2008 National Immunisation Schedule Health Provider booklet

2008 National 

Immunisation Schedule 

Health Provider Booklet

Published in May 2008 by the 

Ministry of Health 

PO Box 5013, Wellington, New Zealand 

ISBN 978-0-478-31748-0 (print) 

ISBN 978-0-478-31749 (online) 

HP 4575 

This document is available on the Ministry of Health’s website: 

http://www.moh.govt.nz

Contents 

Introduction 1 

Informed consent 1 

Eligibility for schedule vaccines 1 

1 National Immunisation Schedule 2 

1.1 National Immunisation Schedule 2 

1.2 Changes to the National Immunisation Schedule 2 

1.3 Other schedule vaccines – Td, Hepatitis B, BCG 3 

1.4 Ordering 2008 Schedule vaccines 4 

1.5 How to claim the immunisation benefit – HealthPAC Information 4 

1.6 What to do with unused 2006 schedule vaccines 4 

1.7 Health education resources 5 

1.8 NIR forms 5 

1.9 Who to contact if you have questions 5 

2 Key Points 6 

2.1 dTap (Boostrix TM ) vaccine 6 

2.2 DTaP-IPV-HepB/Hib (Infanrix®-hexa) vaccine 7 

2.3 PCV7 (Prevenar®) vaccine 10 

2.4 MeNZB TM vaccine 13 

2.5 Expansion of the high risk pneumococcal programme for children under five years of 

age with a chronic condition 16 

2.6 HPV immunisation programme 18 

2.7 New schedule vaccine presentation and administration 21 

3 dTap (Boostrix) Vaccine and Pertussis Epidemiology 23 

3.1 dTap (Boostrix TM ) vaccine schedule 23 

3.2 Rationale for introducing the dTap vaccine 23 

3.3 Pertussis epidemiology 23 

3.4 dTap (Boostrix TM ) vaccine information 25 

3.5 Other recommendations 27 

3.6 National Immunisation Register and School Based Vaccination System 28 

4 DTaP-IPV-HepB/Hib (INFANRIX ® -hexa) 29 

4.1 Early introduction of DTaP-IPV-HepB/Hib from March 2008 29 

4.2 DTaP-IPV-HepB/Hib vaccine schedule – from 1 June 2008 29 

4.3 Change in type of Hib vaccine 29 

4.4 DTaP-IPV-HepB/Hib vaccine information 29 

4.5 DTaP-IPV-HepB/Hib vaccine and the National Immunisation Register 33 

4.6 DTaP-IPV-HepB/Hib vaccine and claiming the immunisation benefit 33 

5 Pneumococcal Conjugate Vaccine (PCV7, Prevenar ® ) and 

Pneumococcal Epidemiology 34 

2008 National Immunisation Schedule: Health Provider Booklet iii

5.1 PCV7 vaccine schedule – from 1 June 2008 34 

5.2 Pneumococcal disease 34 

5.3 Epidemiology 36 

5.4 Effects of introducing pneumococcal vaccine onto the infant immunisation programme 39 

5.5 Immunogenicity and efficacy of pneumococcal conjugate vaccine 45 

5.6 PCV7 vaccine information 46 

5.7 PCV7 vaccine and the National Immunisation Register – National Immunisation 

Schedule only 48 

5.8 PCV7 vaccine and claiming the immunisation benefit – Childhood Immunisation 

Schedule only 48 

6 Expansion of the High Risk Pneumococcal Programme for 

Children under Five Years of Age with a Chronic Condition 49 

6.1 Addition of new eligible groups 49 

6.2 High risk pneumococcal programme immunisation schedule 49 

6.3 Entering high-risk pneumococcal programme vaccines on the National Immunisation 

Register 50 

6.4 Claiming for high-risk pneumococcal programme vaccines 51 

Appendix 1: Immunisation Catch-up Schedules 52 

1.1 National Immunisation Schedule catch-up schedules 52 

1.2 High risk pneumococcal immunisation programme catch-up schedules 55 

Appendix 2: Pre/Post Splenectomy Immunisation Programme 56 

References 58 

List of Tables 

Table 1.1: National Immunisation Schedule from 1 June 2008 2 

Table 2.1: PCV7 vaccine catch-up programme 10 

Table 2.2: Eligibility criteria for high-risk pneumococcal programme 16 

Table 5.1: PCV7 vaccine schedule 34 

Table 6.1: Eligibility criteria for high-risk pneumococcal programme 49 

Table 6.2: 

Schedule for pneumococcal vaccines for children at higher risk of pneumococcal 

disease with no prior history of pneumococcal vaccines 50 

List of Figures 

Figure 3.1: Notifications of pertussis in New Zealand (all ages), 2001–2007 24 

Figure 3.2: Age-specific rates of pertussis in New Zealand 2000–2006 24 

Figure 5.1: Pneumococcal disease spectrum (for use as a guide only) 35 

Figure 5.2: Hospitalisations from pneumococcal meningitis in children under two years of age, 

1999–2006 37 

Figure 5.3: Hospitalisations from pneumococcal septicaemia in children under two years of age, 

1999–2006 38 

Figure 5.4: Rate of vaccine-type (VT) invasive pneumococcal disease (IPD) before and after 

introduction of pneumococcal conjugate vaccine (PCV7), by age group and year; 

Active Bacterial Core surveillance, United States, 1998–2003 40 

iv 

2008 National Immunisation Schedule: Health Provider Booklet

Introduction 

This booklet includes the following information about the 2008 National Immunisation 

Schedule (Schedule): 

• changes to the Schedule in 2008 

• new vaccines (rationale for introduction, vaccine schedules, efficacy, safety) 

• information on stopping the MeNZB vaccine special programme (see Key Points) 

• children starting on or changing to the 2008 Schedule (Catch-up Schedules) 

• key points information on the HPV (human papillomavirus) Immunisation Programme 

• vaccine ordering information 

• National Immunisation Register updates 

• immunisation benefit claims 

• what to do with unused 2006 schedule vaccines 

• an update on immunisation resources available for providers and parents 

• who to contact if you have questions. 

Informed consent 

The Ministry of Health recommends immunisation however it is a parent’s choice to 

immunise their child. For more information on informed consent refer to the 

Immunisation Handbook 2006. 

Eligibility for schedule vaccines 

Children under 16 years of age 

All children under 16 years of age are eligible for free National Immunisation Schedule 

vaccines (http://www.moh.govt.nz/moh.nsf/indexmh/eligibility-healthservices-doctor). 

Unimmunised adults 

Unimmunised adults 16 years and over are eligible for free primary courses of the 

following vaccines: 

• Td (three doses) 

• MMR (two doses) 

• IPV (three doses) 

• Hepatitis B (three doses – household and sexual contacts of hepatitis B carriers 

only). 

The immunisation benefit may be claimed for these vaccines. 

2008 National Immunisation Schedule: Health Provider Booklet 1

1 National Immunisation Schedule 

1.1 National Immunisation Schedule 

Table 1.1: National Immunisation Schedule from 1 June 2008 

Immunisation given 

Brand name 

DTaP-IPV- 

HepB/Hib 

Infanrix®- 

Hexa 

PCV7 Hib MMR DTaP-IPV dTap* HPV** 

Prevenar® Hiberix M-M-R® II Infanrix-IPV Boostrix Gardasil® 

Manufacturer GSK Wyeth GSK MSD GSK GSK CSL 

6 weeks • • 

3 months • • 

5 months • • 

15 months • • • 

4 years • • 

11 years • 

12 years 

girls only 

* From 1 January dTap is given to 11-year-old children. 

** From 2009 

Vaccine key 

D = diphtheria; T = tetanus; aP = acellular pertussis; HepB = hepatitis B; IPV = inactivated polio vaccine; 

Hib = Haemophilus influenzae type b; PCV7 = 7-valent pneumococcal conjugate vaccine; 

MMR = measles-mumps-rubella; d = adult dose diphtheria; ap = adult dose acellular pertussis, HPV = 

human papillomavirus. 

• 3 doses 

1.2 Changes to the National Immunisation Schedule 

From January 2008 

• dTap (Boostrix TM ) vaccine is given at age 11 years instead of dTap-IPV. 

From March 2008 

• Introduction of DTaP-IPV-HepB/Hib (Infanrix®-hexa) vaccine instead of DTaP-IPV 

(Infanrix-IPV) and Hib-HepB (Comvax®) at age six weeks and three and five 

months. 

2 2008 National Immunisation Schedule: Health Provider Booklet

From 1 June 2008 

• Introduction of pneumococcal conjugate (PCV7, Prevenar®) vaccine for all babies 

born from 1 January 2008. 

• Introduction of DTaP-IPV-HepB/Hib (Infanrix®-hexa) vaccine for all babies. 

• Cessation of meningococcal B (MeNZB TM ) vaccine special programme. 

• Expansion of high-risk pneumococcal programme for children under five years of 

age. 

From 1 September 2008 

• Introduction of the human papillomavirus (HPV) vaccine for young women aged 

17 and 18 years (i.e. born in 1990 and 1991). 

From early 2009 

• Introduction of the HPV vaccine onto the National Immunisation Schedule for 12 year 

old girls (in primary care and health clinics) and girls in school Year 8. 

• HPV vaccine given to girls aged 13 to 18 years. Delivery of HPV vaccine to these 

cohorts will be phased over 2009 and 2010. 

For further information about the new vaccines refer to the section 2 Key Points and 

sections 3 to 6. 

1.3 Other schedule vaccines – Td, Hepatitis B, BCG 

There are no changes in the National Immunisation Schedule for the Td, Hepatitis B, 

and BCG vaccines. 

Practitioners are reminded that all pregnant women should be assessed for: 

• their hepatitis B status (HBsAg or HBeAg positive) in early pregnancy 

• the risk of tuberculosis for their baby. 

Neonatal BCG should be offered to newborns at increased risk for tuberculosis, see the 

Immunisation Handbook 2006, chapter 12, page 248 (Ministry of Health 2006). 

Please ensure that all babies of mothers who are HBsAg or HBeAg positive receive: 

• hepatitis B vaccine and hepatitis B immunoglobulin at birth; and 

• doses of hepatitis B vaccine at six weeks and three and five months. 

The baby’s serology must be checked at age five months, at the time of the fourth dose, to 

check for immunity/infection. See the Immunisation Handbook 2006, Figure 3.3, 

page 134 for details (Ministry of Health 2006). 


1.4 Ordering 2008 Schedule vaccines 

All schedule vaccines can be ordered by fax through ProPharma: 

• dTap (Boostrix) is available to order 

• DTaP-IPV-HepB/Hib (Infanrix®-hexa) is available to order 

• PCV7 (Prevenar®) is available to order. 

• While no longer recommended for routine use, the MeNZB vaccine can continue to 

be accessed from ProPharma (See Sections 2 and 6 for more information on the use 

of the MeNZB vaccine) from 1 June 2008. 

• HPV (GARDASIL®) can be ordered by primary care providers from August 2008 and 

will be available for school immunisation programmes to order in early 2009. 

Please ring ProPharma on 0800 400 101 if you: 

• do not have a ProPharma account 

• need a fax order form. 

1.5 How to claim the immunisation benefit – HealthPAC Information 

See Section 2 Key Points and Sections 3-7 for more detailed information on claiming for 

specific vaccines. 

For information about claiming from HealthPAC and error codes and their meanings, 

please refer to the Ministry’s Frequently Asked Questions webpage at: 

http://www.moh.govt.nz/moh.nsf/indexmh/healthpac-faq-immunisation 

For HealthPAC claim forms, please phone Wickliffe Press on 0800 259 138 and quote 

your payee number. 

1.6 What to do with unused 2006 schedule vaccines 

Hib-HepB vaccine – COMVAX ® 

From 1 June 2008, all unused stock of Hib-HepB vaccine (Comvax®) should be 

returned to ProPharma. 

Hepatitis B vaccine – HBvaxPRO ® 

The hepatitis B vaccine (HBvaxPRO) doses for children should be retained if the 

practice is likely to use these vaccines before the expiry date. 

Note that the birth dose of hepatitis B is given to those babies born to mothers who 

carry the hepatitis B virus (see section 8). 

DTaP-IPV – INFANRIX TM -IPV 

DTaP-IPV vaccine (Infanrix®-IPV) will continue to be used for the immunisation event at 

age four years. 


1.7 Health education resources 

The Ministry of Health immunisation resources will be updated to include all the 2008 

changes to the National Immunisation Schedule. These updated resources can be 

ordered through the HealthEd website: http://www.healthed.govt.nz. 

A new resource has been developed to provide parents and caregivers with further 

information on the pneumococcal vaccine (PCV7, Prevenar®). This resource can be 

ordered through the HealthEd website: http://www.healthed.govt.nz. 

1.8 NIR forms 

NIR forms are being updated for the 2008 Schedule effective from 1 June 2008. 

To reorder NIR forms: 

• Phone: (04) 496 2277 

• Email: moh@wickliffe.co.nz 

• Fax: 0800 802 126. 

Please quote the reference number printed on the form with any order made. 

1.9 Who to contact if you have questions 

Vaccine ordering 

Immunisation benefit claiming 

Reordering NIR forms 

Technical Advice 

National Immunisation 

Programme 

Propharma 

0800 400 101 

HealthPAC 

0800 458 448 

www.moh.govt.nz/moh.nsf/indexmh/healthpac-faq-immunisation 

moh@wickliffe.co.nz 

Fax 0800 802 126 

Immunisation Advisory Centre (IMAC) 

0800 IMMUNE or 0800 466 863 

www.immune.org.nz 

• National Immunisation Programme queries: 

immunisation@moh.govt.nz 

• General immunisation information/ Immunisation Handbook 2006: 

www.moh.govt.nz/immunisation 


2 Key Points 

2.1 dTap (Boostrix TM ) vaccine 

For further detailed information about the adult diphtheria, tetanus, adult acellular 

pertussis (dTap, Boostrix TM ) vaccine, see section 3 and the Boostrix TM data sheet (refer 

to the Medsafe data sheets at: 

http://www.medsafe.govt.nz/profs/Datasheet/dsform.asp). 

Note: The dTap vaccine is delivered as a school-based (year 7) immunisation 

programme in the North Island and Nelson Marlborough DHBs and by primary health 

care services in the remainder of the South Island. 

Why was dTap introduced 

From 1 January 2008, the dTap (Boostrix TM ) vaccine replaced the dTap-IPV (Boostrix®- 

IPV) vaccine on the National Immunisation Schedule at 11 years of age. From 2008, all 

11-year-old children will have already received the recommended four doses of polio 

vaccine in childhood. 

Will dTap vaccine be recorded on the National Immunisation Register 

In primary health care situations, dTap vaccine will not be recorded on the National 

Immunisation Register (NIR) as 11-year-old students are not in the NIR’s birth cohort. 

The School Based Vaccination System (SBVS) has been updated for the introduction of 

the dTap vaccine. The SBVS will not provide details of dTap vaccine events to the NIR. 

Why should dTap vaccine be delayed until two years after receipt of a tetanusdiphtheria 

vaccine (eg, Td vaccine after an injury) 

This delay in administering dTap aims to decrease the risk and severity of a local 

reaction at the injection site. This precaution may be waived if a pertussis epidemic is 

beginning and the student lives in a household with an unimmunised younger sibling or 

a pregnant woman. 

Students who have received Td vaccinations in the past two years should be referred to 

their general practitioner for follow-up and recall. The dTap vaccine should be offered 

to these students before they reach 16 years of age. 

If the child received a Td vaccine booster three to five years ago, dTap immunisation is 

recommended. 


2.2 DTaP-IPV-HepB/Hib (Infanrix®-hexa) vaccine 

For further detailed information about Infanrix®-hexa, see section 4, and the Infanrix®hexa 

data sheet (refer to the Medsafe data sheets at: 


Why was DTaP-IPV-HepB/Hib (Infanrix®-hexa) introduced in mid-March 2008 

Due to Hib-HepB (Comvax®) vaccine manufacturing problems, New Zealand was not 

able to secure further supplies of Comvax® vaccine beyond March 2008. Stocks of 

Comvax® vaccine have run out, and DTaP-IPV-HepB/Hib (Infanrix®-hexa) vaccine is 

now available. 

Please continue to use your practice’s supply of Comvax® vaccine until it has run out. 

Who is eligible for the DTaP-IPV-HepB/Hib (Infanrix®-hexa) vaccine 

All babies due for their six-week, three-month or five-month immunisations are eligible 

for the Infanrix®-hexa vaccine. 

The Ministry of Health recommends Infanrix®-hexa also be given to children at five 

months of age, replacing DTaP-IPV and HepB (HBvaxPRO). However DTaP-IPV and 

HepB vaccines may still be given to five-month-old babies until 1 June 2008. 

A change of vaccine within a primary series is safe and expected to be effective. 

The introduction of Infanrix®-hexa vaccine means there will be two injections given at 

six weeks and three and five months of age (Prevenar® and Infanrix®-hexa). 

How is DTaP-IPV-HepB/Hib (Infanrix®-hexa) administered 

Infanrix®-hexa vaccine is administered by intramuscular injection into the thigh. 

Note: The Infanrix®-hexa and Prevenar® vaccines should be given in separate limbs 

Infanrix®-hexa vaccine must be reconstituted prior to administration as follows. 

• Attach the 25-gauge needle to the pre-filled syringe. 

• Transfer the syringe’s liquid suspension to the vial containing the Hib pellet. 

• Shake the vial well to ensure the Hib pellet is completely dissolved. 

• Draw the reconstituted vaccine back into the syringe. 

• Attach the 23-gauge needle to the syringe for vaccine administration. 

• After reconstitution, the vaccine should be injected promptly. 

• However, the vaccine may be kept for up to eight hours at room temperature (21°C). 


DTaP-IPV-HepB/Hib (Infanrix®-hexa) and PCV7 (Prevenar®) – fever management 

A higher incidence of fever (> 39.5°C) was reported in infants receiving Infanrix®-hexa 

and Prevenar® compared to infants receiving Infanrix®-hexa vaccine alone. (See 

section 4.4 for more information.) 

How to manage fever 

• Give the baby extra fluids to drink (more breastfeeds or water). 

• Do not overdress the baby if hot. 

• Paracetamol may be given for pain relief before immunisation. 

The Hib component of DTaP-IPV-HepB/Hib (Infanrix®-hexa) is different to that of 

the Hib-HepB (Comvax®) vaccine. What does this mean for disease protection 

The Haemophilus influenzae type b (Hib) component of the Hib-HepB vaccine was 

previously used as a schedule vaccine because it offers protection after a single dose – 

as early as six weeks of age. The Hib component of the Infanrix®-hexa vaccine does 

not offer this early protection. 

There is a small risk that Hib disease will re-emerge with this change. However, the 

incidence of Hib disease in New Zealand has significantly declined since Hib vaccine 

was introduced in 1994, with five to 10 cases occurring every year in unimmunised 

children. 

Following the vaccine change, Hib disease will be monitored using the existing 

surveillance systems. 

Can alternatives to DTaP-IPV-HepB/Hib (Infanrix®-hexa) vaccine be given 

When a child has a genuine contraindication to a component of the Infanrix®-hexa 

vaccine, alternative vaccines may be given (if available) and the immunisation benefit 

claimed. 

How do I enter DTaP-IPV-HepB/Hib (Infanrix®-hexa) onto the National 

Immunisation Register 

PMS and NIR upgrades for Infanrix®-hexa are expected from 1 June 2008. 

Before 1 June 2008, enter Infanrix®-hexa into the Patient Management System (PMS) 

as two separate vaccines (two events). Therefore: 

• enter Hib-HepB (or HepB) and then enter DTaP-IPV as separate events (as you 

currently do with the 2006 National Childhood Immunisation Schedule) 

• enter the same Infanrix®-hexa batch number and expiry date into both events’ batch 

number and expiry field. 

Note: Prior to 1 June 2008, this will be recorded in your PMS and the NIR as if two 

separate vaccinations were given. 


From 1 June 2008, the NIR will record the Infanrix®-hexa vaccine events as part of the 

National Immunisation Schedule. 

How do I claim the immunisation benefit for Infanrix®-hexa vaccinations given 

HealthPAC payment systems will not be updated for Infanrix®-hexa until 1 June 2008. 

Before 1 June 2008, for the six-week, three and five-months events claim as though 

DTaP-IPV and Hib-HepB or HepB vaccines were given, that is, record the DTaP-IPV- 

HepB/Hib (Infanrix®-hexa) vaccination event as if two separate vaccinations were 

given. 

From 1 June 2008, HealthPAC payment systems will accept claims for the DTaP-IPV- 

HepB/Hib (Infanrix®-hexa) vaccine. 


2.3 PCV7 (Prevenar®) vaccine 

For further detailed information about PCV7 (Prevenar®) and pneumococcal disease, 

see section 5 and the Prevenar® data sheet (refer to the Medsafe data sheets at: 


Why is the PCV7 vaccine being added to the National Immunisation Schedule 

from 1 June 2008 

PCV7 vaccine protects young children against the seven most common strains of the 

Streptococcus pneumoniae bacteria that cause severe pneumococcal disease. Severe 

pneumococcal disease can cause meningitis, blood poisoning and pneumonia. All 

babies are at risk of severe pneumococcal disease. 

The pneumococcus is the most common bacterial cause of otitis media in children and 

a frequent cause of sinusitis and pneumonia in all age groups. 

Who is eligible for the PCV7 vaccine 

All babies born from 1 January 2008 will be eligible to receive PCV7 vaccine from 

1 June 2008. 

What is the PCV7 vaccine schedule 

From 1 June 2008, all new babies beginning their childhood immunisations will be 

offered the PCV7 vaccine. These babies will receive four doses of the PCV7 vaccine at 

the same time as other Schedule vaccines at age six weeks and three, five and 

15 months of age (see the 2008 National Immunisation Schedule table in section 1). 

Babies born from 1 January 2008 will receive a catch-up schedule for PCV7 vaccine. 

What is the catch-up programme for PCV7 vaccine 

A catch-up programme is available for babies born from 1 January 2008. These 

children can receive PCV7 vaccine from 1 June 2008. (See the PCV7 vaccine schedule 

below for the number of doses required for the age of the baby at catch up.) 

Table 2.1: PCV7 vaccine catch-up programme 

Age of baby at PCV7 dose 1 

PCV7 vaccine schedule 

6 weeks to 6 months 6 weeks, 3 months, 5 months, 15 months of age OR 

3 doses 6 to 8 weeks apart + 1 dose at age 15 months 

7 months to 11 months of age* 2 doses 6 weeks apart + 1 dose at age 15 months 

12 to 23 months* 2 doses of PCV7 given 6 to 8 weeks apart 

* Applies only to babies born from 1 January 2008. 

This catch-up programme is in place because children aged under one year are at 

greatest risk of severe pneumococcal disease. 


PCV7 (Prevenar®) and DTaP-IPV-HepB/Hib (Infanrix®-hexa) – fever management 


and Prevenar® compared to infants receiving Infanrix®-hexa vaccine alone (see section 

4.4 for more information). 




• Paracetamol may be given for pain relief before immunisation. 

Avoid giving PCV7 (Prevenar®) at the same visit as MeNZB vaccine 

While no problems are anticipated, either in the immune response or safety, there is no 

data to support giving the MeNZB TM vaccine at the same practice visit as Prevenar®. 

Therefore, where parents are anxious for their child to receive the MeNZB vaccine 

and the doctor agrees, a three-dose course of the MeNZB vaccine could start at six 

months of age (doses six weeks apart). 

See section 2.4 for more information on the eligibility for the MeNZB vaccine from 


How do I enter the PCV7 vaccine on the National Immunisation Register 

From 1 June 2008, the NIR will record PCV7 vaccine events as part of the National 

Immunisation Schedule for: 

• new babies beginning their immunisations 

• babies born from 1 January 2008 on a catch-up schedule. 

Note: The above information does not apply to children receiving PCV7 vaccine as part 

of the high-risk pneumococcal or pre/post-splenectomy programmes (see section 6 and 

Appendix 2). Information for the high risk pneumococcal or pre/post splenectomy 

programmes is recorded on the NIR as the ‘Pneumococcal’ programme. 

How do I claim the immunisation benefit for the PCV7 vaccine 

From 1 June 2008, immunisation benefit claims for the PCV7 vaccine will be valid if 

administered from 1 June 2008. Note: Any immunisation benefit claims for PCV7 

vaccine administered as a schedule vaccine before 1 June 2008 will be rejected. 

Note: Immunisation benefit claims for the PCV7 vaccine as a schedule vaccine are valid 

for babies with a birth date from 1 January 2008. Immunisation benefit claims for the 

PCV7 Schedule vaccine will be rejected if the vaccine has been administered to babies 

with a birth date before 1 January 2008. 


How is PCV7 vaccine expected to benefit New Zealand 

The introduction of PCV7 vaccine to the infant immunisation schedule in the United 

States has resulted in a decline in severe pneumococcal disease incidence in young 

children and a decline in invasive pneumococcal disease (IPD) in unimmunised adults. 

In New Zealand in 2006, there were 151 children aged under five years of age with IPD. 

By comparing the pneumococcal strains that caused their disease against the seven 

strains in the pneumococcal vaccine, ESR predicted that 83% of pneumococcal disease 

in children under five years could have been prevented by using the pneumococcal 

vaccine. 

Is invasive pneumococcal disease notifiable 

It is planned that IPD will be added to the list of infectious diseases to be notified by 

medical practitioners and by laboratories before the vaccine programme starts in 

June 2008. 

Will there be pneumococcal serotype replacement following the introduction of 

PCV7 vaccine 

In the United States, surveillance results suggest some serotype replacement had 

occurred in the three years after the introduction of PCV7 vaccine to infants. However, 

the burden of IPD in young children remained lower than in the years before the 

introduction of Prevenar®. See section 5.4. 

Therefore, ongoing surveillance of IPD in New Zealand will be important to monitor for 

any serotype replacement. Longer term, the development of expanded valency 

vaccines will be important. 


2.4 MeNZB TM vaccine 

From 1 June 2008, the meningococcal B vaccine special programme will be stopped. 

Babies will no longer routinely be offered the MeNZB vaccine. 

Why is the MeNZB TM programme stopping from 1 June 2008 

The MeNZB vaccine was introduced to control an epidemic of a specific strain of 

Group B meningococcus circulating in New Zealand. The programme started in 2004, 

and by the end of December 2006, three doses of MeNZB vaccine had been offered 

to all children and young people aged six weeks to 19 years in New Zealand. From 

January 2007, the MeNZB vaccine has only been available for children under the age 

of five years and to individuals at higher risk. 

The programme will be discontinued from 1 June 2008 for the following reasons. 

• The incidence of invasive meningococcal disease has decreased from a high of 

651 cases in 2001, when 370 cases were found to have the epidemic strain, to 

105 cases in 2007, of whom, 47 individuals were confirmed as having the disease 

due to the epidemic strain. The Meningococcal B vaccine special programme has 

successfully reduced cases of meningococcal disease. 

• It is known from the clinical trials that protection from meningococcal disease may not 

be long term, suggesting that the vaccine may be best used to stop an epidemic 

rather than for a long-term schedule vaccine. 

• Coverage data from the NIR shows that only 58% of infants received the fourth dose 

of MeNZB vaccine at the age of 10 months (for children enrolled on the NIR from 

1 January 2006 to 1 January 2008). 

• There is no data to support the co-administration of MeNZB vaccine with 

Prevenar® vaccine, and therefore the timing of administering the vaccines would 

have to be changed. Adding more visits to the immunisation programme to give 

three doses of MeNZB after the age of six months is unlikely to be popular with 

parents or health providers. 

Can children who have started the MeNZB TM course finish it 

Yes, a child may complete a course of MeNZB vaccine. Parents and children should 

be encouraged to complete the course before 31 December 2008, although the vaccine 

will still be available after that date. 

Is the MeNZB TM vaccine still available if parents request it for their child 

Yes, if the parent of a child or young person up to 19 years of age requests that the 

child receives a course of MeNZB vaccine, and the doctor thinks the child is at risk, 

the MeNZB vaccine will still be available and funded. A GP may start the child’s 

course of MeNZB without further authorisation, and the immunisation benefit may be 

claimed. 


Avoid giving MeNZB TM at same visit as the PCV7 (Prevenar®) vaccine 


data to support giving the MeNZB TM vaccine at the same practice visit as PCV7 

(Prevenar®). Therefore, where parents are anxious for their child to receive the 

MeNZB vaccine and the doctor agrees, a three-dose course of the MeNZB vaccine 

could start at six months of age (doses six weeks apart). 

See sections 2.3 and 5 for more information about the PCV7 (Prevenar®) vaccine. 

Is the MeNZB TM vaccine still available for certain occupational groups 

Yes, the MeNZB vaccine will still be available for microbiologist and laboratory 

workers. See the Immunisation Handbook 2006, page 301 (Ministry of Health 2006). 

Is the MeNZB TM vaccine still available for certain high-risk groups 

Yes, the vaccine will still be available for individuals of any age with a high risk of 

invasive meningococcal infection and specific conditions (three doses of MeNZB 

vaccines at six-week intervals). Specific conditions include: 

• actual or functional asplenia (Individuals scheduled for MeNZB vaccine presplenectomy 

will need to have completed their MeNZB vaccine course (all three 

doses) at least four weeks before the scheduled operation date) 

• sickle cell anaemia 

• deficiencies of the terminal complement components 

• individuals with HIV infection, who may be safely immunised with meningococcal 

polysaccharide vaccines. 

See the Immunisation Handbook 2006, page 302 (Ministry of Health 2006). 

How effective is the MeNZB TM vaccine 

A study looking at the effectiveness of MeNZB vaccine up to the end of December 

2006 estimated that the MeNZB vaccine was effective, with an estimated efficacy of 

68% (Kelly et al 2007). The estimate will be reassessed using data up to the end of 

2007. 

Will the MeNZB TM vaccine be recorded on the National Immunisation Register 

after 1 June 2008 

It is important to record all MeNZB vaccine doses given those up to 19 years of age. 

From 1 June 2008 the National Immunisation Register will continue to accept 

information on MeNZB vaccine doses administered to those up to 19 years of age. 

The NIR messaging and scheduling for the MeNZB vaccine will stop for newborns. 


How do I claim for the MeNZB TM vaccine given after 1 June 2008 

While no longer recommended for routine use the Immunisation Benefit may be claimed 

for administration of the MeNZB vaccine, where: 

• a doctor assesses there to be an indication of high risk of disease 

• parents feel that their child under twenty years of age is at special risk and the doctor 

agrees to MeNZB vaccination. 

Use claim code IMMB and the applicable indication code. 

Will ongoing surveillance of Meningococcal Disease continue 

The Ministry of Health will continue to monitor meningococcal disease and will consider 

reintroducing a meningococcal B immunisation programme if it is needed. 

Even though meningococcal B epidemic strain disease rates are low, the disease is still 

present. The MeNZB vaccine protects against the strain of meningococcal B causing 

the epidemic, but it will not protect against other strains. This is why New Zealanders 

should be reminded to watch out for the signs and symptoms of this disease, and seek 

medical help immediately if they are concerned. Health practitioners need to be aware 

of the risk of meningococcal disease in individuals presenting with illness particularly 

young children. 


2.5 Expansion of the high risk pneumococcal programme for 

children under five years of age with a chronic condition 

The table below shows the eligibility criteria for the high-risk pneumococcal programme 

for children under five years of age from 1 June 2008. 

Table 2.2: Eligibility criteria for high-risk pneumococcal programme 

Children aged under five years with the following conditions: 

On immunosuppressive or radiation 

therapy 

Primary immune deficiencies 

HIV 

Renal failure or nephrotic syndrome 

Organ transplants 

Cochlear implants or intracranial shunts 

With chronic CSF leaks 

On corticosteroid therapy for more than two weeks, at 

daily dose of prednisone of 2 mg/kg or greater, or a total 

daily dosage of 20 mg or more 

Children pre or post splenectomy or with functional 

asplenia* 

Pre-term infants, born at under 28 weeks’ gestation 

Chronic pulmonary disease (including asthma 

treated with high-dose corticosteroid therapy) 

Cardiac disease with cyanosis or failure 

Insulin dependent diabetes 

Down’s syndrome 

* See Appendix 2 – Pre/post Splenectomy Immunisation Programme. 

Note: See bold text for the additional funded chronic conditions from 1 June 2008. 

Children who meet the criteria are eligible for: 

• PCV7 (pneumococcal conjugate, Prevenar®) vaccine 

• 23PPV (pneumococcal polysaccharide, Pneumovax®23) vaccine. 

See Table 6.2 for the high risk pneumococcal programme immunisation schedule. 

Catch-up schedules for children who have already received one or more doses of 

pneumococcal vaccine are found in Appendix 1. 

How do I enter the high-risk pneumococcal programme vaccines on the National 

Immunisation Register (NIR) 

Children born prior to 1 January 2008 

Children born prior to 1 January 2008 and identified as meeting the eligibility criteria for 

the high-risk pneumococcal programme (see Table 6.1) will continue to have their 

pneumococcal vaccines (PCV7 and 23PPV) entered onto the NIR using the 

pneumococcal programme. 


Children born between 1 January 2008 and 31 May 2008 

Children born between 1 January 2008 and 31 May 2008 who have commenced the 

high-risk pneumococcal programme would have already been entered on the NIR as 

part of the pneumococcal programme (PI). They will continue to receive PCV7 under 

this programme, and it will not be scheduled for them under NIR Childhood Schedule 

(CI) 2008. 

Children can receive PCV7 under either CI or PI programmes, with a cross-check 

making sure that PCV7 is not scheduled under both. 

From 1 June 2008, these high-risk children will automatically transfer to the CI and their 

remaining PCV7 doses will recorded as part of this CI schedule. 

When the high-risk child turns two years old and receives 23PPV vaccine, the PI 

programme takes over for these children (on the basis of the NIR receiving a 23PPV 

vaccine, an indicator of high risk). 

Children born from 1 June 2008 

PCV7 is included on the National Immunisation Schedule from 1 June 2008 for all 

children. PCV7 doses given to high-risk children born from 1 June 2008 will be 

recorded on the CI schedule of the NIR. When the high-risk child turns two years old 

and receives 23 PPV vaccine, the PI programme takes over for these children (on the 

basis of the NIR receiving a 23 PPV vaccine, an indicator of high risk). 

How do I claim for high-risk pneumococcal programme vaccines 

The immunisation benefit can be claimed for vaccines given as part of the high-risk 

pneumococcal programme for children under five years of age with a chronic condition. 

Claim using the codes as follows: 

• Vaccine 100 (PCV7) and indication 12 (at risk, no previous history), 13 (at risk, 

previous PCV7) or 14 (at risk, previous 23 PPV). 

• Or, if the PCV7 vaccine is given at six weeks, three or five months as part of the 

usual National Immunisation Schedule you may claim as a usual Schedule vaccine, 

and when the child receives a dose of 23PPV vaccine please claim under the high 

risk pneumococcal programme 

For further details on the High Risk Pneumococcal Programme for children under five 

years of age with chronic medical conditions refer to section 6. 


2.6 HPV immunisation programme 

More detailed information on the Human Papillomavirus (HPV) Immunisation 

Programme will be provided later in 2008 once discussions with District Health Boards 

and the Ministry of Education are complete. 

What is the HPV Immunisation Programme 

The HPV Immunisation Programme aims to reduce cervical cancer in New Zealand by 

protecting girls and young women against HPV infection caused by the HPV types 

present in the vaccine. Currently, around 160 New Zealand women each year are 

diagnosed with cervical cancer and 60 women per year die from cervical cancer. 

Girls and young women aged 12 to 18 years will be offered the HPV vaccine 

(Gardasil®) to protect against the two most common infections (HPV types 16 and 18) 

that can lead to cervical cancer and the HPV types (6 and 11) that cause most genital 

warts. 

Who will be eligible for the HPV vaccine 

Girls born on or after 1 January 1990 will be eligible for the HPV vaccine. The HPV 

immunisation programme will be introduced in stages, beginning with the oldest girls 

first. 

From 1 September 2008 

• Girls aged 17 and 18 years (born in 1990 and 1991) will be able to receive HPV 

vaccine from primary care or health clinics. 

From 2009 

• HPV vaccine will be part of the National Immunisation Schedule for 12 year old girls 

(in primary care and health clinics) and girls in school Year 8, see Table 1.1. 

• HPV vaccine will be offered to girls aged 13 to 18 years. Delivery of HPV vaccine to 

these girls will be phased over 2009 and 2010. More information about cohort 

phasing will follow later in 2008. 

What is the HPV vaccine schedule 

Three doses of Gardasil® are given over a six month period. 

Number of HPV vaccine schedule 

doses 

1 st dose 

2 nd dose 2 months after the 1 st dose 

3 rd dose 6 months after the 1 st dose 

(4 months after the 2 nd dose) 


What is HPV infection 

HPV is a common virus that is spread through skin to skin contact. Some types of HPV 

infection can cause cell changes that may lead to cervical cancer, and these types are 

spread through sexual contact. Other strains can cause warts but those strains do not 

lead to cancer. Most women who develop HPV infections clear the virus naturally and 

do not develop cervical cancer. About four out of five people have HPV infection at 

some time in their lives. 

There is no treatment for HPV infections, but there is treatment for the health problems 

that HPV can cause (such as warts, abnormal changes to cervical cells, and cancers). 

What is in the Gardasil® vaccine 

The vaccine contains HPV virus-like particles (VLPs) of HPV types 16, 18, 6 and 11. 

These particles are proteins from the outer shell of the virus. They are a part of the virus 

but are not live and cannot cause infection. The particles mimic the HPV structure so 

that the immune system makes antibodies against it. The vaccine does not contain 

thiomersal. These recombinant types of vaccine have been used around the world for 

about 20 years. 

For more vaccine information, see the Gardasil® data sheet (refer to the Medsafe data 

sheets at: http://www.medsafe.govt.nz/profs/Datasheet/dsform.asp). 

How effective is the HPV vaccine, and how long does it last 

Gardasil® vaccine targets the types of HPV responsible for most cases of cervical 

cancer (types 16 and 18) and genital warts (types 6 and 11). Clinical trials show 

Gardasil® is highly effective in preventing these types of HPV in young women who 

have not previously been exposed to them. 

So far, ongoing studies show the vaccine protects against HPV infection for five years 

after immunisation, and suggest protection will last much longer. Research is continuing 

to find out how long protection will last. 

Gardasil® does not protect against all types of HPV that can cause cervical cancer. 

And, as with any vaccine, Gardasil® may not provide protection for everyone who is 

vaccinated. 

National Cervical Screening Programme 

There will be no changes to the National Cervical Screening Programme. All women 

should have regular cervical smear tests every three years from the age of 20 until they 

turn 70 if they have been sexually active. 

How safe is the HPV vaccine 

Vaccine safety was assessed in five clinical trials (four of which were placebo 

controlled); 6,160 subjects received Gardasil® and 4,064 received placebo. 


Reported reactions at one to five days post-vaccination included: 

• pain at the injection site (81%) 

• swelling (24%) 

• redness (23%) 

• erythema (3%) 

• pruritis (3%). 

Overall, 94% rated their injection-site adverse experience to be mild or moderate in 

intensity. 

Ten percent of vaccinees experienced fever. Bronchospasm was reported very rarely. 

There have been post-approval reports of fainting (syncope) occurring after vaccination 

with Gardasil®. This can follow any vaccination and requires careful observation of the 

person being vaccinated for at least 15 minutes after administration. 

Other adverse experiences reported during post-approval use have been reported, 

however it is difficult to accurately quantify and determine causation. Other reported 

adverse experiences include: lymphadenopathy, dizziness, headache, Guillian-Barre 

syndrome, nausea, vomiting, arthralgia, myalgia, fatigue, and malaise. 

Gardasil has been licensed for use in more than 100 countries, including New Zealand, 

Australia, Canada, the United States, and the 27 countries in the European Union 

including the United Kingdom. 

Will the HPV vaccine be recorded on the National Immunisation Register 

The National Immunisation Register will record HPV vaccine events given as part of the 

HPV Immunisation Programme and National Immunisation Schedule. 

The School Based Vaccination System (SBVS) will be updated for the introduction of 

the HPV vaccine. The SBVS will message HPV vaccine information to the NIR. 

Further information on how to record HPV vaccine information on the NIR and SBVS 

will be provided later in 2008. 

How do I claim the immunisation benefit for the HPV vaccine 

Claiming the immunisation benefit for the HPV vaccine will be through the standard 

HealthPAC claiming process. The immunisation benefit will be the same as that paid 

for other National Immunisation Schedule vaccines. 


2.7 New schedule vaccine presentation and administration 

Vaccine Packs Cold chain Vaccine reconstitution Vaccine 

administration 

Boostrix 

Boostrix 10-dose box 

contains: 

10 x 1 – dose pre-filled syringes 

Terumo Luer needles: 

10 x 25G x 5/8”, 0.5 mm x 

16 mm 

10x 23G X 1”, 0.6 mm x 25 mm 

(Needles not attached) 

Box dimensions = 120 x 90 x 

120 mm 

Boostrix single dose box 

contains: 

1 x 1-dose pre-filled syringe 


1 x 25G x 5/8”, 0.5 mm x 16 mm 

1 x 23G x 1”, 0.6 mm x 25 mm 

(Needles not attached) 


30 mm 

dTap vaccine should be 

stored between +2°C to 

+8°C. 

dTap vaccine should not 

be frozen. If frozen, dTap 

vaccine should be 

discarded. 

Upon removal from a 

refrigerator, the vaccine is 

stable for eight hours at 

21°C. 

Not required as a pre-filled 

syringe 

Each 0.5 mL dTap 

vaccine is administered 

by deep intramuscular 

injection to the deltoid. 

Infanrix®- 

Hexa 

Infanrix®-hexa box contains: 

10 pre-filled syringes, containing 

0.5 mL DTap-IPV-HepB 

suspension 

10 glass vials, containing the 

Hib pellet 


10 x 25G x 5/8" 0.5 mm x 16 

mm 

10 x 23G x 1" 0.6 mm x 25 mm 

(Needles are not attached) 


51 mm 

Infanrix®-hexa vaccine 

should be stored between 

+2°C and +8°C. Protect 

from light. 

The Infanrix®-hexa 

suspension and the 

reconstituted vaccine 

should not be frozen. 

Discard if frozen. 

After reconstitution, the 

vaccine should be injected 

promptly. However, the 

vaccine may be kept for up 

to eight hours at room 

temperature (21°C). 

Attach the 25-gauge needle 

to the pre-filled syringe. 

Transfer the syringe’s liquid 

suspension to the vial 

containing the Hib pellet. 

Shake the vial well to 

ensure the Hib pellet is 

completely dissolved. 

Draw the reconstituted 

vaccine back into the 

syringe. 

Attach the 23-gauge needle 

to the syringe for vaccine 

administration. 

After reconstitution, the 

vaccine should be injected 

promptly. 

However, the vaccine may 

be kept for up to eight 

hours at room temperature 

(21°C). 

Each 0.5 mL dose of 

the reconstituted 

vaccine is given by 

deep intramuscular 

injection into the thigh. 

Note: Infanrix®-hexa 

and Prevenar® 

vaccines are given in 

separate limbs 

Prevenar 

Packs of 10 x 1-dose pre-filled 

syringes 


50 mm (LxWxH) 

Note: Needles are not supplied 

with the vaccine 

PCV7 vaccine should be 

stored between +2°C and 

+8°C. 

PCV7 vaccine should not 

be frozen. 

If frozen, PCV7 vaccine 

should be discarded. 


syringe. 

Each 0.5mL PCV7 dose 

is given intramuscularly. 

The preferred injection 

sites are: 

• the anterolateral 

aspect of the thigh 

of infants and young 

children 

• the deltoid muscles 

of the upper arm of 

older children 

Note: Infanrix®-hexa 

and Prevenar® 

vaccines are given in 

separate limbs. 


Vaccine Packs Cold chain Vaccine reconstitution Vaccine 

administration 

Gardasil® 

Packs of 10 x 1-dose pre-filled 

syringes 


150mm 

Note: Needles are not supplied 

with the vacccine 

Gardasil vaccine should 

be stored between +2°C 

and +8°C. 

Gardasil vaccine should 

not be frozen. 

Protect Gardasil from light. 

Gardasil should be 

administered as soon as 

possible after being 

removed from 

refrigeration. Gardasil can 

be out of refrigeration at 

temperatures, at or below 

25°C, for a total time of not 

more than 72 hours. 


syringe 

Shake well before use. 

Thorough agitation 

immediately before 

administration is necessary 

to maintain suspension of 

the vaccine. 

After thorough agitation, 

Gardasil is a white, cloudy 

liquid. Parenteral drug 

products should be 

inspected visually for 

particulate matter and 

discolouration prior to 

administration. Discard the 

product of particulates are 

present or if it appears 

discoloured. 

Each 0.5 mL Gardasil 

dose should be 

administered 

intramuscularly. 

The preferred injection 

sites are: 

• In the deltoid region 

of the upper arm 

• In the higher 

anterolateral area of 

the thigh. 


3 dTap (Boostrix) Vaccine and Pertussis 

Epidemiology 

3.1 dTap (Boostrix TM ) vaccine schedule 

From 1 January 2008, 11 year olds (or school-aged year 7 students) receive one dose 

of the adult diphtheria, tetanus, adult acellular pertussis (dTap, Boostrix TM ) vaccine. 

Note: dTap vaccine is delivered as a school-based (year 7) immunisation programme in 

the North Island and Nelson Marlborough DHBs and by primary health care services in 

the remainder of the South Island. 

3.2 Rationale for introducing the dTap vaccine 

Previous schedule changes 

From 1 January 2008, year 7 students (11 years of age) are offered dTap (Boostrix TM ) 

vaccine. From 2008 (due to previous schedule changes), all 11-year-old students will 

have already received the recommended four doses of polio vaccine in childhood. 

Therefore dTap-IPV (Boostrix®-IPV) vaccine is no longer required (see the 

Immunisation Handbook 2006, chapter 8, page 199 (Ministry of Health 2006). 

3.3 Pertussis epidemiology 

Pertussis-containing vaccine was added to the schedule in 2006 because children at 

11 years of age had only received pertussis vaccine in their first year of life. These 

children are at risk from pertussis due to: 

• variable immunisation coverage 

• the whole-cell pertussis vaccine used before 2000 was around 80% effective after 

three doses 

• a child’s immunity wanes over time. 

If immunity is not boosted either with vaccine or natural infection, the population 

gradually becomes increasingly susceptible to pertussis infection, and eventually an 

epidemic occurs. In New Zealand, the most recent epidemic of pertussis was in 2004/5, 

see Figure 3.1. As can be seen in Figure 3.2, in 2004, older children, and many 

adolescents and adults developed pertussis – and they are known to have passed the 

pertussis infection on to babies and infants. 

The acellular pertussis vaccine booster (as dTap, Boostrix TM ) given at age 11 years 

provides protection against the disease during adolescence. 


Figure 3.1: Notifications of pertussis in New Zealand (all ages), 2001–2007 

Pertussis notifications by month Sept 2001 to Sept 2007 

650 

600 

550 

500 

Number of notifications 

450 

400 

350 

300 

250 

200 

4th dose of 

pertussis vaccine 

at age 4 years 

Pertussis vaccine 

to 11 year olds 

150 

100 

50 

0 

Sep-01 

Dec-01 

Mar-02 

Jun-02 

Sep-02 

Dec-02 

Mar-03 

Jun-03 

Sep-03 

Dec-03 

Mar-04 

Jun-04 

Sep-04 

Dec-04 

Mar-05 

Jun-05 

Sep-05 

Dec-05 

Mar-06 

Jun-06 

Sep-06 

Dec-06 

Mar-07 

Jun-07 

Sep-07 

Month 

Source: ESR monthly surveillance reports 

http://www.surv.esr.cri.nz/surveillance/monthly_surveillance.php 

Figure 3.2: Age-specific rates of pertussis in New Zealand 2000–2006 

Age specific rates of pertussis notifications (expansion of Fig 6.2 page 166 Imm 

Handbook) http://www.surv.esr.cri.nz/surveillance/annual_surveillance.php 

800 

700 

600 

Rate per 100,000 

500 

400 

300 

200 

2000 

2004 

2005 

2006 

100 

0 

3.4 dTap (Boostrix TM ) vaccine information 

For detailed dTap (Boostrix TM ) vaccine information refer to: 

• the Boostrix TM data sheet (refer to the Medsafe data sheets at: 

http://www.medsafe.govt.nz/profs/Datasheet/dsform.asp) 

• the Immunisation Handbook 2006 (Ministry of Health 2006). 

dTap (Boostrix TM ) vaccine presentation 

Pack 10-dose syringe Single-dose syringe 

Dimensions (L x W x H) 120 x 90 x 120 mm 50 x 40 x 30 mm 

Contents 10 x 1-dose pre-filled syringes 1 x 1-dose pre-filled syringe 

Needle size 

(gauge and length) 

Needle not attached 

10 x Terumo Luer: 

25G x 5/8”, 0.5 mm x 16 mm 

23G X 1”, 0.6 mm x 25 mm 

1 s Terumo Luer 

25G x 5/8”, 0.5 mm x 16 mm 

23G x 1”, 0.6 mm x 25 mm 

The 10-dose packs are mainly distributed to school-based programmes. However, if a 

GP orders large quantities, then the 10-dose packs will be sent. 

Cold chain management 

• dTap vaccine should be stored between +2°C to +8°C. 

• dTap vaccine should not be frozen. If frozen, dTap vaccine should be discarded. 

• Upon removal from a refrigerator, the vaccine is stable for eight hours at 21°C. 

dTap vaccine administration 

Each 0.5 mL dTap vaccine is administered by deep intramuscular injection to the 

deltoid. 

dTap vaccine immunogenicity and expected efficacy 

Based on the results of immunogenicity studies using dTap, the likely protective effect 

of dTap can be inferred by comparing these results to studies of the immunogenicity of 

DTaP (Infanrix) and Td vaccine. 

Anti-diphtheria and anti-tetanus antibody titres of above 0.01 IU/mL are generally 

accepted to be protective against tetanus and diphtheria (Wharton & Vitek 2004). In two 

adolescent studies, dTap was highly immunogenic for the diphtheria and tetanus toxoid 

components, with all participants having post-vaccination anti-tetanus and antidiphtheria 

antibody titres of at least 0.1 IU/mL and 93 to100% with titres of at least 1.0 

IU/mL (Minh et al 1999). 


No equivalent serological correlate of protection has been identified for pertussis. 

Therefore, the evaluation of the immunogenicity of the pertussis component of dTap 

(Boostrix TM ) is based on: 

• the ability of Boostrix TM to induce a response to each of the pertussis components 

(defined as seroconversion in initially seronegative people or a minimum of two-fold 

rise in antibody titre in initially seropositive people) 

• the immunogenicity of the pertussis components in the combined vaccine compared 

with the monovalent acellular pertussis vaccine in comparative studies 

• antibody studies compared with those obtained in infants given Infanrix (DTaP 

vaccine, GSK) at three, four and five months, in whom the protective efficacy of 

Infanrix against WHO-defined pertussis was 88.7% (95% confidence interval [CI]: 

76.6–94.6%) (Schmitt et al 1997). 

In the adolescent studies with Boostrix TM , a response of more than 92% was recorded 

for each of the pertussis antigens, and 97% of the adolescents were seropositive 

30 days after vaccination. 

There were no differences between the response to the pertussis components of 

Boostrix TM and responses to a monovalent acellular pertussis vaccine. Current expert 

opinion therefore suggests that the efficacy of a primary acellular pertussis vaccine can 

serve as basis for efficacy of that vaccine when administered as a booster to older age 

groups at the same or a lower dose. 

The duration of protection against tetanus and diphtheria after Boostrix TM is expected to 

be the same as after Td vaccine. 

There are so far few published studies of the efficacy of dTap (Boostrix TM ) in preventing 

pertussis in adolescent and adult age groups. However, a randomised controlled trial in 

the United States of dTap (Boostrix TM , GSK) and a control vaccine enrolled 2781 

adolescents and adults aged between 15 and 65 years. Safety, immunogenicity and 

efficacy were studied after a single dose of dTap or a control vaccine during a 2½-year 

follow-up (Ward et al 2005). During follow-up, there were nine cases of pertussis 

fulfilling the primary case definition in the control group and one case of pertussis in the 

group that received the acellular pertussis vaccine, giving an overall efficacy of 92% 

(95% CI 32–99%) when adjusted for the duration of illness and 89% (95% CI 19–99%) 

unadjusted for the duration of illness. During the two years of follow-up, the rate of 

pertussis in the control group was 370 cases per 100,000 person-years. 

A booster dose of dTap (Boostrix TM ) is expected to protect adolescents against 

pertussis. A booster of dTap, if given to the immediate close contacts of newborn 

infants, such as to parents, grandparents and health care workers, is expected to 

reduce exposure of pertussis to newborn infants and infants not yet adequately 

protected through immunisation. 


Expected responses (ER) and adverse events following immunisation with dTap 

vaccine 

The dTap vaccine was assessed as safe and immunogenic during clinical trials. The 

following may be the expected local responses (ERs) following immunisation after 

Boostrix TM (CDC 2006): 

• pain in 75% of recipients, of which 2% were severe (defined as spontaneously painful 

and/or preventing normal everyday activities) 

• swelling in 21% (of which 2.5% ≥ 50 mm) at injection site 

• redness in 23% (of which 1.7% ≥ 50 mm). 

All these local ERs are greater if tetanus vaccine were received from three to less than 

five years previously compared with a longer gap. Other expected reactions include: 

• limitation of movement 

• headaches (in 16%; 0.7% severe) 

• body ache 

• sore joints. 

Expected reactions after Boostrix TM are at least equal to those expected after Td 

vaccination. The incidence of clinically significant adverse events after vaccination with 

Boostrix TM are as low as those after Td booster. 

Rare events after Boostrix TM , in 1/100 to 1/1000 patients, include: 

• pruritis 

• sweating 

• myalgia 

• arthrosis 

• hypertonia 

• lymphadenopathy. 

dTap vaccine contraindications 

Contraindications to dTap vaccine include: known hypersensitivity to any component of 

the vaccine or individuals who have shown signs of hypersensitivity after a previous 

administration of diphtheria, tetanus or pertussis vaccines. 

3.5 Other recommendations 

What if Tetanus-diphtheria vaccine has been given in the past two years 

The 11-year-old dTap vaccine should be delayed until two years after receipt of a tetanusdiphtheria 

vaccine (for example, Td booster after an injury). This delay in administering 

dTap aims to decrease the risk and severity of a local reaction at the injection site. This 

precaution may be waived if a pertussis epidemic is beginning and the student lives in a 

household with an unimmunised younger sibling or a pregnant woman. 


If the student received a Td vaccine booster three to five years ago, dTap immunisation 

is recommended. 

School-based programmes: referral to GPs 

Students who have received a Td vaccine in the past two years should be referred to 

their GP for follow-up and recall. The dTap vaccine should be offered to these students 

before they reach 16 years of age. 

Primary care 

Students who have received Td in the past two years should be followed up and 

recalled for dTap immunisation before they reach 16 years of age. 

Polio vaccine history 

Students at age 11 years who have an unknown immunisation history for polio vaccine 

or who have received three or less polio vaccine doses should complete a four-dose 

series of IPV vaccine from their GP. 

Note: The polio vaccine history will not be checked in school programmes. 

Incomplete tetanus, diphtheria pertussis vaccination history 

Two doses of Td plus one of dTap are recommended, one month apart (see the 

Immunisation Handbook 2006, Appendix 2, pages 395–6; Ministry of Health 2006). 

Alternatively, three doses of dTap, one month apart, may be given, although as yet 

there are no studies looking at the effectiveness of Boostrix TM used in this way. 

See the Immunisation Handbook 2006, chapter 6, pages 171–2; Ministry of Health 

2006) for non-funded pertussis vaccine recommendations for other groups. 

3.6 National Immunisation Register and School Based Vaccination 

System 

The SBVS has been updated for the use of the dTap vaccine in the Year 7 School 

Immunisation Programme. The SBVS will not provide information of dTap vaccine 

events to the NIR. 

In primary health care services dTap vaccine will not be recorded on the NIR because 

11-year-old students are not in the birth cohort registered on the NIR. 


4 DTaP-IPV-HepB/Hib (INFANRIX ® -hexa) 

4.1 Early introduction of DTaP-IPV-HepB/Hib from March 2008 

Due to Hib-HepB (Comvax®) vaccine manufacturing problems, New Zealand is not able 

to secure further supplies of Comvax® vaccine. 

Stocks of Comvax® vaccine have run out, and therefore DTaP-IPV-HepB/Hib 

(Infanrix®-hexa) vaccine is now available. 

4.2 DTaP-IPV-HepB/Hib vaccine schedule – from 1 June 2008 

DTaP-IPV-HepB/Hib vaccine will replace the 2006 schedule vaccine combinations given 

at six weeks, three months and five months of age. 

The introduction of Infanrix®-hexa vaccine means there will be two injections given at 

six weeks and three and five months of age (Prevenar® and Infanrix®-hexa). 

A change of vaccine within a primary series is safe and expected to be effective. 

Giving alternative vaccines to the DTaP-IPV-HepB/Hib vaccine 

When a child has a genuine contraindication to a component of the Infanrix®-hexa 

vaccine, alternative vaccines (if available) may be given and the immunisation benefit 

claimed. 

4.3 Change in type of Hib vaccine 

Using Infanrix®-hexa vaccine changes the Hib vaccine component from Hib-PRP-OMP 

(polyribosylribitol phosphate outer membrane protein) to Hib-PRP-T (polyribosylribitol 

phosphate chemically conjugated to tetanus toxoid). 

Hib-PRP-OMP vaccine was previously used as a schedule vaccine because it offers 

protection after a single dose – as early as six weeks of age. There is a small risk that 

Hib disease will re-emerge with a change to Hib-PRP-T vaccine. However, the 

incidence of Hib disease in New Zealand has significantly declined since Hib vaccine 

was introduced in 1994, with 5 to 10 cases occurring every year in unimmunised or 

incompletely immunised children. Hib disease will be monitored carefully using the 

surveillance systems following the change of vaccine to Hib-PRP-T. 

4.4 DTaP-IPV-HepB/Hib vaccine information 

For detailed DTaP-IPV-HepB/Hib vaccine information, refer to the Infanrix®-hexa 

vaccine data sheet (refer to the Medsafe data sheets at: 



Pack and needle information 

The DTaP-IPV-HepB/Hib vaccine (Infanrix®-hexa) box contains: 

• 10 pre-filled syringes, containing 0.5 mL DTap-IPV-HepB suspension 

• 10 glass vials, containing the Hib pellet. 

Box dimensions = 116 x 200 x 51 mm (L x W x H). 

Brand needle size (gauge and length): 

• 10 x Terumo Luer 25G x 5/8” 0.5 mm x 16 mm. 

• 10 x Terumo Luer 23G x 1” 0.6 mm x 25 mm. 

Needles are not attached. 


Infanrix®-hexa vaccine should be stored between +2°C and +8°C. Protect from light. 

The DTap-IPV-HepB suspension and the reconstituted vaccine should not be frozen. 

Discard if frozen. 

After reconstitution, the vaccine should be injected promptly. However, the vaccine may 

be kept for up to eight hours at room temperature (21°C). 

Infanrix®-hexa vaccine reconstitution 

Infanrix®-hexa must be reconstituted prior to use as follows: 

• Attach the 25-gauge needle to the pre-filled syringe. 

• Transfer the syringe’s liquid suspension to the vial containing the Hib pellet. 

• Shake the vial well to ensure the Hib pellet is completely dissolved. 

• Draw the reconstituted vaccine back into the syringe. 

• Attach the 23-gauge needle to the syringe for vaccine administration. 

• After reconstitution, the vaccine should be injected promptly. 

• However, the vaccine may be kept for up to eight hours at room temperature (21°C). 

DTaP-IPV-HepB/Hib vaccine administration 

Each 0.5 mL dose of the reconstituted vaccine is given by deep intramuscular injection 

into the thigh. Infanrix®-hexa and Prevenar® vaccines are given in separate limbs. 


DTaP-IPV-HepB/Hib vaccine efficacy 

Immunological data 

One month after a three-dose primary course of Infanrix®-hexa: 

• 98.5 to 100% of infants had antibody titres of ≥ 0.1 IU/mL for both tetanus and 

diphtheria 

• the response rate for each of the pertussis antigens (pertussis toxoid, filamentous 

haemaglutinin and pertactin) was between 97.2 and 99.3%, 95.2 and 100%, and 95.9 

and 99.3% respectively 

• there are no correlates of protection for the pertussis components. However, 

protective efficacy of Infanrix®-hexa may be inferred from the DTaP (Infanrix) trials 

where the DTaP vaccine was found to be 88.7% effective against WHO defined 

pertussis (21 days of typical paroxysmal cough) (German study). In an Italian study 

using Infanrix, an efficacy of 84% was confirmed at 60 months after completion of the 

primary series (Italy) 

• Hepatitis B component: 98.5 to 100% of infants developed protective antibody titres 

of ≥ 10 mIU/mL 

• Inactivated poliovirus (IPV) component: the seroprotection rates for each of the three 

serotypes (types 1, 2 and 3) were 99.2 to 100%, 94.5 to 99% and 98.8 to 100% 

respectively 

• Hib: the Geometric Mean Concentration (GMC) of antibodies ranged from 1.52 to 

3.53 μg/mL, with 93.5 to 100% of subjects reaching antibody titres of ≥ 0.15 μg/mL 

• Hib: the GMCs are lower than that elicited by the separate Hib component but are not 

different from those elicited by the licensed DTaP/Hib vaccine. 

A recent study from Germany (Kalies 2008) showed there were no cases of 

haemophilus influenzae type b invasive disease following a four-dose hexavalent 

vaccine series in a five-year follow-up in Germany. The hexavalent vaccines (including 

Infanrix®-hexa) were highly effective 10% in this study. 

Post-marketing surveillance has shown that over a two-year follow-up period, the 

effectiveness of a three-dose primary series of DTaP/Hib or DTaP-IPV/Hib was 98.8%. 

Interference with other vaccines 

Data on concomitant administration of Infanrix®-hexa with Prevenar® have shown no 

clinically relevant interference in the antibody response to each of the individual 

antigens when given as a three-dose primary vaccination. 

Premature babies 

Limited data in 169 premature infants indicate that Infanrix®-hexa can be given to 

premature children. However, a lower immune response may be observed, and the 

level of clinical protection remains unknown. 


Expected responses and adverse events following immunisation with DTaP-IPV- 

HepB/Hib vaccine 

In ≥ 10% of vaccine recipients: 

• loss of appetite 

• irritability 

• restlessness 

• abnormal crying 

• pain, redness and swelling at the injection site 

• fever (> 38°C) 

• fatigue. 

In ≥ 1% and < 10% of vaccine recipients: 

• vomiting 

• diarrhoea 

• local swelling and induration at injection site (≥ 50 mm) 

• fever > 39.5°C. 

Infanrix®-hexa and Prevenar® 


and Prevenar® compared to infants receiving Infanrix®-hexa vaccine alone. 1.2% after 

the first dose of Infanrix®-hexa and PCV7 compared with 0.6 after Infanrix®-hexa alone. 

Of infants with a temperature > 39.5°C after the first dose 4.6 had received Infanrix®hexa 

and PCV7 compared with 1.8 with Infanrix®-hexa alone. After the third dose of 

Infanrix®-hexa and PCV7 2.4% had a fever > 39.5°C (Tichmann-Schumann, 2005). 




• Paracetamol may be given for pain relief prior to immunisation. 

DTaP-IPV-HepB/Hib vaccine contraindications 

DTaP-IPV-HepB/Hib vaccine should not be administered to subjects with known 

hypersensitivity to the active substances or to any of the excipients or residuals or to 

subjects having shown signs of hypersensitivity after previous administration of 

diphtheria, tetanus, pertussis, hepatitis B, polio or Hib vaccines. 

DTaP-IPV-HepB/Hib vaccine is contraindicated if the child has experienced an 

encephalopathy of unknown aetiology, occurring within seven days following previous 

vaccination with pertussis containing vaccine. In these circumstances, pertussis 

vaccination should be discontinued and the vaccination course should be continued with 

diphtheria-tetanus, hepatitis B, inactivated polio and Hib vaccines. 


4.5 DTaP-IPV-HepB/Hib vaccine and the National Immunisation 

Register 

PMS and NIR upgrades for Infanrix®-hexa are expected from 1 June 2008. 

Before 1 June 2008, enter Infanrix®-hexa into the Patient Management System (PMS) 

as two separate vaccines (two events). Therefore: 

• enter Hib-HepB (or HepB) and then enter DTaP-IPV as separate events (as you 

currently do with the 2006 National Childhood Immunisation Schedule) 

• enter the same Infanrix®-hexa batch number and expiry date into both events’ batch 

number and expiry field. 

Note: Prior to 1 June 2008, this will be recorded in your PMS and the NIR as if two 

separate vaccinations were given. 

From 1 June 2008, the NIR will record DTaP-IPV-HepB/Hib vaccine events as part of 

the National Immunisation Schedule. 

4.6 DTaP-IPV-HepB/Hib vaccine and claiming the immunisation 

benefit 

HealthPAC payment systems will not be updated for Infanrix®-hexa until 1 June 2008. 

Before 1 June 2008, for the six-week, three and five-months events claim as though 

DTaP-IPV and Hib-HepB or HepB vaccines were given, that is, record the DTaP-IPV- 

HepB/Hib (Infanrix®-hexa) vaccination event as if two separate vaccinations were 

given. 

From 1 June 2008, HealthPAC payment systems will accept claims for the DTaP-IPV- 

HepB/Hib (Infanrix®-hexa) vaccine. 


5 Pneumococcal Conjugate Vaccine (PCV7, 

Prevenar ® ) and Pneumococcal Epidemiology 

5.1 PCV7 vaccine schedule – from 1 June 2008 

From 1 June 2008, all new babies beginning their childhood immunisations will be 

offered PCV7 vaccine. These babies will receive four doses of PCV7 vaccine at the 

same time as other Schedule vaccines – at six weeks and three, five and 15 months of 

age (see the 2008 National Immunisation Schedule table in section 1). 

In addition, from 1 June 2008, all babies born from 1 January 2008 are eligible to 

receive PCV7 vaccine. For these babies, a catch-up schedule applies – see Table 5.1 

below. 

Table 5.1: PCV7 vaccine schedule 

Age of baby at PCV7 dose 1 

PCV7 vaccine schedule 

6 weeks to 6 months 6 weeks, 3 months, 5 months, 15 months of age three doses 6 to 8 

weeks apart + one dose at age 15 months 

7 months to 11 months of age* Two doses 6 weeks apart + one dose at age 15 months 

12 to 23 months* Two doses of PCV7 given 6 to 8 weeks apart 

* Applies only to babies born from 1 January 2008. 

5.2 Pneumococcal disease 

Streptococcus pneumoniae (pneumococcus) is a lance shaped gram-positive 

diplococcus. It is ubiquitous, with many asymptomatic individuals carrying the organism 

in the upper respiratory tract. 

There are some 90 identifiable serotypes of S. pneumoniae. Some, more commonly 

affect children, while others are of greater significance in adults. 

Transmission of the pneumococcus is from person to person, usually by droplet contact. 

The emergence of antibiotic-resistant strains of S. pneumoniae has become an 

increasing concern both in New Zealand and internationally for the management of IPD. 

ESR analysis of S. pneumoniae isolates from invasive pneumococcal disease (IPD) in 

2004 found that 16.4% of isolates were resistant to penicillin, and 12.1% were resistant 

to cefotaxime. Ninety-eight percent of penicillin-resistant serotypes and 94% of the 

serotypes resistant to third-generation cephalosporins would be covered by the PCV7 

vaccine (Heffernan et al 2006). This suggests that introduction of the PCV7 vaccine will 

reduce disease caused by antibiotic resistant S. pneumoniae isolates. 

The spectrum of disease caused by pneumococcal bacteria 

Pneumococcal disease can cause otitis media at the mildest (but most frequent) end of 

the disease spectrum and pneumococcal meningitis and death at the most severe (but 


less frequent) end of the spectrum (see Figure 5.1). PCV7 vaccine is most effective 

against severe pneumococcal disease. 

Figure 5.1: Pneumococcal disease spectrum (for use as a guide only) 

Disease frequency 

Otitis media 

Pneumococcal 

pneumonia 

Pneumococcal 

bacteraemia 

Pneumococcal 

meningitis 

PCV 7 

effect on 

disease 

Increasing disease severity 

Increasing PCV7 vaccine effectiveness 

against disease 

The pneumococcus may also cause endocarditis, and, less commonly, sites such as 

joints, the peritoneal cavity and the fallopian tubes are affected. 

IPD is defined as isolation of Streptococcus pneumoniae from a normally sterile site, 

usually blood or cerebrospinal fluid (CSF) but also from pleural tissue or other sterile 

sites. The major clinical syndromes of IPD include pneumonia with bacteraemia, 

meningitis and bacteraemia without focus. 

Non-invasive pneumococcal diseases include otitis media, sinusitis and (nonbacteraemic) 

pneumonia. 

The incubation period of S. pneumoniae infection is variable but may be as short as one 

to three days. Illness usually occurs within one month of acquiring a new serotype in 

the upper respiratory tract and does not usually result in prolonged carriage of the 

organism. 

See the Immunisation Handbook 2006, chapter 16: Pneumococcal Disease for more 

information (Ministry of Health 2006). 


5.3 Epidemiology 

Pneumococcal disease occurs throughout the year but is more common in the autumn 

and winter months (Kelly et al 2007). 

The risk of IPD is much higher in infants and elderly people and more frequent in 

individuals with predisposing conditions such as viral upper respiratory tract infections 

or underlying conditions such as immune deficiency states. Mortality is highest in 

patients with underlying medical conditions. 

These conditions include: 

• congenital or acquired immune deficiency 

• splenic dysfunction or asplenia 

• sickle cell anaemia 

• Hodgkin’s disease 

• human immunodeficiency virus (HIV) infection 

• cochlear implants or intracranial shunts 

• chronic cerebrospinal fluid leaks 

• following organ transplantation. 

Other conditions/factors that increase the risk of pneumococcal infection include: 

• diabetes mellitus 

• congestive heart failure 

• chronic pulmonary disease 

• renal failure 

• pre-term infants 

• children attending early childhood services 

• Māori and Pacific children. 

Patients with CSF leakage due to a fracture at the base of the skull or following a 

neurosurgical procedure are at risk of recurrent pneumococcal meningitis. 

New Zealand epidemiology 

ESR serotyping and antibiotic resistance testing 

Pneumococcal invasive disease caused by S. pneumoniae is monitored in New Zealand 

through ESR testing of laboratory isolates from cases of invasive disease. All 

laboratories send isolates of S. pneumoniae from cases of IPD, that is blood, CSF and 

isolates from other usually sterile sites, to ESR for serotyping and antibiotic resistance 

testing. It is thought that almost all isolates are sent to ESR, but this will be confirmed 

with laboratories in 2008. 

In 2006, ESR received 151 isolates from children under the age of five years with IPD, 

and 126 (83.44%) of these were serotypes found in the seven-valent conjugate vaccine 

(PCV7). 


New Zealand Health Information Service data on hospitalisations 

Information is also available from the New Zealand Health Information Service (NZHIS) 

on hospitalisations for pneumococcal infections associated with meningitis and 

septicaemia. However, this information is likely to underestimate the burden of disease 

caused by IPD infection because of how the illness is coded on discharge. 

From the NZHIS data, Figure 5.2 shows the number of cases from 1999 to 2006 

hospitalised with pneumococcal meningitis in children under the age of two years, and 

Figure 5.3 shows the number of children hospitalised with pneumococcal septicaemia. 

Figure 5.2: Hospitalisations from pneumococcal meningitis in children under two years of age, 

1999–2006 

Number of cases 

40 

35 

30 

25 

20 

15 

10 

5 

0 

1999/00 2000/01 2001/2 2002/3 2003/4 2004/5 2005/6 

Year 

under 12 months 

12–23 months 

Source: NZHIS. 


Figure 5.3: Hospitalisations from pneumococcal septicaemia in children under two years of 

age, 1999–2006 

16 

14 

12 

Number 

10 

8 

6 

4 

2 

0 

1999/00 2000/01 2001/2 2002/3 2003/4 2004/5 2005/6 

Year 

septicaemia under 12 months 

septicaemia 12–23 months 

Source: NZHIS. 

New Zealand Paediatric Surveillance Unit study 

A two-year study took place, from May 2005 until April 2007, through the New Zealand 

Paediatric Surveillance Unit to monitor the number of children under 15 years of age 

diagnosed with pneumococcal meningitis (Lennon and Webb 2007). 

During the study period, 38 children were identified who fitted the case definition of 

confirmed pneumococcal meningitis with either a bacterial culture (34 cases) or PCR 

analysis (four cases), a national incidence rate of 2.2 cases per 100,000 per year in 

children under the age of 15 years. 

Of the 38 children with confirmed pneumococcal meningitis: 

• 28 (73.7%) were males 

• 33 (86.8%) were children under 24 months of age, an age-specific rate of 15.7 cases 

per 100,000 per year in children under the age of two years 

• 28 (73.7%) came from the four DHBs of: Auckland, Counties Manukau, Capital and 

Coast, and Canterbury 

• four died from pneumococcal meningitis, a case fatality rate of 10.5% 

• six (17.6%) suffered from a persisting neurodisability. 


Of the 33 children under the age of two years with pneumococcal meningitis: 

• 10 were babies aged 0–6 months 

• 13 were infants aged 6–11 months 

• 10 were young children aged 12–23 months 

• 13 were Māori; an annual Māori age-specific rate of 23.6 per 100,000 per year 

• seven were Pacific children; an age and ethnicity specific rate of 39.2 per 100,000 

year 

• 13 were of other ethnicities; a rate of 13.6 per 100,000 per year. 

Hearing impairment following pneumococcal meningitis was reported in nine children 

out of the 30 where audiology results were available. 

The serotype of S. pneumoniae was identified for 31 of 34 culture positive cases. Of 

these, 25 of 31 (80.6%) were of the serotypes contained in the PCV7 vaccine. 

Information on antimicrobial sensitivity was available for the culture positive cases, and 

of these, eight isolates showed reduced penicillin susceptibility, (Minimum Inhibitory 

Concentration (MIC) to penicillin ≥ 0.06 mg/L). In addition, four of the isolates with 

reduced penicillin susceptibility also demonstrated reduced susceptibility to third 

generation cephalosporins (MIC ≥ 0.5 mg/L). 

Monitoring the effect of PCV7 vaccine 

Following introduction of PCV7 vaccine onto the New Zealand Childhood Immunisation 

Schedule, ongoing monitoring of IPD in all age groups will be essential to monitor for 

changes in disease serotypes and antimicrobial sensitivity. 

It is expected that IPD will be added to the list of infectious diseases to be notified by 

medical practitioners and by laboratories before the vaccine programme starts in June 

2008. 

5.4 Effects of introducing pneumococcal vaccine onto the infant 

immunisation programme 

Pneumococcal conjugate vaccine has been included on the immunisation schedules of 

over 14 countries, including the United States, the United Kingdom, Canada and 

Australia. 

Decline in severe pneumococcal disease incidence in young children and effect 

on invasive pneumococcal disease rates in older age groups 

Introduction of PCV7 vaccine to the United States infant immunisation schedule has 

resulted in a decline in severe pneumococcal disease incidence in young children and a 

decline in invasive pneumococcal disease (IPD) in unimmunised adults. 


Figure 5.4: Rate of vaccine-type (VT) invasive pneumococcal disease (IPD) before and after 

introduction of pneumococcal conjugate vaccine (PCV7), by age group and year; 

Active Bacterial Core surveillance, United States, 1998–2003 

Source: http://www.cdc.gov/mmwr/PDF/wk/mm5436.pdf 

Notes: 

* Per 100,000 population. 

† For each age group, the decrease in VT IPD rate for 2003 compared with the 1998–1999 baseline is 

statistically significant (p

Follow-up reports from the United States Centers for Disease Control and Prevention 

(CDC) Active Bacterial Core surveillance estimated that, in 2005, the rates of IPD were 

77% lower in children aged under five years compared with 1998/99. This means there 

were 13,000 fewer cases of IPD during 2005 (Reingold et al 2008). Since the vaccine’s 

introduction, there has been a shift in IPD serotypes in children aged under five years, 

with only 7% of disease caused by PCV7 serotypes in 2005 compared with 80% during 

1998/99. Serotype 19A was the most common serotype causing IPD among children in 

2005, and the increase in non-vaccine serotypes is estimated to be small compared 

with the overall decrease in PCV7 serotype IPD. 

A review of data reports that the herd effect of immunising children aged 2–23 months 

resulted in decreased IPD in infants too young to be immunised or who had only 

received one dose (Center 2007). In those aged 0–90 days, all IPD decreased from 

11.8/100,000 live births to 7.2/100,000; and rates of vaccine serotype IPD decreased 

significantly from 7.3/100,000 live births to 2.4.100,000 (p < 0.001). In the United States 

prior to PCV7 introduction, IPD was higher in blacks, however, the rates are now 

similar, and the disparity has been reduced. 

In Australia, Prevenar® was introduced for Aboriginal children in 2001, and by 2004, the 

incidence of IPD in Aboriginal children less than two years of age was 91.5 per 100,000, 

compared with 219.2 cases of IPD per 100,000 children in 2001 (Center 2007). 

PCV7 vaccine effects on incidence of otitis media 

The conjugate pneumococcal vaccine is recommended to protect against IPD. 

However, S. pneumoniae is the most common bacterial cause of otitis media in 

children, and therefore, the PCV7 vaccine studies have examined whether the vaccine 

has any effect on the incidence of otitis media. 

Finnish study 

In a Finnish study by Eskola et al (2001), children were followed up between 6.5 and 

24 months of age for episodes of otitis media after receiving heptavalent pneumococcal 

conjugate vaccine at two, four, six and 12 months of age. It was estimated that the 

vaccine reduced the incidence of acute otitis media from any cause by 6% (95% CI: -4 

to 16%), and of culture-confirmed pneumococcal episodes by 34% (95% CI: 21 to 45%). 

The incidence of acute otitis media from vaccine serotypes was reduced by 57% (95% 

CI: 44 to 67%), and there was a 51% reduction in episodes of vaccine related/crossreactive 

serotype otitis media. Significant efficacy was shown against vaccine 

serotypes 6B, 14 and 23F, whereas efficacy against otitis caused by 19F was poorer. 

However, there was an increase of 33% in the number of episodes due to all other 

serotypes (non-vaccine and non-related serotypes). 

Kaiser Permanente trial 

Infants participating in the Kaiser Permanente PCV7 vaccine trial from 1995–1998 were 

followed up to 3.5 years post trial (Fireman et al 2003). The 37,868 infants enrolled in 


the double blind trial received either PCV7 vaccine or a control vaccine at two, four and 

six months of age, plus a booster at age 12–15 months. Follow-up continued until April 

1999, when the study was unblended and the control group children received PCV7 

vaccine. 

The clinical records of all children were assessed for episodes of otitis media, and after 

adjustment of rates of otitis visits for age and season, the effect of PCV7 vaccine was 

assessed. 

Control children had an average of 1.8 otitis visits per year. Children who received 

PCV7 vaccine had: 

• a 7.8% (95% CI: 5.4 to 10.1%) reduction in otitis visits 

• a 5.4% reduction in antibiotic prescriptions. 

Overall, PCV7 vaccine reduced the risk of tympanostomy tubes by 24%. 

In the control group, the otitis visits peaked at age 8 to 12 months, and visits were 17% 

higher in boys and 50% higher in the influenza season. 

Recurrent otitis media 

A study of 383 children aged one to seven years examined whether PCV7 vaccine 

followed by pneumococcal polysaccharide vaccine was effective in preventing otitis 

media in children who had had two or more episodes of otitis media in the two years 

before entry to the study (Veenhoven 2003). The median length of follow-up post 

vaccination was 18 months. 

Results showed no reduction in the number of episodes of acute otitis media in the 

pneumococcal vaccine group compared with controls. Although the nasopharyngeal 

carriage of pneumococci of vaccine serotypes decreased, there was an increase in the 

nasopharyngeal carriage of non-vaccine serotypes. 

Pneumococcal conjugate vaccine is not effective in reducing otitis media in young 

children with a history of previous otitis media who receive vaccine at ages greater than 

one year. 

Effects of the pneumococcal conjugate vaccine on the prevention of pneumonia 

Streptococcus pneumoniae is a common cause of bacterial pneumonia associated with 

both bacteraemia-invasive pneumococcal disease and pneumonia without bacteraemia. 

In order to look at the effect of PCV7 on the incidence of pneumonia, following 

development of a WHO standard for interpretation of chest radiographs, the X-rays from 

children developing pneumonia who participated in the Kaiser Permanente study were 

reviewed (Hansen et al 2006). 

In this study, the efficacy of PCV7 vaccine against first-episode radiograph-confirmed 

pneumonia, calculated by trial radiologists, was 17.7% in the intent-to-treat group and 

20.5% in the per protocol (95% CI: 4.4 to 34%). 


Using the WHO standard, the efficacy against first-episode radiograph-confirmed 

pneumonia was 25.5% for the intent-to-treat group and 30.3% (95% CI: 10.7 to 45.7%) 

for per protocol. 

Serotype replacement 

Long-term surveillance is necessary to monitor any changes in the Streptococcus 

pneumoniae serotypes following introduction of conjugate pneumococcal vaccine to 

infants. 

Surveillance results suggest some serotype replacement occurs three years after the 

introduction of PCV7 vaccine to infants. Therefore surveillance and the development of 

expanded valency vaccines are important. Some of the increase in 19A and other nonvaccine 

serotypes (NVT) may be due to serotype switching within certain vaccine 

strains. 

Massachusetts study 

In Massachusetts, after PCV7 was introduced, IPD due to NVT increased from 73.7% of 

all cases in children under the age of five years in 2001 to 90.6% in 2005 (Hsu et al 

2005). 

As has been noted in other studies, the number and proportion of NVT serotype 19A 

increased over time. In Massachusetts from 2002 to 2005, overall 19A was found in 

27% of all IPD in children under the age of five years but had increased in 2005 to be 

found in 44% of cases of IPD. 

However, the number of cases of IPD due to 19F, a vaccine serotype, remained stable. 

Examination of the 19A isolates by multilocus sequence typing (MLST) showed that the 

diversity of the 19A types increased over time from five MLST types in 2001/02 to 

11 MLST types in 2004/05. Cross protection of the vaccine 19F type for the 19A 

appears to be limited. 

From 2002 to 2004, the majority of isolates of 19A demonstrated intermediate sensitivity 

to penicillin and full sensitivity to ceftriaxone and amoxicillin. However, in 2005 a small 

number of isolates of 19A were multi-drug resistant and of a sequence type not 

previously identified in Massachusetts. 

Alaskan study 

A study among Alaskan native children (Singleton et al 2007) showed that in the first 

three years after PCV7 was introduced, the rate of IPD in children younger than two 

years of age fell from 403.2 per 100,000 between 1995 and 2000 to 134.3 per 100,000 

per year between 2001 and 2003. 

However, from 2001 to 2006, the rate of IPD in Alaskan native children increased to 

244.6 per 100,000 in children under the age of two years, an increase of 82%, mainly 

because of the increase in NVT. 


Since 2004, the NVT serotypes have increased by 140%. The NVT rate between 1995 

and 2000 in children under two years of age was 95 per 100,000 and 228.6 between 

2004 and 2006. In the same time period, disease due to the vaccine serotypes has 

decreased by 96%, compared with the prevaccine period. 

IPD due to serotype 19A was found in 28.3% of IPD in Alaskan native children under 

two years of age during the period 2004 to 2006. There was no increase in NVT in nonnative 

Alaskan children. 

Increase in disease was accompanied by an increase in nasopharyngeal colonisation 

with NVT over this time. In particular, 19A increased in all age groups from 0.5% of 

colonised persons in the period 1998 to 2000 to 3% in 2003 and 15% in 2004. Overall 

41% of all persons were colonised with Streptococcus pneumoniae in 2004. 

Effects of introducing PCV7 on nasopharyngeal carriage of pneumococci and 

disease due to antibiotic resistant serotypes 

In the Alaskan study discussed above, the researchers looked for any change in 

disease presentation with the changes to NVT disease. The illnesses among Alaskan 

native children due to IPD NVT replacement were similar to IPD cases before PCV7 

introduction, except for an increase in the proportion of hospitalised IPD, pneumonia 

and empyema. 

An increase in empyema associated particularly with serotype 1 has been reported in 

other studies, but this type was not found in any of the Alaskan native children under the 

age of two years (Singleton et al 2007). 

In France, after the introduction of PCV7 onto the routine infant schedule, a study 

examined the nasopharyngeal carriage of pneumococci in children age six to 24 months 

presenting with acute otitis media (AOM) (Cohen et al 2006). 

Over the three years of the study, the proportion of infants receiving one or more doses 

of PCV7 increased from 8.2% in year 1 to 61.4% in year 3. The proportion of children 

who had received antibiotics in the three months before enrolment in the study 

decreased from 51.8% in year 1 to 40.9% in year 3. 

Overall, pneumococcal carriage and carriage of PCV7 serotypes decreased over the 

three-year period by 16% (p < 0.001). However, there was an increase in non-vaccine 

serotypes from 9.6% in year 1 to 15.8% of children in year 3. In addition, the rates of 

highly penicillin resistant strains of pneumococci decreased each year from 15.4% in 

year 1 to 10.6% in year 2 and 6.7% in year 3. 

Children who had received PCV7 vaccine and had not received antibiotics in the three 

months before they presented with AOM had the lowest rate of penicillin resistant 

strains. In France, implementation of PCV7 vaccine together with a planned reduction 

in antibiotic use had an impact of reducing the carriage of penicillin non-susceptible 

pneumococci. 


5.5 Immunogenicity and efficacy of pneumococcal conjugate 

vaccine 

See also the Immunisation Handbook 2006, chapter 16, page 316 (Ministry of Health 

2006). 

Polysaccharide vaccines are poorly immunogenic in children under the age of two years 

because the polysaccharide antigens are T cell-independent. 

Covalent coupling of a polysaccharide antigen to an immunogenic protein carrier 

converts the polysaccharide to a T cell-dependent antigen. Conversion to a T celldependent 

antigen enhances the antibody response and elicits immune memory and 

stronger booster responses on re-exposure in infants and young children. 

Prevenar®, a 7-valent conjugate pneumococcal vaccine uses CRM 197 , a mutant nontoxic 

diphtheria toxin , as the carrier protein. Prevenar® contains the purified 

polysaccharides of the capsular antigens of seven Streptococcus pneumoniae 

serotypes (4, 9V, 14, 18C, 19F, 23F and 6B) individually conjugated to CRM 197 . 

The minimum titre of circulating antibody necessary for protection against IPD and otitis 

media has not been determined for any particular serotype. In the Kaiser Permanente 

trial (Black et al 2000), over 97% of PCV7 recipients achieved antibody levels of 

≥ 0.15 mg/mL for all serotypes after a three-dose primary series (at two, four and six 

months of age), and this correlated with the observed protective efficacy against IPD of 

97%. 

The serum antibody responses to some of the conjugate vaccine types are substantial 

after one or two doses, whereas others require completion of three doses. Three doses 

of conjugate vaccine in infants induced functional antibodies and a strong, rapid 

anamnestic response on boosting with conjugate or polysaccharide vaccine six to 

12 months after the primary series (National Advisory Committee on Immunisation 

2002). 

Efficacy of Prevenar® in special groups 

Children with HIV infection 

Infants and young children with HIV infection are at greater risk of IPD than children 

without HIV infection. 

In a randomised controlled trial, 30 infants with HIV infection, aged 56 to 180 days at 

entry, received PCV7 vaccine at weeks zero, eight and 16 after enrolment, and 

15 infants in the control group received a placebo. Few infants were receiving 

antiretroviral therapy at the beginning of the study (Nachman et al 2003). 

The safety was monitored and the children followed until the age of two years. The 

vaccine was well tolerated, although more severe local reactions were seen in children 

who were symptomatic due to HIV infection. The PCV7 vaccine was immunogenic in all 

infants receiving PCV7 vaccine, although longevity of the immune response and the 

efficacy of the vaccine could not be measured in this small study. 


Low birth weight and pre-term infants 

In the Kaiser Permanente trial, a large randomised controlled trial of 37,868 infants, 

there were 1756 low birth weight (LBW) infants, under 2500 gm, including three with 

birth weights under 750 gm (Shinefield et al 2002). There were also 4340 pre-term 

infants (PT) born at gestation 32 to < 38 weeks. 

The LBW and PT infants were randomised and received either PCV7 or 

meningococcal C conjugate vaccine. The vaccine course was started at the time the 

infant was discharged home. 

In both LBW and PT infants, the PCV7 vaccine was well tolerated, safe and 

immunogenic. 

5.6 PCV7 vaccine information 

For further PCV7 vaccine information, refer to: 

• the Prevenar® data sheet (refer to the Medsafe data sheets at: 


• the Immunisation Handbook 2006 (Ministry of Health 2006). 

PCV7 vaccine presentation 

• Pack dimensions = 150 x 110 x 50 mm (L x W x H). 

• Packs of 10 x 1-dose pre-filled syringes. 

• Needles are not supplied with the vaccine. 


• PCV7 vaccine should be stored between +2°C and +8°C. 

• PCV7 vaccine should not be frozen. If frozen, PCV7 vaccine should be discarded. 

PCV7 vaccine administration 

Each 0.5 mL PCV7 dose is given intramuscularly. The preferred injection sites are: 

• the anterolateral aspect of the thigh of infants and young children 

• the deltoid muscle of the upper arm of older children. 

Prevenar® and Infanrix®-hexa vaccines are administered in separate limbs. 

PCV7 vaccine efficacy 

See section 5.5. 


Expected responses and adverse events following immunisation with PCV7 

vaccine 

Local reactions (redness and swelling). In trials 10% of children had erythema after 

PCV7 (refer to the Immunisation Handbook 2006 page 328). 

Rare events (≥ 0.01% and < 0.1%) include: 

• febrile seizures 

• hypotonic, hyporesponsive episodes. 

Very rare events (< 0.01%) include: 

• urticaria 

• angioneurotis oedema 

• erythema multiforme 

• hypersensitivity, including anaphylaxis. 

Infanrix®-hexa and Prevenar® 


and Prevenar® compared to infants receiving Infanrix®-hexa vaccine alone. See 

section 4.4 for more information. 




• Paracetamol may be given for pain relief prior to immunisation. 

Interference with other vaccines 

Data on concomitant administration of Infanrix®-hexa with Prevenar® have shown no 

clinically relevant interference in the antibody response to each of the individual 

antigens when given as a three-dose primary vaccination. 

Avoid giving MeNZB TM vaccine at same visit as PCV7 (Prevenar®) 


data to support giving the MeNZB TM vaccine at the same practice visit as Prevenar®. 

Therefore, where parents are anxious for their child to receive the MeNZB vaccine 

and the doctor agrees, a three-dose course of the MeNZB vaccine could start at six 

months of age (doses six weeks apart). 

See section 2.4 for more information on the eligibility for the MeNZB vaccine from 


PCV7 vaccine contraindications 

Contraindications include: 


• hypersensitivity to any component of the PCV7 vaccine, including diphtheria toxoid 

• allergic reaction or anaphylactoid reaction following prior administration of PCV7 

vaccine. 

5.7 PCV7 vaccine and the National Immunisation Register – National 

Immunisation Schedule only 

From 1 June 2008, the NIR will record PCV7 vaccine events as part of the National 

Immunisation Schedule for: 

• new babies beginning their immunisations 

• babies born from 1 January 2008 on a catch-up schedule. 

Note: The information above does not apply to children receiving PCV7 vaccine as part 

of the high-risk pneumococcal or pre/post-splenectomy programmes (see section 6 and 

Appendix 2). Information for the high risk pneumococcal or pre/post splenectomy 

programmes is recorded on the NIR as the ‘Pneumococcal’ programme. 

5.8 PCV7 vaccine and claiming the immunisation benefit – 

Childhood Immunisation Schedule only 

Note: The following does not apply to babies or children receiving PCV7 vaccine as part 

of the high-risk pneumococcal programme. 

• Vaccine administration date – from 1 June 2008. 

• Immunisation benefit claims for PCV7 given as a schedule vaccine will be valid if the 

vaccine is administered from 1 June 2008. 

• Immunisation benefit claims for the PCV7 as a schedule vaccine will be rejected if the 

vaccine is administered before 1 June 2008. 

• Immunisation benefits for PCV7 as a schedule vaccine are valid for babies with a 

birth date from 1 January 2008. Immunisation benefit claims for PCV7 as a schedule 

vaccine will be rejected if the vaccine is administered to babies with a birth date 

before 1 January 2008. 


6 Expansion of the High Risk Pneumococcal 

Programme for Children under Five Years of Age 

with a Chronic Condition 

6.1 Addition of new eligible groups 

From 1 June 2008, the high-risk pneumococcal programme will be expanded to include 

funding for children under five years with the following chronic conditions: 

• pre-term infants, born at under 28 weeks gestation 

• chronic pulmonary disease 

• cardiac disease with cyanosis or failure 

• insulin dependant diabetes 

• Down’s syndrome. 

Table 6.1 below shows the eligibility criteria for the high-risk pneumococcal programme 

for children under five years of age from 1 June 2008. 

Table 6.1: Eligibility criteria for high-risk pneumococcal programme 

Children aged under five years with the following conditions: 

On immunosuppressive or radiation 

therapy 

Primary immune deficiencies 

HIV 

Renal failure or nephrotic syndrome 

Organ transplants 

Cochlear implants or intracranial 

shunts 

With chronic CSF leaks 

On corticosteroid therapy for more than two weeks, at daily 

dose of prednisone of 2 mg/kg or greater, or a total daily 

dosage of 20 mg or more 

Children pre or post splenectomy or with functional asplenia* 

Pre-term infants, born at under 28 weeks’ gestation 

Chronic pulmonary disease (including asthma treated with 

high-dose corticosteroid therapy) 

Cardiac disease with cyanosis or failure 

Insulin dependent diabetes 

Down’s syndrome 

* See Appendix 2 – Pre/post Splenectomy Immunisation Programme. 

Note: See bold text for the additional funded chronic conditions from 1 June 2008. 

6.2 High risk pneumococcal programme immunisation schedule 

Children who meet the criteria are eligible for: 

• PCV7 (pneumococcal conjugate, Prevenar®) vaccine 

• 23PPV (pneumococcal polysaccharide, Pneumovax®23) vaccine. 

See Table 6.2 below (reproduced from the Immunisation Handbook 2006: Table 16.6, 

page 325; Ministry of Health 2006) for the high-risk pneumococcal programme 

immunisation schedule. 


Table 6.2: Schedule for pneumococcal vaccines for children at higher risk of pneumococcal 

disease with no prior history of pneumococcal vaccines 

Age of child at start 

of course 

Conjugate pneumococcal vaccine 

(PCV7) 

Polysaccharide pneumococcal 

vaccine (23PPV) 

6 weeks to 6 months Three doses PCV7 at least 6–8 weeks 

apart, or at same time as the usual 

schedule; plus a fourth dose at age 

15 months 

7–11 months Two doses of PCV7 at least 6–8 

weeks apart; plus a third dose at age 

15 months 

12–59 months Two doses of PCV7 given at 6–8 

weeks apart 

One dose of 23PPV at age 2 years 

and a second dose at age 4–5 years 





Older children up to 

the age of 16 years 

in high risk groups* 

One dose of PCV7 

One dose of 23PPV 6–8 weeks after 

PCV7 

Note: Prevenar® is approved by Medsafe only for children up to nine years of age. If a specialist 

recommends Prevenar® for older children, informed consent should be obtained. 

Catch-up schedules for children who have already received one or more doses of 

pneumococcal vaccine are found in Appendix 1. 

For children pre or post splenectomy or with functional asplenia, see Appendix 2: 

Pre/post Splenectomy Immunisation Programme, and for vaccine dosage, see the 

Immunisation Handbook 2006: Table 16.5, page 323 (Ministry of Health 2006). 

6.3 Entering high-risk pneumococcal programme vaccines on the 

National Immunisation Register 

Children born prior to 1 January 2008 

Children born prior to 1 January 2008 and identified as meeting the eligibility criteria for 

the high-risk pneumococcal programme (see table 6.1) will continue to have their 

pneumococcal vaccines (PCV7 and 23PPV) entered onto the NIR using the 

pneumococcal programme. 

Children born between 1 January 2008 and 31 May 2008 

Children born between 1 January 2008 and 31 May 2008 who have commenced the 

high-risk pneumococcal programme would have already been entered on the NIR as 

part of the pneumococcal programme (PI). 

From 1 June 2008, these high-risk children will automatically transfer to the NIR 

Childhood Schedule (CI) and their remaining PCV7 doses will recorded as part of this 

CI schedule. 


When the high-risk child turns two years old and receives 23PPV vaccine, the PI 

programme takes over for these children (on the basis of the NIR receiving a 23PPV 

vaccine, an indicator of high risk). 

Children born from 1 June 2008 

PCV7 is included on the National Immunisation Schedule from 1 June 2008 for all 

children. PCV7 doses given to high-risk children born from 1 June 2008 will be recorded 

on the CI schedule of the NIR. When the high-risk child turns two years old and receives 

23PPV vaccine, the PI programme takes over for these children (on the basis of the NIR 

receiving a 23PPV vaccine, an indicator of high risk). 

6.4 Claiming for high-risk pneumococcal programme vaccines 

The immunisation benefit can be claimed for vaccines given as part of the high-risk 

pneumococcal programme for children under five years of age with a chronic condition. 

Claim using the codes as follows. 

• Vaccine 100 (PCV7) and indication 12 (at risk, no previous history), 13 (at risk, 

previous PCV7) or 14 (at risk, previous 23 PPV). 

• Or, if the PCV7 vaccine is given at six weeks, three or five months as part of the 

usual National Immunisation Schedule you may claim as a usual schedule vaccine, 

and when the child receives a dose of 23 PPV vaccine please claim under the high 

risk pneumococcal programme. 


Appendix 1: Immunisation Catch-up Schedules 

The following tables are for use from 1 June 2008. These tables replace Appendix 2 of 

the Immunisation Handbook 2006 (Ministry of Health 2006). 

1.1 National Immunisation Schedule catch-up schedules 

Note: PCV7 is available from 1 June 2008 only for healthy infants born after 1 January 

2008. See Section 2.2 below for catch-up schedules for infants with chronic medical 

conditions who are eligible for funded pneumococcal vaccines. 

First dose at 3–5 months 

First dose DTaP-IPV-HepB/Hib PCV7 

6 week interval DTaP-IPV-HepB/Hib PCV7 


At age 15 months Hib PCV7 MMR 

At age 4 years DTaP-IPV MMR 

At age 11 years 

dTap 

First dose at age 6 months 

First dose DtaP-IPV-HepB/Hib PCV7 

6 week interval DtaP-IPV-HepB/Hib PCV7 

6 week interval DtaP-IPV-HepB/Hib PCV7 

At age 15 months Hib PCV7 MMR 

At age 4 years DtaP-IPV MMR 


dTap 


First dose DTaP-IPV-HepB/Hib PCV7 


6 week interval DTaP-IPV-HepB/Hib 

At age 15 months* Hib PCV7 MMR 



dTap 

* The fourth dose of Hib vaccine and the third dose of PCV7 should be two months after the prior dose. 

However, this should not delay the administration of MMR at 15 months. If the third dose of Hib 

vaccine is given at 15 months or older the fourth dose can be omitted. 



First dose DTaP-IPV-HepB/Hib MMR 

6 week interval* DTaP-IPV-HepB/Hib HepB 

6 week interval* DTaP-IPV HepB 



dTap 

For children born after 1 January 2008, two doses of PCV7 should be given at least six 

weeks apart. PCV7 should be given as a third injection at a scheduled visit. 

* Alternatively, at the third visits, DTaP-IPV-HepB/Hib vaccine may be given. 

First dose at 15 months–3 years 

First dose DTaP-IPV-HepB/Hib MMR 

6 week interval DTaP-IPV HepB 

6 week interval DTaP-IPV HepB 



dTap 

Children born after 1 January 2008 are eligible for funded PCV7 vaccine from 1 June 

2008. 

For children aged 15–23 months, two doses of PCV7 should be given at least six weeks 

apart. PCV7 should be given as a third injection at visits one and two, but can be given 

at an additional visit. Alternatively, at the second visit and third visits, a DTaP-IPV- 

HepB/Hib and a PCV7 vaccine may be given. For ease of delivery though, additional 

doses of hib vaccine beyond 15 months are not required. 

For children aged 24–35 months, one dose of PCV7 should be given as a third injection 

at a scheduled visit but can be given at an additional visit. Alternatively, at the second 

visit, DTaP-IPV-HepB/Hib and a PCV7 vaccine may be given. 

First dose at 4 years 

First dose DTaP-IPV-Hep/Hib MMR 

6 week interval DTaP-IPV Hep B 

6 week interval DTaP-IPV Hep B 

6 month interval DTaP-IPV MMR 


dTap 

Children born after 1 January 2008 are eligible for funded PCV7 vaccines. 

For children age 24–48months, one dose of PCV7 should be given as a third injection at 

the first visit. Alternatively, at the second visit, DTaP-IPV-HepB/Hib and a PCV7 

vaccine may be given. 


First dose at 5–7 years 

First dose DTaP-IPV HepB MMR 

1 month interval DTaP-IPV HepB 

1 month interval DTaP-IPV HepB 

6 months interval DTaP-IPV (or Td and IPV > 7 years) MMR 


dTap 

First dose at 7 years and older* 

First dose dTap* and IPV HepB MMR 

1 month interval Td and IPV HepB 

1 month interval Td and IPV HepB MMR 

10 year interval dTap* and IPV 

* dTap may be considered for all three doses of the primary series. See note 9 below. 

Notes 

1. There is considerable flexibility in these schedules, and the recommended intervals between doses 

are not sacrosanct. Vaccines may be given simultaneously and/or the schedule shortened to monthly 

intervals if this is deemed necessary to ensure the required numbers of doses are administered. 

2. If the schedule is interrupted, it is not necessary to repeat prior doses; simply resume the schedule as 

if no dose had been missed. 

3. If the immunisation status of a vaccine recipient is uncertain or unknown, then the vaccine provider 

should err on the side of giving rather than not giving the vaccine. 

4. If a child attends infrequently and failure to return for future immunisation is of concern, it is prudent to 

administer as many antigens as possible at the first visit. 

5. In the catch-up schedule for children 12–14 months of age, the third hepatitis B vaccine dose may be 

moved to a six-month interval if the MMR dose at 15 months coincides with the third catch-up visit and 

three injections are not accepted. 

6. MMR, Hib and pertussis are given as a priority for children 15 months of age and over because these 

diseases pose the greatest immediate risk. 

7. MMR should be given either at 15 months, or if the child/adult is older than 15 months, at the first 

immunisation visit. 

8. A single dose of Hib vaccine administered at 15 months of age and over is sufficient to induce 

immunity. 

9. After the seventh birthday, Td should be used. The dTap vaccine is given at age 11 years as a 

booster. As at 2008, dTap and dTap-IPV are licensed for distribution for booster doses only. 

However, there are expected to be no safety concerns to giving three doses of dTap to previously 

unimmunised older children and adults. Therefore, using dTap should be considered for all catch-up 

and adult schedules for primary and booster immunisations. 


1.2 High risk pneumococcal immunisation programme catch-up 

schedules 

Following are recommendations for pneumococcal vaccines for children at higher risk of 

pneumococcal disease who have received a dose of a pneumococcal vaccine 

previously. 

Age of child 

Previous dose(s) of any 

pneumococcal vaccine 

Recommendations 

23 months or 

under 

Any or none As in the Immunisation Handbook 2006, chapter 16, 

Table 16.6, page 325 (Ministry of Health 2006) 

24–59 months Four doses of PCV7 

vaccine 

24–59 months 1–3 doses of PCV7 

vaccine 

One dose of 23PPV vaccine at 24 months of age, 6–8 

weeks after the last dose of PCV7 vaccine; and one 

dose of 23PPV vaccine 3–5 years after the first dose 

One dose of PCV7 vaccine; one dose of 23PPV 

vaccine 6–8 weeks after the last dose of PCV7 vaccine; 

and one dose of 23PPV vaccine 3–5 years after the first 

dose 

24–59 months 1 dose of 23PPV Two doses of PCV7 vaccine, 6–8 weeks apart, 

beginning at 6–8 weeks after the dose of 23PPV 

vaccine; one dose of 23PPV vaccine 3–5 years after 

the first dose of 23PPV vaccine 

24–59 months No previous dose of PCV7 

or 23PPV vaccine 

Two doses of PCV7 vaccine 6–8 weeks apart; one 

dose of 23PPV vaccine 6–8 weeks after the last dose of 

PCV7 vaccine; and one dose of 23PPV vaccine 3–5 

years after the first dose of 23PPV vaccine 

PCV7 – 7 valent-conjugate pneumococcal vaccine (Prevenar®) 

23 PPV – 23 valent polysaccharide pneumococcal vaccine (Pneumovax®23) 


Appendix 2: Pre/Post Splenectomy Immunisation 

Programme 

The following groups are eligible for the pre/post splenectomy immunisation 

programme: 

• Children (0–16 years) pre* or post splenectomy or with functional asplenia. 

• Adults pre* or post splenectomy. 

These groups are eligible for the following funded vaccines. 

Eligibility criteria 

Children (0–16 years) 

pre* or post 

splenectomy or with 

functional asplenia 

Adults pre*- or postsplenectomy 

Funded vaccine (trade 

name) 

PCV7 (Prevenar®) 

23PPV (Pneumovax®23) 

Meningococcal ACYW135 

(Menomune®) 

Meningococcal B 

(MeNZB) 

Hib (Hiberix) 

23PPV (Pneumovax®23) 

Meningococcal ACYW135 

(Menomune®) 

Meningococcal B 

(MeNZB) 

Hib (Hiberix) 

Vaccine schedule 

See the Immunisation Handbook 2006, Table 

16.5, page 323, PCV7 vaccine schedule. 

See the Immunisation Handbook 2006, Table 

16.5, page 323, 23PPV vaccine schedule. 

Five-yearly 23PPV boosters are also funded. 

One dose 

Five-yearly Meningococcal ACYW135 boosters 

are also funded if still indicated (ie, risk) 

If the first dose is given at age ≥ 6 months: three 

doses 6 weeks apart. 

If the first dose is given age 6 weeks to 5 months 

give three doses at 6 weeks apart and a fourth 

dose at age 10 months. 

One dose 

Five-yearly boosters are also funded 

One dose 

Five-yearly Meningococcal ACYW135 boosters 

are also funded if still indicated (ie, risk) 

Three doses 6 weeks apart 

One dose 

* Where possible the vaccines should be administered at least 14 days before splenectomy – with the 

exception of MeNZB, where the vaccine course should be completed at least four weeks before 

splenectomy. 

Claiming for the Pre/Post Splenectomy Immunisation Programme vaccines 

PCV7 should be claimed as noted in the section 6.4, that is using the codes Vaccine 

100 (PCV7) and indication 12 (at risk, no previous history), 13 (at risk, previous PCV7) 

or 14 (at risk, previous 23PPV). 


The remaining pre/post-splenectomy vaccines should be claimed using their usual claim 

code (IMMB for MeNZB TM , IMOA for the others) and usual vaccine code and indication 

11 (pre/post-splenectomy). 

For more details refer to the Ministry’s Frequently Asked Questions webpage at: 

http://www.moh.govt.nz/moh.nsf/indexmh/healthpac-faq-immunisation 


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