Immunisation Handbook - 2024, version 7

The Immunisation Handbook provides 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These guidelines are based on the best scientific evidence available at the time of publication, from published and unpublished literature.

Disclaimer

This publication, which has been prepared for, and is published by, Health New Zealand | Te Whatu Ora, is for the assistance of those involved in providing immunisation services in New Zealand.

While the information and advice included in this publication are believed to be correct, no liability is accepted for any incorrect statement or advice. No person proposing to administer a vaccine to any other person should rely on the advice given in this publication without first exercising his or her professional judgement as to the appropriateness of administering that vaccine to another person.

The Health New Zealand | Te Whatu Ora website hosts the most current version of the Immunisation Handbook. Check the website for the updates that will occur as and when required.

Funded vaccines for special groups
Anaphylaxis response/management
National Immunisation Schedule
Introduction
1. General immunisation principles
2. Processes for safe immunisation
3. Vaccination questions and addressing concerns
4. Immunisation of special groups
5. Coronavirus disease (COVID-19)
6. Diphtheria
7. Haemophilus inﬂuenzae type b (Hib) disease
8. Hepatitis A
9. Hepatitis B
10. Human papillomavirus
11. Inﬂuenza
12. Measles
13. Meningococcal disease
14. Mpox
15. Mumps
16. Pertussis (whooping cough)
17. Pneumococcal disease
18. Poliomyelitis
19. Respiratory syncytial virus
20. Rotavirus
21. Rubella
22. Tetanus
23. Tuberculosis
24. Varicella (chickenpox)
25. Zoster (herpes zoster/shingles)
Appendix 1: The history of immunisation in New Zealand
Appendix 2: Planning immunisation catch-ups
Appendix 3: Immunisation standards for vaccinators and guidelines for organisations offering immunisation services
Appendix 4: Authorisation of vaccinators and criteria of vaccinators
Appendix 5: Immunisation certiﬁcate
Appendix 6: Passive immunisation
Appendix 7: Vaccine presentation, preparation, disposal, and needle-stick recommendations
Appendix 8: Websites and other online resources
Main sources
Commonly used abbreviations
Glossary of vaccine brand names and abbreviations

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Download: Immunisation Handbook 2024 version 7 PDF download - PDF, 11 MB

This is version 7 of the Immunisation Handbook 2024, published 10 December 2024.

Summary of changes

Summary of changes published in previous Immunisation Handbook versions.

Immunisation Handbook 2024 version 7 summary of changes

Summary of changes published in Immunisation Handbook 2024 version 7 on 10 December on the Health NZ | Te Whatu Ora website.

Section detail	Change
Major changes	Measles: The wording related to MMR0 (dose zero) has been clarified to reduce confusion: A dose of MMR (called MMR0 [zero]) may be recommended for infants aged 4 months to under 12 months during measles outbreaks for pre-exposure prophylaxis (including for travel). Varicella: Additional wording to vaccinate as scheduled at age 15 months (or as catch up) regardless of clinical history of varicella.
Anaphylaxis emergency management	Footnote – edited wording around intravenous adrenaline to include medical staff while emphasizing this is not the recommended first line treatment. Also updated in Table 2.13 and section 2.3.3 anaphylaxis and emergency management.
Chapters 2, 6 Process for safe immunisation, Diphtheria	Section 2.1.7 – removed footnote re: administration fee as no longer relevant. Table 2.5 footnote – corrected Td to Tdap as Td vaccine discontinued. Section 6.5.2 catch up – removed Td, as above.
Chapter 12 Measles	Table 12.1 and section 12.5.1 MMR for infants aged under 12 months – updated wording for MMR0 as above. Section 12.5.5, Travel – added wording to clarify that 2 further doses of MMR are required if MMR0 has been given for travel reasons. Section 12.8, Public health measures: Section 12.8.1 Diagnosis – updated wording for measles clinical case definition to match wording in the Communicable Disease Control Manual. Section 12.8.2 post-exposure prophylaxis – added wording emphasizing that infants aged under 6 months are to be given HNIG as a priority.
Chapter 14 Mpox	Section 14.7.1 AEFI – addition of Aotearoa New Zealand Post Vaccine Symptom Check data and table.
Chapter 15 Mumps	Table 15.1 - updated footnote wording regarding MMR0 as above.
Chapter 24 Varicella	Section 24.5.1 usual childhood schedule – additional wording to vaccinate at 15 months (or as catch up) regardless of clinical history of varicella. Section 24.6.2 Precautions – removed precaution around VV, salicylates and Reye Syndrome. This has been removed from the Australian Handbook. Section 24.9 variations from the vaccine data sheet – addition of wording regarding VV and salicylate precaution on data sheet.
Chapter 25 Zoster	Section 25.5.1 recommended and funded – clarification that the 2nd rZV dose is only funded for ages 65 or 66 (if first dose given at 65 years), unless otherwise eligible. Section 25.7.1 potential responses – added commentary on fever and shivering when rZV is coadministered with 23 PPV (from data sheet). Section 25.7.2 AEFIs – addition of clinical trial data from data sheet on 23PPV coadministration with rZV.
Minor edits	Throughout – replaced cold chain URL with the Health NZ \| Te Whatu Ora cold chain web page.

Immunisation Handbook 2024 version 6 summary of changes

Summary of changes published in Immunisation Handbook 2024 version 6 on 15 October on the Health NZ | Te Whatu Ora website.

Section detail	Change
Major changes	Mpox chapter inserted as chapter 14, numbering of all following chapters updated along with hyperlinks connecting chapters. Vaccine brand swap updates: Varilrix replaces Varivax – this requires a change in age indications ‘from 12 months’ to ‘from 9 months of age’. Act-HIB replaces Hiberix. Update to health.govt.nz URLs (between publications) which particularly affect all references to the document ‘National standards for vaccine storage and transportation’.
Chapter 1 General immunisation	1.4.1 Live attenuated vaccines - removed live zoster vaccine and included BCG.
Chapter 2 Process for safe immunisation	2.1.3 Pre-vaccination screening - Table 2.2 additional wording for mpox vaccination related to history of myocarditis.
Chapter 4 Immunisation of special groups	4.3.1 Vaccination of close contacts: Removed recommendation for live zoster vaccine for close contacts of immunocompromised people as the non-live vaccine is available to those who are immunocompromised and the risk for virus transmission is low if zoster rash is covered. 4.8 Occupation-related vaccination / Table 4.9: Removed managed quarantine facilities for border staff. Added ‘livestock, wild birds and marine mammals’ to zoo staff and ‘those working with livestock’ to poultry workers for influenza vaccination – particularly for avian influenza reassortment risk with seasonal influenza.
Chapter 5 COVID-19	5.2.1 children and young adults - added in newly published reference for NZ children hospitalisation with COVID-19.
Chapter 7 Hib	7.4.1 Available vaccines - updated funded vaccine for Act-HIB.
Chapter 11 Influenza	Updated table 11.2 for animal handling groups unfunded but recommended influenza vaccine.
Chapter 14 Mpox	New chapter.
Chapter 19 RSV	19.4.2 Efficacy and effectiveness - added new immunogenicity findings around coadministration with aQIV and rZV. 19.4.4 Dosage and admin - altered wording around coadministration with rZV.
Chapter 23 Tuberculosis	Updated 23.2 clinical features, 23.3 epidemiology, 23.4.2 efficacy and references.
Chapter 24 Varicella	Updated with brand change.
Chapter 25 Zoster	25.4.4 Dosage/coadministration - updated with information about coadministration with RSVPreF3.
Appendix 2 Planning for immunisation catch up	A2.2.1 infants and children - bullet point 12, edited wording around getting back on schedule for PCV13 (also updated table A2.1 footnote c).

Immunisation Handbook 2024 version 5 summary of changes

Summary of changes published in Immunisation Handbook 2024 version 5 on 19 August on the Health NZ | Te Whatu Ora website.

Section detail	Change
Major changes	Removed adjuvated recombinant COVID-19 vaccine Nuvaxovid (rCV) as this vaccine is no longer offered as an alternative for mRNA-CV. Also removed all relevant statements about co-administration and use as an alternative COVID-19 vaccine.
Chapter 4 Immunisation of special groups	Removed adjuvated recombinant COVID-19 vaccine (rCV) sections throughout chapter. 4.3.9 Haematopoietic stem cell transplant (HSCT) – included DTaP-IPV-HepB/Hib (Infanrix-Hexa) funded for those aged 10 years to <18 years for revaccination following HSCT. 4.3.8 Oncology – added Herpes zoster (Shingrix) vaccine recommendation, funded for those who are immunocompromised following haematological malignancy diagnosis, HSCT or post cellular therapy. 4.3.12 HIV – defined ‘poorly controlled HIV’ for herpes zoster vaccination eligibility.
Chapter 5 COVID-19	Removed adjuvated recombinant COVID-19 vaccine (rCV) sections throughout chapter. 5.2 Clinical features – edited wording. 5.4.2 Available vaccines / History of approved vaccines – re-ordered text and mentioned Novavax withdrawing Medsafe application for XBB.1.5 rCV.
Chapters 6, 7, 9, 15, 17 & 21 Diphtheria, Hib, Hepatitis B, Pertussis, Polio, Tetanus	Revaccination sections – included DTaP-IPV-HepB/Hib for HSCT aged 10 years to <18 years and removed statements about 5 doses post solid organ transplant up to age 10 years to align with a correction to the planned Pharmaceutical Schedule update. Pertussis / Variations from datasheet – included age increase for DTaP-IPV-HepB/Hib post HSCT.
Chapter 12 Measles	12.8.2 post-exposure prophylaxis – edit to wording about offering MMR to potentially immunocompromised elderly adults – recommended to seek advice from IMAC prior to vaccination of adults born prior to 1960.
Chapter 18 RSV	Key information table – added precaution around rZV and Arexvy co-administration.
Chapter 19 Rotavirus	19.9 Variation from datasheet – removed recommendation not to repeat dose following regurgitation.
Chapter 24 Zoster	Table 24.1 – clarification of haematological malignancy and poorly controlled HIV definitions, added recommendations for potentially immunocompromised cancer patients. This is to cover those with historical cancer treatments who remain immunocompromised rather than those who are fully in remission.

Immunisation Handbook 2024 version 4 summary of changes

Summary of changes published in Immunisation Handbook 2024 version 4 on 16 July on the Health NZ | Te Whatu Ora website.

Section Detail	Change
Major Changes	Chapter 4 and Meningococcal, funded Nimenrix (Meningococcal ACWY) vaccine to replace NeisVac-C (Meningococcal C) vaccine on the extended immunisation programme for special groups. No change to eligibility criteria. Chapter 4 and Zoster, Shingrix (Zoster) vaccine for widened eligibility criteria now includes certain groups with immunocompromise aged 18 years and over. Privacy updates related to the Aotearoa Immunisation Register. Replaced all references to the ‘Privacy Act 1993’ with ‘Privacy Act 2020’. Replaced all references to the ‘Health Information Privacy Code 1994’ with ‘Health Information Privacy Code 2020’
Chapter 4 Immunisation of special groups	Section 4.2.3 Infants with congenital heart disease – wording edited around stand-down period for measles, mumps, rubella vaccine (MMR) and varicella vaccine (VV), after receiving blood products (linking to changes already made in Appendix 6). Section 4.2.5 Infants of mothers who received immunomodulatory agents – updated rotavirus vaccine recommendations – can receive if have had anti-TNF agents. Reordered some sections to place live vaccine caution ahead of COVID-19 vaccine details, as it is a higher priority. Added COVID-19 recommendations to chronic lung disease to align with Starship Hospital guidelines.
Chapter 8 Hepatitis A	Chapter 8 Hepatitis A – vaccine brand name updated from Havrix, to Havrix1440.
Chapter 13 Meningococcal disease	Updated ESR epidemiology data and figures.
Chapter 15 Pertussis & Chapter 4 Immunisation of Special Groups	Clarification of recommended but not funded booster frequency for some occupational groups, can be offered every 5-10 years, in accordance with employer recommendations.
Chapter 18- New Chapter RSV	Adverse Events Following Immunisation (AEFI) – added mention of Guillain Barre syndrome safety signal.

Immunisation Handbook 2024 version 3 summary of changes

Summary of changes published in Immunisation Handbook 2024 version 3 on 1 July on the Health NZ | Te Whatu Ora website.

Section Detail	Change
Major Changes	Updating “Immunisation Handbook 2024 Version 2” to “Immunisation Handbook Version 3” Reorganised layout to put anaphylaxis management, funded vaccines for special groups and National immunisation Schedule card at front of Handbook. Impact of adding a new chapter – chapter numbers moved over, and all hyperlinks required updating.
Chapter 4 Immunisation of special groups	Reorganised infants born to mothers who received immunomodulatory agents during pregnancy and immune checkpoint inhibitor sections. Updated relevant sections with XBB.1.5 COVID-19 vaccines for paediatrics.
Chapter 5 COVID-19	Large overhaul of clinical features and efficacy – to be more current Added in XBB.1.5 paediatric vaccines. Reorganised chapter order to be more relevant to current recommendations (i.e additional doses nearer top of recommended schedule section). Edited tables
Chapter 9 Hepatitis B	Non-responder protocol – changed repeated vaccinations, after failing to respond to a second IM course, to up to two single HepB doses given intradermally (evidence of better chance of immune response).
Chapter 13 & Appendix 2 Meningococcal disease	Removed wording around flexibility of catch up for those who turned 5 years old after 1 March 2023. This group have had 14 months to catch up.
Chapter 18- New Chapter RSV	Providing information about the unfunded vaccines.

Immunisation Handbook 2024 version 2 summary of changes

Summary of changes published in Immunisation Handbook 2024 version 2 on 4 June on the Health NZ | Te Whatu Ora website.

Section Detail	Change
Minor updates Throughout	Updating “Immunisation Handbook 2024 Version 1” to “Immunisation Handbook Version 2” In the notifiable disease chapters, public health measures have been edited and where relevant referred to the Communicable Disease Control Manual (CD Manual) website (see specific section detail changes below) URL and hyperlink updates where website URL addresses have changed including replacing immunise.health.nz with the new location, and updated IMAC factsheets, ESR, and CD manual URLs.
Introduction	Updated ‘Changes to the Handbook since 2020’ to reflect changes that have been made for the 2024 edition. Updated ‘Changes to the National Immunisation Schedule’ section to reflect changes in 2024. Updated ‘Changes to extended immunisation programme for special groups’ section to reflect changes to existing programmes in 2024.
Chapter 4 Immunisation of special groups	Updated section 4.3.3 ‘Primary Immunodeficiency’ to state that live vaccines are not contraindicated for children with down syndrome, unless in the case of underlying comorbidity that causes severe immunocompromise. Updated Table 4.8 footnote to include updated meningococcal vaccine criteria for children who turn 13 years of age while living in boarding school hostels.
Chapter 5 COVID-19	Corrected XBB.1.5. mRNA-CV multidose and single dose vial volumes in Table 5.1 to correctly match data sheet Corrected duplication of text error in section 5.5.3. Removed ‘cleared to leave isolation’ wherever this mentioned for Covid-19, as isolation is no longer a compulsory requirement for Covid.
Chapter 6 Diphtheria	Removed detailed antimicrobial prophylaxis treatment information and replaced with URL link to CD manual. Removed section 6.8.3 ‘Exclusion of contacts’ as this is covered in the CD manual
Chapter 7 Hib disease	Changed specific references to ‘rifampicin’ to general ‘antimicrobial’ prophylaxis Edited and removed content in section 7.8.1 ‘Management of contacts’ that is included in the CD manual, including the removal of detailed rifampicin chemoprophylaxis information.
Chapter 8 Hepatitis A	Removed content from section 8.8 ‘Public health measures’ that is included in the CD manual, including outbreak information.
Chapter 11 Influenza	Removal of content from section 11.8 ‘Public health measures’ that is included in the CD manual, including IPC measures and detailed antiviral drug information.
Chapter 12 Measles	Removal of content from section 12.8 ‘Public health measures’ that is included in the CD manual, including testing for diagnosis, and restriction of contacts information. Added in CD manual link.
Chapter 13 Meningococcal disease	Updated wording to include funding indication for those who turn 13 years of age while in a boarding school. Remove content from 13.8 ‘public health measures’ that is included in the CD manual, including diagnostic methods, contact management, and chemoprophylaxis for contacts.
Chapter 14 Mumps	Removed public health information duplicated in the CD manual, including case exclusion information. Added URL to CD manual.
Chapter 15 Pertussis	Updated ‘key information’ table to include statement to notify local medical officer of health upon suspicion of pertussis Rearranged section 15.8 ‘public health measures’ and removed information on laboratory diagnosis, exclusion and management of contacts, and antimicrobial treatment.
Chapter 17 Poliomyelitis	Removed content from section 17.8 ‘public health measures’ that is duplicated from CD manual, including specimen collection information.
Chapter 18 Rotavirus	Updated wording in section 18.6 to ‘immunomodulatory biologic agents’ from ‘immunosuppressive’
Chapter 19 Rubella	Expanded CRS (congenital rubella syndrome) on first mention Removed duplicated CD manual content from section 19.8 ‘Public health measures’ including exclusion of cases and diagnosis method information.
Chapter 20 Tetanus	Updated ‘key information’ table to include statement to notify local medical officer of health upon suspicion of disease
Chapter 22 Varicella	Renamed 22.8 ‘public health measures’ to ‘control measures’ as Varicella is not a notifiable disease.
Appendix 2 Planning immunisation catch-ups	Included updated wording on catch-up MenB dose schedule in children aged under 12 months Table A2.1 footnote wording updated in reference to MenB catch-up programme for children aged under 12 months, aged 12 months to under 24 months, and aged 24 months and over.
Appendix 3 Immunisation standards	Updated AIR data information
Appendix 8 Websites and other online resources	Update, removal, and addition of websites as necessary

Immunisation Handbook 2024 version 1 summary of changes

Summary of changes published in Immunisation Handbook 2024 version 1 on 17 April on the Health NZ | Te Whatu Ora website.

Section Detail	Change
Minor updates Throughout	Changing household contacts to household members and other close contacts as appropriate. URL updates and hyperlinks to CD manual – to eventually update all the public health measures sections with clear but brief information, particularly notification and vaccination, relevant to vaccinators/providers linking to CD manual. Further corrections will be made around the use of Ministry of Health and Te Whatu Ora.
Chapter 4 Immunisation of special groups	Updated relevant COVID-19 sections in each high-risk group.
Chapter 5 COVID-19	Extensive update to replace original and bivalent mRNA-CV (30 µg) with XBB.1.5 mRNA-CV (30µg) Mentioned end of PHEIC - Public Health Emergency of International Concern. Split table 5.2 into two table for recommendations for healthy and immunocompromised groups Removed reference to booster doses and replaced with ‘additional’ doses. XBB formulation is a one dose primary course. Updated recommendations for additional doses and additional doses in pregnancy. Updated public health measures.
Chapter 6 Diphtheria	Updated antimicrobial prophylaxis. Added URL to link with CD manual. Corrected vaccine details in the vaccination of contacts – Td no longer available but given in the CD manual. Updated ‘exclusion of contacts’ to match CD manual.
Chapter 9 Hepatitis B	Table 9.6 – clarified that 40µg means 2 doses of 1.0 ml (as requested by NZ Formulary). Figure 9.4 – non-responder protocol – add “and include serology for HBsAg and HBcAb to check for chronic infection.” To be conducted at same time as checking serology after a second course.
Chapter 11 Influenza	Updated for the Pharmac funded vaccine under a new purchase agreement – Influvac Tetra. Updated changes to eligibility and wording around that (i.e. removal of vaccine funded for all young children and Māori and Pacific people aged from 55 years).
Chapter 12 Measles	Improved clarity in wording about when children received MMR at 11 months and when 2nd dose is given.
Chapter 13 Meningococcal	Removed mention of MenB catch up for 13–25-year-olds. Added note in Table 13.2 to check NZ Formulary for antibiotic dosages. Corrected footnote in table 13.6 – MenB doesn’t have an upper age limit on licensure.
Chapter 15 Pertussis	Updated wording around unfunded (10-yearly) recommendations. As above added not to check NZ Formulary in Table 15.3
Chapter 16 Pneumococcal	Tables 16.3 and 16.4 – added footnote about giving 23PPV to children born prematurely with ongoing lung disease.
Appendix 4 Authorisation and criteria of vaccinators	A4.4 Resuscitation requirements - Removed mention of mouth to mouth (and mouth to mask and management of choking).
Appendix 6 Passive immunisation	A6.4.1 Interaction with other drugs. Added in a comment explaining that although response to MMR and VV might be blunted if given after receipt of blood products, the benefit could outweigh this reduction in response (especially if MMR given following ZIG).

Immunisation Handbook 2020 version 24 summary of changes

Summary of changes published in Immunisation Handbook 2020 version 24 in December 2023 on the Ministry of Health website.

Section detail	Change
Chapter 13 Meningococcal disease Chapter 16 Pneumococcal disease Chapter 4 Immunisation of special groups	Removal of Menactra – chapter 4, meningococcal and pneumococcal chapters; edits to meningococcal vaccine for extended immunisation for special groups in tables.
Chapter 12 Measles	Slight changes to wording around post-exposure prophylaxis for measles and MMR1 at 11 months to agree with the Communicable Disease Control Manual.
Chapter 15 Pertussis	Slight changes to wording around post-exposure prophylaxis for measles and MMR1 at 11 months to agree with the Communicable Disease Control Manual.
Chapter 22 Varicella Appendix 6 Passive immunisation	IVIG – removal of brand names and information and to refer to NZ Blood for information.
Appendix 8 Websites and other online resources	Minor edits to the Appendix 8 to add a few newer websites and Māori names for some organisations that have them.

Immunisation Handbook - 2024, version 7

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Summary of changes