Aboriginal and Torres Strait Islander Health Performance Framework (HPF) 2012

Tier 3—Effective/appropriate/efficient—3.02 Immunisation

The HPF was designed to measure the impact of the National Strategic Framework for Aboriginal and Torres Strait Islander Health (NSFATSIH) and will be an important tool for developing the new National Aboriginal and Torres Strait Islander Health Plan (NATSIHP).

Page last updated: 15 November 2012

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 vaccines for 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), rotavirus, human papillomavirus (HPV) and influenza. 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 have been effective in reducing the disease disparities between Indigenous and non-Indigenous populations, despite differences in the socioeconomic circumstances of these populations (Menzies et al. 2009).

There are variations in Indigenous identification in the immunisation records and Medicare enrolments used in the denominator. These can affect the accuracy of immunisation data.

Findings:

In December 2011, vaccination coverage for Aboriginal and Torres Strait Islander children at one year of age was around seven percentage points lower than other Australian children (85% compared with 92%). This is partly due to delayed vaccination for many Aboriginal and Torres Strait Islander children. By two years of age, the difference was less than one percentage point (92.3% of Indigenous children compared with 92.6% for other children). At five years of age, the gap was around three percentage points (87% of Indigenous children were fully vaccinated compared with 90% of other children). Coverage rates for Indigenous children aged one year were highest in Tasmania and lowest in SA. For Indigenous children aged five years, coverage rates were highest in the NT and lowest in SA and WA.

Since 2001, there have been changes in the definitions used to determine whether a child is considered to be fully immunised. Additionally, the age at which older children are assessed has changed from six years to five years of age. As a result, some trends should be interpreted with caution. Between 2001 and 2011 there has been no change detected in the proportion of Aboriginal and Torres Strait Islander children who were fully immunised at one and two years of age. Over the same period, there has been a significant increase detected for other children. There was an increase in the proportion of Aboriginal and Torres Strait Islander children aged six years who were fully immunised from 83% in 2002 to 85% in 2007. This trend for older children appears to be continuing, with an increase between 2008 and 2011 in children aged five years (76% to 87%).

In 2004–05, an estimated 60% of Aboriginal and Torres Strait Islander peoples aged 50 years and over reported they had been vaccinated against influenza in the last 12 months, an increase from 51% in 2001. Coverage in the target group for non-Indigenous Australians aged 65 years and over was 73% in 2004–05. In addition, 34% of Indigenous people aged 50 years and over had been vaccinated against invasive pneumococcal disease in the last five years, an increase from 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 had been vaccinated against influenza in the last 12 months and invasive pneumococcal disease in the last five 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 peoples who have various risk factors, such as chronic medical conditions. Twenty three per cent of Indigenous adults aged 18–49 years had been vaccinated for influenza 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 received a pneumococcal vaccination in the previous five years. Those with at least one risk factor had only marginally higher rates (13%) (Menzies et al. 2008).

During the period July 2007 to June 2009 approximately 10,000 valid Child Health Checks were undertaken in the prescribed areas of the NT. Overall, 29% of children received a vaccination during their health check.

Hospitalisation rates among Indigenous Australians for vaccine-preventable diseases have decreased significantly since 1998–99 in Qld, WA, SA and the NT, although there has been no significant change since 2004–05 in NSW, Victoria, Qld, WA, SA and the NT (see measure 3.07).Top of Page

Implications:

Achieving good immunisation coverage is primarily a reflection of the strength and effectiveness of primary health care. Immunisation coverage for Aboriginal and Torres Strait Islander children is high. There are still gaps in coverage at age one and five years, however, Indigenous two year olds had similar coverage to non-Indigenous two year olds.

The National Immunisation Program (NIP) 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. The NIP also provides free influenza vaccines for all Aboriginal and Torres Strait Islander people aged over 15 and free pneumococcal vaccines for those aged over 50 years and those medically at risk in the 15–49 age group. Coverage for adult vaccination for influenza and invasive pneumococcal disease has increased, but further opportunities to improve coverage exist. The identification of Indigenous patients is one important step. From 1 October 2012, funding has been allocated to provide Aboriginal and Torres Strait Islander children aged between 12 and 18 months in Qld, the NT, WA and SA an additional booster dose of the pneumococcal vaccine Prevenar 13. The HPV vaccination program is listed on the NIP Schedule and funded under the Immunise Australia Program. There is currently an ongoing school-based program routinely delivered to girls in the first year of secondary school.

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 the period 1 April 2011 to 31 March 2012, all jurisdictions met these targets. In addition, the National Partnership Agreement on Indigenous Early Childhood Development includes a focus on improving immunisation rates.Top of Page
Figure 148—Proportion of children fully vaccinated at age one year, two years and six/five years, NSW, Victoria, SA, WA and the NT combined, by Indigenous status, 2001 to 2011
Age one year
Figure 148—Proportion of children fully vaccinated at age 1 year, 2 years and 6/5 years, NSW, Victoria, SA, WA and the NT combined, by Indigenous status, 2001 to 2011 - Age one year
Age two yearsTop of Page
Figure 148—Proportion of children fully vaccinated at age 1 year, 2 years and 6/5 years, NSW, Victoria, SA, WA and the NT combined, by Indigenous status, 2001 to 2011—Age two years
Age six years 2001–07, age five years 2008–11Top of Page
Figure 148—Proportion of children fully vaccinated at age 1 year, 2 years and 6/5 years, NSW, Victoria, SA, WA and the NT combined, by Indigenous status, 2001 to 2011—Age six years 2001–07, age five years 2008–11
Source: AIHW analysis of Australian Childhood Immunisation Register, Medicare Australia
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Table 38—Proportion of children fully vaccinated at age one year, two years and five years of age, by Indigenous status and state/territory, at 31 December 2011
State/ Territory
Indigenous Age One Year
Other Age One Year
Indigenous Age Two Years
Other Age Two Years
Indigenous Age Five Years
Other Age Five Years
NSW
87.2
91.8
92.9
92.6
84.9
89.8
Vic.
84.2
93
94.2
93.1
89.5
91.6
Qld
85.8
92
93
92.5
89.6
90.4
WA
81.6
91.1
88
91
80.1
87.2
SA
77
92.3
86.2
92.9
89.6
88.4
Tas.
93.2
92.8
93.1
93.4
90.2
91.2
NT
83.8
90
96.3
93.4
90.7
85.4
Australia*
85.2
93.5
92.3
92.6
86.5
90.1
*Australia total includes ACT. Data not provided seperately due to small numbers.
Source: AIHW analysis of Australian Childhood Immunisation Register, Medicare Australia
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Figure 149—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
Had vaccination for influenza in last 12 months:
Figure 149—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—Had vaccination for influenza in last 12 months
Had vaccination for invasive pneumococcal disease in last five years:Top of Page
Figure 149—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—Had vaccination for invasive pneumococcal disease in last 5 years
Source: ABS and AIHW analysis of 2004–05 NATSIHS, and 2004–05 NHS
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