Immunisation coverage annual report, 2011.

This, the 5th annual immunisation coverage report, documents trends during 2011 for a range of standard measures derived from Australian Childhood Immunisation Register data, and National Human Papillomavirus (HPV) Vaccination Program Register data. The proportion of children ‘fully vaccinated’ at 12, 24 and 60 months of age was 91.4%, 92.2% and 89.5% respectively. Although pneumococcal vaccine had similar coverage at 12 months to other vaccines, coverage was lower for rotavirus at 12 months (83.8%) and varicella at 24 months (83.9%). By late 2011, the percentage of children who received the 1st dose of diphtheria-tetanus-pertussis vaccine dose at less than 8 weeks of age was greater than 50% in 3 jurisdictions, the Australian Capital Territory, Victoria, and Queensland and at 70% for New South Wales and Tasmania. Although coverage at 12 months of age was lower among Indigenous children than non-Indigenous children in all jurisdictions, the extent of the difference varied. Overall, coverage at 24 months of age exceeded that at 12 months of age nationally. At 60 months of age, there was a marked variation between individual jurisdictions, ranging from coverage 8% lower in Indigenous children in South Australia to 6% higher in the Northern Territory. As previously documented, vaccines recommended for Indigenous children only (hepatitis A and pneumococcal polysaccharide vaccine) had suboptimal coverage at 60% and 68%, respectively. On-time receipt (before 49 months of age) of vaccines by Indigenous children at the 60-month milestone age improved between 2010 (18%) and 2011 (19%) but the disparity in on-time vaccination between Indigenous and non-Indigenous children increased at all 3 age milestones. The percentage of vaccine objectors in 2011 (1.7%) increased from 2007 when it was 1.1%. Coverage data for the 3rd dose of HPV from the national HPV register in the school catch up program was 71% but was substantially lower for the catch-up program for women outside school (39%–67%), although this was an improvement from 2010. Commun Dis Intell 2013;37(4):E291–E312.

This 9th annual immunisation coverage report shows data for 2015 derived from the Australian Childhood Immunisation Register and the National Human Papillomavirus (HPV) Vaccination Program Register. This report includes coverage data for ‘fully immunised’ and by individual vaccines at standard age milestones and timeliness of receipt at earlier ages according to Indigenous status. Overall, ‘fully immunised’ coverage has been mostly stable at the 12- and 24-month age milestones since late 2003, but at 60 months of age, coverage reached its highest ever level of 93% during 2015. As in previous years, coverage for ‘fully immunised’ at 12 and 24 months of age among Indigenous children was 3.4% and 3.3% lower than for non-Indigenous children overall, respectively. In 2015, 77.8% of Australian females aged 15 years had 3 documented doses of HPV vaccine (jurisdictional range 68.0–85.6%), and 86.2% had at least one dose, compared to 73.4% and 82.7%, respectively, in 2014. The differential of on-time vaccination between Indigenous and non-Indigenous children in 2015 diminished progressively from 18.4% for vaccines due at 12 months to 15.7% for those due at 24 months of age. In 2015, the proportion of children whose parents had registered an objection to vaccination was 1.2% at the national level, with large regional variations. This was a marked decrease from 1.8% in 2014 and the lowest rate of registered vaccination objection nationally since 2007 when it was 1.1%. Medical contraindication exemptions for Australia were more than double in 2015 compared with the previous year (635 to 1,401).

Role of maternal age at birth in child development among Indigenous and non-Indigenous Australian children in their first school year: a population-based cohort study

To measure the prevalence of respiratory symptoms and atopic disease in Aboriginal and Torres Strait Islander (indigenous) and non-indigenous children in the Australian Capital Territory (ACT). A two-stage questionnaire survey of children in the ACT with stage two completed for children identified by parents as having respiratory symptoms or asthma in the first stage cross-sectional survey. Participants in the study were: (i) all new entrant primary schoolchildren aged 4-6 years in 1999, 2000 and 2001, 217 being indigenous children and 10 604 being non-indigenous children (80% of eligible); and (ii) Year 1-6 primary schoolchildren in 2000, with 216 being indigenous children and 14 202 being non-indigenous children (52% of eligible). Respiratory symptoms (including recent wheeze and parent-reported asthma) and other factors were measured by parental questionnaire. Indigenous kindergarten children had more recent wheeze (21%, odds ratio (OR) 1.4 95% confidence interval (CI) 1.0-2.0)) and parent-reported asthma (24%, OR 1.8 95% CI 1.3-2.5) than non-indigenous children (both 15%). However, indigenous children had less eczema (25%, OR 0.7 95% CI 0.5-0.9) and hayfever (14%, OR 0.7 95% CI 0.5-1.0) than non-indigenous children (32% and 19%, respectively). Among children with respiratory symptoms, the symptom severity did not differ between groups, but indigenous children were exposed to more environmental tobacco smoke (ETS) (63%, OR 3.5 95% CI 2.1-5.9) than non-indigenous children (32%). Indigenous children in the ACT have more respiratory morbidity but less of the atopic diseases of hayfever and eczema than non-indigenous children. Whether the respiratory morbidity represents 'asthma' or results from increased ETS exposure is unclear and needs to be further explored.

Although the prevalence of untreated dental caries among Indigenous Australian children greatly exceeds the prevalence observed among non-Indigenous children, the associations of dental caries with risk factors is considered to be the same. To estimate the association of modifiable risk factors with area-based inequalities in untreated dental caries among Indigenous and non-Indigenous Australian children using decomposition analysis. Cross-sectional study using data from Australia's National Child Oral Health Study 2012-2014, a nationally representative sample of both Indigenous and non-Indigenous children aged 5 to 14 years. Data analyses were completed in November 2018. Outcomes were the mean number of decayed tooth surfaces in the primary dentition for children aged 5 to 10 years and mean number of decayed tooth surfaces in the permanent dentition for children aged 8 to 14 years. The area-based measure was the school-based Index of Community Socio-Educational Advantage, with individual-level variables including sex, equivalized household income, tooth-brushing frequency, sugar-sweetened beverage (SSB) consumption, time from last dental visit, and residing in an area with water fluoridation. There were 720 Indigenous children aged 5 to 10 years, 14 769 non-Indigenous children aged 5 to 10 years, 738 Indigenous children aged 8 to 14 years, and 15 631 non-Indigenous children aged 8 to 14 years. For area-based inequalities in primary dentition among Indigenous children, two-thirds of the contribution was associated with SSB consumption (65.9%; 95% CI, 65.5%-66.3%), followed by irregular tooth brushing (15.0%; 95% CI, 14.6%-15.5%) and low household income (14.5%; 95% CI, 14.1%-14.8%). Among non-Indigenous children, almost half the contribution was associated with low household income (47.6%; 95% CI, 47.6%-47.7%), followed by SSB consumption (31.0%; 95% CI, 30.9%-31.0%) and residing in an area with nonfluoridated water (9.5%; 95% CI, 9.5%-9.6%). For area-based inequalities in permanent dentition among Indigenous children, 40.0% (95% CI, 39.9%-40.1%) of the contribution was associated with residing in an area with nonfluoridated water, followed by low household income (20.0%; 95% CI, 19.7%-20.0%) and consumption of SSBs (20.0%; 95% CI, 19.9%-20.1%). Among non-Indigenous children, the contribution associated with low household income, SSB consumption, and last dental visit more than a year ago were each 28.6%. The association of modifiable risk factors with area-based inequalities in untreated dental caries among Indigenous and non-Indigenous Australian children differed substantially. Targets to reduce SSB consumption may reduce oral health inequalities for both groups; however, Indigenous children require additional focus on oral hygiene.

BackgroundIn the 1990s pneumonia hospitalisation rates in Western Australia (WA) were 13 times higher in Indigenous children than in non-Indigenous children. Rates of invasive pneumococcal disease in Indigenous children declined...

The aim of this study was to investigate dental procedures received under hospital general anaesthetic by indigenous and non-indigenous Australian children in 2002-2003. Separation data from 1297 public and private hospitals were obtained from the Australian Institute of Health and Welfare National Hospital Morbidity Database for 2002-2003. The dependant variable was the admission rate of children receiving four categories of dental care (i.e. extraction, pulpal, restoration or other). The explanatory variables included sex, age group, indigenous status and location (i.e. major city, regional or remote). Rates were calculated using estimated resident population counts. The sample included 24 874 children aged from 2 to 14 years. Some 4.3% were indigenous (n = 1062). Admission rates for indigenous and non-indigenous children were similar, with indigenous males having 1.2 times the admission rate of indigenous females (P < 0.05). Indigenous children aged < 5 years had 1.4 times the admission rate of similarly aged non-indigenous children (P < 0.001) and 5.0 times the admission rate of 10-14-year-old indigenous children (P < 0.001). Remote-living indigenous children had 1.5 times the admission rate of their counterparts in major cities or regional areas (P < 0.001), and 1.4 times the admission rate of remote-living non-indigenous children (P < 0.01). The extraction rate of indigenous males was 1.3 times that of non-indigenous males (P < 0.01), and 1.2 times that of indigenous females (P < 0.05). Pre-school indigenous children had 2.2 times the extraction rate of similarly aged non-indigenous children (P < 0.001), and 5.3 times that of indigenous 10-14-year-olds (P < 0.001). The extraction rate of remotely located indigenous children was 1.5 times that of indigenous children in major cities (P < 0.01), and 1.8 times that of remote-living non-indigenous children (P < 0.001). In certain strata - particularly males, the very young and those in remote locations - indigenous children experienced higher rates of extractions than non-indigenous children when undergoing care in a hospital dental general anaesthetic setting.

Evaluation of impact of 23 valent pneumococcal polysaccharide vaccine following 7 valent pneumococcal conjugate vaccine in Australian Indigenous children

To compare the dental disease experience of Indigenous and non-Indigenous children in South Australia's mid-north region (regional area) and to assess Indigenous oral health differences at a regional- and state-level. Data were collected from a School Dental Service based in an Aboriginal-owned medical health service and standard school dental clinics in the regional area from March 2001 to March 2006. State-level data were obtained over a 12-month period in 2003. Caries prevalence (per cent dmft or DMFT >0) and severity (mean dmft or DMFT, SiC and SiC10) measures were used to assess dental disease experience. In the regional area, Indigenous children aged <10 years had 1.6, 1.9, 1.6 and 1.4 times the percent dmft >0, mean dmft, SiC primary and SiC(10) primary, respectively, of their non-Indigenous counterparts, while Indigenous children aged 6+ years had 1.3, 1.7, 1.7 and 1.6 times the percent DMFT > 0, mean DMFT, SiC permanent and SiC10 permanent, respectively, of non-Indigenous children. Indigenous children in the regional area had significantly higher caries prevalence and severity than Indigenous children at a state-level. Indigenous children in South Australia's mid-north region are dentally disadvantaged in comparison with their non-Indigenous counterparts and with the general South Australian Indigenous child population.

Australian Immunisation Register data have been analysed for children aged &lt; 5 years, focusing on changes in vaccination coverage at standard age milestones (12, 24 and 60 months) between 2018 and 2019. ‘Fully vaccinated’ coverage in 2019 increased by 0.1–0.4% at the three age milestones to 94.3% at 12 months, 90.2% at 24 months (in the context of additional antigens required at 24 months) and 94.2% at 60 months. Rotavirus vaccine coverage (2 doses) increased from 90.9% in 2018 to 91.9% in 2019. ‘Fully vaccinated’ coverage in Aboriginal and Torres Strait Islander (hereafter respectfully referred to as Indigenous) children increased by 0.5–1.1% in 2019, reaching 92.9% at 12 months, 88.9% at 24 months and 96.9% at the 60 months (2.7 percentage points higher than in children overall). Recorded influenza vaccination coverage in children aged 6 months to &lt; 5 years increased by 11.4 percentage points to 42.7% in Indigenous children in 2019, and by 15.6 percentage points to 41.8% in children overall. Longstanding issues with timeliness of vaccination in Indigenous children persisted, although the disparity between Indigenous and non-Indigenous children in on-time coverage (within 30 days of due date), for vaccines due at 4 months of age, decreased from 10.4–10.7 to 9.6–9.8 percentage points between 2018 and 2019. The timeliness of ‘fully vaccinated’ coverage was also examined at earlier age milestones (3 months after due date of last scheduled vaccine) of 9, 15, 21 and 51 months, by Indigenous status, socioeconomic status and remoteness of area of residence. Coverage in children living in the least-advantaged residential area quintile was 2.6–2.7% lower than that for those living in the most-advantaged quintile at the 9-, 15- and 21-month milestones, although these disparities were 0.5–1.5 percentage points lower than in 2018. Coverage at the earlier milestones in Indigenous children in remote areas was 1.5–6.7% percentage points lower than that for Indigenous children in major cities and regional areas, although there were some improvements since 2018. Importantly, although Indigenous children had lower coverage for the second dose of measles-mumps-rubella vaccine at 24 months (92.7% versus 93.3% overall), coverage increased to 98.8% at 60 months; coverage was also high overall at 96.4%, above the 95% target critical to measles control. In conclusion, this report demonstrates continuing improvements across a range of immunisation indicators in Australia in 2019. However, some issues with timeliness persist, particularly in Indigenous and socioeconomically disadvantaged children. New coverage targets for earlier protection in the first 2 years of life may be indicated, along with a review of current ‘fully vaccinated’ assessment algorithms, particularly at the 60-month age milestone.

Australian Immunisation Register data have been analysed for children aged < 5 years, focusing on changes in vaccination coverage at standard age milestones (12, 24 and 60 months) between 2018 and 2019. 'Fully vaccinated' coverage in 2019 increased by 0.1-0.4% at the three age milestones to 94.3% at 12 months, 90.2% at 24 months (in the context of additional antigens required at 24 months) and 94.2% at 60 months. Rotavirus vaccine coverage (2 doses) increased from 90.9% in 2018 to 91.9% in 2019. 'Fully vaccinated' coverage in Aboriginal and Torres Strait Islander (hereafter respectfully referred to as Indigenous) children increased by 0.5-1.1% in 2019, reaching 92.9% at 12 months, 88.9% at 24 months and 96.9% at the 60 months (2.7 percentage points higher than in children overall). Recorded influenza vaccination coverage in children aged 6 months to < 5 years increased by 11.4 percentage points to 42.7% in Indigenous children in 2019, and by 15.6 percentage points to 41.8% in children overall. Longstanding issues with timeliness of vaccination in Indigenous children persisted, although the disparity between Indigenous and non-Indigenous children in on-time coverage (within 30 days of due date), for vaccines due at 4 months of age, decreased from 10.4-10.7 to 9.6-9.8 percentage points between 2018 and 2019. The timeliness of 'fully vaccinated' coverage was also examined at earlier age milestones (3 months after due date of last scheduled vaccine) of 9, 15, 21 and 51 months, by Indigenous status, socioeconomic status and remoteness of area of residence. Coverage in children living in the least-advantaged residential area quintile was 2.6-2.7% lower than that for those living in the most-advantaged quintile at the 9-, 15- and 21-month milestones, although these disparities were 0.5-1.5 percentage points lower than in 2018. Coverage at the earlier milestones in Indigenous children in remote areas was 1.5-6.7% percentage points lower than that for Indigenous children in major cities and regional areas, although there were some improvements since 2018. Importantly, although Indigenous children had lower coverage for the second dose of measles-mumps-rubella vaccine at 24 months (92.7% versus 93.3% overall), coverage increased to 98.8% at 60 months; coverage was also high overall at 96.4%, above the 95% target critical to measles control. In conclusion, this report demonstrates continuing improvements across a range of immunisation indicators in Australia in 2019. However, some issues with timeliness persist, particularly in Indigenous and socioeconomically disadvantaged children. New coverage targets for earlier protection in the first 2 years of life may be indicated, along with a review of current 'fully vaccinated' assessment algorithms, particularly at the 60-month age milestone.

Purpose: Concern exists about the cross-cultural appropriateness of existing language assessments for non-mainstream populations, including Indigenous children who may speak a non-standard dialect of the mainstream language. This study therefore aims to investigate the language skills of Indigenous Australian children in comparison with non-Indigenous children, with a view to exploring the cultural appropriateness of language sampling assessment methods.Method: The performance of 51 typically developing Indigenous and non-Indigenous Australian children was compared on a standardised assessment and a spoken narrative protocol using language sample analysis measures. All children were in their first year of school and from the same regional city.Result: While the Indigenous children attained significantly lower receptive vocabulary scores than the non-Indigenous children, most language sampling measures from the spoken narrative protocol were similar across the two groups of children.Conclusion: Flexible, naturalistic language sampling approaches using a spoken narrative protocol are thus recommended for Indigenous children from the under-researched Australian context. However, normative data for language sampling are lacking, and further research is needed to explore the cultural validity of assessment and diagnostic procedures for Indigenous Australian children, as well as the influence of socioeconomic and family factors on language skills.

To compare the prevalence of undernutrition and anemia in indigenous and non-indigenous children < 5 years of age at the national level, by region and by urban and rural areas, and to evaluate the degree to which the socioeconomic condition of the family predicts the differences. A national probabilistic survey was conducted in Mexico in 1999. Indigenous families were identified as those in which at least one woman 12-49 years of age in the household spoke a native language. The prevalence of undernutrition (stunting, wasting and underweight) and anemia was compared between indigenous and non-indigenous children. Probability ratios (PR) were used to compare prevalences in indigenous and non-indigenous children adjusting for socioeconomic status (SES) of the family and for other covariates. The prevalences of stunting and underweight were greater in indigenous than in non-indigenous children. At the national level and in urban areas the prevalences were three times greater and in rural areas approximately 2 times greater (p < 0.05). No differences were found in the prevalence of wasting (p > 0.05). The prevalence of anemia in indigenous children was one third greater than in non-indigenous children at the national level (p < 0.05) and was between 30 and 60% greater in urban areas and in the regions studied (p < 0.05) but was not statistically significant (p > 0.05) in rural areas. These differences were reduced to about half when adjusting for SES but remained significantly higher in indigenous children (p < 0.05). Indigenous children have higher probabilities of stunting and underweight than non-indigenous children. The differences are larger in urban areas and in higher socioeconomic geographic regions and are explained mostly by socioeconomic factors. The overall difference in the probability of anemia is small, is higher only in urban relative to rural areas, and is explained to a lesser degree by socioeconomic factors. Policy and programs should be designed and implemented to reduce the dramatic differences in nutritional status between indigenous and non-indigenous children in Mexico. The English version of this paper is available too at: http://www.insp.mx/salud/index.html.

Sleep quality and obstructive sleep apnoea in Indigenous and non-Indigenous Australian children

We analysed Australian Immunisation Register (AIR) data, predominantly for National Immunisation Program funded vaccines, as at 2 April 2023 for children, adolescents and adults, focusing on the calendar year 2022 and on trends from previous years. This report aims to provide comprehensive analysis and interpretation of vaccination coverage data to inform immunisation policy and programs. Fully vaccinated coverage in Australian children in 2022 was 0.6-1.1 percentage points lower than in 2021 at the 12-month (93.3%), 24-month (91.0%) and 60-month (93.4%) age assessment milestones. This follows the 0.6-0.8 percentage point decrease at the 12- and 60-month milestones between the 2020 and 2021 reports, which came after eight years of generally increasing coverage. Due to the lag time involved in assessment, fully vaccinated coverage figures for 2021 and 2022 predominantly reflect vaccinations due in 2020 and 2021, respectively, and therefore reflect impacts of the first two years of the coronavirus disease 2019 (COVID-19) pandemic. Fully vaccinated coverage in Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) children was 1.2-2.2 percentage points lower in 2022 than in 2021 at the 12-month (90.0%), 24-month (87.9%) and 60-month (95.1%) milestones, indicating differential impacts of the pandemic. However, at the 60-month milestone, coverage in Indigenous children was 1.7 percentage points higher than in children overall. There were also clear pandemic impacts on on-time (within 30 days of recommended age) vaccination. On-time coverage of both the second dose of diphtheria-tetanus-pertussis and the first dose of measles-mumps-rubella-containing vaccines decreased progressively from mid-2020 onwards (6 and 12 percentage point falls, respectively) before recovering partially in the second half of 2022, with decreases 1.5-2.3 percentage points greater in Indigenous than non-Indigenous children, from an already close to 10 percentage points lower pre-pandemic baseline. Of adolescents turning 15 years in 2022, a total of 85.3% of girls and 83.1% of boys (83.0% and 78.1% of Indigenous girls and boys) had received at least one dose of human papillomavirus (HPV) vaccine by their fifteenth birthday, 0.9-1.3 percentage points lower than in 2021 (2.5-3.1 percentage points for Indigenous adolescents), also reflecting pandemic impacts. It will be important to monitor coverage with the single-dose HPV vaccine schedule - which was implemented from February 2023 - to ensure that it is sustained (ideally, increasing) and equitable, given that coverage in 2022 was 5-6 percentage points lower in adolescents in socioeconomically disadvantaged and remote areas. By 31 December 2022, coverage for an adolescent dose of diphtheria-tetanus-acellular pertussis vaccine in adolescents turning 15 years in 2022 was 86.9% (82.6% for Indigenous adolescents) and coverage for an adolescent dose of meningococcal ACWY vaccine in those turning 17 years was 75.9% (65.6% for Indigenous adolescents). Ongoing adolescent coverage gaps warrant tailored strategies to achieve higher vaccine uptake. Zoster vaccination coverage in 2022 was 41.3% in adults turning 71 years (37.7% in Indigenous adults), 2.6 (3.6) percentage points higher than in 2021, and was highest in adults turning 75 years (54.6% and 54.0%), reflecting a combination of vaccination at 70 years and catch-up at older ages. Coverage of 13-valent pneumococcal conjugate vaccine (13vPCV) was 33.8% in adults turning 70 years in 2022 (37.7% in Indigenous adults), 9.9 (12.6) percentage points higher than in 2021. These increases may be partly due to more complete reporting following the introduction of mandatory reporting to the AIR in mid-2021. Influenza vaccination coverage in adults in 2022 increased with increasing age, reaching 73.0% in the ≥ 75 years age group. Coverage was higher in 2022 than in 2021 across all adult age groups, with the proportionate increase since 2019 four- to five-fold higher in those aged < 65 years than in those aged ≥ 65 years. This likely reflects increased completeness due to mandatory reporting, with coverage previously substantially underestimated in younger adults. Vaccination coverage in children and adolescents decreased modestly in 2022, reflecting impacts of the COVID-19 pandemic, but remained relatively high in global terms. The decrease in coverage was greater in Indigenous children and adolescents, with timeliness of vaccination an ongoing issue exacerbated by the pandemic. While adult coverage increased in 2022 - likely, in part, due to the introduction of mandatory reporting to AIR resulting in more accurate estimates - it remains suboptimal. Limited evidence suggests the lower coverage in children and adolescents is due to a combination of acceptance and access factors. Particularly given the evidence that these modest declines in coverage have continued into the first half of 2023, further exploration is needed to better understand these factors and to inform approaches to effectively address barriers and increase vaccine uptake.