Vaccine Preventable Diseases in Australia, 2005 to 2007

5. Discussion

Page last updated: 24 December 2010

The period January 2006 to December 2007 was marked by continuing gains in the control of vaccine preventable diseases and further expansion of the National Immunisation Program (NIP) to include vaccines against rotavirus and human papillomavirus.

These vaccine policy and program changes represent a large investment in public health, and put Australia’s funded immunisation programs at the forefront internationally, especially when the level and rapidity of population coverage are considered. This investment is set to increase even further in coming years, as new vaccines capable of inducing significant disease reductions in Australia, such as those against herpes zoster and invasive meningococcal disease due to serogroup B, become available. Like other industrialised countries, Australia faces the dual challenges of maintaining both high immunisation coverage and public confidence in immunisation, while making increasingly complex decisions about the introduction of new vaccines for both children and adults. Although the full evaluation of the impact of current programs, and prioritisation and planning for future programs, require more detailed and precise data, the multiple routine data sources (notifications, hospitalisations and mortality) presented in this report and in the complementary reports on vaccination coverage1,2 provide an ongoing picture of progress across the spectrum of Australian immunisation activity.

A summary of the relative morbidity and mortality due to the diseases reported in the 3 years prior to the current report (a 3-year period within 2002–2005 that varied with different data sources) is shown in Table 5.1 and for the 2 years that followed (within 2005–2007) in Table 5.2. While the limitations of the data sources for notifications, hospitalisations and deaths should be borne in mind (see Chapter 2, Methods), and are especially evident for rare diseases or diseases for which a specific diagnostic test is lacking, together these data provide an informative overview of trends in the burden of vaccine preventable diseases in Australia over the past several years.

Table 5.1: Average annual morbidity and mortality from selected vaccine preventable diseases in Australia for 3 years within 2002–2005*

Disease
Notifications
2003–2005
(average number)
Notification
rate/100,000
(average rate)
Hospitalisations
2002/03–2004/05
(average number)
Hospitalisation
rate/100,000
(average rate)
Deaths
2003–2004
(average number)
Death
rate/100,000
(average rate)
0–4 yrs All ages 0–4 yrs All ages 0–4 yrs All ages 0–4 yrs All ages 0–4 yrs All ages 0–4 yrs All ages
Haemophilus influenzae type b§||
7.7
10.3§
0.6
0.3 §
11.7
13.0§
0.9
0.3§
0.0
0.0
Hepatitis A
31.3
358.3
2.5
1.8
9.0
251.7
0.7
1.3
0.0
0.0
Hepatitis B
2.0
291.3
0.2
1.5
0.0
172.3
0.9
0.0
11.0
0.06
Influenza
1,057.7
3,395.0
83.7
16.9
1,038.7
3,038.7
82.1
15.3
2.5
50.5
0.20
0.25
Measles
7.7
49.3
0.6
0.3
12.3
31.3
1.0
0.2
0.0
0.0
Meningococcal disease
142.3
451.7
11.3
2.3
219.0
711.7
17.3
3.6
6.0
23.0
0.48
0.12
Mumps
8.0
139.7
0.6
0.7
3.7
46.0
0.3
0.2
0.0
0.5
<0.005
Pertussis
562.7
8,345.0
44.5
41.5
254.7
439.7
20.1
2.2
0.5
1.0
0.04
<0.005
Pneumococcal (invasive)**
570.7
2,101.0
45.2
10.5
277.0
1,038.3
21.9
5.2
5.5
19.0
0.44
0.10
Poliomyelitis††
0.0
0.0
0.3
1.7
<0.05
<0.05
0.0
0.0
Rubella
4.0
38.7
0.3
0.2
7.0
14.7
0.6
0.1
0.0
0.0
Tetanus
0.0
3.7
<0.05
0.0
22.0
0.1
0.0
0.0
Varicella
NN
NN
NN
NN
532.3
1,427.0
42.1
7.2
1.5
5.5
0.12
0.03
Zoster
NN
NN
NN
NN
36.0
4,975.0
2.8
25.0
0.0
19.0
0.10

* Notification data, National Notifiable Diseases Surveillance System, January 2003–December 2005; hospitalisation data, Australian Institute of Health and Welfare (AIHW) National Hospital Morbidity Database, July 2002–June 2005; death data, AIHW National Mortality Database, January 2003–December 2004.

† See Chapter 4 for case definitions for individual vaccine preventable disease.

‡ Includes only deaths with disease classified as the underlying cause of death.

§ Data for Haemophilus influenzae disease include only cases aged 0–14 years.

|| Invasive Haemophilus influenzae type b disease for notifications. For hospitalisations and deaths, only includes Haemophilus meningitis cases.

¶ Includes only acute hepatitis B notifications, hospitalisations and deaths. Principal diagnosis only for hospitalisations.

** Includes pneumococcal meningitis and septicaemia only for hospitalisation and death data.

†† Principal diagnosis only for hospitalisations.

NN Not notifiable

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Table 5.2: Average annual morbidity and mortality from selected vaccine preventable diseases in Australia for 2 years within 2005–2007

Disease
Notifications
2006–2007
(average number)
Notification
rate/100,000
(average rate)
Hospitalisations
2005/06–2006/07
(average number)
Hospitalisation
rate/100,000
(average rate)
Deaths
2005–2006
(average number)
Death
rate/100,000
(average rate)
0–4 yrs All ages 0–4 yrs All ages 0–4 yrs All ages 0–4 yrs All ages 0–4 yrs All ages 0–4 yrs All ages
Haemophilus influenzae type b§,||
10.5
12.5§
0.8
0.3§
7.5
7.5§
0.6
0.2§
0.0
0.0
Hepatitis A
19.0
222.5
1.4
1.1
6.0
204.0
0.5
1.0
0.0
1.5
0.01
Hepatitis B
2.5
290.0
0.2
1.4
0.0
157.5
0.8
0.0
19.5
0.09
Influenza
1,452.0
6,827.5
110.0
32.7
620.5
2,222.0
47.8
10.8
2.5
27.5
0.19
0.13
Measles
16.5
68.5
1.3
0.3
8.0
28.0
0.6
0.1
0.0
0.0
Meningococcal disease
111.0
311.0
8.4
1.5
190.5
512.0
14.7
2.5
7.5
16.0
0.58
0.08
Mumps
9.5
428.5
0.7
2.1
4.5
53.5
0.4
0.3
0.0
0.5
<0.005
Pertussis
298.0
8,160.5
22.6
39.1
170.0
441.0
13.1
2.1
0.5
1.5
0.04
0.01
Pneumococcal (invasive)**
221.5
1,468.5
16.8
7.0
92.0
711.5
7.1
3.5
2.5
10.5
0.19
0.05
Poliomyelitis††
0.0
0.5
<0.05
0.0
0.5
<0.05
0.0
0.0
Rubella
4.0
47.0
0.3
0.2
4.5
9.0
0.4
<0.05
0.0
0.0
Tetanus
0.0
3.0
<0.05
0.0
18.0
0.1
0.0
0.5
<0.005
Varicella
NA
NA
NA
NA
452.5
1,393.5
34.9
6.8
0.5
5.0
0.04
0.02
Zoster
NA
NA
NA
NA
28.0
5,253.0
2.2
25.6
0.0
17.0
0.08

* Notification data, National Notifiable Diseases Surveillance System, January 2006–December 2007; hospitalisation data, Australian Institute of Health and Welfare (AIHW) National Hospital Morbidity Database, July 2005–June 2007; death data, AIHW National Mortality Database, January 2005–December 2006.

† See Chapter 3 for case definitions for individual vaccine preventable disease.

‡ Includes only deaths with disease classified as the underlying cause of death.

§ Data for Haemophilus influenzae disease include only cases aged 0–14 years.

|| Invasive Haemophilus influenzae type b disease for notifications. For hospitalisations and deaths, only includes Haemophilus meningitis.

¶ Includes only acute hepatitis B notifications, hospitalisations and deaths. Principal diagnosis only for hospitalisations.

** Includes pneumococcal meningitis and septicaemia only for hospitalisation and death data.

†† Principal diagnosis only for hospitalisations.

NA National notification data not available

In children <5 years of age (the main target of the current childhood program), ongoing reductions in relative disease burden continued over the 2-year period under review. Hospitalisations due to measles and rubella have continued to decrease. There were substantial decreases in notifications and hospitalisations for meningococcal disease and pneumococcal disease in this age group in particular, but also in other age groups to a lesser extent. There was also a significant decline in hospitalisation rates for varicella disease in young children, although the vaccination program was only implemented in late 2005. Although both notification and hospitalisation rates for pertussis remain high overall, both decreased in this review period in children aged <5 years and particularly in adolescents, for whom a new immunisation program was introduced in 2004. Hospitalisation due to pertussis continues to be a significant burden in infants too young to be fully immunised. The notification and hospitalisation rates of mumps remained similar to the previous review period for children aged <5 years, but increased in young adults, attributable to an extended outbreak.

With respect to hospitalisations, influenza, varicella, meningococcal disease, pertussis and pneumococcal disease accounted for the largest numbers in those aged <5 years, and influenza and varicella outside this age group. The vaccine preventable diseases most frequently recorded as the underlying cause of death were influenza in adults and meningococcal disease in children aged <5 years.

The implications of these data are discussed below.

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