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THE greatest gains in preventing vaccine-preventable illness will be made by increasing vaccination rates among adult Australians, says the lead author of an article published in the MJA calling for an increased focus on immunising adults.
Dr Robert Menzies, senior lecturer at the University of NSW’s School of Public Health and Community Medicine, told MJA InSight that the childhood program had been very successful, with more than 90% of children having received all recommended vaccines by age milestones of 12, 24 and 60 months.
“We have been served very well by the Australian Childhood Immunisation Register, and further gains to be made in that area – in terms of reductions in serious morbidity – are now small. We have very few children or adolescents who die from vaccine-preventable diseases, but in adults the numbers are in the thousands,” he said.
In the MJA Perspective, the authors called for an increased focus on undervaccination among adults.
They wrote that in recent years, increasing attention had been focused on parents who had ideological objections to vaccinating their children. However, they said, these cases were a “small subset” of the authors’ estimated 4.1 million Australians who are undervaccinated.
There are about 3.5 million Australians aged 65 years and over who are eligible for annual influenza vaccine and 23-valent pneumococcal polysaccharide vaccine under the National Immunisation Program, they wrote.
“Only 51% of this population had received both vaccines when last measured [in 2009], reflecting a large gap between funded infant and adult vaccine programs,” the authors wrote.
Influenza was estimated by the authors to be responsible for 300 000 GP consultations, 18 000 hospital admissions and 3000 deaths in Australia annually. There were also 360 cases of invasive pneumococcal disease, including at least 45 deaths, caused by serotypes included in the pneumococcal vaccine in people aged 65 years and older, they wrote.
Dr Menzies, lead author on the MJA article, said that increasing these vaccination rates could play a key role in reducing the mortality and morbidity associated with influenza, pneumococcal disease and shingles. The herpes zoster vaccine was added to the National Immunisation Program schedule in November 2016, and is provided to people at age 70 years, with a free single catch-up dose provided to those aged 71–79 years until 2021.
He said that there were good reasons to have concentrated on childhood vaccination rates.
“[Achievements] such as measles and rubella elimination can only happen if we target children and then immunity is long-lasting, but with the adult vaccines – influenza in particular – we don’t have long-lasting immunity, it’s an annual process,” he said, adding that this hindered efforts to achieve widespread coverage among older and at-risk adults.
“Vaccinating all of the elderly and all of the younger adults with medical risk factors each year is a huge logistical task.”
Dr Menzies said that last year’s expansion of the Australian Childhood Immunisation Register – now the Australian Immunisation Register – to collect whole-of-life data, would provide much-needed data on vaccination coverage rates among adults, allowing vaccination targets to be set and monitored.
“We have had the childhood register over many years; coverage data is released every quarter, and [targets] are included in state and territory performance indicators,” he said. “The data keep pressure on people whose job it is to keep those rates high, and we need the same for adults.”
Dr Frank Beard, a public health physician at the National Centre for Immunisation Research and Surveillance, agreed that the expansion of the registry had potential to drive increased vaccination rates among adults.
“With the extension to a whole-of-life register from last year, we will be able to capture vaccines at all ages,” he said. “That should be of great potential benefit in raising awareness, and monitoring and improving coverage rates in adults.”
Dr Beard welcomed the call for increased attention on vaccination rates among adults.
“Not to detract from the importance of childhood vaccination, but for many years now, adult vaccination has tended to not get as much attention as it warrants from a public health point of view,” he said.
Dr Menzies said that it was time for a public discussion about the role of vaccines in preventing disease in adults.
“It will remind people what’s at stake, which is serious illness, hospitalisation or perhaps death,” he said. “Some of the common myths about the influenza vaccine – such as ‘it gives you the flu’ – also need to be exposed more frequently because there are still commonly held misconceptions when people are surveyed.”
The MJA authors said that the most important factor influencing vaccination uptake in adults was a recommendation from a health professional. They added that several measures had been shown to effectively boost coverage rates, including reminders for patients and providers, educational interventions and incentives.
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“Australian Physician” what is your point, sure you can decline treatment but no point putting in a comment other than to make ridiculous comments about vaccinations. How many times does it have to be stated a one off statement is not bullying this involves repeated unwanted behaviour – not much of a physician!
For other readers who are interested in what brings commenters with anti-vax views here, it is instructive to read this comment, posted on a public Facebook page of one of the Australian anti-vaccination organisations:
“I commented on the article and i suggest you always do the same.This way anyone who reads any article on vaccines is always hit with a bombardment of anti vax information.People make up there mind not by the information in the article but by the comments at the bottom.So always post on the article itself not facebook when possible.”
Paradoxically, however, a series of anonymous posts by anti-vaxers on a site read mainly by medical practitioners does not evoke a positive response to “a bombardment of anti-vax information.”
Not all people posting against vaccination are concerned parents with genuine inquiries – many are part of an organised movement that does seek to “bombard” any articles about vaccine with misinformation. It is useful for other clinicians to be aware of this phenomenon – genuinely concerned parents can be misled by this bombardment of misinformation.
There is no point trying to reason with the loopy paranoia of anti-vaxxers. The only logical approach is to counter their influence with evidence-based medicine.
Childhood vaccination is justified on the basis of: 1. doing what is in the best interests of a child 2. part of the social compact that is a requisite of the modern welfare state, where we will pick up the tab for some of your healthcare costs if you agree to a few broad brush-stroke and well-evidence supported measures e.g. childhood vaccination, water fluoridation, seat-belts etc..
This latter is not absolute, however, and whereas we act for children because they cannot consent, adults are at liberty to make choices, which may include not having flu or zoster vaccinations, for example, just as they choose how much red meat, alcohol or cholesterol to consume, or whether to ride a bike beside cars on the road.
Resistance to a vaccine registry is another matter altogether, and should be discussed in the context of privacy and data security rather than clinical needs.
I find these comments absolutely staggering. Comparing vaccination which reduces disease and improve health to Coca Cola which leads to obesity, diabetes and other health problems is ridiculous. I agree it is everyone’s right to determine what treatment or screening they have , without bullying, where it does not affect other members of the community. The scaremongering is from the anti-vaccine lobby and I certainly don’t want my children and grandchildren to be affected by diseases which can be effectively eliminated with vaccination. The vaccination push comes from real medical experts, not the prime minister and the anti-vaccination comments from anonymous ? medical professionals is staggering. The medical load will be decreased by having a healthy population, not increased by immunization.
are we living in North Korea ???? Slowly but surely our right to make choices about what we put in our own bodies is being taken away.
No jab no play /pay is also a disgrace!!
If vaccines give us herd immunity wouldn’t that mean that all adults would have to be up to date as well???
I’m an Australian physician with well-controlled late onset type I diabetes. I visited my local practice, and saw a GP for the first time, for the sole purpose of renewing my insulin. She saw the over-70 dialog box and offered me Pneumococcal, Influenza, Perttussis, and Herpes Zoster vaccination, and was visibly upset when I said no. She asked whether I had had a colonoscopy or returned my “kit” and when I said no asked if I preferred to die of colon cancer. She asked if I had had a PSA and actually agreed it isn’t regarded as a screening test. The whole confrontation was distasteful. The wish to lower disease rates (even unscientific ones) does not trump a patient’s right to decline a service or justify bullying.
Malcolm Turnbull, along with his wife, Lucy, has a vested interest in vaccine manufacture. This is a conflict of interest on his behalf. He has no right to enforce vaccines on any person. He is not medically or scientifically educated. He knows nothing about vaccine other than it will make he and his wife a lot of money.
A ” Whole of Life Vaccine Register” is a medical record of each and every person’s vaccination history. Every person’s Medical History, is private. Every person is entitled to privacy. No person’s medical history should ever be made Public information without consent.
Australia is fast becoming a Dictatorship. The enforcement of vaccinination is evidence of that!
We know why the vaccine legislation push is on, because people are waking up to the vaccine fraud and you know it. Not to mention the Turnbulls are set to make a huge amount of money through their investments in vaccines and Lucy Turnbull being the head of Prima Biomed a vaccine manufacturer.
The medical establishment already can’t handle the load. So sure, lets load it up some more. Because that’s exactly what will happen as a result.
Stop with all this vaccine scaremongering, get rid of the Flouride toxins out of our water, ban pesticides, GMO, Chemtrails, unhealthy processed foods, preservatives,aspartame, plastic bottles, and bags. You are wrecking our immune system.
Vaccines are nothing more than a “product” and the vaccine register is nothing more than a way for corporations to track there “product” sales.They look for segments of the population that are not using there “product” via the vaccine register and then target that specific segment of the population not using there “product” via legal legislation and propaganda.Can you imagine if we forced large sections of the population to drink CocaCola via social stigma, fear propaganda and force of law? Because that is exactly what is happening with the vaccine “products”.