What motivated this review?
Title: Immunization programs for the indigenous communities in Australia: A systematic review
Evidence on the topic
Delayed vaccination as well as vaccine preventable communicable diseases still remain a public health issue among the Aboriginal communities. The strategies to initiate the vaccination coverage as well as timelines can be very resource intensive. The Aboriginal Medical Service Sydney (AMSWS) in 2008-2009 came up with this low cost initiative to help boost childhood immunization among the Aboriginal communities.
The National Immunization Program (NIP) provide extra immunization services to the indigenous communities in Australia for free with the aim of protecting them against infections (Collins et al., 2017). The extra immunizations provided are just an addition to the other routine vaccines that are provided throughout the lives of children, adults, seniors as well as expectant women in Australia.
It is recommended by the NIP that all children below five years among the Aboriginal and Torres Islander people should receive the vaccines .There are different diseases that the children should be immunized against and they include pneumococcal disease(Falster et al., 2016). The NIP recommend that children between 12 and 18 months living in Queensland, Northern Territory, Western Australia and South Australia should be immunized with the additional booster dose of the pneumococcal vaccine.
The NIP also provide two doses of the Hepatitis A vaccine which is usually provided 6 months apart .It is recommended for children as from 12 months and should be provided to all the indigenous communities children living in Queensland, Northern Territory, Western Australia and the South Australia (Fathima et al., 2017). However, the age at which the pneumococcal and the Hepatitis A vaccines are provided vary among the four regions. The Flu vaccine is also provided by the NIP to all the Aboriginal and Torres Islander children between the age of 6 months and 5 years.
Children between the age of 5 and 9 years are usually provided with catch up vaccines .This are the routine vaccines that the children missed at a certain stage of their lives. This is the same case for children between 10 and 15 years (Gidding et al., 2018) .Besides the catch up vaccines to this age group, The Human papilloma virus, tetanus, diphtheria and the whooping cough vaccines are also provided.
Adults among the indigenous communities are also not exempted from the catch up vaccines. Adults between the age of 15 and 49 years receive the catch up vaccine from the NIP. Some of the vaccines at this group include flu (Influenza) for people above 15 years (Hendry et al., 2018). Pneumococcal vaccine is also provided to people within this age group. Those adults above 50 years within the Aboriginal and Torres Islander people are also immunized against the pneumococcal disease.
There are several studies on the immunization programs among the Aboriginal and Torres Islander people of Australia .However, there are very few systematic reviews and this was the driving force behind my study. This is to ensure that there is comprehending of how the immunization services are carried out among the indigenous communities in Australia. The systematic review would also provide an insight for the future policy makers to target the indigenous communities for future interventions.
Methods
Search strategy
Data sources: I used the five major electronic databases that include PubMed, Scopus, CINAHL, Google scholar and the web of science. The databases were searched for English journals or articles on the immunization /vaccination programs among the Aboriginal and Torres Islander People of Australia for a period between 2014 up to date. To seek additional materials, the google website was also used.
Search terms/keywords: The main search term used was “Immunization” OR “Vaccination” and then the subsequent searches involved the Aboriginal and the Torres Islander people of Australia, immunization practices in Australia etc.
All the articles that mentioned immunization or vaccination among the indigenous communities in Australia were considered.
Those Articles the mentioned immunization/vaccination among the indigenous communities in Australia in exceptionally difficult circumstances like vaccination and the prevalence of HIV were excluded. Those that mentioned vaccination in comparison with nutrition were also excluded.
Immunization/vaccination programs were defined by the both the young and adults immunization indicators as stipulated by the WHO/UNICEF.
The different study characteristics such as the study design used were considered.
It is only the articles that were published in English that were considered for the systematic review.
Below is a demonstration of how the material used were selected.
Records identified through database for “Immunization/vaccination” (n=10567+)
Records screened for inclusion (n=617) & (n=86)
Records after duplicates were removed (n=52) & (n=12)
Full text articles on Immunization among the Aboriginal and Torres Islanders people in Australia, opinions pieces, case reports and finally reviews were excluded.(n=20) & (n=5)
Studies included in the review 7 were cohort studies, 18 were cross-sectional studies and 7 were mixed methods for determining immunization among the indigenous communities in Australia.
Summary evidence from the reviewed studies
Conclusion:
Conclusion from the evidence
Immunization among the Aboriginal communities is quite evident due to the reduced burden of diseases as well as a decreased rate in the hospital admission rates since the introduction of the National Immunization Program (Jayasinghe et al., 2015). According to studies, the hospital admission rates have dropped from 28% to only 6% in the past decade.
However, the studies have found out that there exists a very wide gap in the rates of immunization between the indigenous and the non-indigenous communities. By the time the children are two years, the gap widens further and this implies delays in immunization among the Aboriginal communities (Lotter, Regan, Thomas, Effler, & Mak, 2017). The delays makes the children vulnerable to diseases that can be prevented through vaccination.
Children are however not exclusively protected until they complete the recommended childhood vaccinations at 4 years of age. At the moment, the studies found out that 94-95% of Aboriginal children who are above 4 years are considered fully vaccinated.
The rates of immunization are generally improving but the studies established that there are some factors that affect the immunization coverage rates among the Aboriginals (Pearce, Marshall, Bedford, & Lynch, 2015). Some of the factors include timeliness as well as identification of the Aboriginal status among the different healthcare providers (Reekie et al., 2018) .Immunization rates have shown reduction in the rates of preventable diseases among the Aboriginal children in Australia and there should be different strategies to make it better.
Use of personalized calendars can boost the timelines of vaccination among the Aboriginal children.This is accoding to the AMSWS tool.This is a very cost effective tool and it also seems practical and effective in improving early childhood vaccination among the Aboriginal communities in Australia.This program should therefore be supported by the Australian Government.
Study objectives from the evidence:
The main objective from the evidence was to improve vaccination or immunization among the indigenous communities in Australia.
- To educate these communities on the importance of immunization
- To train different healthcare professionals on how to conduct immunization and how to handle potential resistance from certain sections of the community.
- To collaborate with different stakeholders such as the government, the community and other organizations to fully implement immunization programs among the Aboriginal and Torres Islander people.
There is need for further intervention studies to be conducted so as to provide further evidence concerning the best strategies that should be employed to encourage more aboriginal and Torres islander people to be vaccinated against most of the preventable infections in Australia.
References
Collins, D. A., Hoskins, A., Snelling, T., Senasinghe, K., Bowman, J., Stemberger, N. A., … Lehmann, D. (2017). Predictors of pneumococcal carriage and the effect of the 13-valent pneumococcal conjugate vaccination in the Western Australian Aboriginal population. Pneumonia, 9(1). doi:10.1186/s41479-017-0038-x
Falster, K., Banks, E., Lujic, S., Falster, M., Lynch, J., Zwi, K., … Jorm, L. (2016). Inequalities in pediatric avoidable hospitalizations between Aboriginal and non-Aboriginal children in Australia: a population data linkage study. BMC Pediatrics, 16(1). doi:10.1186/s12887-016-0706-7
Fathima, P., Blyth, C. C., Lehmann, D., Lim, F. J., Abdalla, T., De Klerk, N., & Moore, H. C. (2017). The Impact of Pneumococcal Vaccination on Bacterial and Viral Pneumonia in Western Australian Children: Record Linkage Cohort Study of 469589 Births, 1996–2012. Clinical Infectious Diseases, 66(7), 1075-1085. doi:10.1093/cid/cix923
Gidding, H., McCallum, L., Fathima, P., Moore, H., Snelling, T., Blyth, C., … McIntyre, P. (2018). Effectiveness of a 3 + 0 pneumococcal conjugate vaccine schedule against invasive pneumococcal disease among a birth cohort of 1.4 million children in Australia. Vaccine, 36(19), 2650-2656. doi:10.1016/j.vaccine.2018.03.058
Hendry, A. J., Beard, F. H., Dey, A., Meijer, D., Campbell-Lloyd, S., Clark, K. K., … Sheppeard, V. (2018). Closing the vaccination coverage gap in New South Wales: the Aboriginal Immunisation Healthcare Worker Program. The Medical Journal of Australia, 209(1), 24-28. doi:10.5694/mja18.00063
Jayasinghe, S., Chiu, C., Menzies, R., Lehmann, D., Cook, H., Giele, C., … McIntyre, P. (2015). Evaluation of impact of 23 valent pneumococcal polysaccharide vaccine following 7 valent pneumococcal conjugate vaccine in Australian Indigenous children. Vaccine, 33(48), 6666-6674. doi:10.1016/j.vaccine.2015.10.089
Lotter, K., Regan, A. K., Thomas, T., Effler, P. V., & Mak, D. B. (2017). Antenatal influenza and pertussis vaccine uptake among Aboriginal mothers in Western Australia. Australian and New Zealand Journal of Obstetrics and Gynaecology, 58(4), 417-424. doi:10.1111/ajo.12739
Pearce, A., Marshall, H., Bedford, H., & Lynch, J. (2015). Barriers to childhood immunisation: Findings from the Longitudinal Study of Australian Children. Vaccine, 33(29), 3377-3383. doi:10.1016/j.vaccine.2015.04.089
Reekie, J., Kaldor, J., Mak, D., Ward, J., Donovan, B., Hocking, J., … Liu, B. (2018). Long-term impact of childhood hepatitis B vaccination programs on prevalence among Aboriginal and non-Aboriginal women giving birth in Western Australia. Vaccine, 36(23), 3296-3300. doi:10.1016/j.vaccine.2018.04.057
Verdon, S., & McLeod, S. (2015). Indigenous Language Learning and Maintenance Among Young Australian Aboriginal and Torres Strait Islander Children. International Journal of Early Childhood, 47(1), 153-170. doi:10.1007/s13158-015-0131-3
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