Vaccination for Aboriginal and Torres Strait Islander people
Some vaccines have different recommendations 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
- meningococcal disease
- pneumococcal disease
- tuberculosis (BCG [bacille Calmette–Guérin] vaccine)
For adults, these are vaccines against:
Introduction of infectious diseases to 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
- measles (mortality rate >20%)1
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
Success in vaccination for Aboriginal and Torres Strait Islander people
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.5 The vaccine-preventable diseases among Aboriginal and Torres Strait Islander people that have been significantly reduced by successful vaccination programs are:6
- hepatitis A
- hepatitis B
Burden of vaccine-preventable diseases in Aboriginal and Torres Strait Islander people
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.)
These vaccines are in addition to the vaccines recommended for all Australians, or those recommended in particular medical, occupational, behavioural or other risk groups.
Recommendation for Aboriginal and Torres Strait Islander people
MenACWY and MenB (meningococcal)
13vPCV (pneumococcal conjugate)
23vPPV (pneumococcal polysaccharide)
Immunisation service delivery in Aboriginal and Torres Strait Islander communities
The following groups all provide vaccination services to Aboriginal and Torres Strait Islander people, and are important to the success of immunisation programs:
- 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.10 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.11-13
- 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.
- Boughton CR. Smallpox and Australia. Internal Medicine Journal 2002;32:59-61.
- Australian Institute of Health and Welfare (AIHW). The health and welfare of Australia’s Aboriginal and Torres Strait Islander people: an overview. Cat. no. IHW 42. Canberra: AIHW; 2011.
- Eades SJ. Reconciliation, social equity and Indigenous health [editorial]. Medical Journal of Australia 2000;172:468-9.
- 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.
- 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.
- Quinn EK, Massey PD, Speare R. Communicable diseases in rural and remote Australia: the need for improved understanding and action. Rural and remote health 2015;15:3371.
- 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.
- 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.
- 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.
- 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.
- 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.
- Couzos S, Delaney Thiele D. The new "Indigenous health" incentive payment: issues and challenges. Medical Journal of Australia 2010;192:154-7.
- bacille Calmette-Guérin
- polyribosylribitol phosphate
- 13-valent pneumococcal conjugate vaccine
- 23-valent pneumococcal polysaccharide vaccine