Vaccination for Aboriginal and Torres Strait Islander people

Some vaccines have different recommendations for Aboriginal and Torres Strait Islander people. For children, these are vaccines against:

• hepatitis A
• influenza
• meningococcal disease
• pneumococcal disease
• tuberculosis (BCG [bacille Calmette–Guérin] vaccine)

For adults, these are vaccines against:

• hepatitis B
• influenza
• pneumococcal disease
• respiratory syncytial virus

The Aboriginal and Torres Strait Islander peoples are a diverse population characterised by diverse languages, culture and geographic distribution. Aboriginal and Torres Strait Islander people live all over the country with a majority living in metropolitan areas compared to remote and regional settings.¹ It is important for clinicians to accurately identify Aboriginal and Torres Strait Islander peoples and to critically evaluate vaccine preventable disease (VPD) risk based on the individual (e.g. age, health, lifestyle) and the differing vaccine recommendations across states.

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%)²
• tuberculosis
• influenza
• measles (mortality rate >20%)²
• syphilis

In recent decades, vaccination has been very successful in eliminating or substantially reducing the rates of many vaccine-preventable diseases in all Australians. Vaccination has also substantially improved Aboriginal and Torres Strait Islander child mortality rates.³ The vaccine-preventable diseases among Aboriginal and Torres Strait Islander people that have been significantly reduced by successful vaccination programs are:⁴

• diphtheria
• poliomyelitis
• tetanus
• hepatitis A 
• hepatitis B
• measles
• mumps 
• rubella

Risk factors often associated with the burden of vaccine preventable diseases among Aboriginal and Torres Strait Islander people, such as smoking and overcrowded housing, are downstream indicators secondary to a range of inter-related historical, cultural, political, psychosocial and environmental factors. There are some extra vaccines that are recommended for Aboriginal and Torres Strait Islander peoples, for those disease where Aboriginal and Torres Strait Islander people have a disproportionately higher burden of disease 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 disproportionate disease among Aboriginal and Torres Strait Islander people.⁴

Vaccination against Haemophilus influenzae type b (Hib) disease is an example where recommendations for Aboriginal and Torres Strait Islander children have previously differed to those for non-indigenous people due to disparities in the incidence of Hib disease between the two population groups. Following a targeted immunisation program where Aboriginal and Torres Strait Islander children were recommended Hib-containing vaccines known as PRP-OMPs, which were more immunogenic than the other conjugate Hib (PRP-T) vaccines, Hib disease in Aboriginal and Torres Strait Islander children has declined.^5,6 Now, Aboriginal and Torres Strait Islander children and non-Indigenous children receive the same vaccine and the same schedule.

The following groups all provide vaccination services to Aboriginal and Torres Strait Islander people, and are important to the success of immunisation programs by promoting access to culturally safe services and practices:

• general practitioners
• Aboriginal Community Controlled Health Services
• Aboriginal Medical Services
• community health services
• the Royal Flying Doctor Service
• state and territory corrective services

Disparities in vaccination coverage point to the importance of ascertaining people who identify as being Aboriginal and/or Torres Strait Islander, particularly in mainstream health services in urban areas. Using patient information systems to record Aboriginal and Torres Strait Islander status and schedule preventive health services could increase opportunistic vaccination and enable patients to receive reminders.

This could lead to improvements in coverage and ensure that people receive their vaccines at the right time.⁷ Recording Aboriginal and Torres Strait Islander status also plays a critical role in informing any changes needed to vaccine recommendations for Aboriginal and Torres Strait Islander people. Using culturally appropriate service delivery and communication strategies, and specific Medicare items will also help to improve access to health services for Aboriginal and Torres Strait Islander people.^8-10

1. Telethon Kids Institute. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. Perth, WA: Telethon Kids Institute; 2022. (Accessed 17 October 2022). https://www.telethonkids.org.au/globalassets/media/documents/aboriginal-health/working-together-second-edition/working-together-aboriginal-and-wellbeing-2014.pdf
2. Dowling PJ. 'A great deal of sickness': introduced diseases among the Aboriginal people of colonial southeast Australia, 1788–1900 [PhD thesis]. Canberra: Australian National University; 1998.
3. Menzies R, Turnour C, Chiu C, McIntyre P. Vaccine preventable diseases and vaccination coverage in Aboriginal and Torres Strait Islander people, Australia, 2003 to 2006. Communicable Diseases Intelligence 2008;32 Suppl:S2-67.
4. Naidu L, Chiu C, Habig A, et al. Vaccine preventable diseases and vaccination coverage in Aboriginal and Torres Strait Islander people, Australia 2006–2010. Communicable Diseases Intelligence 2013;37 Suppl:S1-95.
5. Markey P, Krause V, Boslego JW, et al. The effectiveness of  Haemophilus influenzae  type b conjugate vaccines in a high risk population measured using immunization register data. Epidemiology and Infection 2001;126:31-6.
6. Hanna JN. Impact of Haemophilus influenzae type b (Hib) vaccination on Hib meningitis in children in Far North Queensland, 1989 to 2003. Communicable Diseases Intelligence 2004;28:255-7.
7. Bailie RS, Togni SJ, Si D, Robinson G, d'Abbs PH. Preventive medical care in remote Aboriginal communities in the Northern Territory: a follow-up study of the impact of clinical guidelines, computerised recall and reminder systems, and audit and feedback. BMC Health Services Research 2003;3:15.
8. Andrews B, Simmons P, Long I, Wilson R. Identifying and overcoming the barriers to Aboriginal access to general practitioner services in rural New South Wales. Australian Journal of Rural Health 2002;10:196-201.
9. Hayman NE, White NE, Spurling GK. Improving Indigenous patients' access to mainstream health services: the Inala experience. Medical Journal of Australia 2009;190:604-6.
10. Couzos S, Delaney Thiele D. The new "Indigenous health" incentive payment: issues and challenges. Medical Journal of Australia 2010;192:154-7.