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AU immunisation schedule

Australian guidance: Australian Immunisation Handbook (Australian Government Department of Health and Aged Care, online edition; chapters cited last updated Aug 2025–Jan 2026)

1. Definition and epidemiology

Australia's National Immunisation Program (NIP) is a universal, government-funded schedule delivered at chronological age regardless of prematurity, covering the period from birth through to adult life. Vaccine-preventable disease rates have declined substantially since the program's expansion in the 1990s, with measles, diphtheria and Haemophilus influenzae type b (Hib) disease now at historically low levels. Immunisation coverage in Australia is tracked via the Australian Immunisation Register (AIR), accessible through Medicare Online. Aboriginal and Torres Strait Islander children carry a disproportionately higher burden of several vaccine-preventable diseases and receive an augmented schedule.

2. Pathophysiology

Vaccines prevent disease through active or passive immunisation. Active immunisation involves introducing an antigen (live attenuated, inactivated whole pathogen, subunit, toxoid, or mRNA) to stimulate a primary immune response, generating antigen-specific memory B and T cells. On subsequent exposure to the pathogen, memory cells mount a rapid, high-titre secondary response that clears infection before clinical disease develops. Conjugate vaccines attach a polysaccharide antigen to a protein carrier, converting a T-cell-independent response (poorly immunogenic in infants under 2 years) into a T-cell-dependent one, enabling protective immunity from 6 weeks of age. Live attenuated vaccines (measles-mumps-rubella, varicella, rotavirus) replicate briefly and elicit robust, long-lasting cellular and humoral immunity, but require intact immune function. Toxoid vaccines (diphtheria, tetanus) neutralise circulating toxin rather than the organism itself. Herd immunity thresholds vary by pathogen transmissibility; measles requires approximately 95% population coverage to prevent outbreaks.

3. Clinical presentation and diagnostic criteria

The immunisation schedule is a preventive public health intervention rather than a clinical condition with symptoms or diagnostic criteria. Clinically, the schedule is applied through structured encounters at birth, 2 months, 4 months, 6 months, 12 months, 18 months and 4 years, then during adolescence (12 to 13 years and 14 to 16 years). At each encounter, the provider reviews the child's AIR Immunisation History Statement, screens for contraindications (including anaphylaxis to vaccine components, acute febrile illness, and immunocompromising conditions), and administers due vaccines. Mild adverse events (injection site reactions, low-grade fever) are expected and do not constitute contraindications to future doses. Apnoea in hospitalised preterm infants following vaccination is a recognised adverse event requiring 48-hour monitoring but does not preclude future immunisation.

4. Investigations and AU-specific cutoffs

Laboratory testing to determine immunity from previous vaccination or infection, to guide the need for catch-up vaccination, is reliable only for hepatitis A, hepatitis B, measles, mumps and rubella, and (with the caveat that it does not always detect vaccine-induced immunity) varicella. For other diseases — for example pneumococcal disease or influenza — serology is not routinely recommended to guide catch-up, either because it is unreliable or because infection with one serotype/strain does not protect against the others in the vaccine [AIH — catch-up-vaccination.md]. If a person's previous vaccination cannot be confirmed by the Australian Immunisation Register (AIR) or the vaccinating provider, and no written record exists, assume the vaccine has not been received and offer catch-up vaccination for their age, rather than testing; for most vaccines there is no adverse-event penalty for an unnecessary extra dose in someone already immune. Q fever is the recognised exception to this "just vaccinate" default: serological or skin testing beforehand is specifically relevant for Q fever because of the risk of adverse reactions to vaccination in people with existing immunity [AIH — catch-up-vaccination.md].

For hepatitis B specifically, the sources read for this note describe post-vaccination serology only for two groups (they do not mention it for the general, term-born infant population): (1) low-birthweight (<2000 g) and/or <32-weeks-gestation infants, who — after their 4-dose schedule at birth, 2, 4 and 6 months — either receive a routine booster at 12 months without testing, or have anti-HBs measured about 1 month after the 6-month dose (i.e. around 7 months of age), with a booster given if the titre is below 10 mIU/mL [AIH — vaccination-preterm-infants.md; AIH — hepatitis-b.md]; and (2) infants born to HBsAg-positive mothers, who have HBsAg and anti-HBs measured 3 to 12 months after completing the vaccine course (not before 9 months of age, to avoid detecting passive anti-HBs from birth-dose immunoglobulin) — protection is confirmed by anti-HBs ≥10 mIU/mL with a negative HBsAg [AIH — hepatitis-b.md].

For catch-up planning, a child's or adult's Immunisation History Statement (IHS) can be obtained from the AIR via Health Professional Online Services (HPOS), by calling the AIR enquiries line on 1800 653 809, or — for parents/carers and adults — through a Medicare online account via myGov or the myGov app [AIH — catch-up-vaccination.md]. A "valid" dose is one that met the minimum age and minimum inter-dose interval for the vaccine and the recipient's age; the minimum age for the first dose is 6 weeks for DTPa-, hepatitis B-, Hib-, IPV- and pneumococcal-containing vaccines and for MenACWY/MenB, 12 months for MMR, and (for rotavirus) 6 weeks with a strict upper limit that differs by brand: Rotarix's first dose must be given before the infant turns 15 weeks old and Rotarix's second (final) dose before 25 weeks old; RotaTeq's first dose must be given before turning 13 weeks old and its third (final) dose before turning 33 weeks old — rotavirus catch-up is not offered once these upper age limits have passed [AIH — catch-up-vaccination.md; AIH — rotavirus.md].

5. Management

Standard NIP schedule (birth to 4 years)

At birth: hepatitis B monovalent vaccine, within 7 days of birth (ideally within 24 hours, before hospital discharge) [AIH — hepatitis-b.md].

At 2 months (can start from 6 weeks): DTPa-hepB-IPV-Hib — diphtheria-tetanus-acellular pertussis, hepatitis B, inactivated poliovirus, Hib, given as either Infanrix hexa or Vaxelis — oral rotavirus vaccine (Rotarix or RotaTeq), and 20-valent pneumococcal conjugate vaccine (20vPCV) [AIH — hepatitis-b.md; AIH — poliomyelitis.md; AIH — rotavirus.md; AIH — pneumococcal.md].

At 4 months: DTPa-hepB-IPV-Hib, rotavirus (2nd dose), and 20vPCV.

At 6 months: DTPa-hepB-IPV-Hib, and rotavirus 3rd dose (RotaTeq only — the Rotarix 2-dose series is complete at 4 months) [AIH — rotavirus.md]. This is the routine 3-dose primary schedule point for 20vPCV (2, 4 and 12 months) becoming a 4-dose schedule with an extra dose here for Aboriginal and Torres Strait Islander children and children with a risk condition for pneumococcal disease [AIH — pneumococcal.md].

At 12 months: MMR (measles-mumps-rubella, as Priorix or M-M-R-II), MenACWY (single dose of Nimenrix or MenQuadfi, or 2 doses of Menveo, 8 weeks apart, for children starting at 12–23 months), and the 20vPCV booster [AIH — measles.md; AIH — meningococcal.md; AIH — pneumococcal.md]. Hepatitis A vaccine (2 doses) is recommended for Aboriginal and Torres Strait Islander children in the Northern Territory, Queensland, South Australia and Western Australia, with the 1st dose in the 2nd year of life — the catch-up chapter specifies dose 1 at 18 months and dose 2 at 4 years [AIH — catch-up-vaccination.md; AIH — vaccination-aboriginal-torres-strait-islander.md].

At 18 months: MMRV (measles-mumps-rubella-varicella, as Priorix-Tetra or ProQuad), plus the 4th (1st booster) dose of DTPa-containing vaccine and the 4th (booster) dose of Hib-containing vaccine. Hepatitis B and IPV are not boosted at this visit — their primary courses are already complete by 6 months, and IPV's next (and final childhood) dose is at 4 years, so the 18-month product is a DTPa/Hib-containing vaccine rather than the full hexavalent used at 2/4/6 months [AIH — haemophilus-influenzae-type-b-hib.md; AIH — poliomyelitis.md; AIH — hepatitis-b.md]. Varicella-containing vaccine is routinely given as this 2nd MMR-containing dose (MMRV) rather than as a 1st dose, to minimise febrile-convulsion risk [AIH — catch-up-vaccination.md].

At 4 years: DTPa-IPV (the 5th DTPa dose, and the 4th and final IPV dose in the routine 2-/4-/6-month-and-4-year IPV schedule) [AIH — poliomyelitis.md], and the 2nd MMR-containing dose if MMRV was not already given at 18 months.

Catch-up principle: never restart a series from scratch — count previously documented valid doses and build forward, and give all overdue vaccines at the first catch-up visit rather than staging them, except for oral cholera vaccine (the one documented exception to "never restart") [AIH — catch-up-vaccination.md]. For rotavirus specifically, catch-up vaccination of older infants is not offered at all if the child is beyond the upper age limits given in section 4 above — do not start or continue the course beyond those limits [AIH — catch-up-vaccination.md; AIH — rotavirus.md].

Preterm and low-birthweight infants: infants born at <28 weeks gestation receive an additional 20vPCV dose at 6 months, on top of the routine 2-, 4- and 12-month doses, giving a 4-dose schedule (2, 4, 6, 12 months) [AIH — vaccination-preterm-infants.md]. Infants <2000 g and/or born at <32 weeks gestation receive hepatitis B vaccine at birth, 3 further doses at 2, 4 and 6 months, and then either a routine 12-month booster or anti-HBs testing around 7 months with a booster if the titre is low, as in section 4 [AIH — vaccination-preterm-infants.md; AIH — hepatitis-b.md]. Rotavirus is given at the infant's chronological age, not corrected for prematurity, subject to the same strict upper age limits as full-term infants [AIH — rotavirus.md].

Aboriginal and Torres Strait Islander children receive the same DTPa/hepB/IPV/Hib, rotavirus, MMR(V), and 12-month MenACWY schedule as other children, plus, nationally: 20vPCV at 2, 4, 6 and 12 months (the extra 6-month dose described above); and MenB vaccine (Bexsero, the only MenB brand currently available in Australia — Trumenba was discontinued in 2024), routinely a 3-dose schedule at 2, 4 and 12 months for infants starting at 2 months of age. Hepatitis A (2 doses, 1st dose in the 2nd year of life) is the one vaccine in this list restricted to children in the Northern Territory, Queensland, South Australia and Western Australia. An additional MenB dose at 6 months, and an additional MenACWY dose, apply only to Aboriginal and Torres Strait Islander infants and children who also have a specified medical condition that increases meningococcal risk — not to all Aboriginal and Torres Strait Islander infants as a routine matter [AIH — meningococcal.md; AIH — vaccination-aboriginal-torres-strait-islander.md].

Adolescents: the NIP includes a dTpa (reduced-antigen diphtheria-tetanus-acellular pertussis) booster at 11 to 13 years [AIH — pertussis.md]; HPV vaccine, usually given in School Year 7 (around 12 to 13 years) as a single dose, funded from 12 to 25 years of age (3 doses if immunocompromised, regardless of age) [AIH — human-papillomavirus-hpv.md]; and MenACWY at 14 to 16 years [AIH — meningococcal.md].

6. Pharmacology and AU PBS notes

NIP vaccines are funded through the National Immunisation Program rather than the PBS — they are provided free to eligible people through immunisation providers, not dispensed as a PBS prescription item. Brand names and sponsors below are as given in the Australian Immunisation Handbook's vaccine tables [AIH — hepatitis-b.md; AIH — haemophilus-influenzae-type-b-hib.md; AIH — rotavirus.md; AIH — pneumococcal.md; AIH — measles.md; AIH — meningococcal.md; AIH — respiratory-syncytial-virus.md].

DTPa-hepB-IPV-Hib: Infanrix Hexa (GlaxoSmithKline Australia) and Vaxelis (Maxx Pharma Pty Ltd) — no preferential recommendation between the two; both funded from birth (as the 2-, 4- and 6-month doses) for all infants.

Rotavirus: Rotarix (GlaxoSmithKline Australia, 2-dose schedule at 2 and 4 months) and RotaTeq (Merck Sharp & Dohme (Australia), 3-dose schedule at 2, 4 and 6 months) — both funded through the NIP for infants under 6 months of age.

Pneumococcal conjugate: the current NIP vaccine is 20vPCV, brand name Prevenar 20 (Pfizer Australia) — not Apexxnar, which is a different market's brand name for the same antigen composition and is not the name used in the AU handbook capture read for this note. Prevenar 20 replaced 13vPCV (Prevenar 13, Pfizer Australia) on the NIP. Children who received earlier-valency pneumococcal vaccines — 7vPCV, 10vPCV, 13vPCV or 15vPCV (Vaxneuvance, Merck Sharp & Dohme) — do not need supplementary doses of a higher-valency vaccine; where a completed course used 13vPCV/15vPCV, some Aboriginal and Torres Strait Islander and at-risk children are recommended a single catch-up 20vPCV dose, which has replaced the previously used 23-valent polysaccharide vaccine (23vPPV, Pneumovax 23, Merck Sharp & Dohme (Australia)) for this purpose.

MMR and MMRV: MMR is available as Priorix (GlaxoSmithKline Australia) or M-M-R-II (Merck Sharp & Dohme (Australia)), both registered from 12 months. MMRV is available as Priorix-Tetra (GlaxoSmithKline Australia, registered from 9 months) or ProQuad (Merck Sharp & Dohme (Australia), registered 12 months to 12 years); MMRV is given as the 2nd (not 1st) dose of MMR-containing vaccine in children under 4 years to reduce febrile-convulsion risk.

MenACWY: Nimenrix (Pfizer Australia), MenQuadfi (Sanofi-Aventis Australia) and Menveo (GlaxoSmithKline Australia) have no brand preference for people aged ≥12 months (Menveo or Nimenrix are preferred for infants <12 months); NIP-funded for all children at 12 months, all adolescents 14–16 years, and people ≥2 months with a specified medical condition that increases meningococcal risk.

MenB: Bexsero (GlaxoSmithKline Australia) is the only MenB vaccine currently registered and available in Australia — Trumenba was discontinued in 2024. NIP-funded for Aboriginal and Torres Strait Islander people aged <2 years at their first dose, and for people aged ≥2 months with a specified medical condition that increases meningococcal risk. Outside these funded groups Bexsero can be obtained by private prescription; the sources read for this note do not describe a PBS subsidy pathway for that scenario, so none is asserted here.

RSV monoclonal antibodies: nirsevimab is marketed as Beyfortus (Sanofi-Aventis Australia, not AstraZeneca), a long-acting RSV F-protein monoclonal antibody preferred over the short-acting alternative, palivizumab (Synagis, AstraZeneca), for eligible infants. Nirsevimab is not itself a vaccine and is funded through state and territory programs rather than the NIP directly; recommended infants include those born at <32 weeks gestation and others with risk conditions for severe RSV disease, per the flowchart in the RSV chapter.

7. Complications and monitoring

The primary complications of the schedule relate to missed doses, catch-up errors and adverse events rather than to disease itself. Key monitoring points:

Apnoea and bradycardia: preterm infants vaccinated in hospital, especially those born before 32 weeks or with a prior apnoea history, must be monitored for up to 48 hours after each vaccination encounter.

Febrile convulsion: risk is approximately 1 in 2000 after the 1st dose of MMRV, compared to 1 in 3000 after MMR alone. This is why MMRV is reserved for the 2nd dose of varicella-containing vaccine in children under 4 years.

Injection site reactions: repeated doses of DTPa, pertussis-containing and pneumococcal polysaccharide vaccines increase the frequency of local reactions. This does not constitute a contraindication to future doses but should be documented.

Immunisation status review: every clinical encounter is an opportunity to check AIR status and offer catch-up. The AIR flags children as "up to date" or "overdue" using the national due and overdue rules. Natural immunity to a disease recorded on AIR counts as a valid exemption for certain antigens.

Surveillance: Australia's immunisation coverage target is 95% for all NIP vaccines by 5 years of age. Coverage data are published annually via the AIR and the Australian Childhood Immunisation Coverage Dashboard. Children of Aboriginal and Torres Strait Islander background are flagged separately to allow targeted outreach and monitoring.

Written for Australian practice and grounded in the guidance named above. Study material only — not medical advice. Always check against current guidelines.