Vaccine preventable diseases and vaccination coverage in Aboriginal and Torres Strait Islander people, Australia 2006–2010

3.3 Vaccination coverage estimates from the Australian Childhood Immunisation Register for Aboriginal and Torres Strait Islander versus other children

Page last updated: 19 December 2013

‘Fully vaccinated’ coverage using the ‘old’ (1996 – June 2013) inclusion criteria

‘Fully vaccinated’ coverage estimates for Australian children born in 2009 (assessed at 12 months of age), 2008 (assessed at 24 months of age) and 2005 (assessed at 60 months of age), using the inclusion criteria which applied from 1996 to June 2013, are presented in Table 3.3.1. ‘Fully vaccinated’ coverage estimates by cohort, Indigenous status and jurisdiction are presented in Appendix E.

Table 3.3.1: Percentage of Australian children immunised, by vaccine type and Indigenous status
Age Vaccine Indigenous (%) Other
(%)

* ‘Fully vaccinated’ definition from 1996 to June 2013: at 12 months of age – defined as receipt of 3 doses of diphtheria, tetanus, pertussis, Hib, hepatitis B and polio, but did not include rotavirus and pneumococcal vaccines, which are also due at the same schedule points; at 24 months of age – included 3 or 4 doses of Hib and hepatitis B, and 1 dose of measles, mumps, rubella, but did not include meningococcal C or varicella vaccines; at 5 years (60 months) – included a fourth dose of diphtheria, tetanus, pertussis, polio and a second dose of measles, mumps and rubella.

† ‘Fully vaccinated’ definition from July 2013: pneumococcal vaccine added at 12 months, varicella and meningococcal vaccines added at 24 months, unchanged at 60 months.

Source: ACIR, data as at June 2011.

Coverage at 12 months of age
(born January – December 2009)
DTP 3 doses
85.7
92.6
Polio 3 doses
85.7
92.6
Hib (2 or 3 doses)
85.7
92.4
Hep B (2 or 3 doses)
85.6
92.1
7vPCV 3 doses
85.3
91.7
Rotavirus (3-dose states)
66.4
83.4
Rotavirus (2-dose states)
77.4
86.5
'Fully vaccinated'*
85.5
91.9
'Fully vaccinated' (including 7vPCV)
85.0
90.0
'Fully vaccinated' (including 7vPCV) + rotavirus
69.9
83.7
Coverage at 24 months of age
(born January – December 2008)
DTP 3 doses
94.1
94.7
Polio 3 doses
94.0
94.6
Hib (2 or 3 doses)
94.0
94.4
Hep B (2 or 3 doses)
94.0
93.9
MMR first dose
94.4
93.8
MenC 1 dose
93.9
93.3
Varicella 1 dose
82.3
82.9
'Fully vaccinated'*
91.3
92.0
'Fully vaccinated' (including varicella and MenC)
79.4
81.1
Coverage at 60 months
(born January – December 2005)
MMR 2 doses
86.1
89.6
DTP-polio
85.0
88.8
'Fully vaccinated'*
85.3
89.2

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At 12 months of age, the proportion of Aboriginal and Torres Strait Islander children who were recorded as ‘fully vaccinated’ was 85.5%, compared with 91.9% for all other children. Coverage was lower in Aboriginal and Torres Strait Islander children than in other children in all jurisdictions, with the difference ranging from 4 to 13 percentage points.

At 24 months of age, ‘fully vaccinated’ coverage estimates in Aboriginal and Torres Strait Islander children were similar to those in other children – 91.3% and 92.0%, respectively. This was the case in most jurisdictions; however, in Western Australia and South Australia coverage was lower in Aboriginal and Torres Strait Islander children than in other children by 4 and 3 percentage points, respectively. In the Australian Capital Territory, 24-month coverage was 5 percentage points higher in Aboriginal and Torres Strait Islander children than in other children.

At 60 months of age, ‘fully vaccinated’ coverage was 4 percentage points lower in Aboriginal and Torres Strait Islander children (85.3%) than in other children (89.2%). Coverage at 60 months of age was between 2 and 8 percentage points lower in Aboriginal and Torres Strait Islander children than in other children in all jurisdictions, except the Northern Territory, where it was 5 percentage points higher among Aboriginal and Torres Strait Islander children (89.2%).

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‘Fully vaccinated’ coverage using the ‘new’ extended inclusion criteria (from July 2013)

Vaccination coverage estimates using the new ‘fully vaccinated’ criteria are presented in Table 3.3.1. Coverage estimates by cohort, Indigenous status and jurisdiction are presented in Appendix E.

‘Fully vaccinated’ coverage estimates at 12 months of age using the new criteria (including 3 doses of PCV) are little different to those using the old criteria – 0.5 percentage points lower for Aboriginal and Torres Strait Islander children and 1.9 percentage points lower for other children. However, if rotavirus vaccine was also to be included, coverage would be substantially lower: 16 percentage points lower for Aboriginal and Torres Strait Islander children, and 8 percentage points lower for other children. This discrepancy is accounted for by the significantly lower coverage achieved for rotavirus vaccine, particularly in jurisdictions with a 3-dose schedule for rotavirus vaccination, and more so in Aboriginal and Torres Strait Islander children. Therefore, the inclusion of rotavirus and pneumococcal vaccines in the ‘fully vaccinated’ definition at 12 months of age results in a wider disparity (24 percentage points) between Aboriginal and Torres Strait Islander and other children.

At 24 months of age, the ‘fully vaccinated’ estimates using the new criteria (including varicella and meningococcal C vaccines) are substantially lower than estimates excluding these vaccines. This is mainly due to the lower coverage for varicella vaccine. However, the difference is similar in scale in both Aboriginal and Torres Strait Islander and other children, resulting in little change in the disparity between the two groups.

Between 2005 and 2010, 12-month and 24-month vaccine coverage in Aboriginal and Torres Strait Islander children has remained stable (Figure 3.3.1).

Figure 3.3.1: Trend in 12-, 24- and 60-month ‘fully vaccinated’ coverage in Aboriginal and Torres Strait Islander and other children, 2005 to 2010, by 3-month birth cohorts

Figure 3.3.1: is a line chart showing the Trend in 12-, 24- and 60-month fully vaccinated coverage in Aboriginal and Torres Strait Islander and other children. A link to a text description follows.

Source: ACIR, data as at coverage assessment date.

Text description of Figure 3.3.1 (TXT 1 KB)

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Individual vaccines or antigens

Australian vaccination coverage estimates for specific vaccines are presented in Table 3.3.1. Tables of vaccine-specific coverage estimates by cohort, Indigenous status and jurisdiction are presented in Appendix E. The comparison of coverage estimates between Aboriginal and Torres Strait Islander children and other children for specific vaccines is consistent with the comparisons of ‘fully vaccinated’ coverage. However, rotavirus coverage is substantially lower in Aboriginal and Torres Strait Islander children than in other children, by 11 percentage points in jurisdictions with the 2-dose schedule and by 17 percentage points in jurisdictions with the 3-dose schedule (Table 3.3.1).

Hepatitis A vaccine is recommended for all Aboriginal and Torres Strait Islander children in the Northern Territory, Queensland, South Australia and Western Australia. The 2 doses are scheduled at 12 and 18 months of age in the Northern Territory and Western Australia, and at 18 and 24 months of age in Queensland and South Australia. Vaccination coverage for both dose 1 and dose 2 of hepatitis A vaccine is presented in Figure 3.3.2. Coverage for hepatitis A vaccine remains substantially lower than the coverage achieved for universally recommended vaccines. However, hepatitis A coverage has increased dramatically since the previous reporting period in which combined coverage for children born in April to June 2004 was reported to be 29%.13

Figure 3.3.2: Percentage of Aboriginal and Torres Strait Islander children born in 2008 who had received 1 or 2 doses of Hepatitis A vaccine within 6 months of the relevant schedule point

Figure 3.3.2: is a bar chart showing the Percentage of Aboriginal and Torres Strait Islander children born in 2008 who had received 1 or 2 doses of Hepatitis A vaccine within 6 months of the relevant schedule point. A link to a text description follows.

NT: Northern Territory; Qld: Queensland; SA: South Australia; WA: Western Australia

Source: ACIR, data as at June 2011.

Text description of Figure 3.3.2 (TXT 1 KB)

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The 23vPPV was recommended for Aboriginal and Torres Strait Islander children in the Northern Territory, Queensland, South Australia and Western Australia, as a booster dose following the routine course of primary vaccination with 7vPCV. This dose was scheduled at 18 months of age in the Northern Territory and Western Australia, and at 24 months of age in Queensland and South Australia. All children in the Northern Territory received the 10-valent pneumococcal conjugate vaccine (10vPCV) instead of the 7vPCV from October 2009 to September 2011, and a fourth dose of 10vPCV at 18 months of age replaced the 23vPPV.122 Pneumococcal booster coverage is presented in Figure 3.3.3. Similar to hepatitis A coverage, pneumococcal booster coverage is substantially lower than coverage for universally recommended vaccines. Coverage across all the four jurisdictions has increased since the previous reporting period (44%, for 2003–2004 birth cohorts), and increases from 2007 to 2008 occurred in Queensland, the Northern Territory and overall (four jurisdictions combined).

Figure 3.3.3: Percentage of Aboriginal and Torres Strait Islander children who had received a pneumococcal booster dose* within 6 months of the relevant schedule point, 2007 and 2008, by year of birth

Figure 3.3.3: is a bar chart showing the Percentage of Aboriginal and Torres Strait Islander children who had received a pneumococcal booster dose within 6 months of the relevant schedule point. A link to a text description follows.

* 23vPPV or 10v/13vPCV

NT: Northern Territory; Qld: Queensland; SA: South Australia; WA: Western Australia

Source: ACIR, data as at June 2011.

Text description of Figure 3.3.3 (TXT 1 KB)

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Geographic variations of vaccination coverage

‘Fully vaccinated’ coverage at 12 months of age is presented by Statistical Division in Figure 3.3.4. This figure should be interpreted with caution as the number of Aboriginal and Torres Strait Islander children within some Statistical Divisions is small. Despite this, the map demonstrates the significant variation in vaccination coverage within jurisdictions, in particular lower coverage in the remote regions of South Australia and Western Australia, and generally higher coverage in areas in the north and south-east of the country.

Figure 3.3.4: ‘Fully vaccinated’ coverage at 12 months of age in Aboriginal and Torres Strait Islander children born in 2009, Australia, by Statistical Division

Figure 3.3.4: is a map showing fully vaccinated coverage at 12 months of age in Aboriginal and Torres Strait Islander children born in 2009. A link to a text description follows.

Source: ACIR, data as at September 2011

Text description of Figure 3.3.4 (TXT 1 KB)

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Timeliness of vaccination

Delays in receipt of the second dose of the DTPa vaccine, the second dose of 7vPCV, and the first dose of MMR are used here as indicators for assessing timeliness of vaccination.

Timeliness of the second dose of DTPa vaccine is presented in Figure 3.3.5. Among Aboriginal and Torres Strait Islander children, 74.0% of the cohort born in 2009 received age-appropriate vaccination (before 7 months of age), compared with 90.4% of other children. In addition, substantially larger proportions of Aboriginal and Torres Strait Islander children were vaccinated 3 or more months after the schedule point (7.1% vs 1.6% of other children). However, the overall proportion of children within the cohort who eventually received the second dose of DTPa by 18 months of age was similar in Aboriginal and Torres Strait Islander children and other children (92.4% and 94.0%, respectively).

Figure 3.3.5: Timeliness of the second dose of DTPa vaccine, children born in 2009, by Indigenous status

Figure 3.3.5: is a bar chart showing Timeliness of the second dose of DTPa vaccine, children born in 2009, by Indigenous status. A link to a text description follows.

Source: ACIR, data as at June 2011.

Text description of Figure 3.3.5 (TXT 1 KB)

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Timeliness of the second dose of DTPa among Aboriginal and Torres Strait Islander children varied by jurisdiction (Figure 3.3.6). Jurisdictions achieved coverage between 88.0% and 96.2% for receipt of the second dose of DTPa by 18 months of age. However, timeliness varied between jurisdictions, with 63.6% to 85.1% of Aboriginal and Torres Strait Islander children born in 2009 receiving age-appropriate vaccination.

Figure 3.3.6: Timeliness of the second dose of DTPa vaccine, Aboriginal and Torres Strait Islander children born in 2009, by jurisdiction

Figure 3.3.6: is a bar chart showing Timeliness of the second dose of DTPa vaccine, Aboriginal and Torres Strait Islander children born in 2009, by jurisdiction. A link to a text description follows.

ACT: Australian Capital Territory; NSW: New South Wales; NT: Northern Territory; Qld: Queensland; SA: South Australia; Tas: Tasmania; Vic: Victoria; WA: Western Australia

Source: ACIR, data as at June 2011.

Text description of Figure 3.3.6 (TXT 1 KB)

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Trends over time in timeliness of the first dose of MMR vaccine are presented in Figure 3.3.7. There has been an improvement in vaccination timeliness for the first dose of MMR vaccine between 2004 and 2008 in both Aboriginal and Torres Strait Islander and other children. Despite the improvement over time, the proportion of Aboriginal and Torres Strait Islander children with delayed vaccination remains higher than in other children.

Figure 3.3.7: Timeliness of the first dose of MMR vaccine, by Indigenous status and year of birth, 2004 to 2008

Figure 3.3.7: is a bar chart showing Timeliness of the second dose of MMR vaccine, by Indigenous status and year of birth, 2004 to 2008. A link to a text description follows.

Source: ACIR, data as at June 2011.

Text description of Figure 3.3.7 (TXT 1 KB)

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Table 3.3.2 shows vaccination delay by remoteness. It shows that poorer timeliness for Aboriginal and Torres Strait Islander children is consistent across both remote and accessible regions, and there is relatively little difference by remoteness classification.

Table 3.3.2: Vaccination delay in children born in 2008, Australia, by Indigenous status and remoteness status
Vaccine dose Indigenous status Remoteness 1–6 months after schedule point (%) >6 months after schedule point (%)

* Areas classified as ‘Highly accessible’, ‘Accessible’ or ‘Moderately accessible’ by the Accessibility/Remoteness Index of Australia.

† Areas classified as ‘Remote’ or ‘Very remote’ by the Accessibility/Remoteness Index of Australia.

DTP second dose
Indigenous
Accessible*
21.0
3.5
Remote
27.0
3.0
Other
Accessible
8.7
0.8
Remote
8.9
0.6
MMR first dose
Indigenous
Accessible
33.2
5.6
Remote
32.9
4.4
Other
Accessible
25.1
2.1
Remote
24.0
1.9

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Uptake of first dose of pertussis-containing vaccine before 2 months of age, by jurisdiction

In March 2009, the Australian Technical Advisory Group on Immunisation recommended that the first dose of DTPa vaccine be given at 6 weeks instead of the usual 2 months (8.5 weeks) of age. This was to provide protection to infants as early as possible during a pertussis epidemic. This change was promoted by some jurisdictions more than others, partly depending on the severity of their respective pertussis epidemics at the time. Among the cohort of Australian children born in 2010, there was evidence of the implementation of the earlier first dose of DTPa vaccine in New South Wales and Tasmania (Figure 3.3.8). In these two states, the proportion of age-appropriately vaccinated children who received a first dose of DTPa between 42 and 60 days of age was greater than 70% for both Aboriginal and Torres Strait Islander and other children. In all other jurisdictions, the majority of age-appropriately vaccinated children received their first dose of DTPa after 60 days of age. The proportion of children vaccinated at 42–60 days tended to be slightly higher in non-Indigenous children than in Aboriginal and Torres Strait Islander children, but in general, where this policy was implemented, it was implemented for both Indigenous and non-Indigenous children.

Figure 3.3.8: Proportion of on-time vaccinated infants born October–December 2009 who received the first dose of pertussis-containing vaccine at 6–8.5 weeks versus 2–<3 months, by jurisdiction

Figure 3.3.8: is a bar chart showing the Proportion of on-time vaccinated infants born October-December 2009 who received the first dose of pertussis-containing vaccine. A link to a text description follows.

ACT: Australian Capital Territory; NSW: New South Wales; NT: Northern Territory; Qld: Queensland; SA: South Australia; Tas: Tasmania; Vic: Victoria; WA: Western Australia

Source: ACIR, data as at June 2011.

Text description of Figure 3.3.8 (TXT 1 KB)

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Vaccine refusal

Among all Australian children born between 2004 and 2008, 1.6% were recorded as vaccine refusers. The proportion of Aboriginal and Torres Strait Islander children who were recorded as vaccine refusers was less than one-quarter of that in other children (0.37% vs 1.65%). The difference in proportions was statistically significant (P<0.0001).