A National Review of Vaccine Preventable Diseases in Australia
Date
2019
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Meder, Kelley
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My MAE projects centred around vaccine preventable diseases in Australia. My projects consisted of: a national audit of the Australian Immunisation Register, an epidemiological review of pneumococcal disease, an evaluation of the enhanced surveillance system for Haemophilus influenzae type b (Hib) disease, and contributing to response efforts of the exposure of an active case of tuberculosis to immunocompromised patients.
My epidemiological project (Chapter 2) consisted of an audit of the Australian Immunisation Register (AIR), which captures vaccination status for all Australians, to assess the effectiveness of the transfer of immunisation encounter records to the AIR and to identify ways to improve it. Through this research, I documented an error rate of 13.7%, meaning 13.7% of antigen-specific records on the register which were classified as being overdue for administration were actually up to date. Recommendations to reduce vaccination encounter data in the AIR included improving data entry in electronic systems and considering options to reduce the failure of electronic data transfer to AIR via practice management software.
Topical to an upcoming change on the Australian National Immunisation Program (NIP) to a 2+1 pneumococcal immunisation schedule, I analysed notification, hospitalisation, and mortality data for pneumococcal disease from 2002-2016 for my data analysis project (Chapter 3). Focusing on the impact of the 13-valent pneumococcal conjugate vaccine (13vPCV) since its NIP introduction mid-2011, I analysed national trends by age group, Indigenous status, and serotype. Through this review I identified the decline or stabilisation in rates of invasive pneumococcal disease (IPD) in all age groups except those <5 years of age, adding to the evidence which supported the immunisation schedule change to include a booster dose at 12 months of age. This change aimed to increase protection in those <5 years of age. I also identified similar trends to that of IPD, although to a lesser extent, in presumptive non-invasive pneumococcal community acquired pneumonia hospitalisations, presenting national trends for the first time.
The Haemophilus influenzae type b (Hib) Case Surveillance Scheme (HCSS) is the national enhanced Hib disease surveillance system which captures data not routinely collected from Hib disease case notifications. Additional information collected includes detailed case immunisation status, risk factor history, and laboratory diagnostic information. I conducted the first evaluation on the HCSS (Chapter 4). This evaluation supported the collection of enhanced Hib disease data, however areas identified for improvement included: data quality, output production, system simplicity, and the return of the HCSS to the Department of Health with adjusted methods for enhanced data collection.
My final project was a response to an acute public health incident; the exposure of immunocompromised patients to an active tuberculosis case (Chapter 5). Tuberculosis screening was prioritised to those deemed of highest risk based on immunocompromised status. I developed a database using REDCap data management software which captured case and patient information for reference and future analysis. I developed and generated reports to produce epidemiological snapshots of response efforts. In addition, I undertook a risk assessment to identify key risks, barriers, and areas for improvement regarding the response.
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