Vaccination for Aboriginal and Torres Strait Islander people

After European colonisation of Australia, Aboriginal and Torres Strait Islander peoples experienced infectious disease epidemics with very high morbidity and mortality. The diseases with the most serious effects were:

• smallpox (mortality rate >30%)¹
• tuberculosis
• influenza
• measles (mortality rate >20%)¹
• syphilis

High rates of disease were mainly due to lack of previous exposure² and high-density living in newly established settlements. Over many decades, higher rates of infectious disease have been associated with:

• lower standards of living; higher burden of chronic disease (such as diabetes, heart disease and chronic kidney disease); and poorer access to water, housing and health care³
• social determinants of health, such as low educational outcomes, lack of control over life circumstances and lack of cultural safety⁴

Because Aboriginal and Torres Strait Islander people have higher rates of some diseases, some extra vaccines are recommended for this group of people. Some vaccines that are recommended for non-Indigenous people may be recommended in a broader age range for Aboriginal and Torres Strait Islander people (see Table. Extra vaccines recommended for Aboriginal and Torres Strait Islander people).

Some vaccine-preventable diseases have a disproportionately high burden of disease in Aboriginal and Torres Strait Islander people compared with non-Indigenous Australians. One example is invasive pneumococcal disease. Vaccination reduced the burden of disease caused by serotypes that are in the vaccines, but other serotypes that are not included in the available vaccines continue to cause disease among Aboriginal and Torres Strait Islander people.⁶ Environmental factors such as living conditions, especially overcrowding, can also contribute to increased exposure to the disease.⁷ Timeliness of vaccination can also be a factor.⁵

Vaccination against Haemophilus influenzae type b (Hib) disease is an example where recommendations for Aboriginal and Torres Strait Islander children have changed over time. In the past, Aboriginal and Torres Strait Islander children received a different Hib vaccine in a different schedule from non-Indigenous children. Now, Aboriginal and Torres Strait Islander children and non-Indigenous children receive the same vaccine and the same schedule.

Before an effective Hib vaccine was introduced, the incidence of invasive Hib disease was very high in Aboriginal and Torres Strait Islander children, particularly in remote areas. It also occurred at a younger age than in non-Indigenous children. Thus, a vaccine to prevent Hib disease in Aboriginal and Torres Strait Islander children needed to be immunogenic as early as possible in infancy.

The previous Hib-containing vaccines, known as PRP-OMPs, were more immunogenic at 2 months of age than the other conjugate Hib (PRP-T) vaccines. For this reason, PRP-OMPs were the preferred Hib vaccine type for Aboriginal and Torres Strait Islander children in the first Hib vaccination programs, which started in 1993. Since then, Hib disease in Aboriginal and Torres Strait Islander children has declined.^8,9

Since October 2009, all infants receive PRP-T vaccines. Invasive Hib disease and nasopharyngeal colonisation with Hib are being closely monitored in high-incidence settings such as the Northern Territory and Western Australia after this change. To date, Hib epidemiology has not changed in relation to the change to PRP-T-containing vaccines for Aboriginal and Torres Strait Islander children. (See Haemophilus influenzae type b.)

See Infographic. Vaccination for Aboriginal and Torres Strait Islander children

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