Public Health Amendment (Vaccination of Children Attending Child Care Facilities) Act 2013: its impact in the Northern Rivers, NSW.

OBJECTIVE: The objective of the study was to explore the impact of implementation of the Public Health Amendment (Vaccination of Children Attending Child Care Facilities) Act 2013 on child-care centres in the Northern Rivers region of New South Wales (NSW), from the perspective of child-care centre directors. Importance of study: Immunisation is an effective public health intervention, but more than 75 000 Australian children are not fully vaccinated. A recent amendment to the NSW Public Health Act 2010 asks child-care facilities to collect evidence of complete vaccination or approved exemption before allowing enrolment. METHODS: Ten child-care centre directors participated in a semiscripted interview. Interviews were recorded, transcribed and analysed. RESULTS: Common themes included misinterpretation of the amendment before implementation, the importance of adequate notice for implementation, lack of understanding of assessment of compliance, increased administrative requirements, the importance of other public health efforts, and limited change in vaccination rates. Child-care centres differed in their experience of the resources provided by the government, interactions with Medicare, and ease of integration with existing record-keeping methods. CONCLUSIONS: Participants felt that the amendment was successfully implemented. The amendment was felt to have fulfilled its aim of prompting parents who had forgotten to vaccinate, but failed to significantly affect conscientious objectors. Overall, the amendment was perceived to be a positive step in improving vaccination rates, but its impact was largely complementary to other components of the multifaceted vaccination policy.

A field study of household attack rates and the effectiveness of macrolide antibiotics in reducing household transmission of pertussis.

Bordetella pertussis (whooping cough) is an endemic, highly contagious bacterial respiratory infection, which is notifiable to Australian state and territory health departments. Between 2008 and 2011 there was a substantial outbreak in New South Wales with an initial increase in cases occurring in North Coast New South Wales from late 2007. During September and October 2011 the North Coast Public Health Unit conducted a household study of secondary attack rates to assess the effectiveness of pertussis vaccination as well as the timely use of antibiotics in preventing household transmission. At the time the study was commenced, notified cases included a large proportion of individuals with a documented history of vaccination against pertussis. We found lower attack rates amongst vaccinated compared with non-vaccinated subjects in all age groups, with the exception of the 5-11 years age group, who were also primarily responsible for the introduction of pertussis into the household. There was an increased risk of pertussis transmission from the household first primary case to contacts when antibiotic treatment was commenced later than 7 days after the onset of symptoms compared with within 7 days. This protective effect of timely antibiotic treatment in relation to transmission highlights the need to control for antibiotic treatment in field studies of pertussis. The benefits of timely diagnosis and use of antibiotics in preventing household transmission underscore the importance of early presentation and diagnosis of pertussis cases, particularly in households with susceptible occupants.

Evaluating the implementation of the 13-valent pneumococcal vaccine supplementary dose program in Australian primary health care settings.

BACKGROUND: The availability of new pneumococcal conjugate vaccines covering a broader range of serotypes, has seen many countries introduce these into their national immunisation program. When transitioning from 7-valent to 13-valent pneumococcal conjugate vaccines, Australia is one of a small number of countries that included a supplementary dose of the 13-valent pneumococcal conjugate vaccine to offer protection against additional serotypes to an expanded age group of children. An evaluation of the implementation and uptake of the 13-valent pneumococcal conjugate vaccine supplementary dose was undertaken in two local health districts (LHDs) in New South Wales, Australia. METHODS: A self-administered postal survey of immunisation providers in the Northern New South Wales and Mid North Coast LHDs. Trends in vaccine ordering were examined. Coverage was assessed using data from the Australian Childhood Immunisation Register (ACIR). RESULTS: Of the 177 surveys sent, 125 were returned (70%). Almost all providers (96%) were aware of the 13vPCV supplementary dose program though took an opportunistic approach to program promotion and parental reminders. Supplementary doses of 13vPCV were ordered for 37% of the eligible cohort, mostly in the program's first six months. Coverage as recorded on the ACIR was 27%, though was lower in older children and those not due for scheduled childhood vaccines. Of the children who received the 13vPCV supplementary dose, 3% received it at the same time as vaccines due at 12-months of age, and 44% at the time of those due at 18-months of age. CONCLUSION: Despite the high awareness of the program, reported coverage was lower than that for other PCV supplementary dose programs in Australia and internationally. This may be influenced by providers' largely opportunistic approach to implementation, under-reporting to the ACIR or vaccine uptake. Lessons learned from this evaluation are relevant for future time-limited childhood vaccination programs. Prior to commencement, providers should be informed about the importance of catch-up/supplementary vaccination for their patients and their active role in promoting this. They should also receive program information before parents. An understanding of parental reasons for non-receipt of time-limited childhood vaccines and evaluation of the effect of aligning supplementary (or catch up) vaccination programs with the NIP schedule would be useful to inform future programs.

Immunisation attitudes, knowledge and practices of health professionals in regional NSW.

OBJECTIVE: This study investigated the immunisation knowledge, attitudes and practices among health professionals in two regional Area Health Services of NSW with low and high immunisation rates. It also compared these factors between the areas and between the health professional groups. METHODS: A self-administered questionnaire was posted in 2006 to health professionals, located within the North Coast and Hunter New England Area Health Services, whose practice could include immunisation. This included general practitioners (GPs), practice nurses, community nurses, hospital nurses and midwives. RESULTS: Out of 926 surveys sent, 434 were returned (47%). The great majority of the health professionals (97%) believed that vaccines were safe, effective and necessary. However, in approximately one-third of respondents, there were specific concerns about additives, immune system overload and the number of vaccines. Significantly more health professionals in the North Coast area believed that additives in vaccines may be harmful and that adding more vaccines to the schedule would make immunisation too complex. Among GPs, over half felt uncomfortable about giving more than two injections at the one visit. CONCLUSIONS: Health professionals in this study had overall confidence in vaccines but had specific concerns about the number of vaccines given to children and vaccine content. These unfounded concerns may reduce parental confidence in immunisation. IMPLICATIONS: There is value in governments and immunisation support workers continuing their efforts to maintain up-to-date knowledge among health professionals and support the delivery of appropriate and targeted information to address concerns about vaccines.