Aboriginal and Torres Strait Islander Health Performance Framework - 2010
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 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) and rotavirus. The National Immunisation Program Schedule provides free childhood vaccines for Australian children aged 0–7 years. Aboriginal and Torres Strait Islander children living in some states and territories also have access to a hepatitis A vaccine. 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 are effective in reducing the disease disparities between Indigenous and non-Indigenous populations, despite socioeconomic circumstances (Menzies & Singleton 2009). Vaccination rates are estimated from data recorded in the Australian Immunisation Register (ACIR). A study in 2001 found the ACIR underestimated overall Australian immunisation coverage by 2.7% at 1 year of age, and 5% at 24 months (Hull et al. 2002). Variations in Indigenous identification in the immunisation records and Medicare enrolments used in the denominator affect data accuracy.
The National Indigenous Pneumococcal and Influenza Immunisation Program provides free pneumococcal and influenza vaccines for all Indigenous people aged over 50 years and those medically at risk in the 15–49 years age group. For the general population, free vaccinations are available for people aged 65 years and older. Influenza and its consequences, together with pneumonia, account for many deaths in the elderly population and place significant burden on the health system. Vaccination has been demonstrated to reduce deaths (Nichol et al. 1994; Gross et al. 1995).
Findings:In December 2009, vaccination coverage for Aboriginal and Torres Strait Islander children at 1 year of age was around 8 percentage points lower than for other children (84% compared with 92%). Some of this is due to delayed vaccination in Aboriginal and Torres Strait Islander children. By 2 years of age, the difference is around 4 percentage points (87% of Indigenous children compared with 91% for other children). At 5 years of age, the gap narrows to around 5 percentage points (78% of Indigenous children were fully vaccinated compared with 83% of other children). Coverage rates for children aged 1 year are highest in Tas, NSW and Qld. For children aged 5 years, coverage rates are highest in the NT, Tas and Vic.
Since 2001 there have been some changes in the definitions used to determine whether a child is considered to be fully immunised. In addition, the measure used for assessing older children has switched from 6 years to 5 years of age. As a result some trends should be interpreted cautiously. Between 2001 and 2009 there has been no significant change in the proportion of Aboriginal and Torres Strait Islander and other children who were fully immunised at 1 year of age. There was a non-significant increase in Indigenous children fully immunised at 2 years of age between 2001 and 2006 but since then rates have declined for this age cohort. There was a significant increase for children aged 6 years from 83% in 2002 to 85% in 2007. This trend for older children appears to be continuing with an increase between 2008 and 2009 in children aged 5 years who are fully immunised.
In 2004–05, an estimated 60% of Aboriginal and Torres Strait Islander people aged 50 years and over reported they had been vaccinated against influenza in the last 12 months, which is an increase from an estimated 51% for 2001. Coverage in the target group for non-Indigenous Australians aged 65 years and over was 73% in 2004-05. In the same year, approximately 34% of Indigenous people aged 50 years and over had been vaccinated against invasive pneumococcal disease in the last 5 years, an increase from an estimated 25% in 2001. Coverage in the target group for non-Indigenous Australians aged 65 years and over was 43% in 2004-05. A higher proportion of Indigenous people aged 50 years and over, living in remote areas have been vaccinated against influenza in the last 12 months and invasive pneumococcal disease in the last 5 years (80% and 56% respectively) than in non-remote areas (52% and 26% respectively). Adult vaccinations are also targeted at younger Aboriginal and Torres Strait Islander people who have various risk factors. Twenty-three per cent of Indigenous adults aged 18–49 years had an influenza vaccination in the previous year. This was higher for those with at least one risk factor (29%). Twelve per cent of Indigenous adults aged 18–49 years had a pneumococcal vaccination in the previous 5 years. Those with at least one risk factor had only marginally higher rates (13%) (Menzies et al. 2008).
Between July 2007 and June 2009 approximately 10,000 valid Child Health Checks were undertaken in the prescribed areas of the Northern Territory. Overall, 29% of children received a vaccination during their health check.
Indigenous hospitalisation rates for vaccine-preventable diseases have decreased steadily since 2001–02 (see measure 3.06).
Implications:Achieving good immunisation coverage is primarily a reflection of the strength and effectiveness of primary health care. Rates of coverage for Aboriginal and Torres Strait Islander children fall below the rest of the community for children aged 1 year in particular. The gap narrows by age 5, but rates are lower than those reported for other Australian children.
In Queensland the Jabba Jabba Indigenous Immunisation Program improved access to immunisation by providing an interface with mainstream health programs and enhanced understanding of the role of Indigenous Health Workers by hospital and community health services. Key factors for success included cultural awareness training, home visits and outreach services.
The benefits of improved coverage and new vaccines have been demonstrated for Hepatitis B, measles and pneumococcal disease (Menzies et al. 2008). Periodic epidemics of pertussis continue to be a problem, partly due to delayed vaccination in Indigenous infants and environmental living conditions (Kolos et al. 2007). Benefits are expected from the more recent introduction of vaccines for hepatitis A and chickenpox (Menzies et al. 2008). Coverage for adult vaccination for influenza and invasive pneumococcal disease has increased, but opportunities to improve coverage further exist. Around 30% of all Indigenous Australians who had never been vaccinated against influenza or invasive pneumococcal disease had visited a doctor in the last 2 weeks.
From 2009–10 the Australian Government has provided facilitation incentive payments to state and territory governments through the National Partnership Agreement on Essential Vaccines to encourage increases in vaccine coverage for Indigenous Australians. Jurisdictions receive reward payments if targets for Indigenous vaccine coverage are met. In addition, the Indigenous Early Childhood Development National Partnership Agreement, includes a focus on improving immunisation rates.
Figure 140 – Proportion of children fully vaccinated at age 1 year, 2 years and 6 years, NSW, Vic., SA, WA and NT combined, by Indigenous status, 2001 to 2009
Source: AIHW analysis of Australian Childhood Immunisation Register, Medicare Australia
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Table 58 – Proportion of children fully vaccinated at 1 year, 2 years and five years of age, by Indigenous status and state/territory, as at 31 December 2009
Age One Year
Age Two Years
Age Five Years
Figure 141 – Proportion of Aboriginal & Torres Strait Islander persons aged 50 years and over and non-Indigenous persons aged 65 years and over: immunisation status 2004–05
Source: ABS and AIHW analysis of 2004–05 National Aboriginal and Torres Strait Islander Health Survey, and 2004–05 National Health Survey
Text description of figure 141 (TXT 1KB)