Perceptions of caregivers and providers regarding the potential introduction of the varicella vaccine to the childhood immunisation schedule in New Zealand: A qualitative exploratory study.

AIM: The varicella vaccine has been proposed to be added to the childhood immunisation schedule in New Zealand as the fourth injectable at the 15-month event. We sought to understand the perceptions of caregivers and health-care providers regarding the potential introduction of routine varicella vaccination. METHODS: A qualitative exploratory study was conducted using semi-structured interviews with caregivers and providers (N = 20) in Auckland. Key themes from the interviews were identified through thematic analysis using a combination of deductive and inductive coding. RESULTS: All of the participants were aware of varicella but levels of awareness varied among caregivers regarding the varicella vaccine. Participants expressed positive support towards universal varicella vaccination and a high intention to vaccinate if available as a routine vaccine. However, many concerns were raised about multiple injections at a single immunisation visit, and participants suggested alternative scheduling options. CONCLUSION: The results indicated a need to raise awareness among caregivers about the varicella vaccine, focusing on positive health beliefs about vaccination in terms of protecting the child's health and reducing the impact of a child getting varicella on the family. Health-care providers and government health authorities may play an important role in increasing positive health beliefs about the varicella vaccine. Should the varicella vaccine be introduced as proposed, our findings recommend an educational campaign to address both caregiver and provider concerns about multiple injections and how to manage alternative immunisation schedules. These insights may help inform national strategies for the proposed addition to increase acceptance of the varicella vaccination.

The challenges and opportunities of translating best practice immunisation strategies among low performing general practices to reduce equity gaps in childhood immunisation coverage in New Zealand.

BACKGROUND: Immunisation coverage rates vary considerably at the local level across New Zealand and challenges remain with effectively translating best available research evidence into public health practice. This study aimed to translate best practices from high performing general practices into strategies to improve childhood immunisation coverage among low performing practices. METHODS: An intervention study was undertaken of general practices with low immunisation coverage rates and a high percentage of the enrolled population being of Maori ethnicity. Intervention groups received customised action plans and support for a 12 month period while control groups received 'business as usual' support. Structured interviews were conducted with key informants from all participating practices to understand current aspects related to childhood immunisation delivery and surveys were conducted to understand how the intervention worked. Collected data were thematically analysed. RESULTS: Ten sites were randomised to either intervention (n = 6) or control group (n = 4). Positive aspects of childhood immunisation delivery included high prioritisation at the practice and staff being pro-immunisation and knowledgeable. Key challenges experienced included inaccurate family contact information and discrepancies with referral processes to other providers. Other challenges noted were building rapport with families and vaccine hesitancy. The action plans included various strategies aimed to improve processes at the practice, contact and engagement with parents, and partnership development with local service providers. CONCLUSIONS: Creating customised action plans and providing support to providers were considered as helpful approaches when attempting to improve childhood immunisation coverage rates. Our study supports the notion that one strategy will not solely by itself improve childhood immunisation rates and highlights the importance of having a toolkit of strategies from which to draw from.

Vaccine-Preventable Disease-Associated Hospitalisations Among Migrant and Non-migrant Children in New Zealand.

Migrants may experience a higher burden of vaccine-preventable disease (VPD)-associated hospitalisations compared to the host population. A retrospective cohort study from 2006 to 2015 was conducted that linked de-identified data from government sources using Statistic NZ's Integrated Data Infrastructure. VPD-related hospitalisations were compared between three cohorts of children from birth to 5 years old: foreign-born children who migrated to NZ, children born in NZ of recent migrant mothers, and a comparator group of children born in NZ without a recent migration background. VPD-related hospitalisation rates were higher among NZ-born non-migrant children compared to NZ-born migrant and foreign-born children for all of the diseases of interest. For instance, 5.21% of NZ-born non-migrant children were hospitalised at least once due to all-cause gastroenteritis compared to 4.47% of NZ-born migrant children and only 1.13% of foreign-born migrant children. The overall hospitalisation rate for NZ-born non-migrant children was 3495 hospitalisations per 100,000 person years. Among children with migrant backgrounds, higher hospitalisation rates were noted among those of Pacific ethnicity and those with refugee backgrounds. Those arriving on Pacific visa schemes were hospitalised at rates ranging from 2644/100,000 person years among foreign-born migrant children and 4839/100,000 person years among NZ-born migrant children. Foreign-born quota refugee children and NZ-born children of quota refugee mothers were hospitalised at a rate of 4000-5000/100,000 person years. It is important to disaggregate migrant data to improve our understanding of migrant health. Children need to be age-appropriately vaccinated, and other individual and environmental factors addressed, to reduce the risk of infectious diseases.

100 years since the 1918 influenza pandemic-progress made, yet questions remain. A synopsis of the 4th New Zealand Influenza Symposium, February 2018.

The year 2018 marks 100 years since the 1918 influenza pandemic that caused devastating social and economic destruction worldwide. Despite substantial progress made with influenza research and strategies to control disease outbreaks, influenza continues to be a global public health problem. This paper presents a synopsis of the 4th New Zealand Influenza Symposium hosted by the Immunisation Advisory Centre in February 2018. During this symposium, international and national experts and service providers convened to discuss strategies to mitigate the effects of seasonal influenza and prepare for the next influenza pandemic.

Exploring immunisation inequities among migrant and refugee children in New Zealand.

Migrants may experience immunisation inequities compared with the host population related to barriers with accessing immunisations in their home countries, while migrating and/or post-arrival. This retrospective cohort study explored vaccination rates among migrant and non-migrant children in New Zealand (NZ). Linked de-identified data from various government sources from 1 January 2006 to 31 December 2015 were analysed using Statistic NZ's Integrated Data Infrastructure. Vaccination rates were compared between three cohorts of children aged up to 5 years: foreign-born children who migrated to NZ; children born in NZ of migrant mothers; and a comparator group of children born in NZ to non-migrant mothers. Less than half of foreign-born children (46%) had a record in the NZ National Immunisation Register compared with 95% and 96% among migrant and non-migrant NZ-born children, respectively. Foreign-born migrant children had lower age-appropriate reported vaccination rates by vaccine of interest, ethnicity and visa category compared with NZ-born children. Migrant children from Pacific ethnicities had lower reported coverage than other ethnicities. High rates of not age-appropriately vaccinated were noted among foreign-born children on refugee, Pacific and humanitarian visa schemes. This study highlights possible shortfalls around immunisation data, particularly about recording vaccinations given overseas for foreign-born children, and potential challenges around engagement with immunisation services for migrant children. However, results highlight the successful engagement of quota refugee children as part of NZ's refugee orientation programme. It is important to monitor vaccination coverage by migrant and refugee background to inform improvements to policy and practice for wider population health benefits.

Quantifying the incidence and burden of herpes zoster in New Zealand general practice: a retrospective cohort study using a natural language processing software inference algorithm.

OBJECTIVE: To investigate the incidence of primary care presentations for herpes zoster (zoster) in a representative New Zealand population and to evaluate the utilisation of primary healthcare services following zoster diagnosis. DESIGN: A cross-sectional retrospective cohort study used a natural language processing software inference algorithm to identify general practice consultations for zoster by interrogating 22 million electronic medical record (EMR) transactions routinely recorded from January 2005 to December 2015. Data linking enabled analysis of the demographics of each case. The frequency of doctor visits was assessed prior to and after the first consultation diagnosing zoster to determine health service utilisation. SETTING: General practice, using EMRs from two primary health organisations located in the lower North Island, New Zealand. PARTICIPANTS: Thirty-nine general practices consented interrogation of their EMRs to access deidentified records for all enrolled patients. Out-of-hours and practice nurse consultations were excluded. MAIN OUTCOME MEASURES: The incidence of first and repeated zoster-related visits to the doctor across all age groups and associated patient demographics. To determine whether zoster affects workload in general practice. RESULTS: Overall, for 6 189 019 doctor consultations, the incidence of zoster was 48.6 per 10 000 patient-years (95% CI 47.6 to 49.6). Incidence increased from the age of 50 years to a peak rate of 128 per 10 000 in the age group of 80-90 years and was significantly higher in females than males (p<0.001). Over this 11-year period, incidence increased gradually, notably in those aged 80-85 years. Only 19% of patients had one or more follow-up zoster consultations within 12 months of a zoster index consultation. The frequency of consultations, for any reason, did not change between periods before and after the diagnosis. CONCLUSIONS: Zoster consultations in general practice are rare, and the burden of these cases on overall general practice caseload is low.

What's new with the flu? Reflections regarding the management and prevention of influenza from the 2nd New Zealand Influenza Symposium, November 2015.

Influenza is a common respiratory viral infection. Seasonal outbreaks of influenza cause substantial morbidity and mortality that burdens healthcare services every year. The influenza virus constantly evolves by antigenic drift and occasionally by antigenic shift, making this disease particularly challenging to manage and prevent. As influenza viruses cause seasonal outbreaks and also have the ability to cause pandemics leading to widespread social and economic losses, focused discussions on improving management and prevention efforts is warranted. The Immunisation Advisory Centre (IMAC) hosted the 2nd New Zealand Influenza Symposium (NZiS) in November 2015. International and national participants discussed current issues in influenza management and prevention. Experts in the field presented data from recent studies and discussed the ecology of influenza viruses, epidemiology of influenza, methods of prevention and minimisation, and experiences from the 2015 seasonal influenza immunisation campaign. The symposium concluded that although much progress in this field has been made, many areas for future research remain.

Factors associated with immunisation coverage and timeliness in New Zealand.

BACKGROUND: Immunisation coverage in New Zealand is lower than what is necessary to prevent large epidemics of pertussis. Primary care is where most immunisation delivery occurs. General practices vary in their structure and organisation, both in a general sense and specifically with respect to immunisation delivery. AIM: To identify the structural and organisational characteristics of general practices associated with higher immunisation coverage and more timely immunisation delivery. DESIGN OF STUDY: A random sample of practices during 2005 and 2006. SETTING: General practices in the Auckland and Midland regions, with over-sampling of indigenous Maori governance practices. METHOD: Practice immunisation coverage and timeliness were measured. Primary care practice characteristics relevant to immunisation delivery by the practice were described. Associations of these practice characteristics with higher practice immunisation coverage and more timely immunisation delivery were determined. RESULTS: A total of 124 (61%) of 205 eligible practices were recruited. A median (25th to 75th centile) of 71% (57-77%) of registered children at each practice were fully immunised, and 56% (40-64%) had no immunisation delay. In multivariate analyses, both practice immunisation coverage (P<0.001) and timeliness (P<0.001) decreased with increased social deprivation. After adjustment for socioeconomic deprivation, region, and governance, immunisation coverage and timeliness were better at practices that enrolled children at a younger age (coverage: P = 0.002; timeliness P = 0.007), used one of the four available practice management systems (coverage: P<0.001; timeliness: P = 0.006), and had no staff shortages (coverage: P = 0.027; timeliness: P = 0.021). CONCLUSION: Practice immunisation coverage and timeliness vary widely in New Zealand. General organisational and structural aspects of general practices are key determinants of general practice immunisation delivery.

The use and misuse of media headlines: lessons from the MeNZB immunisation campaign.

AIM: Tracking the use of headlines with single issue stories in the New Zealand print media from their source, three case studies of the MeNZB vaccination campaign's presentation in the print media were examined. METHOD: Article headlines were tracked in the three case studies. All headlines were coded between two researchers to review for accurate or misleading presentations in terms of whether the headlines matched the article content. RESULTS: In these three case studies 26 out of 51 headlines were inaccurate when compared with the article content (51%), with a further 6 being misleading (total of 61%). CONCLUSIONS: These small case studies illustrate the difficulties arising at the intersection between media and public health interests. There is an inherent tension between public health publicity needs, and the print media needs. To maintain public confidence, health planners constantly need to develop and review their health promotion messages and relationships with the media. Close and ongoing dialogue between media and public health professionals are important, with recognition on each side of the different drivers and needs in two different sectors.