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Abstract
BACKGROUND The effectiveness of interventions to increase influenza vaccination uptake in people aged 60 years and older varies by country and participant characteristics. This review updates versions published in 2010 and 2014. OBJECTIVES To assess access, provider, system, and societal interventions to increase the uptake of influenza vaccination in people aged 60 years and older in the community. SEARCH METHODS We searched CENTRAL, which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE, Embase, CINAHL, and ERIC for this update, as well as WHO ICTRP and ClinicalTrials.gov for ongoing studies to 7 December 2017. We also searched the reference lists of included studies. SELECTION CRITERIA Randomised controlled trials (RCTs) and cluster-randomised trials of interventions to increase influenza vaccination in people aged 60 years or older in the community. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as specified by Cochrane. MAIN RESULTS We included three new RCTs for this update (total 61 RCTs; 1,055,337 participants). Trials involved people aged 60 years and older living in the community in high-income countries. Heterogeneity limited some meta-analyses. We assessed studies as at low risk of bias for randomisation (38%), allocation concealment (11%), blinding (44%), and selective reporting (100%). Half (51%) had missing data. We assessed the evidence as low-quality. We identified three levels of intervention intensity: low (e.g. postcards), medium (e.g. personalised phone calls), and high (e.g. home visits, facilitators).Increasing community demand (12 strategies, 41 trials, 53 study arms, 767,460 participants)One successful intervention that could be meta-analysed was client reminders or recalls by letter plus leaflet or postcard compared to reminder (odds ratio (OR) 1.11, 95% confidence interval (CI) 1.07 to 1.15; 3 studies; 64,200 participants). Successful interventions tested by single studies were patient outreach by retired teachers (OR 3.33, 95% CI 1.79 to 6.22); invitations by clinic receptionists (OR 2.72, 95% CI 1.55 to 4.76); nurses or pharmacists educating and nurses vaccinating patients (OR 152.95, 95% CI 9.39 to 2490.67); medical students counselling patients (OR 1.62, 95% CI 1.11 to 2.35); and multiple recall questionnaires (OR 1.13, 95% CI 1.03 to 1.24).Some interventions could not be meta-analysed due to significant heterogeneity: 17 studies tested simple reminders (11 with 95% CI entirely above unity); 16 tested personalised reminders (12 with 95% CI entirely above unity); two investigated customised compared to form letters (both 95% CI above unity); and four studies examined the impact of health risk appraisals (all had 95% CI above unity). One study of a lottery for free groceries was not effective.Enhancing vaccination access (6 strategies, 8 trials, 10 arms, 9353 participants)We meta-analysed results from two studies of home visits (OR 1.30, 95% CI 1.05 to 1.61) and two studies that tested free vaccine compared to patient payment for vaccine (OR 2.36, 95% CI 1.98 to 2.82). We were unable to conduct meta-analyses of two studies of home visits by nurses plus a physician care plan (both with 95% CI above unity) and two studies of free vaccine compared to no intervention (both with 95% CI above unity). One study of group visits (OR 27.2, 95% CI 1.60 to 463.3) was effective, and one study of home visits compared to safety interventions was not.Provider- or system-based interventions (11 strategies, 15 trials, 17 arms, 278,524 participants)One successful intervention that could be meta-analysed focused on payments to physicians (OR 2.22, 95% CI 1.77 to 2.77). Successful interventions tested by individual studies were: reminding physicians to vaccinate all patients (OR 2.47, 95% CI 1.53 to 3.99); posters in clinics presenting vaccination rates and encouraging competition between doctors (OR 2.03, 95% CI 1.86 to 2.22); and chart reviews and benchmarking to the rates achieved by the top 10% of physicians (OR 3.43, 95% CI 2.37 to 4.97).We were unable to meta-analyse four studies that looked at physician reminders (three studies with 95% CI above unity) and three studies of facilitator encouragement of vaccination (two studies with 95% CI above unity). Interventions that were not effective were: comparing letters on discharge from hospital to letters to general practitioners; posters plus postcards versus posters alone; educational reminders, academic detailing, and peer comparisons compared to mailed educational materials; educational outreach plus feedback to teams versus written feedback; and an intervention to increase staff vaccination rates.Interventions at the societal levelNo studies reported on societal-level interventions.Study funding sourcesStudies were funded by government health organisations (n = 33), foundations (n = 9), organisations that provided healthcare services in the studies (n = 3), and a pharmaceutical company offering free vaccines (n = 1). Fifteen studies did not report study funding sources. AUTHORS' CONCLUSIONS We identified interventions that demonstrated significant positive effects of low (postcards), medium (personalised phone calls), and high (home visits, facilitators) intensity that increase community demand for vaccination, enhance access, and improve provider/system response. The overall GRADE assessment of the evidence was moderate quality. Conclusions are unchanged from the 2014 review.
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Affiliation(s)
- Roger E Thomas
- University of CalgaryDepartment of Family Medicine, Faculty of MedicineHealth Sciences Centre3330 Hospital Drive NWCalgaryABCanadaT2N 4N1
| | - Diane L Lorenzetti
- Faculty of Medicine, University of CalgaryDepartment of Community Health Sciences3rd Floor TRW3280 Hospital Drive NWCalgaryABCanadaT2N 4Z6
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Dyda A, Karki S, Hayen A, MacIntyre CR, Menzies R, Banks E, Kaldor JM, Liu B. Influenza and pneumococcal vaccination in Australian adults: a systematic review of coverage and factors associated with uptake. BMC Infect Dis 2016; 16:515. [PMID: 27670446 PMCID: PMC5037616 DOI: 10.1186/s12879-016-1820-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 09/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the absence of an adult vaccination register, coverage estimates for influenza and pneumococcal vaccination come from surveys and other data sources. METHODS Systematic review and meta-analysis of studies examining vaccination coverage in Australian adults from 1990 to 2015, focusing on groups funded under the National Immunisation Program, and intervals prior to and following the introduction of universal funding. RESULTS Twenty-two studies met the inclusion criteria; 18 used self-report to determine vaccination status. There were 130 unique estimates of coverage extracted. Among adults aged ≥65y, during the period of universal funding (1999-onwards), the summary estimate of annual influenza vaccination coverage from 27 point estimates was 74.8 % (95 % CI 73.4-76.2 %; range 63.9-82.4 %); prior to this period (1992-1998) from 10 point estimates it was 61.3 % (95 % CI 58.0-64.6 %; range 44.3-71.3 %). For the period of universal funding for pneumococcal vaccination (2005-onwards) the summary estimate for coverage was 56.0 % (95 % CI 53.2-58.8 %; range 51.2-72.8 %, 10 point estimates); prior to 2005 it was 35.4 % (95 % CI 18.8-52.0 %; range 15.4-45.2 %). Coverage for both vaccines was significantly higher following the introduction of universal funding. Influenza vaccination coverage in those aged 18-65 years with a medical indication was lower but data were not combined. Seven studies reported on Aboriginal Australians with three studies reporting five coverage estimates for influenza vaccination in adults ≥65 years (range 71 % - 89 %). CONCLUSIONS Adult influenza and pneumococcal vaccination coverage has increased since the introduction of universal funding, but remains sub-optimal, with pneumococcal coverage lower than influenza. IMPLICATIONS This review highlights the need for more coverage data overall and in high risk groups, to support public health programs to improve coverage.
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Affiliation(s)
- Amalie Dyda
- School of Public Health and Community Medicine, University of New South Wales (UNSW), Sydney, New South Wales (NSW), Australia.
| | - Surendra Karki
- School of Public Health and Community Medicine, University of New South Wales (UNSW), Sydney, New South Wales (NSW), Australia
| | - Andrew Hayen
- School of Public Health and Community Medicine, University of New South Wales (UNSW), Sydney, New South Wales (NSW), Australia
| | - C Raina MacIntyre
- School of Public Health and Community Medicine, University of New South Wales (UNSW), Sydney, New South Wales (NSW), Australia
| | - Robert Menzies
- School of Public Health and Community Medicine, University of New South Wales (UNSW), Sydney, New South Wales (NSW), Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Acton, Australian Capital Territory, Australia
| | | | - Bette Liu
- School of Public Health and Community Medicine, University of New South Wales (UNSW), Sydney, New South Wales (NSW), Australia
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Dyda A, MacIntyre CR, McIntyre P, Newall AT, Banks E, Kaldor J, Liu B. Factors associated with influenza vaccination in middle and older aged Australian adults according to eligibility for the national vaccination program. Vaccine 2015; 33:3299-305. [DOI: 10.1016/j.vaccine.2015.05.046] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 05/11/2015] [Accepted: 05/19/2015] [Indexed: 11/30/2022]
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Abstract
BACKGROUND The effectiveness of interventions to increase the uptake of influenza vaccination in people aged 60 and older is uncertain. OBJECTIVES To assess access, provider, system and societal interventions to increase the uptake of influenza vaccination in people aged 60 years and older in the community. SEARCH METHODS We searched CENTRAL (2014, Issue 5), MEDLINE (January 1950 to May week 3 2014), EMBASE (1980 to June 2014), AgeLine (1978 to 4 June 2014), ERIC (1965 to June 2014) and CINAHL (1982 to June 2014). SELECTION CRITERIA Randomised controlled trials (RCTs) of interventions to increase influenza vaccination uptake in people aged 60 and older. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study quality and extracted influenza vaccine uptake data. MAIN RESULTS This update identified 13 new RCTs; the review now includes a total of 57 RCTs with 896,531 participants. The trials included community-dwelling seniors in high-income countries. Heterogeneity limited meta-analysis. The percentage of trials with low risk of bias for each domain was as follows: randomisation (33%); allocation concealment (11%); blinding (44%); missing data (49%) and selective reporting (100%). Increasing community demand (32 trials, 10 strategies)The interventions with a statistically significant result were: three trials (n = 64,200) of letter plus leaflet/postcard compared to letter (odds ratio (OR) 1.11, 95% confidence interval (CI) 1.07 to 1.15); two trials (n = 614) of nurses/pharmacists educating plus vaccinating patients (OR 3.29, 95% CI 1.91 to 5.66); single trials of a phone call from a senior (n = 193) (OR 3.33, 95% CI 1.79 to 6.22), a telephone invitation versus clinic drop-in (n = 243) (OR 2.72, 95% CI 1.55 to 4.76), a free groceries lottery (n = 291) (OR 1.04, 95% CI 0.62 to 1.76) and nurses educating and vaccinating patients (n = 485) (OR 152.95, 95% CI 9.39 to 2490.67).We did not pool the following trials due to considerable heterogeneity: postcard/letter/pamphlets (16 trials, n = 592,165); tailored communications (16 trials, n = 388,164); customised letter/phone-call (four trials, n = 82,465) and client-based appraisals (three trials, n = 4016), although several trials showed the interventions were effective. Enhancing vaccination access (10 trials, six strategies)The interventions with a statistically significant result were: two trials (n = 2112) of home visits compared to clinic invitation (OR 1.30, 95% CI 1.05 to 1.61); two trials (n = 2251) of free vaccine (OR 2.36, 95% CI 1.98 to 2.82) and one trial (n = 321) of patient group visits (OR 24.85, 95% CI 1.45 to 425.32). One trial (n = 350) of a home visit plus vaccine encouragement compared to a home visit plus safety advice was non-significant.We did not pool the following trials due to considerable heterogeneity: nurse home visits (two trials, n = 2069) and free vaccine compared to no intervention (two trials, n = 2250). Provider- or system-based interventions (17 trials, 11 strategies)The interventions with a statistically significant result were: two trials (n = 2815) of paying physicians (OR 2.22, 95% CI 1.77 to 2.77); one trial (n = 316) of reminding physicians about all their patients (OR 2.47, 95% CI 1.53 to 3.99); one trial (n = 8376) of posters plus postcards (OR 2.03, 95% CI 1.86 to 2.22); one trial (n = 1360) of chart review/feedback (OR 3.43, 95% CI 2.37 to 4.97) and one trial (n = 27,580) of educational outreach/feedback (OR 0.77, 95% CI 0.72 to 0.81).Trials of posters plus postcards versus posters (n = 5753), academic detailing (n = 1400) and increasing staff vaccination rates (n = 26,432) were non-significant.We did not pool the following trials due to considerable heterogeneity: reminding physicians (four trials, n = 202,264) and practice facilitators (three trials, n = 2183), although several trials showed the interventions were effective. Interventions at the societal level We identified no RCTs of interventions at the societal level. AUTHORS' CONCLUSIONS There are interventions that are effective for increasing community demand for vaccination, enhancing access and improving provider/system response. Heterogeneity limited pooling of trials.
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Affiliation(s)
- Roger E Thomas
- University of CalgaryDepartment of Family Medicine, Faculty of MedicineUCMC#1707‐1632 14th AvenueCalgaryCanadaT2M 1N7
| | - Diane L Lorenzetti
- Faculty of Medicine, University of CalgaryDepartment of Community Health Sciences3rd Floor TRW3280 Hospital Drive NWCalgaryCanadaT2N 4Z6
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Jacups SP, Cheng A. The epidemiology of community acquired bacteremic pneumonia, due to Streptococcus pneumoniae, in the Top End of the Northern Territory, Australia--over 22 years. Vaccine 2011; 29:5386-92. [PMID: 21651943 DOI: 10.1016/j.vaccine.2011.05.082] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 05/20/2011] [Accepted: 05/23/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Diseases caused by Streptococcus pneumoniae continue to cause substantial morbidity and mortality throughout the world. Furthermore, detrimental outcomes are more pronounced in some populations--such as those living in third world poverty, and Indigenous people who live in developed nations. METHODS This study describes the epidemiology of blood culture positive S. pneumoniae community-acquired pneumonia (CAP) in the Top End of the Northern Territory of Australia. Demographics, indigenous status, medical risk factors, serotype and outcomes were collected from adults presenting to hospital with blood culture positive S. pneumoniae CAP, from 1987 to 2008. RESULTS We report 205 cases, with a median age of 40 years. The average overall incidence rate ratio was 10.3 for indigenous adults compared with non-indigenous adults. There was no statistical difference between incidence rates pre and post-23-valent pneumococcal polysaccharide vaccine (23vPPV) introduction. Serotypes in presenting cases were predominantly (84.7%) 23vPPV types. The whole-population logistic regression model identified significant adjusted relative risks: 95% CI, for age 45 and older 1.6: 1.1, 2.2, indigenous 5.9: 3.7, 9.5, diabetes 2.3: 1.6, 3.3, excess alcohol 4.8: 2.8, 8.3, smoking 2.7: 1.9, 3.7 with indigenous+excess alcohol 18.5: 17.3, 19.7 as predictive for bacteremic S. pneumoniae CAP presentation. CONCLUSIONS Our results suggest that, the national 23vPPV program appears to be under-utilized. An integrated Public Health approach vigorously targeting indigenous adolescents, before substances such as alcohol and smoking are habitual, together with increased vaccine coverage, will reduce the burden of pneumococcal disease in this population.
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Affiliation(s)
- Susan P Jacups
- School for Environmental Research, Charles Darwin University, Northern Territory, Australia.
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Abstract
BACKGROUND Although the evidence to support influenza vaccination is poor, it is promoted by many health authorities. There is uncertainty about the effectiveness of interventions to increase influenza vaccination rates in those 60 years or older. OBJECTIVES To assess effects of interventions to increase influenza vaccination rates in those 60 or older. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2010, issue 3), containing the Cochrane Acute Respiratory Infections Group's Specialized Register, MEDLINE (January 1950 to July 2010), PubMed (January 1950 to July 2010), EMBASE (1980 to 2010 Week 28), AgeLine (1978 to July 2010), ERIC (1965 to July 2010) and CINAHL (1982 to July 2010). SELECTION CRITERIA Randomized controlled trials (RCTs) to increase influenza vaccination rates in those aged 60 years and older, recording influenza vaccination status either through clinic records, billing data or local/national vaccination registers. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study quality and extracted data. MAIN RESULTS Forty-four RCTs were included. All included RCTs studied seniors in the community and in high-income countries. No RCTs of society-level interventions were included. Heterogeneity was marked and meta-analysis was limited. Only five RCTs were graded at low and six at moderate risk of bias. They included three of 13 personalized postcard interventions (all three with the 95% confidence interval (CI) above unity), two of the four home visit interventions (both with 95% CI above unity, but one a small study), three of the four reminder to physicians interventions (none with 95% CI above unity) and three of the four facilitator interventions (one with 95% CI above unity, and one P < 0.01). The other 33 RCTs were at high risk of bias and no recommendations for practice can be drawn. AUTHORS' CONCLUSIONS Personalized postcards or phone calls are effective, and home visits, and facilitators, may be effective. Reminders to physicians are not. There is insufficient good evidence for other interventions.
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Affiliation(s)
- Roger E Thomas
- Department of Medicine, University of Calgary, UCMC, #1707-1632 14th Avenue, Calgary, Alberta, Canada, T2M 1N7
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Moberley S, Krause V, Cook H, Mulholland K, Carapetis J, Torzillo P, Andrews R. Failure to vaccinate or failure of vaccine? Effectiveness of the 23-valent pneumococcal polysaccharide vaccine program in Indigenous adults in the Northern Territory of Australia. Vaccine 2010; 28:2296-301. [PMID: 20116468 DOI: 10.1016/j.vaccine.2009.12.066] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Revised: 11/03/2009] [Accepted: 12/29/2009] [Indexed: 11/20/2022]
Abstract
Over the last decade, there has been no discernible reduction in Invasive Pneumococcal Disease (IPD) amongst Indigenous adults in the Northern Territory (NT) of Australia, despite increasing vaccination coverage. We examined the utility of two common methods, the screening method and the indirect method, to determine the 23-valent pneumococcal polysaccharide vaccine effectiveness (VE) in prevention of IPD amongst Indigenous adults in this setting. VE was calculated for the period 2001-2005 across two distinct geographical areas where the disease burden was known to differ. VE against vaccine-type IPD was 3.4% (95% CI -43, 35) for the NT. However, population vaccination coverage varied widely according to geographical region and where this was within the range appropriate for the use of the screening method, VE was within the expected range (67.2%, 95% CI 47, 80). VE according to the indirect cohort appeared unreliable in this setting due to the analysis being based on a very limited number of non-vaccine-type IPD cases. Surveillance based estimates of VE such as these need to be considered with caution, but the results suggest failure to vaccinate is the most likely reason vaccine-type IPD has not reduced in this setting.
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Abstract
There are many similarities regarding the health status of Indigenous people in the 4 English-speaking developed countries of North America and the Pacific (United States, Canada, Australia, New Zealand), where they are all now minority populations. Although vaccines have contributed to the reduction or elimination of disease disparities for many infections, Indigenous people continue to have higher morbidity and mortality from many chronic and infectious diseases compared with the general populations in their countries. This review summarizes the available data on the epidemiology of vaccine-preventable diseases in Indigenous populations in these 4 countries in the context of the vaccination strategies used and their impact, with the aim of identifying successful strategies with the potential for wider implementation.
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Affiliation(s)
- Robert I Menzies
- The National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, Australia
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Abstract
Whereas considerable attention has been devoted to achieving high levels of influenza immunization, the importance of this issue is magnified by concern over pandemic influenza. Most recommendations for vaccine administration address high risk groups such as the elderly and those with chronic diseases, but coverage for hard-to-reach (HTR) populations has had less attention. HTR populations include minorities but also include other primarily urban groups such as undocumented immigrants, substance users, the homeless, and homebound elderly. Obstacles to the provision of immunization to HTR populations are present at the patient, provider, and structural levels. Strategies at the individual level for increasing immunization coverage include community-based educational campaigns to improve attitudes and increase motivation for receiving vaccine; at the provider level, education of providers to encourage immunizations, improving patient-provider interactions, broadening the provider base to include additional nurses and pharmacists, and adoption of standing orders for immunization administration; and at the structural level, promoting wider availability of and access to vaccine. The planning process for an influenza pandemic should include community engagement and extension of strategies beyond traditional providers to involve community-based organizations addressing HTR populations.
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Affiliation(s)
- David Vlahov
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029, USA.
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Hanna JN, Humphreys JL, Murphy DM. Invasive pneumococcal disease in Indigenous people in north Queensland, 1999–2004. Med J Aust 2006; 184:118-21. [PMID: 16460296 DOI: 10.5694/j.1326-5377.2006.tb00149.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Accepted: 11/02/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the epidemiology of invasive pneumococcal disease (IPD), and the impact of pneumococcal vaccines on IPD, in Indigenous people in north Queensland. SETTING North Queensland, 1999-2004; there are about 53 750 Indigenous people in the region, including nearly 6900 children < 5 years and nearly 5650 adults > or = 50 years. MAIN OUTCOME MEASURES Incidences of IPD in Indigenous children and in Indigenous adults compared between the 3 years before and after the introduction of a 7-valent pneumococcal conjugate vaccine (7vPCV) (1999-2001 versus 2002-2004). RESULTS Estimated annual incidence of IPD in Indigenous children < 5 years of age declined from 170 to 78 cases per 100 000 in the 3 years following the introduction of 7vPCV in 2001. The annual incidence of vaccine-preventable IPD in Indigenous adults had declined by 86% since a 23-valent pneumococcal polysaccharide vaccine (23vPPV) was introduced to the region in 1996, to 15 cases per 100 000 (95% CI, 8-25) in 2002-2004. CONCLUSION Although there was a rapid decline in IPD in young Indigenous children, it is unlikely that the incidence will fall much further with the current 7-valent vaccine. There was a suggestion that vaccinating Indigenous children indirectly protected those aged 5-14 years and Indigenous adults > or =15 years of age. Incidence of IPD in Indigenous adults in 2002-2004 was the lowest on record in the region.
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Affiliation(s)
- Jeffrey N Hanna
- Tropical Public Health Unit Network, Queensland Health, PO Box 1103, Cairns, QLD 4870, Australia.
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Abstract
OBJECTIVE To describe the epidemiology of invasive pneumococcal disease (IPD) in the Kimberley and examine whether cases could have been prevented by vaccination. DESIGN Prospective case series of IPD cases from 1 January 1995 to 31 December 2001. SETTING The Kimberley region of far north-western Australia. SUBJECTS Seventy IPD cases in 37 men and 33 women aged 5 months to 90 years. Aboriginal people comprised 90% (63/70) of cases. MAIN OUTCOME MEASURES Demographic, clinical and microbiological characteristics of IPD cases. Proportion of cases caused by vaccine-preventable serotypes. IPD incidence in the Kimberley. RESULTS Pneumonia and bacteraemia were the commonest clinical presentations. Of IPD cases, 15% (children) and 67% (adults) had a risk factor for IPD. The case fatality rate was 13%. Of cases, 46% (95% confidence interval (CI) 35-58%) were caused by serotypes covered by an age-appropriate vaccine. Of the 26 cases eligible for pneumococcal vaccination, only 4 (16%) had been appropriately vaccinated. IPD incidence in Aboriginal people aged 15 years and over declined from 97.8/100,000 person years (95% CI 56.5-139.1) in 1997 to 38.1/100,000 person years (95% CI 22.5-53.9) in 2001. CONCLUSIONS The significant proportion of cases caused by vaccine-preventable serotypes and that was, therefore, preventable underscores the importance of pneumococcal vaccination.
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Affiliation(s)
- Donna B Mak
- School of Public Health, The University of Western Australia, Nedlands, Western Australia 6009, Australia.
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