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Feature Article

Immunisation: it’s not just for kids

LUCY DENG, RYAN MACDOUGALL, Kristine Macartney
OPEN ACCESS

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Abstract

In an ageing population with a high burden of vaccine-preventable diseases, vaccines are equally as important in adults as they are in children. Although there are many potential barriers to adult vaccination, these can be addressed, and every healthcare provider should routinely review the immunisation status of their adult patients as part of health promotion.

Key Points

  • Adults may require vaccines for multiple reasons, including incomplete childhood schedules, waning immunity, medical and lifestyle risk factors, occupation-related risks, travel and migration.
  • The majority of undervaccinated people in Australia (those who are eligible for vaccines under the National Immunisation Program but do not receive them) are adults.
  • Vaccines are one of the key components to healthy ageing, given the high burden of vaccine-preventable diseases in the older population.
  • More vaccines are becoming available and are recommended for the adult population, including zoster vaccine for adults aged 70 to 79 years.
  • Barriers to the delivery of adult vaccinations include cost, lack of documentation of doses previously received and public misconceptions about the need for vaccination in adulthood.
  • The ‘HALO’ (Health, Age, Lifestyle, Occupation) principle can be applied when assessing vaccine requirements for adults.
  • The Australian Immunisation Register, introduced in 2016, aims to capture all immunisations across the lifespan of a person.

    
Picture credit: © BSIP/Medical Images
    Models used for illustrative purposes only

Immunisation is equally as important for adults as it is for children, and just as the number of vaccines recommended in early childhood has increased in recent years, so too has the number recommended for adults. Waning immunity following childhood immunisations, the increased risk of infectious diseases with age, medical comorbidities, behavioural and lifestyle factors, occupational exposures, travel and migration are some of the reasons that vaccinations are recommended in adults.

Adults comprise the majority of undervaccinated people in Australia, and in some instances have been responsible for outbreaks of diseases such as measles.1 As recommendation by a healthcare provider is the most important factor in influencing vaccine uptake in adults, the vaccination needs of adults should be reviewed regularly by healthcare providers to ensure individuals are offered recommended vaccines.2,3 This article provides an overview of how to assess vaccination requirements and the current indications for immunisation of adults as recommended in The Australian Immunisation Handbook 10th edition, 2017 update (the Handbook), with discussions on vaccinations for several specific diseases and for Aboriginal and Torres Strait Islander (Indigenous) Australians.4 Helpful resources include the Handbook, the National Centre for Immunisation Research and Surveillance (NCIRS) ‘Immunisation recommendations for adults in Australia’ and the National Immunisation Program (NIP) Schedule.4-6 Discussion of travel vaccinations is outside the scope of this article.

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Why does it matter?

Infectious diseases remain one of the leading contributors to poor health in people aged 60 years and over.7 Immunosenescence, comorbidities and poorer nutrition in older people all contribute to higher rates of morbidity and mortality from infectious diseases than in younger people.8,9 Older adults are also implicated in the transmission of infection to vulnerable groups; for example, of the 50% of cases where the source of pertussis is known in young infants, grandparents account for 5% of the cases.10

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Dr Deng is the Immunisation Fellow at the National Centre for Immunisation Research & Surveillance (NCIRS), Westmead; and a General Paediatric Advanced Trainee at The Children’s Hospital at Westmead, Sydney. Mr MacDougall is the Regional Infection Prevention and Control Specialist at Public Health Ontario, Toronto, Ontario, Canada. Associate Professor Macartney is the Deputy Director of the National Centre for Immunisation Research & Surveillance (NCIRS), Westmead; Staff Specialist in Infectious Disease and Microbiology at The Children’s Hospital at Westmead; and Associate Professor in the Discipline of Paediatrics and Child Health at the University of Sydney, Sydney, NSW.