This report outlines the major positive impacts of vaccines on the health of Aboriginal and Torres Strait Islander people from 2007 to 2010, as well as highlighting areas that require further ...attention. Hepatitis A disease is now less common in Aboriginal and Torres Strait Islander children than in their non-Indigenous counterparts. Hepatitis A vaccination for Aboriginal and Torres Strait Islander children was introduced in 2005 in the high incidence jurisdictions of the Northern Territory, Queensland, South Australia and Western Australia. In 2002–2005, there were 20 hospitalisations for hepatitis A in Aboriginal and Torres Strait Islander children aged<5 years--over 100 times more common than in other children--compared to none in 2006/07–2009/10. With respect to invasive pneumococcal disease (IPD), there has been a reduction of 87% in notifications of IPD caused by serotypes contained in 7-valent pneumococcal conjugate vaccine (7vPCV) since the introduction of the childhood 7vPCV program among Aboriginal and Torres Strait Islander children. However, due to a lower proportion of IPD caused by 7vPCV types prior to vaccine introduction, the decline in total IPD notifications has been less marked in Aboriginal and Torres Strait Islander children than in other children. Higher valency vaccines (10vPCV and 13vPCV) which replaced 7vPCV from 2011 are likely to result in a greater impact on IPD and potentially also non-invasive disease, although disease caused by non-vaccine serotypes appears likely to be an ongoing problem. Among Aboriginal and Torres Strait Islander people aged ≥50 years, there have been recent increases in IPD, which appear related to low vaccination coverage and highlight the need for improved coverage in this high-risk target group. Since routine meningococcal C vaccination for infants and the high-school catch-up program were implemented in 2003, there has been a significant decrease in cases caused by serogroup C. However, the predominant serogroup responsible for disease remains serogroup B, and Aboriginal and Torres Strait Islander children have significantly higher incidence of serogroup B disease than other children. A vaccine against meningococcus type B has now been licensed in Australia. The decline in severe rotavirus disease after vaccine introduction in 2007 was less marked in Aboriginal and Torres Strait Islander children than in other children. By far the highest hospitalisation rates continue to occur among Aboriginal and Torres Strait Islander children in the Northern Territory. Consideration of the role of age cut-offs and 2-dose versus 3-dose schedules may be necessary. Genotype surveillance is critically important to allow detection of any possible emergence of genotypes for which there is lower vaccine-derived immunity. Although Haemophilus influenzae type b disease rates have decreased significantly since the introduction of vaccines in 1993, the plateauing of rates in Aboriginal and Torres Strait Islander children, and increasing disparity with other children, are concerning. While it is possible that higher disease rates in young infants could be associated with the later age of protection from the newer 4-dose schedule, it is also possible that higher vaccine immunogenicity will result in reduced carriage. Close monitoring is important to detect any re-emergence of Hib disease as soon as possible. Pandemic and seasonal influenza and pneumonia are other diseases with comparatively higher rates in Aboriginal and Torres Strait Islander people. For Aboriginal and Torres Strait Islander people aged≥50 years, it is unclear whether or not there has been a decline in influenza hospitalisations since the start of the National Indigenous Pneumococcal and Influenza Immunisation Program in 1999, but hospitalisation rates are still higher in Aboriginal and Torres Strait Islander people. Achieving high coverage in those aged≥15 years should now be a priority. A prolonged mumps outbreak occurred in 2007/2008 predominantly affecting Aboriginal and Torres Strait Islander adolescents and young adults in north-western Australia. A potential contributor to this mumps outbreak was greater waning of immunity after receipt of the first dose of mumps-containing vaccine at 9, rather than 12, months of age in the Northern Territory in the 1980s and 1990s. However, outbreaks in Australia and overseas have subsided without additional boosters being routinely implemented. Pertussis epidemics continue to occur in Australia and affect both Aboriginal and Torres Strait Islander and other people. Parents are now encouraged to have their infant’s first vaccination given at 6 weeks of age, instead of the usual 2 months, and this is being successfully implemented for Aboriginal and Torres Strait Islander and other infants. Timely provision of the 4- and 6-month doses remains very important. High coverage for standard vaccines, poor timeliness of vaccination and lower coverage for ‘Indigenous only’ vaccines are continuing features of vaccination programs for Aboriginal and Torres Strait Islander people. There have been some improvements in vaccination timeliness in recent years for all children, but disparities remain between Aboriginal and Torres Strait Islander and other children. Poor timeliness reduces the potential benefits of vaccination, most importantly for pneumococcal, Hib and rotavirus vaccines in infants. The age cut-offs for rotavirus vaccines present a particular challenge for timely vaccination, limiting the capacity for catching up on late vaccination and resulting in lower overall coverage. This is more pronounced for the 3-dose than for the 2-dose rotavirus schedule. Coverage for vaccines recommended only for Aboriginal and Torres Strait Islander children continues to remain substantially lower than that for universal vaccines. This underlines the importance of immunisation providers establishing the Indigenous status of their clients, so that additional vaccines are offered as appropriate. The absence of any coverage data for Aboriginal and Torres Strait Islander adolescents, or for adults since 2004/2005, is a substantial obstacle to implementing and improving programs in these age groups.
In November 2016, herpes zoster (HZ) vaccination for older adults, using the live-attenuated zoster vaccine (Zostavax; ZVL) was added to the Australian National Immunisation Program (NIP) with the ...aim of reducing morbidity from HZ and its complications, particularly for people at increased risk. Prior to the program, there were on average 5.6 cases of HZ per 1,000 persons annually in Australia, with highest risk of disease in older and in immunocompromised people. The burden of complications of HZ, such as post-herpetic neuralgia (PHN), was also highest in older and immunocompromised groups. No formal comprehensive program evaluation has been undertaken since program commencement. This review examined published literature and available vaccine administration data to summarise the evidence and considerations underpinning current use of HZ vaccines and potential future program directions in Australia. There have been modest reductions in the incidence of HZ and its complications since program introduction. However, five years into the program, challenges remain, including suboptimal vaccine coverage and significant safety concerns arising from inadvertent use of ZVL in immunocompromised people, who are contraindicated to receive this vaccine. This reduces opportunities to offset the burden of HZ-related disease. The recombinant subunit zoster vaccine (Shingrix; RZV), first registered in Australia in 2018, became available on the Australian market in June 2021. This vaccine has higher efficacy than ZVL and, as a non-live vaccine, can be used in both immunocompetent and immunocompromised people. RZV has potential to address the unmet needs of at-risk population groups. However, it has not yet demonstrated cost-effectiveness for inclusion as a funded vaccine under the NIP. The Australian HZ vaccination program has had limited effectiveness in meeting its aim in highest risk groups. Future options and challenges anticipated in using vaccination to reduce the burden of HZ and its complications are discussed in this review.
The overarching goal of the Australian coronavirus disease 2019 (COVID-19) vaccination program has been to protect all people in Australia from the harm caused by the novel coronavirus SARS-CoV-2. ...This review reflects on the role of the Australian Technical Advisory Group on Immunisation (ATAGI) in the national COVID-19 vaccination program, in terms of the initial programmatic and clinical recommendations in the evolving context of evidence relating to the disease and vaccines, epidemiology, and the program rollout. To fulfil the obligation to provide evidence-based advice to the Minister for Health and Aged Care on the safe, effective and equitable use of COVID-19 vaccines, ATAGI has worked closely with other agencies and committees such as the Therapeutic Goods Administration (TGA) and the Communicable Diseases Network Australia. ATAGI recommendations have sought to optimise the use of the available vaccine doses in achieving the objectives of preventing serious illness and death from COVID-19 while addressing any emerging safety signals following program commencement on 22 February 2021. As of mid-November 2021, the use of COVID-19 vaccines in children aged 5 to 11 years was being considered by the TGA and ATAGI; and emerging evidence, in areas such as use of heterologous vaccine schedules and co-administration with other vaccines, was under review. Despite unprecedented challenges which the delivery of mass COVID-19 vaccination presented to health systems globally, in Australia much was achieved in 2021 with over 90% coverage for primary doses in the vaccine-eligible population. Evaluation, using high quality data and assessment methods, of vaccination program outcomes-such as coverage, vaccine effectiveness and impact-is key to determine whether program objectives have been achieved and where gaps remain. Reflecting on the lessons learned so far would help further improve the national COVID-19 vaccination program and would also benefit programs for other routine vaccines and planning for future pandemics.
Residents in residential care facilities (RCF) are frequent users of acute hospital services. However, the interface between the two sectors remains relatively unexplored. Our objective was to ...determine the patterns of utilization, characteristics and experiences of RCF residents accessing a tertiary referral center (TRC). An observational study of RCF residents presenting to the TRC emergency department (ED). The experiences of acute care services were explored for more than one-quarter of this group 2-3 days postdischarge. The carer within the RCF acted as the proxy respondent. During the study period, RCF residents accounted for 2.3% of all ED presentations. These presentations involved 526 residents. The dimension "continuity of care" for the Picker Patient Experience questionnaire had the highest proportion (53.1%) reporting a problem. The likelihood of reporting a problem for "continuity of care" (odds ratio OR, 3.58; confidence interval CI, 1.72-7.45) and "information and education" (OR, 2.62; CI, 1.14-3.01) were higher if the resident was admitted to a ward compared to ED only. If the resident had a low level care status the likelihood of reporting a problem for "continuity of care" (OR, 2.8; CI, 1.02-7.72) also increased. The odds of RCF staff reporting a problem for "ambulance service" were significantly higher if the resident's presentation was related to a fall. (OR, 3.35; CI, 1.28-8.8). The utilization rates for acute hospital care in our study were similar to the two previous Australian studies. Factors at the patient and organizational level impacted significantly on problems relating to the quality and safety of care being reported. PUBLICATION ABSTRACT
The Australian Technical Advisory Group on Immunisation (ATAGI) updated recommendations on the use of human papillomavirus (HPV) vaccines in the Australian Immunisation Handbook in 2018, regarding ...the use of the recently available 9-valent (9vHPV) vaccine, Gardasil 9, and a 2-dose schedule for young adolescents for HPV vaccines. This report provides an overview of the relevant scientific evidence that underpinned these updated recommendations. The 9vHPV vaccine includes 5 HPV types (HPV 31, 33, 45, 52 and 58) additional to the 4 that are also covered by the 4vHPV (Gardasil) vaccine (HPV 6,11,16,18). Accordingly, the 9vHPV vaccine is expected to prevent an additional 15% of cervical cancers and up to 20% of other HPV-related cancers. Non-inferior antibody responses after two 9vHPV vaccine doses given 6-12 months apart in girls and boys aged 9-14 years compared to women aged 16-26 years after three doses support the 2-dose schedule for adolescents of this age group. In clinical trials 9vHPV vaccine was well-tolerated with a similar safety profile to 4vHPV vaccine. The switch to 9vHPV vaccine and a 2-dose schedule is anticipated to improve public acceptability of the program and reduce HPV-related disease in the long-term.
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