those aged 66 years and over, pre- and post-haematopoietic stem cell transplant or cellular therapy pre- or post-solid organ transplant with haematological malignancies living with poorly controlled HIV infection prior to planned or receiving disease-modifying anti-rheumatic drugs (DMARDs – targeted synthetic, biologic, or conventional synthetic) for polymyalgia rheumatica, systemic lupus erythematosus or rheumatoid arthritis with end-stage kidney disease (CKD 4 or 5) with primary immunodeficiency.
a. Upon the recommendation of an internal medicine physician or paediatrician. b. The period of immunosuppression due to steroid or other immunosuppressive therapy must be longer than 28 days. c. PCV13 is funded pre- or post-HSCT or chemotherapy. 23PPV is only funded post-HSCT or chemotherapy. d. Only PCV13 is funded for these indications; 23PPV is recommended but not funded.

Eligibility for publicly funded vaccines

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 districts to providers for the administration of:

all childhood Schedule vaccines
influenza vaccine to eligible children and adults (ie, those at higher risk of disease)
zoster vaccine to individuals aged 65 years
tetanus-diphtheria-pertussis (Tdap) boosters given at ages 45 and 65 years (now funded)
hepatitis A, hepatitis B, Hib-PRP, human papillomavirus (HPV), inactivated polio vaccine (IPV), MMR, meningococcal conjugate, pertussis, pneumococcal conjugate and/or polysaccharide, varicella and zoster vaccines only, for eligible children and adults (ie, at higher risk of disease) as part of an extended immunisation programme for special groups.

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 aged under 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 Health New Zealand | Te Whatu Ora website.

As part of the COVID-19 pandemic response the preferred vaccine, mRNA-CV, is available for certain children aged 6 months to 4 years, all children aged from 5 years and all adults in New Zealand, regardless of eligibility for publicly funded health and disability services.

Notifiable diseases

It is a legal requirement (under the Health Act 1956) that health professionals notify their local medical officer of health of any notifiable disease they suspect or diagnose so that appropriate action (eg, public health prevention and control activities) can be undertaken.

All diseases preventable by vaccines on the Schedule (or as part of a targeted programme) are notifiable, except for HPV, seasonal influenza, rotavirus, varicella and herpes zoster.

Note: Rotavirus infections presenting as gastroenteritis are notifiable as acute gastroenteritis.

Notification processes, and the diseases to which they relate, have been updated in the Health Act and supporting Health (Infectious and Notifiable Diseases) Regulations 2016. See the Ministry of Health’s 2017 document Guidance on Infectious Disease Management under the Health Act 1956 for an explanation, as well as the processes and forms for notifiable diseases.

The case deﬁnitions used by the medical ofﬁcer of health to classify the notiﬁed case for surveillance purposes (and to assist in identifying appropriate prevention and control activities) and the laboratory tests required to conﬁrm the diagnosis can be found in the Communicable Disease Control Manual. For the most up-to-date information, refer to the online version.

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