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Feature Article

Immunisation: it’s not just for kids

LUCY DENG, RYAN MACDOUGALL, Kristine Macartney
OPEN ACCESS

From 2003 to 2015, following the commencement of the MenCCV vaccination program, meningococcal serogroup B was the main cause of invasive meningococcal disease in children and young adults. MenBV is recommended in a two-dose schedule for all adolescents aged 15 to 19 years due to their higher risk of meningococcal disease, particularly for those living in close quarters, and is available through private prescription. In South Australia, MenBV is funded from April 2017 for students in Years 10 to 12 as part of a two-year study (see the ‘B Part of It’ website, www.bpartofit.com.au).

Serogroup W has been an increasing cause of meningococcal disease since 2013, and in 2016 became the main serogroup causing invasive meningococcal disease, accounting for almost half of all serotyped cases. To address this, 4vMenCV has been funded by the states in 2017 for adolescents and young adults in New South Wales, Victoria, Queensland and Western Australia (age coverage varies between states). It is otherwise available through private prescription for anyone older than 2 months.

People with medical conditions or treatments that increase their risk of meningococcal disease should also receive MenBV and 4vMenCV; extra doses are indicated. 4vMenCV is also recommended for travellers to areas with an increased risk of exposure to meningococcal serogroups A, C, W-135 and Y, particularly the ‘meningitis belt’ of sub-Saharan Africa, and those travelling to mass gatherings, including the annual Hajj pilgrimage.

For further details on meningococcal vaccines, including who should be vaccinated, see the NCIRS online fact sheet ‘Meningococcal vaccines for Australians’ (Box 3).

Aboriginal and Torres Strait Islander (Indigenous) Australians

Indigenous Australians are eligible for additional vaccines under the NIP as they are at higher risk of acquiring and developing complications from vaccine-preventable diseases. Every effort should be made to identify Indigenous people in primary care to ensure their immunisation needs are met.

All Indigenous adults should have the annual influenza vaccine, and those aged 15 to 49 years with conditions increasing their risk of invasive pneumococcal disease and all those aged 50 years and over should receive the pneumococcal polysaccharide vaccine (23vPPV). Both of these vaccines are included in the NIP for these uses.

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Given the increased risk of acquiring hepatitis B in this population, vaccination status should be reviewed in Indigenous persons and testing offered (for evidence of immunity from vaccination or past or chronic infection); vaccination can be provided if nonimmune.34

Indigenous women of child-bearing age living in rural and remote Australia are more likely to be nonimmune to rubella than their non-Indigenous peers.35 Seronegative Indigenous women can be identified before pregnancy and be given MMR vaccine to prevent congenital rubella syndrome and ensure adequate protection against measles.

Japanese encephalitis vaccination is recommended for residents of the outer islands in the Torres Strait.

Hepatitis B, MMR and Japanese encephalitis vaccinations for Indigenous adults are not included in the NIP but are funded by some states and territories.

Australian Immunisation Register

A milestone event occurred in late 2016 when the Australian Childhood Immunisation Register (ACIR) was expanded to become the Australian Immunisation Register (AIR). The change lays the foundation for a more holistic capture of vaccines given to people of all ages, with the long-term objective of providing a whole-of-life immunisation history.

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The AIR will make tracking of adult vaccinations across different healthcare providers easier and will assist with the monitoring of safety, quality, delivery and coverage of vaccinations among the adult population. The AIR uses the same processes of data transfer via general practice software as have been used to populate the ACIR; it will currently only add vaccines given prospectively from the time of commencing use in November 2016. As such, it will be some time before reliable population estimates can be derived.

Safety

Vaccines are subjected to rigorous testing in clinical trials and must pass stringent safety testing before being approved for use by the Therapeutic Goods Administration (TGA). Once in use, ongoing safety monitoring through a national spontaneous reporting surveillance system collates reports of adverse events following immunisations from health authorities, immunisation providers, consumers and vaccine sponsors. These reports are then reviewed by the TGA and are listed on the Database of Adverse Event Notifications, with summary data published annually.36,37

There is now also an active surveillance system, AusVaxSafety, led by NCIRS. This system monitors vaccine safety through automated surveillance tools, including SmartVax and Vaxtracker, which send SMSs or web-based surveys to recently vaccinated people for more immediate real-time feedback. In 2017, AusVaxSafety will specifically track the safety profile of influenza and herpes zoster vaccines given to adults.

Conclusion

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. The use of the HALO principle can assist healthcare providers in starting the discussion on vaccination with adult patients. It should be every healthcare provider’s business to make immunisation of adults their issue and an integral part of promoting a healthy lifestyle and healthy ageing. MT

Acknowledgements

The authors would like to thank Dr Sarah Moberley, Newcastle, NSW, for her contribution in the initial drafting of this article.

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COMPETING INTERESTS. Dr Deng and Mr MacDougall: None. Associate Professor Macartney is Deputy Director of NCIRS, which receives funding from Commonwealth, state and territory health departments and independent funding agencies; and a chief investigator on research grants funded by the NHMRC.
 
 

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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.