National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people

Chapter 3. Child health
Immunisation
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☰ Table of contents

Recommendations: Immunisation

Preventive intervention type

Who is at risk?

What should be done?

How often?

Level/ strength of evidence

References

Immunisation*

 All children Conduct regular review of all infants and children and offer vaccination As per National Immunisation Program Schedule (NIPS)23 and relevant state and territory immunisation schedules IA 19
Use the ‘catch-up’ schedule for all children behind in their vaccination schedule Opportunistic IA 19
Pregnant women Offer influenza vaccination At any stage of pregnancy IA 19, 23
Offer diphtheria/tetanus/pertussis (dTpa) vaccination Third trimester of each pregnancy (28–32 weeks)  IA 19
Women planning pregnancy and those post-delivery Vaccinate with measles, mumps, rubella, with or without varicella as appropriate >28 days prior to conception or as soon as possible following delivery. Serological status should be checked post-vaccination 28 days prior to conception or post delivery where serological immunity is inadequate IA 19

Environmental

 

 Implement provider/system based interventions

Review vaccination status at every clinic visit and make a documented plan for the next vaccination		 Every visit IA 24
Ascertain local clinic vaccination rates via audits of health records and Australian Immunisation Register (AIR) records   IA 24, 25,. 26, 27
Implement recall and reminder systems and computer prompts for staff and patients to address immunisation gaps, particularly in the first 12 months of age   IA 24, 25, 26, 27, 28, 29, 30
Implement an adverse events reporting system   IA 24, 25, 26, 27, 28, 29, 30
Increase access to vaccinations via:
  • fast-tracking children presenting for immunisation
  • training and reminders for staff to screen and offer vaccinations
  • providing home visits and mobile clinics for immunisation
If resources are limited, focus particularly on vaccinations due in the first 12 months		   IA 24, 25, 26, 27, 28, 29, 30
Increase community demand for vaccinations by:
  • promotion of vaccination to parents, childcare staff, Aboriginal and Torres Strait Islander community workers such as Aboriginal and Torres Strait Islander liaison officers
  • use of posters and other visual materials in public places
  • personalised health records
  • giving all parents/carers a record in card or book form of their child’s immunisation status
  • commencing promotional activities for parents in the antenatal period and in places attended by parents of very young babies
 Ongoing IA 21,  24, 26,  27,  28,  29, 31, 32
*Vaccination should be implemented according to best practice recommendations of the NIPS23 and relevant state and territory immunisation schedules.


Background

Immunisation has had a powerful impact in preventing disease in Aboriginal and Torres Strait Islander children.1,2 However, Aboriginal and Torres Strait Islander children still experience higher rates of vaccinepreventable diseases,1,3–6 issues with timeliness of vaccination,7,8 and suboptimal rates of vaccination coverage for vaccines in the National Immunisation Program (NIP) when compared to non-Indigenous children, particularly at younger ages.2,8–13 There has, however, been continued improvement in immunisation coverage since the last edition of this guide.8 Data from the Australian Immunisation Register (AIR) show annual rates of coverage to March 2017 for children aged 60 to <63 months was higher in Aboriginal and Torres Strait Islander children at 95.26% compared with all children of the same age at 93.32%. For the same period, 93.63% of children Australia-wide aged 12 to <15 months were fully vaccinated, while 91.76% of Aboriginal and Torres Strait Islander children at the same age were fully vaccinated.1,2,9–14 The AIR coverage estimates are reliable with regards to identifying Aboriginal and Torres Strait Islander status of children;12 however, routine reports on immunisation coverage allow for significant lags in immunisation. The AIR’s reporting of coverage rates at one year of age are based on completion of vaccinations scheduled at age six months or earlier,12,13 so these data do not show the magnitude of the problem of vaccine delay. Figures published in the National Centre for Immunisation Research and Surveillance’s Annual immunisation coverage report, 2015 show a differential of 18.4% lower coverage for seven-month-old Aboriginal and Torres Strait Islander children compared to non-Indigenous children.8

Some vaccination programs are not universally applicable to all Australian children and target Aboriginal and Torres Strait Islander children only. Comparison of rates of immunisation coverage from universally applicable versus targeted vaccination programs show the latter are usually associated with lower rates of immunisation coverage in Aboriginal and Torres Strait Islander children. This is reflected in low rates of coverage for hepatitis A vaccine (2014 coverage one dose [63%] or two doses [79.8%]) and 13vPPV (66.9%), both of which are vaccinations recommended for Aboriginal and Torres Strait Islander children only.1,2,5,6,15 Rates for influenza vaccination vary greatly across jurisdictions, with over 50% of children aged six months to <60 months in the Northern Territory receiving at least one dose of vaccine in 2015, while only 2.5% were recorded as having received at least one dose in Victoria.1,15,16 These data come with the caveat that there is likely underreporting of influenza immunisation as there is currently no incentive payment to report this to AIR.15

There is also evidence that non-vaccine serotypes cause a disproportionate amount of disease in Aboriginal children compared to non-Aboriginal children with regard to some vaccine-preventable diseases. This has been seen with invasive pneumococcal disease.1,17–19 It is likely that factors other than immunisation coverage, such as heavy nasopharyngeal colonisation, poorer immunologic responses, and persistent nasopharyngeal carriage continue to contribute to higher rates of vaccine-preventable and non–vaccinepreventable disease in Aboriginal and Torres Strait Islander children.6
Compared to young non-Indigenous adults, young Aboriginal and Torres Strait Islander adults experience a much higher rate of invasive pneumococcal disease due to non-7vPCV serotypes.1,5,20 Coverage rates for influenza and pneumococcal vaccination 23vPPV in eligible Aboriginal and Torres Strait Islander people aged 15–49 years are low.1

The Australian immunisation handbook, 10th edition,19 recommends specific vaccines for Aboriginal and Torres Strait Islander peoples. Many of these vaccines are funded under the NIP, others are funded by state or territory government programs, and others are recommended but not currently funded under any program.


Interventions

In addition to the general vaccination schedule for all children, the following vaccines are covered under the NIP for Aboriginal and Torres Strait Islander children and adolescents:

  • influenza – ages six months to <5 years and ≥15 years
  • hepatitis A – 12–24 months (two doses) in high-risk areas (ie Northern Territory, Queensland, South Australia and Western Australia)
  • pneumococcal disease – additional fourth dose at 12–18 months of age with 13vPPV in high-risk areas  (ie Northern Territory, Queensland, South Australia and Western Australia).

In addition to the NIP vaccines, The Australian immunisation handbook recommends the following vaccines for Aboriginal and Torres Strait Islander peoples (health authorities should be consulted to determine exact geographic boundaries):

  • tuberculosis (BCG) – newborns living in areas of high tuberculosis incidence (one dose)
  • influenza – people aged ≥6 months (refer to Chapter 9: Respiratory health, ‘Influenza prevention’ for more detail)
  • pneumococcal disease – people aged 15–49 years with underlying conditions at increased risk of invasive pneumococcal disease19 (refer to Chapter 9: Respiratory health, ‘Pneumococcal disease prevention’ for more detail).

A large number of interventions can improve immunisation coverage and these can be summed up under three categories: provider/system based interventions, enhancing access to vaccination services, and increasing community demand for vaccination. Effects may be increased if the interventions are administered in combination rather than as single interventions.21,22
 

 

Resources
 
National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people

 





 
 
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