ATAGI targeted review 2025: Immunisation considerations for immunocompromised people in Australia
DOI:
https://doi.org/10.33321/cdi.2026.50.056Keywords:
immunocompromise, vaccine-preventable diseases, immunisation programs, inborn errors of immunity, immunosuppressive medication, Australian Technical Advisory Group on Immunisation (ATAGI)Abstract
Vaccination plays a pivotal role in protecting people who are immunocompromised, and who may therefore be at increased risk of infectious diseases, including vaccine preventable diseases (VPDs). However, there are special challenges in clinical practice and the development of immunisation policies to accurately address the vaccination needs of this heterogeneous population. This review aims to highlight the immunisation needs and challenges of immunocompromised populations, and to summarise the rationale behind the immunisation recommendations for these populations in Australia.
The chapter Vaccination for people who are immunocompromised, in the Australian Immunisation Handbook, was recently updated by the Australian Technical Advisory Group on Immunisation (ATAGI). The updated chapter introduces new categorisation and risk classification for various types of immunocompromise, alongside the principles of immunisation. When planning immunisation for immunocompromised people, it is crucial to consider their underlying diagnoses, exposure to immunosuppressive therapies, susceptibility to VPDs, and their immune response to vaccination. Strategies to improve protection for immunocompromised persons include booster doses or altered schedules of routine vaccines; additional vaccines to prevent specific VPDs; and complete revaccination following immune reconstitution. Several national and jurisdictional vaccination programs have been implemented for immunocompromised populations (alongside other priority populations); however, monitoring vaccine coverage in these groups is challenging, and strategies to improve coverage are needed.
There are significant evidence gaps in vaccine research for immunocompromised people, particularly regarding the optimal timing and scheduling of vaccinations to ensure maximum efficacy and safety. Future research should prioritise the inclusion of immunocompromised people in clinical trials and should integrate evidence from post-licensure use through data linkage. Emerging vaccine technologies may enable the development of more immunogenic vaccines or may offer more effective vaccination strategies for better protection against VPDs in immunocompromised people.
Downloads
References
Antinori A, Bausch-Jurken M. The burden of COVID-19 in the immunocompromised patient: implications for vaccination and needs for the future. J Infect Dis. 2023;228(Suppl 1):S4–12. doi: https://doi.org/10.1093/infdis/jiad181.
Australian Technical Advisory Group on Immunisation (ATAGI), Australian Centre for Disease Control (Australian CDC). Australian Immunisation Handbook: Vaccination for people who are immunocompromised. [Webpage.] Canberra: Australian CDC; 24 October 2025. Available from: https://immunisationhandbook.health.gov.au/contents/vaccination-for-special-risk-groups/vaccination-for-people-who-are-immunocompromised.
Australian Institute of Health and Welfare (AIHW). Australian Burden of Disease Study 2024. Canberra: Australian Government, AIHW; 12 December 2024. Available from: https://www.aihw.gov.au/reports/burden-of-disease/australian-burden-of-disease-study-2024/contents/about.
Miller FW. The increasing prevalence of autoimmunity and autoimmune diseases: an urgent call to action for improved understanding, diagnosis, treatment, and prevention. Curr Opin Immunol. 2023;80:102266. doi: https://doi.org/10.1016/j.coi.2022.102266.
Cancer Australia. Cancer in Australia statistics. [Webpage.] Canberra: Australian Government, Cancer Australia; 22 January 2025. Available from: https://www.canceraustralia.gov.au/research-data/data-and-statistics/cancer-australia-statistics.
Donges E, Staatz CE, Benham H, Kubler P, Hollingworth SA. Patterns in use and costs of conventional and biologic disease-modifying anti-rheumatic drugs in Australia. Clin Exp Rheumatol. 2017;35(6):907–12.
Quinn J, Modell V, Orange JS, Modell F. Growth in diagnosis and treatment of primary immunodeficiency within the global Jeffrey Modell Centers Network. Allergy Asthma Clin Immunol. 2022;18(1):19. doi: https://doi.org/10.1186/s13223-022-00662-6.
Abolhassani H, Azizi G, Sharifi L, Yazdani R, Mohsenzadegan M, Delavari S et al. Global systematic review of primary immunodeficiency registries. Expert Rev Clin Immunol. 2020;16(7):717–32. doi: https://doi.org/10.1080/1744666X.2020.1801422.
Kirkpatrick P, Riminton S. Primary immunodeficiency diseases in Australia and New Zealand. J Clin Immunol. 2007;27(5):517–24. doi: https://doi.org/10.1007/s10875-007-9105-z.
Baumgart KW, Britton WJ, Kemp A, French M, Roberton D. The spectrum of primary immunodeficiency disorders in Australia. J Allergy Clin Immunol. 1997;100(3):415–23. doi: https://doi.org/10.1016/s0091-6749(97)70257-4.
Kolobova I, Nyaku MK, Karakusevic A, Bridge D, Fotheringham I, O'Brien M. Burden of vaccine-preventable diseases among at-risk adult populations in the US. Hum Vaccin Immunother. 2022;18(5):2054602. doi: https://doi.org/10.1080/21645515.2022.2054602.
Zhang D, Petigara T, Yang X. Clinical and economic burden of pneumococcal disease in US adults aged 19–64 years with chronic or immunocompromising diseases: an observational database study. BMC Infect Dis. 2018;18(1):436. doi: https://doi.org/10.1186/s12879-018-3326-z.
McKay SL, Guo A, Pergam SA, Dooling K. Herpes zoster risk in immunocompromised adults in the United States: a systematic review. Clin Infect Dis. 2020;71(7):e125–34. doi: https://doi.org/10.1093/cid/ciz1090.
Kojic EM, Conley L, Bush T, Cu-Uvin S, Unger ER, Henry K et al. Prevalence and incidence of anal and cervical high-risk human papillomavirus (HPV) types covered by current HPV vaccines among HIV-infected women in the SUN study. J Infect Dis. 2018;217(10):1544–52. doi: https://doi.org/10.1093/infdis/jiy087.
Kim AHJ, Sparks JA. Immunosuppression and SARS-CoV-2 breakthrough infections. Lancet Rheumatol. 2022;4(6):e379–80. doi: https://doi.org/10.1016/S2665-9913(22)00127-8.
Wang X, Patel C, Giles ML, Burns P, Macartney K, Teh B et al. Glucocorticoid dosing and implications for vaccination: evolution of global definitions. Clin Infect Dis. 2025;80(5):998–1004. doi: https://doi.org/10.1093/cid/ciae613.
Caldwell MB, Oxtoby MJ, Simmonds RJ, Lindegren ML, Rogers MF. 1994 revised classification system for human immunodeficiency virus infection in children less than 13 years of age. MMWR Recomm Rep. 1994;43(RR-12):1–10. Available from: https://beta.cdc.gov/mmwr/preview/mmwrhtml/00032890.htm.
Nellore A, Goepfert P, Tan CS, Bajema K, Belden K, Blumberg D et al. IDSA 2025 Guidelines on the use of vaccines for the prevention of seasonal COVID-19, influenza, and RSV infections in immunocompromised patients. Clin Infect Dis. 2026:ciag114. doi: https://doi.org/10.1093/cid/ciag114.
Dubey V, MacFadden D. Disseminated varicella zoster virus infection after vaccination with a live attenuated vaccine. CMAJ. 2019;191(37):E1025–7. doi: https://doi.org/10.1503/cmaj.190270.
Price NB, Grose C. Corticosteroids contribute to serious adverse events following live attenuated varicella vaccination and live attenuated zoster vaccination. Vaccines (Basel). 2021;9(1):23. doi: https://doi.org/10.3390/vaccines9010023.
Hoeve CE, Gadroen K, Kwa MSG, van Haren A, Sturkenboom MCJM, Straus SMJM. Fatal outcomes following immunization errors as reported to the EudraVigilance: a case series. Vaccine. 2020;38(15):3086–95. doi: https://doi.org/10.1016/j.vaccine.2020.02.074.
Grint DJ, McDonald HI, Walker JL, Amirthalingam G, Andrews N, Thomas S. Safety of inadvertent administration of live zoster vaccine to immunosuppressed individuals in a UK-based observational cohort analysis. BMJ Open. 2020;10(1):e034886. doi: https://doi.org/10.1136/bmjopen-2019-034886.
Carr S, Allison KJ, Van De Velde LA, Zhang K, English EY, Iverson A et al. Safety and immunogenicity of live attenuated and inactivated influenza vaccines in children with cancer. J Infect Dis. 2011;204(10):1475–82. doi: https://doi.org/10.1093/infdis/jir561.
Issa NC, Marty FM, Leblebjian H, Galar A, Shea MM, Antin JH et al. Live attenuated varicella-zoster vaccine in hematopoietic stem cell transplantation recipients. Biol Blood Marrow Transplant. 2014;20(2):285–7. doi: https://doi.org/10.1016/j.bbmt.2013.11.013.
Su JR, Ng C, Lewis PW, Cano MV. Adverse events after vaccination among HIV-positive persons, 1990–2016. PLoS One. 2018;13(6):e0199229. doi: https://doi.org/10.1371/journal.pone.0199229.
Lara AN, Miyaji KT, Ibrahim KY, Lopes MH, Sartori AMC. Adverse events following yellow fever vaccination in immunocompromised persons. Rev Inst Med Trop Sao Paulo. 2021;63:e13. doi: https://doi.org/10.1590/S1678-9946202163013.
Barte H, Horvath TH, Rutherford GW. Yellow fever vaccine for patients with HIV infection. Cochrane Database Syst Rev. 2014;2014(1):CD010929. doi: https://doi.org/10.1002/14651858.CD010929.pub2.
Linnemann CC Jr, First MR, Schiffman G. Revaccination of renal transplant and hemodialysis recipients with pneumococcal vaccine. Arch Intern Med. 1986;146(8):1554–6. doi: https://doi.org/10.1001/archinte.1986.00360200116019.
Kernéis S, Launay O, Turbelin C, Batteux F, Hanslik T, Boëlle PY. Long-term immune responses to vaccination in HIV-infected patients: a systematic review and meta-analysis. Clin Infect Dis. 2014;58(8):1130–9. doi: https://doi.org/10.1093/cid/cit937.
Lee GM. Preventing infections in children and adults with asplenia. Hematology Am Soc Hematol Educ Program. 2020;2020(1):328–35. doi: https://doi.org/10.1182/hematology.2020000117.
Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tomblyn M et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis. 2014;58(3):e44–100. doi: https://doi.org/10.1093/cid/cit684.
Shahid Z, Jain T, Dioverti V, Pennisi M, Mikkilineni L, Thiruvengadam SK et al. Best practice considerations by the American Society of Transplant and Cellular Therapy: infection prevention and management after chimeric antigen receptor T cell therapy for hematological malignancies. Transplant Cell Ther. 2024;30(10):955-69. doi: https://doi.org/10.1016/j.jtct.2024.07.018.
Machado CM. Reimmunization after hematopoietic stem cell transplantation. Expert Rev Vaccines. 2005;4(2):219–28. doi: https://doi.org/10.1586/14760584.4.2.219.
Ison MG. Vaccines for use in special populations: immunocompromised hosts. J Infect Dis. 2025;231(3):552–5. doi: https://doi.org/10.1093/infdis/jiae508.
Hill JA, Martens MJ, Young J-AH, Bhavsar K, Kou J, Chen M et al. SARS-CoV-2 vaccination in the first year after hematopoietic cell transplant or chimeric antigen receptor T cell therapy: a prospective, multicenter, observational study. Clin Infect Dis. 2024;79(2):542–54. doi: https://doi.org/10.1093/cid/ciae291.
Teh BW, Leung VKY, Mordant FL, Sullivan SG, Joyce T, Harrison SJ et al. A randomized trial of two 2-dose influenza vaccination strategies for patients following autologous hematopoietic stem cell transplantation. Clin Infect Dis. 2021;73(11):e4269–77. doi: https://doi.org/10.1093/cid/ciaa1711.
Victoria State Government Department of Health (Victoria Health). Immunisation schedule Victoria and vaccine eligibility criteria. [Webpage.] Melbourne: Victoria Health; 29 May 2025. Available from: https://www.health.vic.gov.au/immunisation/immunisation-schedule-victoria-and-vaccine-eligibility-criteria.
Government of South Australia Department of Health (SA Health). High Risk Hepatitis B Immunisation Program. [Webpage.] Adelaide: SA Health; 28 June 2023. Available from: https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/conditions/immunisation/immunisation+programs/high+risk+hepatitis+b+immunisation+program.
Government of Western Australia Department of Health (WA Health). Immunisation schedule and catch-up vaccines. [Webpage.] Perth: WA Health; 12 June 2023. Available from: https://www.health.wa.gov.au/Articles/F_I/Immunisation-schedule-and-catch-up-vaccines.
Government of New South Wales Department of Health (NSW Health). Additional Commonwealth and NSW-funded free vaccines. [Webpage.] Sydney: NSW Health; 16 April 2025.
Canadian Government, Public Health Agency of Canada (PHAC). Canadian Immunization Guide. Part 3. Vaccination of specific populations: Immunization of immunocompromised persons. [Webpage.] Ottawa: PHAC; 8 September 2023. Available from: https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-3-vaccination-specific-populations/page-8-immunization-immunocompromised-persons.html.
Health Information and Quality Authority, National Immunisation Advisory Committee (NIAC). Immunisation Guidelines for Ireland. Chapter 03. Immunisation of Immunocompromised Persons. Dublin: NIAC; 30 May 2023. Available from: https://www.hiqa.ie/reports-and-publications/niac-immunisation-guideline/chapter-03-immunisation-immunocompromised.
Bass AR, Chakravarty E, Akl EA, Bingham CO, Calabrese L, Cappelli LC et al. 2022 American College of Rheumatology guideline for vaccinations in patients with rheumatic and musculoskeletal diseases. Arthritis Care Res (Hoboken). 2023;75(3):449–64. doi: https://doi.org/10.1002/acr.25045.
Government of the United Kingdom (UK), UK Health Security Agency. Chapter 6: Contraindications and special considerations. In Immunisation Against Infectious Disease (The Green Book), ed. UK Health Security Agency; 11 September 2013. Available from: https://assets.publishing.service.gov.uk/media/5a82ce28e5274a2e8ab5970f/Greenbook_chapter_6.pdf.
Aotearoa New Zealand Government Ministry of Health (Health New Zealand / Te Whatu Ora). Immunisation Handbook: Section 4: Immunisation of special groups - 4.3 Immunocompromised individuals. Wellington: Health New Zealand / Te Whatu Ora; 2020. Available from: https://www.tewhatuora.govt.nz/for-health-professionals/clinical-guidance/immunisation-handbook/4-immunisation-of-special-groups#4-3-immunocompromised-individuals.
Shapiro Ben David S, Goren I, Mourad V, Cahan A. Vaccination coverage among immunocompromised patients in a large health maintenance organization: findings from a novel computerized registry. Vaccines (Basel). 2022;10(10):1654. doi: https://doi.org/10.3390/vaccines10101654.
Kolobova I, Nyaku MK, Karakusevic A, Bridge D, Fotheringham I, O'Brien M. Vaccine uptake and barriers to vaccination among at-risk adult populations in the US. Hum Vaccin Immunother. 2022;18(5):2055422. doi: https://doi.org/10.1080/21645515.2022.2055422.
Doherty M, Schmidt-Ott R, Santos JI, Stanberry LR, Hofstetter AM, Rosenthal SL et al. Vaccination of special populations: protecting the vulnerable. Vaccine. 2016;34(52):6681–90. doi: https://doi.org/10.1016/j.vaccine.2016.11.015.
Teh BW, Joyce T, Slavin MA, Thursky KA, Worth LJ. Impact of a dedicated post-transplant vaccination service at an Australian cancer centre. Bone Marrow Transplant. 2017;52(12):1681–3. doi: https://doi.org/10.1038/bmt.2017.195.
Yeung JH, Goodman KJ, Fedorak RN. Inadequate knowledge of immunization guidelines: a missed opportunity for preventing infection in immunocompromised IBD patients. Inflamm Bowel Dis. 2012;18(1):34–40. doi: https://doi.org/10.1002/ibd.21668.
Dey A, Rashid H, Sharma K, Phillips A, Li-Kim-Moy J, Manocha R et al. General practitioner knowledge gaps regarding live attenuated zoster vaccination of immunocompromised individuals: an ongoing concern? Aust J Gen Pract. 2022;51:529–34. doi: https://doi.org/10.31128/AJGP-09-21-6175.
Neusser S, Neumann A, Zur Nieden P, Speckemeier C, Schlierenkamp S, Walendzik A et al. Facilitators and barriers of vaccine uptake in patients with autoimune inflammatory rheumatic disease: a scoping review. RMD Open. 2022;8(2):e002562. doi: https://doi.org/10.1136/rmdopen-2022-002562.
ATAGI, Australian CDC. Australian Immunisation Handbook: Catch-up Calculator. [Online application.] Canberra: Australian CDC; 28 May 2026. Available from: https://immunisationhandbook.health.gov.au/catch-up-calculator/calculator.
Di Fusco M, Lin J, Vaghela S, Lingohr-Smith M, Nguyen JL, Scassellati Sforzolini T et al. COVID-19 vaccine effectiveness among immunocompromised populations: a targeted literature review of real-world studies. Expert Rev Vaccines. 2022;21(4):435–51. doi: https://doi.org/10.1080/14760584.2022.2035222.
Lee ARYB, Wong SY, Chai LYA, Lee SC, Lee MX, Muthiah MD et al. Efficacy of covid-19 vaccines in immunocompromised patients: systematic review and meta-analysis. BMJ. 2022;376:e068632. doi: https://doi.org/10.1136/bmj-2021-068632.
Friedman MA, Curtis JR, Winthrop KL. Impact of disease-modifying antirheumatic drugs on vaccine immunogenicity in patients with inflammatory rheumatic and musculoskeletal diseases. Ann Rheum Dis. 2021;80(10):1255–65. doi: https://doi.org/10.1136/annrheumdis-2021-221244.
Boeckh M, Pergam SA, Limaye AP, Englund J, Corey L, Hill JA. How immunocompromised hosts were left behind in the quest to control the COVID-19 pandemic. Clin Infect Dis. 2024;79(4):1018–23. doi: https://doi.org/10.1093/cid/ciae308.
Sapkota B, Saud B, Shrestha R, Al-Fahad D, Sah R, Shrestha S et al. Heterologous prime-boost strategies for COVID-19 vaccines. J Travel Med. 2022;29(3):taab191. doi: https://doi.org/10.1093/jtm/taab191.
Van Tilbeurgh M, Lemdani K, Beignon AS, Chapon C, Tchitchek N, Cheraitia L et al. Predictive markers of immunogenicity and efficacy for human vaccines. Vaccines (Basel). 2021;9(6):579. doi: https://doi.org/10.3390/vaccines9060579.
Cotugno N, Santilli V, Pascucci GR, Manno EC, De Armas L, Pallikkuth S et al. Artificial intelligence applied to in vitro gene expression testing (IVIGET) to predict trivalent inactivated influenza vaccine immunogenicity in HIV infected children. Front Immunol. 2020;11:559590. doi: https://doi.org/10.3389/fimmu.2020.559590.
Le D, Miller JD, Ganusov VV. Mathematical modeling provides kinetic details of the human immune response to vaccination. Front Cell Infect Microbiol. 2015;4:177. doi: https://doi.org/10.3389/fcimb.2014.00177.
Facciolà A, Visalli G, Laganà A, Di Pietro A. An overview of vaccine adjuvants: current evidence and future perspectives. Vaccines (Basel). 2022;10(5):819. doi: https://doi.org/10.3390/vaccines10050819.
Brisse M, Vrba SM, Kirk N, Liang Y, Ly H. Emerging concepts and technologies in vaccine development. Front Immunol. 2020;11:583077. doi: https://doi.org/10.3389/fimmu.2020.583077.
Dos Reis EC, Leal VNC, Soares J, Fernandes FP, Souza de Lima D, de Alencar BC et al. Flagellin/NLRC4 pathway rescues NLRP3-inflammasome defect in dendritic cells from HIV-infected patients: perspective for new adjuvant in immunocompromised individuals. Front Immunol. 2019;10:1291. doi: https://doi.org/10.3389/fimmu.2019.01291.
Garçon N, Di Pasquale A. From discovery to licensure, the Adjuvant System story. Hum Vaccin Immunother. 2017;13(1):19–33. doi: https://doi.org/10.1080/21645515.2016.1225635.
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2026 Communicable Diseases Intelligence

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
