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3.02 Immunisation

Why is it important?

Immunisation is highly effective in reducing morbidity and mortality caused by vaccine-preventable diseases. Childhood vaccination for diphtheria was introduced in Australia in 1932 and use of vaccines to prevent tetanus, pertussis (whooping cough) and poliomyelitis became widespread in the 1950s, followed by vaccines for measles, mumps and rubella in the 1960s. In more recent years, vaccines have been included for hepatitis B, Haemophilus influenza type b (Hib), pneumococcal disease, meningococcal C, varicella (chicken pox), rotavirus, human papillomavirus (HPV) and influenza. Since the introduction of childhood vaccination, deaths from vaccine-preventable diseases have fallen for the general population by 99%. Vaccinations are estimated to have saved some 78,000 lives (Burgess 2003) and have been effective in reducing the disease disparities between Indigenous and non-Indigenous populations, despite differences in the socio-economic circumstances of these populations (Menzies et al. 2009).

There are variations in Indigenous identification in the immunisation records and enrolments used in the denominator. These variations can affect the accuracy of immunisation data.

Findings

In December 2013, vaccination coverage for Aboriginal and Torres Strait Islander children at 1 year of age was around 4 percentage points lower than other Australian children (86% compared with 90%). By 2 years of age, the difference was within 1 percentage point (91.4% of Indigenous children compared with 92.2% for other children). By 5 years of age the Indigenous rate (92.8%) was slightly higher than for other children (91.7%). Coverage rates for Indigenous children were highest in the NT and lowest in SA for children in all age groups 1, 2 and 5 years.

Between 2001 and 2013 there has been no change detected in the proportion of Aboriginal and Torres Strait Islander children or other Australian children who were fully immunised at 1 year of age. Over the same period, however, there has been a significant increase detected for 2-year-olds (both Indigenous and other children). There was an increase between 2008 and 2013 for Indigenous children aged 5 years (from 76% to 92%). Note that the age at which older children are assessed has changed from 6 years to 5 years of age and comparisons of trends over time are affected by the introduction of new vaccines on the schedule.

In 2012–13, an estimated 57% of Aboriginal and Torres Strait Islander peoples aged 50 years and over reported they had been vaccinated against influenza in the last 12 months, similar to the proportion in 2004–05 (60%). The 2009 Adult Vaccination Survey collected data on influenza coverage for all Australians. In 2009, coverage in the target group for Australians aged 65 years and over was 75% (AIHW 2011a). In addition, 29% of Indigenous Australians aged 50 years and over had been vaccinated against invasive pneumococcal disease in the last 5 years, a decrease from 34% in 2004–05. Coverage in the target group for all Australians aged 65 years and over was 54% in 2009. A higher proportion of Indigenous Australians aged 50 years and over living in remote areas were vaccinated against influenza in the last 12 months and invasive pneumococcal disease in the last 5 years (68% and 35% respectively) than in non-remote areas (54% and 27% respectively). Adult vaccinations are also targeted at younger Aboriginal and Torres Strait Islander peoples who have various risk factors, such as chronic medical conditions. In 2012–13, 28% of Indigenous Australians aged 15–49 years were vaccinated for influenza in the previous year and 10% had received a pneumococcal vaccination in the previous five years. Indigenous adults who had diabetes or circulatory disease were more likely to have had recent vaccinations than those without those diseases.

Implications

Achieving good immunisation coverage reflects the strength and effectiveness of primary health care. Immunisation coverage for Aboriginal and Torres Strait Islander children is high. There are still gaps in coverage at 1 year of age; however, Indigenous and non-Indigenous children have similar coverage at ages 2 and 5 years. Disparities in the timeliness of vaccinations between Indigenous and non-Indigenous children remain (Naidu et al. 2012).

Vaccinations have contributed to reductions in vaccine-preventable diseases in the Indigenous population, such as hepatitis A, invasive pneumococcal disease (IPD), Meningococcal C and Haemophilus influenza type B (Naidu et al. 2012). However, increasing rates of IPD in Indigenous Australians aged 50 years and over, high hospitalisation rates for rotovirus in the NT and much higher rates of hepatitis B for Indigenous Australians remain areas for focus.

The National Immunisation Program (NIP) provides free childhood vaccines to eligible Australians. In addition to the standard childhood schedule, the NIP provides additional pneumococcal vaccine and hepatitis A vaccine to Indigenous children living in high-risk areas. The NIP also provides free influenza vaccines for all Aboriginal and Torres Strait Islander people aged 15 and over and free pneumococcal vaccines for those aged 50 and over and those medically at risk in the 15–49 age group.

The National Human Papillomavirus (HPV) Vaccination Program commenced in 2007 for females and was extended to males in February 2013. It is delivered through an ongoing, school-based programme to students aged 12–13 years. A catch up programme for males aged 14–15 years was available until the end of 2014.

Communication activities to support the HPV Vaccination Program and the Influenza Vaccination Program include specific components for Aboriginal and Torres Strait Islander communities. These components include distribution of tailored resources to schools and stakeholders, as well as targeted public relations activities and social media engagement.

The Australian Government has provided facilitation incentive payments to state and territory governments through the National Partnership Agreement on Essential Vaccines (NPEV) since 2009. The payments encourage states and territories to maintain or increase vaccine coverage for Indigenous Australians. Jurisdictions have shown the greatest improvement in vaccination rates for five-year-olds. A review of the NPEV was conducted in 2013–14 and found that the NPEV has been effective in providing the funding and delivery of a national coordinated and integrated approach to maintaining and improving effective immunisation in Australia.

South Australia monitors coverage rates of Indigenous children, particularly at one year of age, given that their rates are lower than national levels for Aboriginal children, but their rates are also considerably lower than rates for non-Aboriginal children. A range of recall and promotional resources are being developed for clients and primary health providers to increase knowledge and management of vaccination timeliness. The programme closely monitors quarterly releases from the Australian Childhood Immunisation Register to identify trends and review or develop new approaches aimed at mothers and children most at risk.

Figure 3.02-1 Proportion of children fully vaccinated at age 1 year, 2 years and 5/6 years, NSW, Vic, SA, WA and the NT combined, by Indigenous status, 2001 to 2013
proportion of children fully vaccinated ages

Figure 3.02-1 shows that between 2001 and 2013 there has been no change in the proportion of Aboriginal and Torres Strait Islander children or other Australian children who were fully immunised at 1 year of age. Over the same period there has been a significant increase detected for 2 year olds and an increase for Indigenous children aged 5 years between 2008 and 2013, from 76% to 92%. The age at which older children are assessed has changed from 6 years to 5 years of age and comparisons of trends over time are affected by the introduction of new vaccines on the schedule.

Source: AIHW analysis of Australian Childhood Immunisation Register, Department of Human Services

Table 3.02-1 Proportion of children fully vaccinated at age 1 year, 2 years and 5 years, by Indigenous status and state/territory, at 31 December 2013
Age One Year
Indig.
Age One Year
Other
Age Two Years
Indig.
Age Two Year
Other
Age Five Years
Indig.
Age Five Years
Other
NSW 87.0 89.6 90.7 91.8 93.2 92.0
Vic 82.8 90.6 90.0 92.9 93.4 92.4
Qld 87.9 91.3 92.3 92.9 93.8 91.8
WA 82.2 90.0 89.6 90.2 90.8 89.4
SA 80.0 90.1 87.3 92.5 83.1 91.1
Tas 85.3 89.5 93.2 93.7 93.2 92.7
NT 88.7 90.8 95.7 90.7 96.7 89.5
ACT 82.9 93.6 91.2 93.7 90.5 90.9
Australia 86.1 90.3 91.4 92.2 92.8 91.7

Source: AIHW analysis of Australian Childhood Immunisation Register, Department of Human Services

Figure 3.02-2 Proportion of Aboriginal and Torres Strait Islander persons aged 50 years and over and total persons aged 65 years and over: immunisation status 2012–13 and 2009 for total population
Aboriginal & Torres Strait Islander immunisation for total population

Figure 3.02-2 shows that in 2012–13, an estimated 57% of Aboriginal and Torres Strait Islander peoples aged 50 years and over reported they had been vaccinated against influenza in the last 12 months. The 2009 Adult Vaccination Survey found that coverage in the target group for Australians aged 65 years and over was 75%. In addition, 29% of Indigenous people aged 50 years and over had been vaccinated against invasive pneumococcal disease in the last 5 years. Coverage in the target group for all Australians aged 65 years and over was 54% in 2009. A higher proportion of Indigenous people aged 50 years and over living in remote areas had been vaccinated against influenza in the last 12 months and invasive pneumococcal disease in the last 5 years (68% and 35% respectively) than in non remote areas (54% and 27% respectively).

Source: ABS and AIHW analysis of 2012–13 AATSIHS and 2009 Adult Vaccination Survey (AIHW 2011a)