Annual Immunisation Coverage Report 2017

Annual ImmunisationCoverage Report2017

Authors

Brynley HullA

Alexandra HendryA

Aditi DeyA,B

Julia BrothertonC

Kristine MacartneyA,B

Frank BeardA,B

ANational Centre for Immunisation Research and Surveillance, Locked Bag 4001, Westmead, NSW 2145BThe University of Sydney, NSW 2006 AustraliaCNational HPV Vaccination Program Register, VCS Foundation, PO Box 310, East Melbourne, VIC 8002Corresponding author: Mr Brynley Hull, National Centre for Immunisation Research and Surveillance, The Children's Hospitalat Westmead and The University of Sydney, Locked Bag 4001, Westmead, NSW 2145. Telephone: 161 2 9845 1435.Facsimile: 161 2 9845 1418. Email: [email protected]

The National Centre for Immunisation Research and Surveillance is supported by the Australian Government Department ofHealth, the NSWMinistry of Health and The Children's Hospital at Westmead. The opinions expressed in this report are thoseof the authors, and do not necessarily represent the views of these agencies.The authors acknowledge Karen Winch from the National HPV Vaccination Program Register for extracting and preparing allthe human papillomavirus (HPV) data in this report, and Peter McIntyre for his comments on a late draft of the report.

2

Contents

Abstract ................................................................................................ ................................................................................................ ................................................... 7Introduction......................................................................................................................................................................... ................................................................. 7Methods ................................................................................................ ................................................................................................ .................................................. 9

Coverage in young children aged ,10 years ................................................................................................................................................................ 9Coverage in adolescents ................................................................................................ ................................................................................................ ........ 11Indigenous status................................................................................................ ................................................................................................ ....................... 11

Results ................................................................................................ ................................................................................................ ................................................... 11Young children................................................................................................ ................................................................................................ ............................. 11Adolescents ................................................................................................ ................................................................................................ ...................................23

Discussion......................................................................................................................................................................... .................................................................. 28Conclusion......................................................................................................................................................................... ..................................................................33References......................................................................................................................................................................... ..................................................................33

3

Tables

Table 1. Australian National Immunisation Program Schedule for children, adolescents and adults in 2017 ......................8Table 2. Vaccination coverage estimates (%) by age assessment milestone, vaccine/antigen and Indigenous

status, Australia, 12-month wide cohorts assessed during 2017a................................................................................................ 18Table 3. Vaccination delay, by length of delay, Indigenous status and remoteness category, Australia, 2017 ....................24Table 4. Catch-up vaccination activity for adolescents aged 10–19 years of agea not recorded as having received

relevant doses before 1 January 2017 who received catch-up vaccines during 2017, by state orterritory, Australia................................................................................................ .................................................................................................. 30

Table 5. Catch-up vaccination activity for adolescents aged 10–19 years of agea not recorded as having receivedrelevant doses before 1 January 2017 who received catch-up vaccines during 2017, by Indigenousstatus, Australia ................................................................................................ ....................................................................................................... 31

Table 6. Coverage (%) for 3 doses of human papillomavirus (HPV) vaccine for girls aged 15 years in 2012–2017,and boys aged 15 years in 2014-2017, by state/territory, Australia............................................................................................. 31

Table 7. HPV vaccination completion status (%) among those who commenced the course by birth year,Indigenous status, sex and number of doses received, Australia, 2007-2017 .......................................................................33

4

Figures

Box 1. Significant changes in immunisation policy, immunisation incentives and coverage calculationalgorithms, Australia, 2013 to 2017 ................................................................................................ ................................................................. 9

Figure 1. Trends in 'fully immunised' vaccination coverage estimates by quarter, Australia, 2006 to 2017........................... 12Figure 2. Trends in vaccination coverage estimates at 12 months of age, by vaccine/antigena and quarter,

Australia, 2006 to 2017 ................................................................................................ ........................................................................................ 13Figure 3. Trends in vaccination coverage estimates at 24 months of age by vaccine/antigena and quarter,

Australia, 2006 to 2017 ................................................................................................ ........................................................................................ 14Figure 4. Trends in vaccination coverage estimates at 60 months of age (72 months prior to December 2007) by

vaccine/antigena and quarter, Australia, 2006 to 2017 .................................................................................................................... 15Figure 5. Trends in 'fully immunised' vaccination coverage at 12 months of age by Indigenous status and

quarter, Australia, 2006 to 2017............................................................................................ ..........................................................................16Figure 6. Trends in 'fully immunised' vaccination coverage at 24 months of age by Indigenous status and

quarter, Australia, 2006 to 2017 ................................................................................................ ..................................................................... 16Figure 7. Trends in 'fully immunised' vaccination coverage at 60 months of age by Indigenous status and

quarter, Australia, 2006 to 2017................................................................................................ ...................................................................... 17Figure 8. Trends in coverage estimates for hepatitis Aa vaccine for Indigenous children by jurisdiction, Australia,b

2008 to 2017 ................................................................................................ ................................................................................................ ..............19Figure 9. Trends in coverage estimates for pneumococcala vaccine for Indigenous children by jurisdiction,b

Australia, 2008 to 2017 ................................................................................................ ........................................................................................ 19Figure 10. Recorded coverage of any dose of seasonal influenza vaccinea administered during 2017 to children

aged 6 months to,5 years, by Indigenous status and jurisdiction, Australia .................................................................. 20Figure 11. Trends in recorded coverage of any dose of seasonal influenza vaccinea among Indigenous children

aged 6 months to ,5 years, by jurisdiction, Australia, 2007-2017............................................................................................. 20Figure 12. Trendsa in on-time vaccination for the first dose of DTPa, by Indigenous status, Australia,

2008-2017 ................................................................................................ ................................................................................................................... 21Figure 13. Trendsa in on-time vaccination for the second dose of DTPa, by Indigenous status, Australia,

2008-2017 ................................................................................................ ................................................................................................................... 21Figure 14. Trendsa in on-time vaccination for the third dose of DTPa, by Indigenous status, Australia, 2008-2017 ...........22Figure 15. Trendsa in on-time vaccination for the first dose of MMR, by Indigenous status, Australia, 2008-2017..............22Figure 16. Trendsa in on-time vaccination for the second dose of MMR, by Indigenous status, Australia,

2008-2017 ................................................................................................ ...................................................................................................................23Figure 17. Pneumococcal conjugate vaccine (PCV) coverage at 12 months of age (3 doses) by Statistical Area 3,

Australia and major capital cities, 2017................................................................................................ .....................................................25Figure 18. Measles-mumps-rubella (MMR) coverage at 24 months of age (2 doses) by Statistical Area 3,

Australia and major capital cities, 2017................................................................................................ .................................................... 26Figure 19. Diphtheria-tetanus-acellular pertussis (DTPa) coverage at 24 months of age (4 doses) by Statistical

Area 3, Australia and major capital cities, 2017................................................................................................ ..................................... 27Figure 20. Trends in the number of children aged 6 months to 10 years with at least one new vaccination

exemption due to a medical contraindication entered into the Australian Immunisation Register,by state/territory, Australia, 2011-2017 ................................................................................................ ..................................................... 28

Figure 21. Proportion of vaccinations given to children aged ,7 years by provider type and state or territory,Australia, 2017 ................................................................................................ ................................................................................................ ......... 28

Figure 22. Proportion of vaccinations given to children aged ,7 years by type of reporting mechanism andstate or territory, Australia, 2017................................................................................................ ....................................................................29

Figure 23a. HPV vaccination coverage by dose number for females by age group as of mid-2017, Australia,2017 ................................................................................................ ................................................................................................ ................................32

Figure 23b. HPV vaccination coverage by dose number for males by age group as of mid-2017, Australia, 2017 ....................32

5

Vaccine abbreviations

13vPCV – 13-valent pneumococcal conjugate vaccine23vPPV – 23-valent pneumococcal polysaccharide vaccinedT – diphtheria-tetanus (adults, adolescents and children aged over 10 years formulation)dTpa – diphtheria-tetanus-acellular pertussis (adults, adolescents and children aged over 10 years formulation)DTPa – diphtheria-tetanus-acellular pertussis (children aged under 10 years formulation)Flu – influenzaHep A – hepatitis AHep B – hepatitis BHib – Haemophilus influenzae type bHib-MenC – combined Haemophilus influenzae type b and meningococcal CHPV – human papillomavirusHZ – herpes zosterMenACWY – quadrivalent (A, C, W, Y) meningococcal conjugateMenC – meningococcal CMMR – measles-mumps-rubellaMMRV – measles-mumps-rubella-varicellaPCV – pneumococcal conjugate vaccinePPV – pneumococcal polysaccharide vaccinePRP-OMP – Haemophilus influenzae type b conjugate (meningococcal outer membrane conjugate)VZV – varicella-zoster virus

6

AbstractThis 11th annual immunisation coverage report showsdata for the calendar year 2017 derived from the AustralianImmunisation Register (AIR) and the National HumanPapillomavirus (HPV) Vaccination Program Register. Thisis the first report to include data on HPV vaccine coursecompletion in Aboriginal and Torres Strait Islander (Indig-enous) adolescents. 'Fully immunised' coverage at the 12-month assessment age increased in 2017 to reach 93.8%and at the 60-month assessment age to reach 94.5%in December 2017. 'Fully immunised' coverage at the24-month assessment age decreased slightly to 89.8% inDecember 2017 following amendment in December 2016 toreintroduce the fourth DTPa vaccine dose at 18 months.'Fully immunised' coverage at 12 and 60 months of age inIndigenous children reached the highest ever recordedlevels of 93.2% and 96.9%, respectively, in December 2017.Catch-up vaccination activity for the second dose ofmeasles-mumps-rubella–containing vaccine was consid-erably higher among Indigenous adolescents compared tonon-Indigenous adolescents aged 10–19 years (20.3% ver-sus 6.4%, respectively, of those who had not previouslyreceived that dose). In 2017, 80.2% of females and 75.9% ofmales aged 15 years had received a full course of 3 dosesof HPV vaccine. Of those who received dose one, 79% ofIndigenous girls and 77% of Indigenous boys aged 15 yearsin 2017 completed 3 doses, compared to 91% and 90% ofnon-Indigenous girls and boys, respectively. A separatereport is planned to present adult AIR data and assess thecompleteness of reporting.

Keywords: immunisation coverage, immunisation delay,Indigenous immunisation coverage, influenza vaccination,adolescent immunisation coverage, human papillomavirusvaccine coverage

IntroductionThis is the 11th Annual Immunisation Coverage Report, withreports now covering the years 2007–2017.1–10 This reportcomplements other reports providing data on immunisa-tion coverage in Australia11–13 and highlights importanttrends, as well as policy and program changes in relationto these trends. It covers data for the calendar year 2017 aswell as trend data from 2006 onwards. For the first time, thisreport also includes data from the National Human Papil-lomavirus (HPV) Vaccination Program Register on comple-tion rates for the HPV vaccine course in Aboriginal andTorres Strait Islander adolescents. This report uses thelongstanding international practice of reporting at keymilestone ages for children to measure coverage againstnational targets and to track trends over time. Readers arereferred to the first report in the series for a more detailedexplanation of the methods used to analyse data.1 Table 1shows the Australian National Immunisation Program (NIP)Schedule for 2017.

The Australian Childhood Immunisation Register (ACIR) wasestablished on 1 January 1996 by incorporating demograph-ic data from Medicare on all enrolled children aged ,7years.14 On 30 September 2016, the ACIR expanded tobecome the AIR to collect data on vaccinations given frombirth to death.15 All people registered with Medicare areautomatically added to the AIR. Participation in the AIR is'opt-out' and so constitutes a nearly complete populationregister for Australian residents.14 A person not enrolled inMedicare can also be added to the AIR via a supplementarynumber. Since 2001, vaccinations given overseas may berecorded if a provider endorses their validity. Data aretransferred to the AIR when a recognised immunisationprovider supplies details of an eligible vaccination. Thiscould occur via medical practice management software,through direct data entry on the AIR website or by submit-ting paper encounter or history forms. High levels ofreporting to the AIR for child vaccinations are maintainedby a system of incentive payments for immunisation pro-viders and carers. These have been discussed in detailelsewhere.1,6 All vaccination records for a person remain onthe register indefinitely.

Important recent changes to immunisation policy, theincentive payment system and the 'fully immunised' cover-age algorithms for children are highlighted in Box 1.16 Newimmunisation requirements for federal government familyassistance payments (the 'No Jab, No Pay' policy) came intoeffect on 1 January 2016.17 Under this policy, only parents ofchildren (aged ,20 years, up from 9 years previously) whoare 'fully immunised' or on a recognised catch-up scheduleare eligible for the Child Care Benefit, Child Care Rebateand/or the Family Tax Benefit Part A end-of-year supple-ment. Children with medical contraindications or naturalimmunity to certain diseases (as reported by their generalpractitioner, and based on guidance in The AustralianImmunisation Handbook,18 a vaccination provider fact-sheet19 and the AIR Medical Exemption Form)17 continueto be exempt from the requirements, but 'conscientious'objection to vaccination on non-medical grounds is nolonger a valid exemption from immunisation requirementsfrom 1 January 2016 and, therefore, is no longer recordedon the AIR.19 In March 2016, a booster dose of diphtheria-tetanus-acellular pertussis (DTPa) vaccinewas funded at 18months of age, almost 13 years after it was removed fromthe NIP in 2003. A funded national herpes zoster (HZ)vaccine program commenced in November 2016, with asingle dose of HZ vaccine at 70 years of age (with a 5-yearcatch up for 71–79 year olds) for people who have notpreviously received a dose of zoster vaccine.20 BetweenFebruary and September 2017, state-funded meningococ-cal ACWY conjugate vaccination programs were implemen-ted in most jurisdictions for students in Years 10–12 as wellas adolescents aged 15–19 years who no longer attendschool. In July 2017, Queensland, South Australia, Victoriaand Western Australia changed the rotavirus vaccine

7

Annual Immunisation Coverage Report, 2017

Table1.

Australia

nNa

tiona

lImmun

isationProg

ram

Sche

dule

forc

hildren,

adoles

centsan

dad

ults

in20

17

Age

Vaccine

Child

hood

vaccines

Birth

HepB

2mon

ths

HepB

DTPa

Hib

Polio

13vP

CVRo

tavirus

4mon

ths

HepB

DTPa

Hib

Polio

13vP

CVRo

tavirusa

6mon

ths

HepB

DTPa

Hib

Polio

13vP

CVFlub

12mon

ths

Hib-Men

CMMR

HepAc

13vP

CVd

Flub

18mon

ths

DTPa

MMRV

HepAc

13vP

CVd

Flub

24mon

ths

Flub

48mon

ths

DTPa

Polio

23vP

PVe

Flub

Adolesce

ntva

ccines

12–15ye

ars

dTpa

HPV

15–4

9ye

ars

Flub

23vP

PVf

Adultv

accine

s

$50

years

Flub

23vP

PVf

65ye

ars

Flub

23vP

PVf

Preg

nant

wom

en(any

age)

dTpa

gFluh

70ye

ars

HZi

a Que

enslan

d,So

uthAu

stralia

,Victoria

andWestern

Australia

chan

gedfrom

a3-do

serotavirusva

ccinesche

dule

toa2-do

sesche

dule

on1July

2017.

b Ann

ualvac

cina

tion–allA

borig

inal

andTo

rres

StraitIsland

erch

ildrenag

ed6mon

thst

o,5ye

ars,allchildrenag

ed$6mon

thsw

ithmed

ical

riskfactors,Ab

original

andTo

rres

StraitIsland

erpe

ople

aged

$15

years,no

n-Indige

nous

adults

aged

$65

years.

c Abo

riginal

andTo

rres

StraitIsland

erch

ildren–do

sesat

12mon

thsan

d18

mon

thsof

agein

theNo

rthe

rnTe

rrito

ry,W

estern

Australia

,Que

enslan

dan

dSo

uthAu

stralia

.d B

ooster

dose

fora

llmed

icallyat

riskch

ildrenat

12mon

thso

fage

,and

Aboriginal

andTo

rres

StraitIsland

erch

ildrenag

ed12

mon

ths(So

uthAu

stralia

andWestern

Australia

)and

18mon

ths(No

rthe

rnTe

rrito

ryan

dQu

eens

land

).e M

edically

at-riskch

ildren.

f One

dose

every5ye

ars–Ab

original

andTo

rres

StraitIsland

erpe

ople

aged

$15

yearswith

med

ical

riskfactors;Ab

original

andTo

rres

StraitIsland

erad

ults

aged

$50

yearsan

dalla

dults

aged

$65

years.

g Duringthethird

trim

estero

fpregn

ancy.

h Ata

nystag

eof

preg

nanc

y.i A

sing

ledo

seof

HZva

ccineisfund

edfora

dults

aged

70ye

ars(w

itha5-ye

arca

tchup

for7

1–79

year

olds

)who

have

notp

reviou

slyrece

ived

ado

seof

HZva

ccine.

8

schedule from the 3-dose RotaTeq� schedule to the 2-doseRotarix� schedule, in line with the other jurisdictions.21

While 2017 represents the first full year of data of theexpanded whole-of-life register, adult vaccination datafrom the AIR are not included in this report. A separatereport is planned to present adult AIR data and assess thecompleteness of reporting.

MethodsCoverage in young children aged ,10 yearsThis report details national immunisation coverage usingAIR data as at 31 March 2018. The cohort method has beenused for calculating coverage at the population level(national and state/territory since the ACIR's inception).22

Cohort immunisation status was assessed at 12 months ofage (for vaccines due at 6 months), 24 months of age

Box 1. Significant changes in immunisation policy, immunisation incentives and coverage calculation algorithms, Australia,2013 to 2017

July 2017 – Queensland, South Australia, Victoria and Western Australia changed from the 3-dose RotaTeq� rotavirusvaccine schedule to the 2-dose Rotarix� schedule.

Coverage for the second dose of MMR-containing vaccine was no longer assessed at 60 months of age.

February – September 2017 – state-funded meningococcal ACWY conjugate vaccine programs implemented in mostjurisdictions for students in Years 10–12, as well as for adolescents aged 15–19 years who no longer attend school.

November 2016 – Funded national HZ vaccine program commenced, with a single dose of HZ vaccine at 70 years of agefor people who have not previously received a dose of zoster vaccine and a catch-up program for people aged 71–79years.

March 2016 – A booster dose of DTPa funded at 18 months of age.

January 2016 – New immunisation requirements for federal government family assistance payments (the 'No Jab, NoPay' policy) came into effect. Only parents of children (aged ,20 years, up from 9 years previously) who are 'fullyimmunised' or on a recognised catch-up schedule are eligible to receive the Child Care Benefit, Child Care Rebate and/or the Family Tax Benefit Part A end-of-year supplement. Children with medical contraindications or natural immunityfor certain diseases continue to be exempt from the requirements; however, objection on non-medical grounds is nolonger a valid exemption.

July 2014 – June 2015 – state/territory funded dTpa programs for women during the third trimester of pregnancycommenced in all jurisdictions.

March 2015 – Advice provided that first dose of 13vPCV could be given as early as 6 weeks of age.

Seasonal influenza vaccine funded for Aboriginal and Torres Strait Islander children aged 6 months to ,5 years. Therecommended upper age for children requiring 2 doses in the first year they receive influenza vaccine changed from,10 years to ,9 years.

December 2014 – Immunisation coverage assessment algorithm for 'fully immunised' at the 24-month milestoneamended to require 1 dose of MenC vaccine and 1 dose of varicella vaccine, along with the second dose of MMR vaccineinsteadof the first dose as previously. The seconddoseofMMRvaccine remained in the coverage assessment algorithmfor the 60-month milestone age.

December 2013 – Immunisation coverage assessment algorithm for 'fully immunised' at the 12-month milestoneamended to include a third dose of pneumococcal conjugate vaccine (PCV).

July 2013 – Combined Haemophilus influenzae type b (Hib) and MenC conjugate vaccine, Menitorix�, funded in the NIPSchedule at 12 months of age, replacing the single dose of monovalent MenC vaccine and booster dose of monovalentHib vaccine previously scheduled at 12 months of age.

Combination measles-mumps-rubella-varicella (MMRV) vaccine funded in the NIP at 18 months of age, replacing MMRdose previously scheduled at 4 years of age, and varicella vaccine dose previously scheduled at 18months of age. MMRvaccination at 4 years of age continued in parallel until first cohort eligible for MMRV vaccine reached 4 years of age.

Hepatitis A vaccination schedule for Indigenous children changed so that dose 1 administered at 12 months of age anddose 2 at 18 months of age in all four relevant jurisdictions (the Northern Territory, Western Australia, Queensland andSouth Australia).

February 2013 – HPV vaccine funded under the NIP for males aged 12–13 years, delivered in school-based programs.Catch up to age 15 to end of 2014.Source: NCIRS History of Vaccination.16

9


(for vaccines due at 12 and 18 months) and 60 months ofage (for vaccines due at 48 months). A minimum three-month lag period was allowed for late notification ofvaccinations to the AIR, but only vaccines given on orbefore a child's first, second or fifth birthdays, respective-ly, were included in coverage calculations.22 If a child'srecords indicated receipt of the last dose of a vaccine thatrequired more than 1 dose to complete the series, it wasassumed that earlier vaccines in the sequence had beengiven. This assumption has been shown to be valid in thepast.23,24

Three-month wide birth cohorts were used for most of thetime-trend analyses, with children aged 12 to,15 monthsfor the 12-month assessment age, children aged 24 to,27 months for the 24-month assessment age and chil-dren aged 60 to,63months for the 60-month assessmentage. Both 3-month wide and 12-month wide cohorts wereused for all other analyses in this report. The 12-monthwide cohorts used in this report were children bornbetween 1 January 2016 and 31 December 2016 for the12-month milestone; between 1 January 2015 and 31December 2015 for the 24-month milestone; and between1 January 2012 and 31 December 2012 for the 60-month(5-year) milestone.

The proportion of children designated as 'fully immu-nised' was calculated using the number of childrencompletely immunised with the vaccines of interest bythe designated age as the numerator and the totalnumber of Medicare-registered children in the agecohort as the denominator. 'Fully immunised' at 12months of age was defined as a child having a recordon the AIR of a third dose of a diphtheria (D), tetanus (T)and acellular pertussis (Pa) vaccine, a third dose of poliovaccine, a second or third dose of PRP-OMP–containingHaemophilus influenzae type b (Hib) vaccine or a thirddose of any other Hib-containing vaccine, a third dose ofhepatitis B vaccine, and a third dose of 13-valent pneu-mococcal conjugate vaccine (13vPCV). 'Fully immunised'at 24 months of age was defined as a child having arecord on the AIR of a fourth dose of DTPa – vaccine, thirddoses of hepatitis B and polio vaccines, a third or fourthdose of PRP-OMP Hib-containing vaccine, Infanrix Hexaor Hiberix (a third dose only of Infanrix Hexa or Hiberix ifgiven after 11.5 months of age), or a fourth dose of anyother Hib-containing vaccine, a dose of MenC vaccine, adose of varicella vaccine and a second dose of measles-containing vaccine (given as either MMR or MMRV). 'Fullyimmunised' at 60 months of age was defined as a childhaving a record on the AIR of a fifth dose of a DTPavaccine, a fourth dose of polio vaccine and second doseof an MMR vaccine.

Immunisation coverage estimates were also calculated forindividual NIP vaccines, including the three NIP vaccinesgiven in early childhood but not routinely reported on

and not part of 'fully immunised' calculations at 12, 24and 60 months of age. These are a second or third doseof rotavirus vaccine by 12 months of age; a second dose ofhepatitis A vaccine in Aboriginal and Torres Strait Islander(hereafter respectfully referred to as Indigenous) childrenby 30 months of age; and a fourth (booster) dose of PCV inIndigenous children by 30 months of age.

Timeliness of vaccinationOn-time vaccination was assessed for children aged ,2years, definedas receipt of a scheduled vaccinedosewithin30 days of the recommended age. For example, a child whoreceived the first dose of DTPa vaccine (due at 60 days ofage), when he or she was more than 90 days of age, wasclassified as late for that dose. For descriptive purposes, wecategorised the delay outcome measure for each dose aseither 'delay of 1 to,3 months', delay of 3 to,7 months or'delay of$7months'. On-time vaccination wasmeasured in12-month birth wide cohorts. Therefore, these cohorts arenot the same as those assessed for coverage milestones.Trends in on-time vaccination were also assessed for thefirst, second and third doses of DTPa vaccine and the firstand second doses of MMR vaccine. The interval betweendoses was not evaluated.

Remoteness statusThe area of residence of children aged ,2 years wasdefined as 'Major cities', 'Inner regional', 'Outer regional','Remote' and 'Very remote' using the Accessibility/Remote-ness Index of Australia (ARIAþþ).25 ARIAþþ is a continuousvarying indexwith values ranging from0 (high accessibility)to 15 (high remoteness), and is based on road distancemeasurements from over 12,000 populated localities to thenearest Service Centres in five categories based on popu-lation size. For analysis in this report, we combined the two'Regional' categories ('Inner Regional' and 'Outer Regional')into one category and the two 'Remote' categories('Remote' and 'Very Remote') into one category. ARIA Acces-sibility/Remoteness categories were assigned for eachchild using their current recorded postcode of residenceon the AIR.

Small area analysisAnalysis of coverage in children aged#2 years was under-taken at small area level using the ABS-defined StatisticalArea 3 (SA3),26 chosen because each is small enough toshow differences within jurisdictions but not too small torender maps unreadable. For both privacy and precisionreasons, SA3s with denominators of less than 26 childrenwere not included in any small area analysis. Maps werecreated using version 15 of theMapInfomapping software27

and the ABS Census Boundary Information. As postcode isthe only geographical indicator available from the AIR, theABSPostal Area to SA3 Concordance 2011was used tomatchAIR postcodes to SA3s.28

10

Medical contraindication exemptionsWe examined trends in medical contraindication exemp-tions to assess any potential effect of recent policy changessuch as 'No Jab, No Pay' and the associated removal of theconscientious objector exemption.17 The trends in thenumber of children aged 6 months to 10 years with at leastone new vaccination exemption due to a medical contrain-dication entered into the AIR during each year was calcu-lated by state/territory for the years 2011–2017. AIR data arealso available on natural immunity exemptions for certaindiseases; however, we did not report on these data as thenumbers involved are very small.

Coverage in adolescentsAIR dataVaccination coverage estimates calculated using datarecorded on the AIR for catch-up doses of the second doseof MMR vaccine and the third dose of dTpa/dT vaccine foradolescents (10–19 years of age) not recorded as havingreceived these doses of vaccines before 1 January 2017 wereassessed by jurisdiction and Indigenous status. The cohortof children assessed were those born from 1 July 1997 to30 June 2007, aged 10–19 years of age as at 30 June 2017.

HPV Register dataData onHPV vaccinationwere provided by theNational HPVVaccination Program Register, which is operated by VCSFoundation. Coverage for a full course of HPV vaccine(defined as 3 doses of quadrivalent HPV vaccine at accept-able minimum dose intervals) was assessed for femalesand males aged 15 years (as recommended by the WorldHealth Organization for the purposes of international com-parison) in 2017. As HPV vaccination is delivered routinely inearly high school, usually at the age of 12–13 years, allchildren in each cohort have had the opportunity to com-plete the vaccination course by 15 years of age. Numeratordata comprise valid doses allocated to the child's state/territory of residence and denominator data compriseAustralian Bureau of Statistics (ABS) Estimated ResidentPopulation (ERP) data, based on the 2016 census, in con-trast to the Medicare enrolment data used as the denomi-nator for AIR reporting in the rest of this report. A previousstudy has found that ABS ERP denominator data producecoverage estimates comparable to Medicare enrolmentdata when applied to the early adolescent age group.29

HPV coverage estimates were also provided separatelyfor doses 1, 2 and 3 and by four age groups: 14–15 years;16–17 years; 18–19 years; and 20–26 years of age.

The proportion of adolescents completing the HPV vaccinecourse (3 doses received) and proportion receiving only 1 or2 doses were calculated by Indigenous status for year ofbirth cohorts turning 15 years of age for each year from 2007through 2017. None of the 15-year olds assessed in thisreport were on the new 2-dose schedule. To assesswhether

timeliness is also an issue for HPV vaccination coursecompletion among Indigenous adolescents, the mediantime between receipt of dose 1 and dose 3 was alsoestimated by year of birth cohort and Indigenous statusfor those who completed the course, as well as the propor-tion who took more than 12 months to complete.

Indigenous statusIndigenous status on the AIR is recorded as 'Indigenous','non-Indigenous' or 'unknown', as reported by the person(or parent/carer) to Medicare or by the immunisationprovider to the AIR. For this report we considered twocategories: 'Indigenous' and 'non-Indigenous'. Indivi-duals whose Indigenous status was not specified weredeemed to be non-Indigenous for the purposes of ouranalysis. It is noteworthy while Indigenous status isavailable in the AIR, other parameters such as countryof birth, ethnicity and medical condition (including preg-nancy) are not.

Results

Highlights'Fully immunised' coverage at the 12-month and60-month age assessment milestones reached theirhighest ever recorded levels in 2017, at 94.3% and94.5%, respectively.

Coverage for the third dose of PCV by 12 months of agereached 94.7% at the end of June 2017, its highest everrecorded level.

Young children'Fully immunised' coverageFigure 1 shows time trends in quarterly 'fully immunised'vaccination coverage estimates in Australia, assessed at12 months, 24 months and 60 months of age, for 3-monthwide cohorts born from 1 January 2000 to 31 December 2016.'Fully immunised' coverage at the 12-month assessmentagemilestonewas largely stable at around 90–92% throughuntil 2014, but then increased to 93.8% at the age assess-ment quarterly data point in December 2017. 'Fully immu-nised' coverage at the 24-month assessment agemilestonewas also largely stable at around 92–93% through until2014, but then declined by 5.5 percentage points in thelatter half of 2014. The bulk of this decreasewas likely due tothe assessment algorithm being amended in July 2014 toinclude additional requirements: 1 dose of MenC vaccine,1 dose of varicella vaccine and a second dose of MMRvaccine. 'Fully immunised' coverage at 24months increasedto 90.8% in December 2015 but decreased marginally to89.6% at the age assessment quarterly data point inDecember 2016. This was likely due to the coverage


11

assessment algorithm being amended in December 2016 torequire a fourth dose of DTPa vaccine, following inclusion ofa dose at 18 months of age in the NIP. 'Fully immunised'coverage at 24 months of age increased to 91.2% in the firsthalf of 2017 but decreased in the second half of the yearto 89.8%. In contrast, 'fully immunised' coverage at the60-month assessment age milestone increased steadilyfrom 2009, reaching 94.5% at the age assessment quarterlydata point in December 2017.

Coverage by vaccine/antigen12 months of ageCoverage at the 12-month age assessment milestone forantigens in the relevant combination vaccine (DTPa-hepB-polio-Hib) remained relatively stable throughout 2017 fol-lowing the increase of around three percentage pointsbetween late 2014 and the end of 2016 (91.6% to 94.5%)(refer to Figure 2). Coverage for the third dose of PCV by12 months of age reached 94.7% at the end of June 2017,its highest ever level and similar to the level of coverage forall other vaccines/antigens assessed at this age except forrotavirus vaccine. While rotavirus vaccine coverage was

lower, due to strict upper age limits for administration, itincreased from late 2014 onwards and was at 86.3% inDecember 2017 (refer to Figure 2).

24 months of ageIn 2017, coverage at the 24-month age assessmentmilestone increased for all vaccines/antigens (refer toFigure 3). Coverage estimates for the age assessmentquarterly data points in December 2017 were 95% or greaterfor all vaccines/antigens, except DTPa (93.0%) and MMRV(92.0%) (refer to Figure 3). Following the decline in MMRvaccine coverage in the latter half of 2014, because of thesecond dose of MMR vaccine being assessed at 24 monthsof age for the first time instead of the first dose aspreviously assessed, coverage steadily increased over2015 and 2016, but decreased at the beginning of 2017.

60 months of ageFor vaccines/antigens due at 48 months of age, trends incoverage were similar to those seen for 'fully immunised'coverage (refer to Figure 4). Coverage for DTPa and poliovaccines increased in 2017 to 94.5% at the age assessment

50

55

60

65

70

75

80

85

90

95

100

31 M

ar 0

6

30 S

ep 0

6

31 M

ar 0

7

30 S

ep 0

7

31 M

ar 0

8

30 S

ep 0

8

31 M

ar 0

9

30 S

ep 0

9

31 M

ar 1

0

30 S

ep 1

0

31 M

ar 1

1

30 S

ep 1

1

31 M

ar 1

2

30 S

ep 1

2

31 M

ar 1

3

30 S

ep 1

3

31 M

ar 1

4

30 S

ep 1

4

31 M

ar 1

5

30 S

ep 1

5

31 M

ar 1

6

30 S

ep 1

6

31 M

ar 1

7

30 S

ep 1

7

Cov

erag

e (%

)

Coverage assessment date for each cohort

Fully immunised by 12 monthsa

Fully immunised by 12 monthsb

Fully immunised by 24 monthsc

Fully immunised by 24 monthsd

Fully immunised by 72 months

Fully immunised by 60 months

Coverage algorithm changed to assess children at 60 months, not 72 months

12-month coverage algorithm changed to include pneumococcal conjugatevaccine

24-month coverage algorithm changedto include MMR2, Men C and varicella

24-month coverage algorithm changed toinclude 4 doses of DTPa

60-month coverage algorithm changed to no longer include 2nd dose of MMR

Figure 1. Trends in 'fully immunised' vaccination coverage estimates by quarter, Australia, 2006 to 2017.By 3-month birth cohorts born between 1 January 2005 and 31 December 2016. Coverage assessment date was 12 monthsafter the last birth date of each cohort. Vaccination coverage estimates are calculated by quarter and may differ slightlyfrom estimates published elsewhere using rolling annualised data.aCoverage algorithm before 1 July 2013.bCoverage algorithm from 1 July 2013.cCoverage algorithm before 1 July 2014.dCoverage algorithm from 1 July 2014.MMR25 2nd dose of MMR vaccineMenC5meningococcal CDTPa5diphtheria-tetanus-acellular pertussis

Source: Australian Immunisation Register, data as at 31 March 2018.

12

quarterly data points in December 2017 (refer to Figure 4).During the first half of 2017, coverage for the second dose ofMMR increased by almost 2 percentage points to 96.3%.From July 2017, the second dose of MMR was no longerassessed at 60 months of age.

Coverage estimates by Indigenous status

HighlightsIn 2017, 'fully immunised' coverage at 12 and 60monthsof age in Indigenous children reached highest everrecorded levels of 93.2% and 96.9%, respectively.

The gap in 'fully immunised' coverage between Indig-enous and non-Indigenous children at 12 months ofage has closed considerably, from 6.7 percentagepoints in 2013 to 0.7 percentage points in 2017.

Recorded coverage in the influenza immunisationprogram for Indigenous children aged 6 months to,5 years remained low in 2017, with overall nationalcoverage of 14.9%. Only the Northern Territory (60.6%)achieved coverage above 20%.

'Fully immunised''Fully immunised' coverage at 12 and 60 months in Indige-nous children steadily increased reaching 93.2% and 96.9%,respectively, by the end of 2017. Figure 5 shows 'fully immu-nised' coverage at 12 months of age for Indigenous childrencompared to non-Indigenous children. From 2006, coveragefor Indigenous children tracked well below coverage fornon-Indigenous children. However, from mid-2013 the gapin coverage (Indigenous versus non-Indigenous) has pro-gressively decreased, from 6.7 percentage points in March2013 to only 0.7 percentage points in December 2017.

The proportion of Indigenous children 'fully immunised' by24 months of age was consistently higher than at either the12- or 60-month milestones until 2012, when coverage at60 months rose to comparable levels (Figures 5–7). Figure 6shows 'fully immunised' coverage at 24 months of agefor Indigenous children compared to non-Indigenous chil-dren. From 2006 to early 2011, coverage for Indigenouschildren tracked 1–4 percentage points below coveragefor non-Indigenous children. From 2011 to mid-2014 cover-age was similar for both groups. Following the amendmentof the 24-month coverage algorithm in 2014 to includea second dose of MMR vaccine, 1 dose of MenC vaccine

70

75

80

85

90

95

100

31 M

ar 0

6

30 S

ep 0

6

31 M

ar 0

7

30 S

ep 0

7

31 M

ar 0

8

30 S

ep 0

8

31 M

ar 0

9

30 S

ep 0

9

31 M

ar 1

0

30 S

ep 1

0

31 M

ar 1

1

30 S

ep 1

1

31 M

ar 1

2

30 S

ep 1

2

31 M

ar 1

3

30 S

ep 1

3

31 M

ar 1

4

30 S

ep 1

4

31 M

ar 1

5

30 S

ep 1

5

31 M

ar 1

6

30 S

ep 1

6

31 M

ar 1

7

30 S

ep 1

7

Cov

erag

e (%

)


DTPa

Polio

Hib

Hep B

PCV

Rotavirus

Change in coverage algorithms that tightened the rules regarding the receipt of Hib and Hep B vaccines for children aged 12 and 24 months

Figure 2. Trends in vaccination coverage estimates at 12 months of age, by vaccine/antigena and quarter, Australia, 2006to 2017.By 3-month birth cohorts born between 1 January 2005 and 31 December 2016. Coverage assessment date was 12 monthsafter the last birth date of each cohort. Vaccination coverage estimates are calculated by quarter and may differ slightlyfrom estimates published elsewhere using rolling annualised data.a3rd dose of DTPa vaccine, polio vaccine and PCV, 2nd or 3rd dose of Hib and rotavirus vaccines, and 3rd dose of hepatitis Bvaccine.DTPa5diphtheria-tetanus-acellular pertussisHib5Haemophilus influenzae type bHep B5hepatitis BPCV5pneumococcal conjugate vaccine



13

and 1 dose of varicella vaccine, coverage has been consid-erably lower for Indigenous children. 'Fully immunised'coverage at 24 months in Indigenous children increasedto 90.4% in mid-2016 but fell to 87.2% at the end of 2016,when the coverage assessment algorithm was amended inthe last quarter of 2016 to include a fourth dose of DTPavaccine instead of a third dose (refer to Figure 6). However,coverage increased marginally to 87.9% in December 2017.

Figure 7 compares 'fully immunised' vaccination coverageat 60 months of age for Indigenous children and non-Indigenous children. From 2007 to 2011 coverage for Indig-enous children tracked 1–5 percentage points below thecoverage for non-Indigenous children. However, from late2012 onwards, coverage for Indigenous children has beenhigher than for non-Indigenous children, reaching 2.5 per-centage points higher in December 2017.

Coverage by vaccine/antigenImmunisation coverage estimates in 2017 for the three agemilestones by vaccine/antigen and Indigenous status are

provided in Table 2. Coverage for Indigenous children waslower than that fornon-Indigenous children forall vaccines/antigens at 12months of age, but was higher at 24months ofage for polio, Hib, hepatitis B and MenC vaccines, and washigher at 60months of age forDTPa, polio andMMRvaccines.

Hepatitis A vaccine for Indigenous childrenFor the four jurisdictions in which hepatitis A vaccine isfunded for Indigenous children (the Northern Territory,Queensland, South Australia and Western Australia), com-bined coverage of the second dose of hepatitis A vaccine by30 months of age was stable at close to 60% from 2010 to2014 but then increased to 74.7% by the end of 2017 (refer toFigure 8). Coverage has consistently been highest in theNorthern Territory (86% at the end of 2017). By late 2017,coverage was greater than 65% in all jurisdictions (refer toFigure 8).

Pneumococcal vaccine for Indigenous childrenFor the four jurisdictions (the Northern Territory,Queensland, South Australia and Western Australia) in

70

75

80

85

90

95

100

31 M

ar 0

6

30 S

ep 0

6

31 M

ar 0

7

30 S

ep 0

7

31 M

ar 0

8

30 S

ep 0

8

31 M

ar 0

9

30 S

ep 0

9

31 M

ar 1

0

30 S

ep 1

0

31 M

ar 1

1

30 S

ep 1

1

31 M

ar 1

2

30 S

ep 1

2

31 M

ar 1

3

30 S

ep 1

3

31 M

ar 1

4

30 S

ep 1

4

31 M

ar 1

5

30 S

ep 1

5

31 M

ar 1

6

30 S

ep 1

6

31 M

ar 1

7

30 S

ep 1

7

Cov

erag

e (%

)


DTPa Polio

Hib Hep B

MMR MMRV

MenC Varicella

18-month DTPa boosterdose added to NIP

Change in coverage algorithms that tightened the rulesregarding the receipt of Hib and Hep B vaccines for children aged 12 and 24 months

18-month MMRV vaccine added to NIP

Figure 3. Trends in vaccination coverage estimates at 24 months of age by vaccine/antigena and quarter, Australia, 2006to 2017.By 3-month birth cohorts born between 1 January 2004 and 31 December 2015. Coverage assessment date was 12 monthsafter the last birth date of each cohort. Vaccination coverage estimates are calculated by quarter and may differ slightlyfrom estimates published elsewhere using rolling annualised data.a4th dose of DTPa vaccine (from October 2016), 3rd dose of polio vaccine, 3rd or 4th dose of Hib vaccine, 3rd dose ofhepatitis B vaccine, 2nd dose of MMRV (from September 2014), 1st dose of MenC vaccine.DTPa5diphtheria-tetanus-acellular pertussisHib5Haemophilus influenzae type bHep B5hepatitis BMMR5measles-mumps-rubellaMenC5meningococcal CMMRV5measles-mumps-rubella-varicella


14

which an 18-month booster dose of PCV is funded forIndigenous children), combined coverage increased fol-lowing the 13vPCV catch-up campaign in 2012, fell in 2013,but then increased to 74.7% by the end of 2017 (refer toFigure 9). Coverage has consistently been highest in theNorthern Territory (87.8% at the end of 2017). By late 2017,coverage was greater than 63% in all jurisdictions (referto Figure 9).

Influenza vaccine coverage for Indigenous childrenaged 6 months to ,5 yearsRecorded influenza vaccine coverage in Indigenous chil-dren aged 6 months to ,5 years was generally low acrossAustralia in 2017, with overall national coverage of 14.9%.There was substantial variation in recorded coverage byjurisdiction (refer to Figure 10). Apart from the NorthernTerritory (60.1%), coverage was only above 10% in theAustralian Capital Territory, Queensland and WesternAustralia (10.7%, 14.9% and 15.3%, respectively). For non-Indigenous children aged 6 months to ,5 years, coverageof seasonal influenza vaccine in 2017 was recorded as5.0% in Australia, and coverage was below 10% in all

jurisdictions, except Western Australia where it was 11.8%(refer to Figure 10).

Figure 11 shows the time trends of seasonal influenzavaccine coverage recorded on the AIR between 2007 and2017 for Indigenous children aged 6 months to,5 years, byjurisdiction. Coverage inWApeakedat 28% in 2009 followingthe introduction of a state-funded universal immunisationprogram for all children aged 6months to,5 years in 2008.However, coverage was substantially lower in subsequentyears following the temporary suspensionof theprogram in2010 due to an increase in febrile reactions, later shown tobe related to a single brand of influenza vaccine. Followingthe commencement of the nationally funded program forIndigenous children aged 6 months to ,5 years in 2015,seasonal influenza vaccine coverage in Indigenous childrenrose 4-fold to 12.1% nationally in 2015, and reached 14.9% in2017 (refer toFigure 11). Upward trends in coverageover timewere seen for all jurisdictions, with coverage markedlyhighest in the Northern Territory from 2015 onwards, fol-lowed by Western Australia and Queensland. Comparedwith 2014, flu vaccine coverage in 2017 increased 13-fold inthe Northern Territory and almost 7-fold in Queensland.

70

75

80

85

90

95

100

31 M

ar 0

6

30 S

ep 0

6

31 M

ar 0

7

30 S

ep 0

7

31 M

ar 0

8

30 S

ep 0

8

31 M

ar 0

9

30 S

ep 0

9

31 M

ar 1

0

30 S

ep 1

0

31 M

ar 1

1

30 S

ep 1

1

31 M

ar 1

2

30 S

ep 1

2

31 M

ar 1

3

30 S

ep 1

3

31 M

ar 1

4

30 S

ep 1

4

31 M

ar 1

5

30 S

ep 1

5

31 M

ar 1

6

30 S

ep 1

6

31 M

ar 1

7

30 S

ep 1

7

Cov

erag

e (%

)


DTP at 72 months

Polio at 72 months

MMR at 72 months

DTP at 60 months

Polio at 60 months

MMR at 60 months

Coverage algorithm changedto assess children at 60 months,not 72 months

2nd dose of MMR no longer assessed at 60 months

Figure 4. Trends in vaccination coverage estimates at 60 months of age (72 months prior to December 2007) by vaccine/antigena and quarter, Australia, 2006 to 2017.By 3-month birth cohorts born between 1 January 2000 and 31 December 2012. Coverage assessment date was 72 monthsafter the last birth date of each cohort up to December 2007 and then 60 months after the last birth date of each cohort.Vaccination coverage estimates are calculated by quarter and may differ slightly from estimates published elsewhereusing rolling annualised data.a4th dose of DTPa and polio vaccines, 2nd dose of MMR vaccine.DTPa5diphtheria-tetanus-acellular pertussisMMR5measles-mumps-rubella



15

90.0

87.9

80

85

90

95

100

31 M

ar 0

6

30 S

ep 0

6

31 M

ar 0

7

30 S

ep 0

7

31 M

ar 0

8

30 S

ep 0

8

31 M

ar 0

9

30 S

ep 0

9

31 M

ar 1

0

30 S

ep 1

0

31 M

ar 1

1

30 S

ep 1

1

31 M

ar 1

2

30 S

ep 1

2

31 M

ar 1

3

30 S

ep 1

3

31 M

ar 1

4

30 S

ep 1

4

31 M

ar 1

5

30 S

ep 1

5

31 M

ar 1

6

30 S

ep 1

6

31 M

ar 1

7

30 S

ep 1

7

Cov

erag

e (%

)


Non-Indigenous fully immunised by 24 monthsa

Non-Indigenous fully immunised by 24 monthsb

Indigenous fully immunised by 24 monthsa

Indigenous fully immunised by 24 monthsb

24-month coverage algorithm changed to include MMR2,MenC and varicella

24-month coverage algorithm changed to include 4 doses of DTPa

Figure 6. Trends in 'fully immunised' vaccination coverage at 24 months of age by Indigenous status and quarter, Australia,2006 to 2017.Vaccination coverage estimates are calculated by quarter and may differ slightly from estimates published elsewhereusing rolling annualised data.aCoverage algorithm before 1 July 2014.bCoverage algorithm from 1 July 2014.

93.9

93.2

80

85

90

95

100

31 M

ar 0

6

30 S

ep 0

6

31 M

ar 0

7

30 S

ep 0

7

31 M

ar 0

8

30 S

ep 0

8

31 M

ar 0

9

30 S

ep 0

9

31 M

ar 1

0

30 S

ep 1

0

31 M

ar 1

1

30 S

ep 1

1

31 M

ar 1

2

30 S

ep 1

2

31 M

ar 1

3

30 S

ep 1

3

31 M

ar 1

4

30 S

ep 1

4

31 M

ar 1

5

30 S

ep 1

5

31 M

ar 1

6

30 S

ep 1

6

31 M

ar 1

7

30 S

ep 1

7

Cov

erag

e (%

)


Non-Indigenous fully immunised by 12 monthsa

Non-Indigenous fully immunised by 12 monthsb

Indigenous fully immunised by 12 monthsa

Indigenous fully immunised by 12 monthsb

12-month coverage algorithm changed to include pneumococcal conjugate vaccine

Figure 5. Trends in 'fully immunised' vaccination coverage at 12 months of age by Indigenous status and quarter, Australia,2006 to 2017.Vaccination coverage estimates are calculated by quarter and may differ slightly from estimates published elsewhereusing rolling annualised data.aCoverage algorithm before 1 July 2013.bCoverage algorithm from 1 July 2013.

16

Timeliness of immunisation

HighlightsThedisparity inon-timevaccinationof the first, secondand third doses of DTPa vaccine between Indigenousandnon-Indigenous children inAustralia decreasedby2.4–5.8 percentage points from 2008 to 2017.

Moving the second dose ofMMR vaccine inmid-2014 tobeingdueat 18monthsof age resulted inan immediateimprovement in on-time vaccination for this vaccine,for both Indigenous and non-Indigenous children,although the disparity for this vaccine dose betweenIndigenous and non-Indigenous children increasedfrom 2.9 percentage points to 14.2 percentage points.

For both Indigenous and non-Indigenous children,the majority of delayed vaccination occurred 1 to,3months after the schedule point for all four vaccinedoses assessed and across all remoteness categories.

In this section, both on-time vaccination and delay invaccination are presented. On-time vaccination providesa measure of the percentage of children receiving vaccina-tions within 30 days of the recommended age, while delayin vaccination provides more detailed information on thelength of vaccination delay occurring. Trends in on-timevaccination for the first dose of DTPa vaccine from 2008 to

2017 by Indigenous status are shown in Figure 12. Between2008 and 2017, the disparity in on-time vaccination of thefirst dose of DTPa vaccine between Indigenous and non-Indigenous children in Australia decreased from almost10 percentage points in 2008 to 4.2 percentage points in2017 (refer to Figure 12).

Trends in on-time vaccination for the second dose of DTPavaccine from 2008 to 2017 by Indigenous status are shownin Figure 13. Between 2008 and 2017, the disparity in on-timevaccination of the second dose of DTPa vaccine betweenIndigenous and non-Indigenous children in Australiadecreased from 15.4 percentage points in 2008 to 11.1percentage points in 2017.

Trends in on-time vaccination for the third dose of DTPavaccine from 2008 to 2017 by Indigenous status are shownin Figure 14. Between 2008 and 2017, the disparity in on-timevaccination of the third dose of DTPa vaccine betweenIndigenous and non-Indigenous children in Australiadecreased from 18.0 percentage points in 2008 to 15.6percentage points in 2017.

Trends in on-time vaccination for the first dose of MMRvaccine from 2008 to 2017 by Indigenous status areshown in Figure 15. Between 2008 and 2017, the disparityin on-time vaccination of the first dose of MMR vaccinebetween Indigenous and non-Indigenous children inAustralia remained stable at around 10 percentagepoints.

94.4

96.9

70

75

80

85

90

95

100

31 M

ar 0

6

30 S

ep 0

6

31 M

ar 0

7

30 S

ep 0

7

31 M

ar 0

8

30 S

ep 0

8

31 M

ar 0

9

30 S

ep 0

9

31 M

ar 1

0

30 S

ep 1

0

31 M

ar 1

1

30 S

ep 1

1

31 M

ar 1

2

30 S

ep 1

2

31 M

ar 1

3

30 S

ep 1

3

31 M

ar 1

4

30 S

ep 1

4

31 M

ar 1

5

30 S

ep 1

5

31 M

ar 1

6

30 S

ep 1

6

31 M

ar 1

7

30 S

ep 1

7

Cov

erag

e (%

)


Non-Indigenous fully immunised by 72 monthsNon-Indigenous fully immunised by 60 monthsIndigenous fully immunised by 72 monthsIndigenous fully immunised by 60 months

Coverage algorithm changed to assess children at 60 months, not 72 months

60-month coverage algorithm changed to no longer include 2nd dose of MMR

Figure 7. Trends in 'fully immunised' vaccination coverage at 60 months of age by Indigenous status and quarter, Australia,2006 to 2017.Vaccination coverage estimates are calculated by quarter and may differ slightly from estimates published elsewhereusing rolling annualised data.


17

Trends in on-time vaccination for the second dose of MMRvaccine from 2008 to 2017 by Indigenous status are shownin Figure 16. Between 2008 and 2014, the percentageof children in Australia who received their second dose ofMMR vaccine on time (i.e. between 47 and ,49 months ofage) rose from 27.7% to 47.1% for non-Indigenous childrenand from 29.3 to 44.2% for Indigenous children. Moving thesecond dose of MMR vaccine in mid-2014 to being due at18 months of age resulted in an immediate improvementin on-time vaccination for the second dose of MMR vaccinefor both Indigenous and non-Indigenous children. How-ever, the disparity in on-time vaccination between Indige-nous and non-Indigenous children for this vaccine doseincreased from 2.9 percentage points (disparity of seconddose of MMR vaccine when given on time between 47 and,49 months of age) to 14.2 percentage points (disparity of

second dose of MMR vaccine when given on time between17 and ,19 months of age). Between 2014 and 2017, thepercentage of children who received their second dose ofMMR vaccine on time (i.e. between 17 and ,19 months ofage) decreased from 73.9% to 70.1% for non-Indigenouschildren and from 59.1% to 55.9% for Indigenous children.

Vaccination delay in 2017 for the first and second doses ofDTPa vaccines, and the first and second doses of MMRvaccines by length of delay, Indigenous status and remote-ness category is shown in Table 3. For both Indigenous andnon-Indigenous children, the majority of delayed vaccina-tionoccurred 1 to,3months after the schedule point for allfour vaccine doses assessed and across all remotenesscategories. The proportion of Indigenous children living inmajor cities with a delay of 1 to,3 months for the first and

Table 2. Vaccination coverage estimates (%) by age assessment milestone, vaccine/antigen and Indigenous status,Australia, 12-month wide cohorts assessed during 2017a

Vaccine/antigen Milestone age Indigenous (%) Non-Indigenous (%)

Diphtheria, tetanus, acellular pertussis 12 monthsb 92.5 94.924 monthsc 90.3 92.560 monthsd 96.5 93.5

Polio 12 monthsb 92.5 94.824 monthsc 97.1 96.360 monthsd 96.4 93.6

Haemophilus influenzae type b 12 monthsb 92.5 94.724 monthsc 95.7 94.760 months N/I N/I

Hepatitis B 12 monthsb 92.5 94.524 monthsc 97.1 95.660 months N/I N/I

Measles, mumps, rubella 12 months N/I N/I24 monthsc 91.9 93.060 monthsd 98.4 95.6

Varicella 12 months N/I N/I24 monthsc 91.1 92.760 months N/I N/I

Meningococcal C conjugate 12 months N/I N/I24 monthsc 96.4 94.960 months N/I N/I

Pneumococcal conjugate 12 monthsb 92.5 94.324 months N/I N/I60 months N/I N/I

Rotavirus 12 monthsb 83.5 89.524 months N/I N/I60 months N/I N/I

aVaccination coverage estimates in this table are calculated using 12-month wide cohorts and may differ slightly from estimatespublished elsewhere using rolling annualised cohorts.bCohort born 1 January 2016 – 31 December 2016.cCohort born 1 January 2015 – 31 December 2015.dCohort born 1 January 2012 – 31 December 2012.N/I Not included in coverage estimates for that group.Source: Australian Immunisation Register, data as at 31 March 2018.

18

75.6

72.4

63.6

87.8

74.7

0

10

20

30

40

50

60

70

80

90

100

Mar

08

Sep

08

Mar

09

Sep

09

Mar

10

Sep

10

Mar

11

Sep

11

Mar

12

Sep

12

Mar

13

Sep

13

Mar

14

Sep

14

Mar

15

Sep

15

Mar

16

Sep

16

Mar

17

Sep

17

Cov

erag

e (%

)

Month/year of assessment

Qld SA

WA NT

Australia

13vPCV catch-upcampaign in place

Figure 9. Trends in coverage estimates for pneumococcala vaccine for Indigenous children by jurisdiction,b Australia, 2008to 2017.a18-month booster dose assessed at 30 months of age in all four jurisdictions.bNorthern Territory (NT), Queensland (Qld), South Australia (SA) and Western Australia (WA) only.13vPCV5 13-valent pneumococcal conjugate vaccine


75.8

69.365.5

86

74.7

0

10

20

30

40

50

60

70

80

90

100

Mar

08

Sep

08

Mar

09

Sep

09

Mar

10

Sep

10

Mar

11

Sep

11

Mar

12

Sep

12

Mar

13

Sep

13

Mar

14

Sep

14

Mar

15

Sep

15

Mar

16

Sep

16

Mar

17

Sep

17

Cov

erag

e (%

)

Month/year of assessment

Qld SAWA NTAust.

Figure 8. Trends in coverage estimates for hepatitis Aa vaccine for Indigenous children by jurisdiction, Australia,b 2008to 2017.a18-month dose assessed at 30 months of age in all four jurisdictions.bNorthern Territory (NT), Queensland (Qld), South Australia (SA) and Western Australia (WA) only.Aust.5Australia



19

second doses of DTPa vaccines, and the first and seconddoses of MMR vaccines was lower compared to the propor-tion of Indigenous children living in remote and very

remote areas (3.4% versus 7.5%, 11.6% versus 17.9%, 22.9%versus 24.6% and 28% versus 30.7%, respectively). However,the proportion with very late vaccination ($7 months after

0

10

20

30

40

50

60

70

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Cov

erag

e (%

)

Year of vaccination

ACT NSW VIC

QLD SA WA

TAS NT AUSTRALIA

Figure 11. Trends in recorded coverage of any dose of seasonal influenza vaccinea among Indigenous children aged6 months to ,5 years, by jurisdiction, Australia, 2007-2017.aAny influenza vaccine dose.ACT5Australian Capital Territory; NSW5New South Wales; NT5Northern Territory; Qld5Queensland; SA5 SouthAustralia; Tas5 Tasmania; Vic5 Victoria; WA5Western Australia


10.76.2

8.2

14.9

8.7

15.3

5.2

60.1

14.9

0

10

20

30

40

50

60

70

Cov

erag

e (%

)Indigenous Non-Indigenous

State/Territory

ACTNSW VIC

QLD SAW

ATAS NT

AUSTRALIA

Figure 10. Recorded coverage of any dose of seasonal influenza vaccinea administered during 2017 to children aged6 months to ,5 years, by Indigenous status and jurisdiction, Australia.aAny influenza vaccine dose.ACT5Australian Capital Territory; NSW5New South Wales; NT5Northern Territory; Qld5Queensland; SA5 SouthAustralia; Tas5 Tasmania; Vic5 Victoria; WA5Western Australia


20

the schedule point) was higher for Indigenous childrenresiding inmajor cities for the second dose of DTPa vaccineand the first dose of MMR vaccine (2.4% versus 1.3% and2.5 versus 2.3%, respectively).

Small area coverage analysisVaccination coverage in Australia in 2017 varied substan-tially within jurisdictions and major capital cities, withsome areas substantially below the national averages(Figures 17–19). A total of 249 (over 75%) Statistical Area 3

(SA3) level areas in Australia had coverage for the thirddose of PCV higher than 93% (Figure 17). A total of 170 (52%)SA3 areas had coverage for the seconddose ofMMRvaccinehigher than 93% (Figure 18). A total of 51 (16%) SA3 areas hadcoverage below 90% for the fourth dose of DTPa vaccine by24 months of age (Figure 19).

Medical contraindication exemptionsThe trends in the number of children aged 6 months to10 years with at least one new vaccination exemption due

85 85.7 85.3 86.9 86.7 88.7 90.5 91.4 92.2 93.4

94.9 94.9 95.1 96 96 96.8 96.9 97.1 97.1 97.6

0

10

20

30

40

50

60

70

80

90

100

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Cov

erag

e (%

)

Year

Indigenous

Non-Indigenous

Figure 12. Trendsa in on-time vaccination for the first dose of DTPa, by Indigenous status, Australia, 2008-2017.aAll data points are calculated for a 12-month wide birth cohort using AIR data.

71.5 72.4 72 73 73.2 74.1 75.3 77.2 77.8 80

86.9 87.2 88 89.1 89.2 89.8 89.6 89.8 90.3 91.1

0

10

20

30

40

50

60

70

80

90

100

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Cov

erag

e (%

)

Year

Indigenous

Non-Indigenous

Figure 13. Trendsa in on-time vaccination for the second dose of DTPa, by Indigenous status, Australia, 2008-2017.aAll data points are calculated for a 12-month wide birth cohort using AIR data.


21

to a medical contraindication entered into the AIR duringeach year from 2011 to 2017, by state/territory, areshown in Figure 20. From 2011 to 2015 there was a cleartrend of increasing numbers of new exemptions. Newexemptions more than doubled in 2015 compared with2014 (635 to 1401), but then decreased markedly in both2016 and 2017.

Provider type/setting where vaccination occurredIn 2017, the largemajority of vaccinations given to childrenaged ,7 years in Australia were administered in generalpractice settings (80.6%, up from 78.8% in 2016) (Figure 21).Local councils delivered 7.9%, and Community and

Indigenous Health Services delivered 7.1%. In the NorthernTerritory, 46.8% of vaccinations were administered by acommunity health service, while in Victoria, 23% of vacci-nations were administered in local government/councilclinics.

Mechanism of reporting to the AIRIn 2017, 75.5% of vaccination encounter notificationsfor children aged ,7 years in Australia were reportedto the AIR electronically via practice management soft-ware, 16.4% via direct entry on the AIR website, 6.2% byinternet data interchange and only 1.9% by paper forms(Figure 22).

58.5 60.1 60.2 59.2 59.3 59.8 60.4 62.4 63.2 65.8

76.4 76.9 78.6 79.6 79.8 80.1 79.5 79.6 79.6 81.5

0

10

20

30

40

50

60

70

80

90

100

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Cov

erag

e (%

)

Year

Indigenous

Non-Indigenous

Figure 14. Trendsa in on-time vaccination for the third dose of DTPa, by Indigenous status, Australia, 2008-2017.aAll data points are calculated for a 12-month wide birth cohort using AIR data.

59 61.5 61.658.3 60.2 60

63.9 64.1 66.1 67.468.9 70.1 71.9 70.9 73.1 72.7 75.1 75.4 77.3 77.5

0

10

20

30

40

50

60

70

80

90

100

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Cov

erag

e (%

)

Year

Indigenous

Non-Indigenous

Figure 15. Trendsa in on-time vaccination for the first dose of MMR, by Indigenous status, Australia, 2008-2017.aAll data points are calculated for a 12-month wide birth cohort using AIR data.

22

AdolescentsCatch-up vaccination activity

HighlightsThe proportion of adolescents recorded as not previ-ously having received the relevant dose who receivedcatch-up vaccination in 2017 was 6.8% for the seconddose of MMR vaccine and 3.6% for the third dose ofdTpa/dT vaccine.

Adolescent catch-up vaccination activity for the sec-onddose ofMMRvaccine during 2017was considerablyhigher for Indigenous adolescents (20.3% of thoserecorded as not having received the dose) than non-Indigenous adolescents (6.4%).

Table 4 shows catch-up vaccination activity for adoles-cents aged 10–19 years recorded as not having receivedrelevant doses of vaccines before 1 January 2017 whoreceived a catch-up dose during 2017, by jurisdiction. InAustralia, 22,743 (6.8%) of the 337,141 adolescents aged10–19 years recorded as not having received a seconddose of MMR (MMR2) vaccine before 1 January 2017received a catch-up dose of MMR2 vaccine during 2017.The proportion varied from 6.0% in Western Australiato 11.3% in Tasmania. Adolescent catch-up vaccinationactivity for the third dose of dTpa/dT vaccine during 2017was relatively low at 3.6% nationally but also varied byjurisdiction, from 2.3% in the Western Australia to 7.3% inTasmania.

Table 5 shows catch-up activity by Indigenous status foradolescents aged 10–19 years recorded as not having

received relevant doses of vaccines before 1 January 2017who received their catch-up doses during 2017. Adolescentcatch-up vaccination activity for the second dose of MMRvaccine during 2017 was considerably higher for Indigenousadolescents than non-Indigenous adolescents (20.3% ver-sus 6.4%). Adolescent catch-up vaccination activity fordTpa/dT3 vaccine during 2017 was also higher for Indige-nous adolescents than non-Indigenous adolescents (8.0%versus 3.5%).

Human papillomavirus vaccine coverage

HighlightsIn 2017, 80.2% of Australian girls aged 15 years com-pleted a full 3-dose course of HPV vaccine, up from79.7% in 2016.

In 2017, 75.9% of Australian boys aged 15 years com-pleted a full 3-dose course of HPV vaccine, up from73.8% in 2016.

In 2017, 79% of Indigenous girls (and 77% of Indigenousboys) aged 15 years who received dose one of HPVvaccine completed the 3-dose course, compared to91% and 90% among non-Indigenous girls and boys,respectively.

Vaccination coverage, as notified to the National HPVVaccination Program Register, for 3 doses of HPV vaccine,for girls and boys aged 15 years in 2017, is shown in Table 6.At the national level, 80.2% of girls completed a full courseof the vaccine, up from 79.7% in 2016. Coverage in girlsvaried by jurisdiction, from 74.6% in Tasmania to 92.5% in

29.3 31.133.8 36.5 37 39.2

44.2

27.730.4

33.7

41.4 41.7 44.047.1

59.1 57.6 55.3 55.9

73.9 72.3 70.9 70.1

0

10

20

30

40

50

60

70

80

90

100

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Cov

erag

e (%

)

Year

Indigenous at 48 months Non-Indigenous at 48 months

Indigenous at 18 months Non-Indigenous at 18 months

Figure 16. Trendsa in on-time vaccination for the second dose of MMR, by Indigenous status, Australia, 2008-2017.aAll data points are calculated for a 12-month wide birth cohort using AIR data.


23

Table3.

Vaccinationde

lay,

byleng

thof

delay,Indige

nous

status

andremoten

essca

tego

ry,A

ustralia,2

017

Vaccinedo

seIndige

nous

status

Remoten

essca

tego

ry1 ],3mon

thsafter

sche

dule

point(%)

3 ],7mon

thsafter

sche

dule

point(%)

$7mon

thsafter

sche

dule

point(%)

DTPa

1aIndige

nous

Major

Citie

s3.4

1.51.0

Inne

rand

OuterR

egiona

l4.1

1.51.1

Remotean

dVe

ryRe

mote

7.51.3

Noda

taNo

n-Indige

nous

Major

Citie

s1.6

0.4

0.6

Inne

rand

OuterR

egiona

l1.4

0.4

0.6

Remotean

dVe

ryRe

mote

1.1No

data

Noda

taDT

Pa2a

Indige

nous

Major

Citie

s11.6

4.3

2.4

Inne

rand

OuterR

egiona

l13.4

4.9

2.3

Remotean

dVe

ryRe

mote

17.9

4.9

1.3No

n-Indige

nous

Major

Citie

s6.0

1.10.8

Inne

rand

OuterR

egiona

l6.3

1.30.9

Remotean

dVe

ryRe

mote

5.5

1.0No

data

MMR1

aIndige

nous

Major

Citie

s22.9

6.9

2.5

Inne

rand

OuterR

egiona

l23.6

7.42.5

Remotean

dVe

ryRe

mote

24.6

8.2

2.3

Non-Indige

nous

Major

Citie

s17.7

3.9

1.3Inne

rand

OuterR

egiona

l18.0

3.5

1.2Re

motean

dVe

ryRe

mote

18.6

3.7

0.8

MMR2

bIndige

nous

Major

Citie

s28

10.3

5.3

Inne

rand

OuterR

egiona

l28

.812.1

4.7

Remotean

dVe

ryRe

mote

30.7

13.3

5.5

Non-Indige

nous

Major

Citie

s20

.45.2

3.4

Inne

rand

OuterR

egiona

l22

5.7

2.4

Remotean

dVe

ryRe

mote

22.4

5.4

2.3

a The

coho

rtof

child

renbo

rnin

2015

andassessed

in20

17.

b The

coho

rtof

child

renbo

rnin

2014

andassessed

in20

17.

DTPa

1¼1std

oseof

diph

theria-tetan

us-ace

llularv

accine

DTPa

2¼2n

ddo

seof

diph

theria-tetan

us-ace

llularp

ertussisva

ccine

MMR1

¼1std

oseof

mea

sles,m

umps

,rub

ella

vaccine

MMR2

¼2n

ddo

seof

mea

sles,m

umps

,rub

ella

vaccine

Noda

ta¼ce

llsizessm

allert

han25

child

ren

Source

:Aus

tralianIm

mun

isationRe

gister,d

ataas

at31

March

2018.

24

the Northern Territory. All jurisdictions except WesternAustralia recorded an increase in HPV coverage between2016 and 2017. At the national level, 75.9% of boys complet-ed a full course of the vaccine in 2017, up from 73.8% in 2016(refer to Table 6). Coverage for males ranged from 64.0% in

Tasmania to 84.8% in the Northern Territory. HPV vaccinecoverage in males increased between 2016 and 2017 in alljurisdictions except Western Australia, with the largestincrease seen in the Australian Capital Territory (7.2 per-centage points).

% children vaccinated

Tablelands (East) –Kuranda – 87.9%

Richmond Valley –Coastal – 80.7%

95 to �100 (115)(134)

(58)(16)

(1)(27)

93 to �9590 to �9385 to �9080 to �85No data/low denominator

Huon – Bruny Island– 88.0%

Major capital cities

SydneyBrisbane Melbourne

PerthAdelaide Hobart

SOURCE: Australian Immunisation Register

Barkly� 85.2%

Figure 17. Pneumococcal conjugate vaccine (PCV) coverage at 12 months of age (3 doses) by Statistical Area 3, Australia andmajor capital cities, 2017.


25

HPV vaccine coverage in 2017 was highest for the first doseand lower for the second and third doses in both malesand females and across all age groups. In females, cover-age of the first dose was highest (89.0%) in the 14- to15-year-old age group (refer to Figure 23a). Coveragedecreased by age, with only 58.0% of females aged 20–26years fully vaccinated compared to 80.0% of females aged14–15 years. In males, coverage for the first dose in the 14-to 15-year-old age group was 86.0%, up three percentagepoints from 2016, and coverage in the 16- to 17-year-old

age group was 79.0%, up 5 percentage points from that in2016 (refer to Figure 23b).

Analysis of trends in HPV vaccine course completion showlower rates for Indigenous compared to non-Indigenouspeople for both females and males and across all birthcohorts (refer to Table 7). In 2017, 79% of 15-year-oldIndigenous girls who received the first dose of HPV vaccinehad completed the course compared to 91% of non-Indigenous girls. The disparity was 1% higher among males

% children vaccinated

Richmond Valley –Coastal – 78.7%

95 to �100 (65)(105)(121)

(28)(5)

(27)


South East Coast– 82.5%


SydneyBrisbane Melbourne

PerthAdelaide Darwin


Adelaide City – 84.3%

Mundaring– 83.9%

Barkly� 83.3%

Figure 18. Measles-mumps-rubella (MMR) coverage at 24 months of age (2 doses) by Statistical Area 3, Australia and majorcapital cities, 2017.

26

in 2017 (77% completion for Indigenous boys compared to90% for non-Indigenous boys) (refer to Table 7).

Among thosewhodid complete theHPV vaccine course, thetime taken to complete was consistently longer for Indige-nous compared to non-Indigenous people across all birthcohorts (data not shown). For those aged 15 years in 2017

there was an average of 8.8 months between the first doseand the third dose for both Indigenous girls and boys,compared to 7.5 months for non-Indigenous girls and boys.As many as 12.6 per cent of Indigenous girls and 14.2%of Indigenous boys took over 12 months to complete,compared to 3.8% of non-Indigenous girls and 4.2% ofnon-Indigenous boys (data not shown).

Richmond Valley –Costal – 79.3%

Mundaring– 83.4%


Brisbane Sydney Melbourne

Adelaide Perth Hobart

% children vaccinated95 to �100 (41)

(104)(129)

(47)(3)

(27)


Manjimup – 82.4%


Figure 19. Diphtheria-tetanus-acellular pertussis (DTPa) coverage at 24 months of age (4 doses) by Statistical Area 3,Australia and major capital cities, 2017.


27

DiscussionVaccination coverage in young children'Fully immunised' coverage at the 12-month age assess-ment milestone has progressively increased since 2014,

after a decade of being largely stable at around 90%, andreached its highest ever recorded level of 94.3% in June2017. 'Fully immunised' coverage at the 24-month ageassessment milestone was also largely stable at around

63.2

88.8

25.8

86.583.2

94.7

71.575.6

80.6

0

10

20

30

40

50

60

70

80

90

100

ACT NSW NT Qld SA Tas Vic WA Australia

% o

f vac

cina

tions

by

prov

ider

type

State/Territory

General practitioner Local government/council clinic

Community health service Hospital

Indigenous health service

Figure 21. Proportion of vaccinations given to children aged,7 years by provider type and state or territory, Australia, 2017.ACT5Australian Capital Territory; NSW5New South Wales; NT5Northern Territory; Qld5Queensland; SA5 SouthAustralia; Tas5 Tasmania; Vic5 Victoria; WA5Western Australia


16

354 367

479

5490

9 3

1401

5

143 146 128

22 42 4 3

508

0

200

400

600

800

1000

1200

1400

ACT NSW Vic Qld SA WA Tas NT Australia

Num

ber

of c

hild

ren

State/Territory

2011 2012 2013

2014 2015 2016

2017

Figure 20. Trends in the number of children aged 6months to 10 years with at least one new vaccination exemption due to amedical contraindication entered into the Australian Immunisation Register, by state/territory, Australia, 2011-2017.ACT5Australian Capital Territory; NSW5New South Wales; NT5Northern Territory; Qld5Queensland; SA5 SouthAustralia; Tas5 Tasmania; Vic5 Victoria; WA5Western Australia


28

92–93% through until 2014, but then decreased to below90% due to addition of several new vaccine doses to theassessment algorithm in July 2014. Coverage at this mile-stone reached 91.2% in the first half of 2017 but thendecreased to 89.8% in the second half of the year, followingthe inclusion of the new 18-month DTPa booster dose in theassessment algorithm. 'Fully immunised' coverage at the60-month age assessment milestone, which has increasedsteadily since 2009, reached its highest ever recorded levelof 94.5% in December 2017. The increases in coveragedocumented at 12 and 60 months of age are likely to havebeen contributed to by a range of measures, including thefederal government 'No Jab No Pay' policy (implementedfrom 1 January 2016) and 'No Jab No Play' policies imple-mented in some states. Although rotavirus vaccine cover-age is still lower than that for other vaccines because ofthe strict upper age limits for vaccine administration,the coverage achieved has resulted in substantial herdimmunity and decreases in rotavirus hospitalisations inAustralia.31,32

'Fully immunised' coverage at 12 and 60 months of age inIndigenous children has steadily increased since 2012, andreached the highest ever recorded levels of 93.2% and96.9%, respectively, in December 2017. The gap in 'fullyimmunised' coverage between Indigenous and non-Indigenous children at 12 months of age has closedconsiderably from 6.7 percentage points in 2013 to 0.7percentage points in December 2017. Coverage for Indige-nous children at 60 months of age has been higher than

that in non-Indigenous children since 2012. However 'fullyimmunised' coverage at 24 months of age was 2.1% lower inIndigenous children compared to non-Indigenous childrenat the end of 2017, after having been similar from 2011 to2013. This highlights a differential impact on coverage inIndigenous children after additional vaccine doses wereincorporated into the assessment algorithm in 2014 and2016, most likely related to timeliness issues.

The 'fully immunised' coverage figures presented in thisreport likely underestimate true coverage by an amountthat is difficult to precisely quantify. This is because ofunder-reporting due to a range of factors, including incor-rect data entry and failure of transfer of information frompractice management software to the AIR, as documentedin a recent report.33

Recorded coverage in the influenza immunisation programfor Indigenous children aged 6 months to ,5 years (whichcommenced in 2015) was low in 2017 with overall nationalcoverage of 15%, and only the Northern Territory (60.6%)achieving coverage above 20%. However, upward trends incoverage over timewere seen for all jurisdictions. Influenzavaccine coverage in 2017 increased 13-fold in the NorthernTerritory and almost 7-fold in Queensland compared withthe coverage in 2014. Influenza vaccine coverage datashould be regarded as a minimum estimate because ofthe potential for under-reporting. The extent of under-reporting to the AIR for influenza vaccine is unclear, butmay be more than that for 'universal' vaccines, given the

58

76.4

26.1

79.373.9

90.1

77.3

70.675.5

40.1

20.824.7

17.2 18.1 16.4

70

0

10

20

30

40

50

60

70

80

90

100

ACT NSW NT Qld SA Tas Vic WA Australia

% o

f vac

cina

tions

rep

orte

d

State/Territory

PMSa AIR website

IDI uploadb Non-approvedpaper formsApproved paper forms

Figure 22. Proportion of vaccinations given to children aged,7 years by type of reportingmechanism and state or territory,Australia, 2017.aPractice management software.bIDI5 internet data interchange (approved immunisation providers/organisations can send vaccination encounter detailsin bulk to the AIR using the IDI upload facility).ACT5Australian Capital Territory; NSW5New South Wales; NT5Northern Territory; Qld5Queensland; SA5 SouthAustralia; Tas5 Tasmania; Vic5 Victoria; WA5Western Australia



29

lack of incentive payments for notification to the AIR. Otherfactors contributing to the low coverage of influenza vac-cine likely include parental and provider attitudes andconcerns, along with other issues such as the seasonalnature of the program, the two doses required in the firstyear a child under 9 years of age receives influenza vaccineand the 'gap' in NIP funding for 5- to 14-year-old Indigenouschildren.34

Coverage for established programs of vaccines targetedspecifically at Indigenous children, that is, hepatitis A vac-cine and a booster dose of pneumococcal polysaccharidevaccine has increased in recent years but still remainssuboptimal. Both these vaccines are included on the NIPfor Indigenous children in the Northern Territory, Queens-land, SouthAustralia andWesternAustralia. Coverage for thesecond dose of hepatitis A vaccine in these jurisdictionscombinedhas increased fromaround30% in 2007 to 74.7%atthe end of 2017, the highest figure on record, with coveragegreater than 65% in each jurisdiction. The targeted nationalhepatitis A immunisation program has been shown to havehad a significant impact with relatively modest vaccinecoverage, and with evidence suggestive of substantial herdprotection effects.35 Coverage of the pneumococcal boosterdose in Indigenous children has also increased, reaching74.7% for the four jurisdictions combined in 2017, withcoverage greater than 63% in each. The extent of under-reporting to the AIR for hepatitis A vaccine and the pneumo-coccal booster dose is unclear, but may be more than thatfor 'universal' vaccines, given the lack of incentive paymentsfor notification to the AIR. However, lower coverage forvaccines targeted specifically at Indigenous people hasbeen a relatively consistent finding for both children36 andadults.37 Lack of provider and parent knowledge about therecommendations and suboptimal identification of Indige-nous children by immunisation providers are likely to beimportant contributing factors.

Althoughmost children eventually complete the scheduledvaccination series, many still do not do so in a timelymanner. On-time vaccination (within 30 days of the recom-mended age) for the first, second and third doses of DTPavaccines, and the first dose of MMR vaccine increased in2017 for both Indigenous and non-Indigenous children,compared to that in 2016, and also increased for the seconddose of MMR vaccine for Indigenous children. The disparityin on-time vaccination of the first, second and third dosesof DTPa vaccine between Indigenous and non-Indigenouschildren in Australia has decreased by 2.4–5.8 percentagepoints from 2008 to 2017. However, timeliness of vaccina-tion remains an ongoing problem for Indigenous childrenin Australia, particularly given the higher rates of manydiseases at a younger age.38 As younger children are oftenmore vulnerable to severe disease, immunisation at theearliest appropriate age should be a public health goal forcountries such as Australia where high levels of vaccinecoverage at milestone ages have been achieved.Ta

ble4.

Catch-up

vaccinationac

tivity

fora

dolescen

tsag

ed10

]19

yearsof

agea

notr

ecorde

das

having

rece

ived

releva

ntdo

sesbe

fore

1Janu

ary20

17who

rece

ived

catch-up

vaccines

durin

g20

17,b

ystateor

territo

ry,A

ustralia

Stateor

territo

ryAC

TNS

WNT

Qld

SATa

sVic

WA

Australia

Numbe

rwith

noMMR2

reco

rd55

711024

2840

6076230

21219

4599

7158

25145

2337141

Numbe

rofM

MR2

dose

sgive

n374

6279

272

4883

2190

518

5161

3066

22743

MMR2

catch-up

activ

ity(%

)6.7

6.1

6.7

6.4

10.3

11.3

7.26.0

6.8

Numbe

rwith

noDT

Pa/d

Tpa/

dT3reco

rd4183

7754

130

1759

972

15232

3008

5669

742

466

262116

Numbe

rofd

Tpa/

dT3do

sesgive

n122

2819

921591

973

220

2648

968

9433

dTpa

/dT3

catch-up

activ

ity(%

)2.9

3.6

3.1

2.7

6.4

7.34.7

2.3

3.6

a Coh

ortb

orn1July1997

–30

June

2007,vac

cina

tions

give

n1Jan

uary

–31

Dece

mbe

r2017.

ACT¼

Australia

nCa

pitalT

errit

ory;NS

W¼Ne

wSo

uthWales;N

T¼No

rthe

rnTe

rrito

ry;Q

ld¼Qu

eens

land

;SA¼So

uthAu

stralia

;Tas

¼Ta

sman

ia;V

ic¼Victoria;W

A¼Western

Australia

Source

:Aus

tralianIm

mun

isationRe

gister,d

ataas

at31

March

2018.

30

In 2017, parental vaccination objection could not be esti-mated as objection on non-medical grounds is no longer avalid exemption. The number of children aged 6 monthsto 10 years of age with new medical exemptions recordedon AIR, which had increased sharply in 2015 and thendecreased in 2016, following introduction of stricter eligi-bility criteria,39 decreased further in all jurisdictions in 2017.

Vaccination coverage in adolescentsOf 337,141 adolescents in Australia aged 10–19 yearsrecorded as not having received their second dose ofMMR vaccine (MMR2) before 1 January 2017, 22,743 (6.8%)received a catch-up dose of MMR2 during 2017. Some ofthese doses are likely to have been administered as a result

of the Australian government's 'No Jab No Pay' policy,introduced on 1 January 2016, which introduced annualimmunisation requirements for eligibility for federal gov-ernment family assistance payments through to 19 years ofage, and removed non-medical exemptions.

Coverage for HPV vaccine, as derived from the NationalHPV Vaccination Program Register, continues to increase,reflecting a successful school-based program and thesuccess of the gender-neutral approach to HPV vaccina-tion.10,40,41 Three-dose national coverage by age 15 years in2017 reached over 80% for girls and 76% for boys, repre-senting incremental improvements in coverage for bothgenders and closing of the gap between them over time.Ongoing declines in vaccine-type HPV infection rates and

Table 6. Coverage (%) for 3 doses of human papillomavirus (HPV) vaccine for girls aged 15 years in 2012]2017, and boys aged15 years in 2014-2017, by state/territory, Australia

State/territoryACT NSW NT Qld SA Tas Vic WA Australia

Girls

2012 73.0 71.6 86.6 69.9 71.4 66.0 74.5 70.6 71.92013 71.4 69.3 86.4 72.1 73.4 65.9 75.2 72.7 72.12014 70.1 71.2 85.6 75.2 74.9 70.8 77.7 78.7 74.82015 78.3 81.4 91.2 76.6 75.1 71.0 79.2 76.5 78.72016 79.9 82.4 92.2 77.6 75.8 71.6 79.1 80.0 79.72017 80.1 82.9 92.5 79.1 78.7 74.6 79.7 76.9 80.2Boys

2014 64.6 57.6 64.8 62.4 64.3 58.2 67.8 63.1 62.42015 69.3 64.8 72.5 68.7 69.6 61.9 71.9 64.8 67.82016 71.4 74.5 82.2 70.8 72.6 63.8 74.5 78.1 73.82017 78.6 78.1 84.8 73.7 74.4 64.0 76.3 75.3 75.9

ACT¼Australian Capital Territory; NSW¼New South Wales; NT¼Northern Territory; Qld¼Queensland; SA¼South Australia;Tas¼ Tasmania; Vic¼ Victoria; WA¼Western AustraliaPopulation is Estimated Resident Population (ERP) provided by the Australian Bureau of Statistics (ABS).30Source: National HPV Vaccination Program Register, data as of 4 July 2018.

Table 5. Catch-up vaccination activity for adolescents aged 10]19 years of agea not recorded as having received relevantdoses before 1 January 2017 who received catch-up vaccines during 2017, by Indigenous status, Australia

Indigenous statusIndigenous Non-Indigenous Total

Number with no MMR2 record 7986 329155 337141Number of MMR2 doses given 1620 21123 22473MMR2 catch-up activity (%) 20.3 6.4 6.8Number with no DTPa/dTpa/dT3 record 3497 258619 262116Number of dTpa/dT3 doses given 280 9153 9433dTpa/dT3 catch-up activity (%) 8.0 3.5 3.6aCohort born 1 July 1997 – 30 June 2007, vaccinations given 1 January – 31 December 2017.Source: Australian Immunisation Register, data as at 31 March 2018.


31

86

79

51

82

76

48

76

69

42

0

10

20

30

40

50

60

70

80

90

100

12–13 14–15 16–17 18–19 20–26

Cov

erag

e (%

)

Age (in years at mid-2017)

Dose 1

Dose 2

Dose 3

Vaccine data not yet complete for this age groupa

Figure 23b. HPV vaccination coverage by dose number for males by age group as of mid-2017, Australia, 2017.aIn some states those aged 12–13 years in 2017 are not eligible for vaccination until 2018.Population is Estimated Resident Population (ERP) provided by the Australian Bureau of Statistics (ABS) (as at 30 June2016).30

Source: National HPV Vaccination Program Register, data as of 4 July 2018.

8986

77

68

8683

74

65

8077

68

58

0

10

20

30

40

50

60

70

80

90

100

12–13 14–15 16–17 18–19 20–26

Cov

erag

e (%

)

Age (in years at mid-2017)

Dose 1

Dose 2

Dose 3

Vaccinedata not yetcompletefor this agegroupa

Figure 23a. HPV vaccination coverage by dose number for females by age group as of mid-2017, Australia, 2017.aIn some states those aged 12–13 years in 2017 are not eligible for vaccination until 2018.Population is Estimated Resident Population (ERP) provided by the Australian Bureau of Statistics (ABS) (as at 30 June2017).30

Source: National HPV Vaccination Program Register, data as at 4 July 2018.

32

incidence of high-grade cervical lesions in young womenhave been documented, building on the rapid and sub-stantial decreases seen initially.42–44 Australia is wellplaced to respond to the recent WHO call for countries towork towards the elimination of cervical cancer as a publichealth problem,45 especially given that modelling studiesof the population impact of HPV vaccination programssuggest that sustained vaccination coverage of over 80%will be sufficient for elimination of targeted HPV types.46

With the transition from 2018 to a two-dose HPV vaccineschedule for those aged 14 years or younger at first dose, itwill be important to monitor coverage, particularly inIndigenous adolescents, given the lower completion rateand longer time to completion documented for the firsttime at a national level in this report. Indigenous womenhave twice the incidence of cervical cancer and four timesthe mortality rate from cervical cancer, compared to otherAustralian women,44 and vaccination represents a signifi-cant opportunity to close this gap.

ConclusionData presented in this report reflect continuing successfuldelivery of theNIP in Australia, while identifying someareasfor further improvement, particularly timeliness of vacci-nation for Indigenous children and coverage of vaccinesspecifically targeted to Indigenous children. A separate

report is planned to present adult AIR coverage and dosesadministered data and assess completeness of reporting.

References1. Hull B, Deeks S, Menzies R, McIntyre P. Immunisation

coverage annual report, 2007. Commun Dis Intell 2009; 33:170–87.

2. Hull B, Dey A, Mahajan D, Menzies R, McIntyre PB. Immuni-sation coverage annual report, 2009. Commun Dis Intell2011; 35: 132–48.

3. Hull B, Dey A, Menzies R, McIntyre P. Annual immunisationcoverage report, 2010. Commun Dis Intell 2013; 37: E21–39.

4. Hull BP, Dey A, Beard FH et al. Immunisation coverageannual report, 2013. Commun Dis Intell 2016; 40: E146–69.

5. Hull BP, Dey A, Menzies RI, Brotherton JM, McIntyre PB.Immunisation coverage annual report, 2011. Commun DisIntell 2013; 37: E291–312.

6. Hull BP, Dey A, Menzies RI, Brotherton JM, McIntyre PB.Immunisation coverage, 2012. Commun Dis Intell 2014; 38:E208–31.

7. Hull BP, Hendry AJ, Dey A et al. Immunisation coverageannual report, 2014. Commun Dis Intell Q Rep 2017; 41:E68–90.

8. Hull BP, Mahajan D, Dey A, Menzies RI, McIntyre PB. Immu-nisation coverage annual report, 2008. Commun Dis Intell2010; 34: 241–58.

Table 7. HPV vaccination completion status (%) among those who commenced the course by birth year, Indigenous status,sex and number of doses received, Australia, 2007-2017

Birth year Equates to15 yearsold in

% of those who commencedcourse who received 1 dose

only

% of those who commencedcourse who received 2 doses

only

% of those who commencedcourse who received

all 3 dosesIndigenous Non-Indigenous Indigenous Non-Indigenous Indigenous Non-Indigenous

Females

1992 2007 13 6 17 9 71 851993 2008 12 5 14 9 74 851994 2009 10 5 15 8 75 871995 2010 9 4 14 8 77 881996 2011 10 4 16 9 74 861997 2012 11 5 14 9 75 871998 2013 10 5 15 8 74 881999 2014 9 4 14 7 78 902000 2015 8 3 12 6 80 912001 2016 9 3 12 6 80 912002 2017 8 3 12 6 79 91Males

1997 2012 20 9 22 14 58 771998 2013 12 5 20 11 68 851999 2014 12 4 18 11 70 852000 2015 10 3 14 7 76 892001 2016 10 3 12 7 77 902002 2017 10 3 13 7 77 90

Source: National HPV Vaccination Program Register, data as of 4 July 2018.


33

9. Hull B, Hendry A, Dey A, Beard F, Brotherton J, McIntyre P.Annual immunisation coverage report, 2015. Sydney: NCIRS;2017. Available from: http://www.ncirs.edu.au/surveillance/immunisation-coverage/ (Accessed 20 June 2017).

10. Hull B, Hendry A, Dey A, Beard F, Brotherton J, McIntyre P.Annual immunisation coverage report, 2016. Sydney:NCIRS; 2018. Available from: http://www.ncirs.edu.au/surveillance/immunisation-coverage/ (Accessed 19July 2018).

11. National Health Performance Authority. Healthy commu-nities: Immunisation rates for children in 2012–13. 2014.Available from: http://www.myhealthycommunities.gov.au/our-reports/immunisation-rates-for-children/march-2014 (Accessed 2 December 2014).

12. National Health Performance Authority. Healthy commu-nities: Immunisation rates for children in 2014–15. 2016.Available from: http://www.myhealthycommunities.gov.au/our-reports/immunisation-rates-for-children/february-2016 (Accessed 20 February 2016).

13. Australian Institute of Health and Welfare. Healthy Com-munities: Immunisation rates for children in 2015–16. Can-berra: Australian Institute of Health and Welfare; 2017.Available from: https://www.myhealthycommunities.gov.au/our-reports/immunisation-rates-for-children/june-2017 (Accessed 9 August 2018).

14. Hull BP, McIntyre PB, Heath TC, Sayer GP. Measuringimmunisation coverage in Australia: a review of theAustralian Childhood Immunisation Register. Aust FamPhysician 1999; 28: 55–60.

15. Australian Government Department of Health. ImmuniseAustralia Program: Expansion of Registers. 2016. Availablefrom: http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/expansion-registers(Accessed 21 October 2016).

16. National Centre For Immunisation Research and Surveil-lance. History of vaccination in Australia. 2018. Availablefrom: http://www.ncirs.edu.au/provider-resources/vaccination-history/ (Accessed 19 September 2018).

17. Australian Government Department of Human Services.Australian Immunisation Register (AIR) – Immunisationmedical exemption form (IM011). Available from: https://www.humanservices.gov.au/organisations/health-professionals/forms/im011 (Accessed 24 October 2016).

18. Australian Technical Advisory Group on Immunisation(ATAGI). The Australian immunisation handbook. 10th edn.Canberra: Australian Government Department of Healthand Ageing; 2013.

19. Australian Government Department of Health. No Jab, NoPay – New Immunisation Requirements for Family Assis-tance Payments: Fact sheet for vaccination providers. 2016.Available from: http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/67D8681A67167949CA257E2E000EE07D/$File/No-Jab-No-Pay-FSheet.pdf (Accessed 23 November 2017).

20. Australian Government Department of Health. NationalImmunisation Program Schedule. 2016. Available from:https://beta.health.gov.au/topics/immunisation/immunisation-throughout-life/national-immunisation-program-schedule (Accessed 20 February 2018).

21. Australian Government Department of Health. Clinicalupdate: ATAGI advice on Rotarix� to replace RotaTeq�.

Canberra: Australian Government Department of Health;2017. Available from: https://beta.health.gov.au/news-and-events/news/clinical-update-atagi-advice-on-rotarixr-to-replace-rotateqr (Accessed 27 August 2018).

22. O'Brien ED, Sam GA, Mead C. Methodology for measuringAustralia's childhood immunisation coverage. CommunDisIntell 1998; 22: 36–7.

23. Hull BP, McIntyre PB. Immunisation coverage reportingthrough the Australian Childhood Immunisation Register –an evaluation of the third-dose assumption. Aust N Z JPublic Health 2000; 24: 17–21. doi:10.1111/j.1467-842X.2000.tb00717.x

24. Hull BP, Lawrence GL, MacIntyre CR, McIntyre PB. Estimatingimmunisation coverage: is the 'third dose assumption' stillvalid? Commun Dis Intell 2003; 27: 357–61.

25. Hugo Centre for Migration and Population Research.Accessibility/Remoteness Index of Australia – ARIAþþ(2011). 2011. Available from: https://www.adelaide.edu.au/hugo-centre/spatial_data/ (Accessed 17 November 2017).

26. Australian Bureau of Statistics. Australian StatisticalGeography Standard (ASGS). 2011. Available from: http://www.abs.gov.au/websitedbs/d3310114.nsf/home/australianþstatisticalþgeographyþstandardþ%28asgs%29 (Accessed 17 November 2014).

27. MapInfo. MapInfo Pro version 15.0. Stamford, Connecticut,USA. 2015. MapInfo; 2015.

28. Australian Bureau of Statistics. Australian StatisticalGeography Standard (ASGS): Correspondences, July 2011(Cat. no. 1270.0.55.006). 2012. Available from: http://www.abs.gov.au/AUSSTATS/[email protected]/Lookup/1270.0.55.006MainþFeatures1July%202011?OpenDocument(Accessed 17 November 2014).

29. Barbaro B, Brotherton JM. Measuring HPV vaccination cov-erage in Australia: comparing two alternative population-based denominators. Aust N Z J Public Health 2015; 39:326–30. doi:10.1111/1753-6405.12372

30. Australian Bureau of Statistics. 3101.0 – Australian Demo-graphic Statistics, Jun 2017. Canberra: Australian Bureau ofStatistics; 2017. Available from: http://www.abs.gov.au/AUSSTATS/[email protected]/DetailsPage/3101.0Jun%202017?OpenDocument (Accessed 12 September 2018).

31. Buttery JP, Lambert SB, Grimwood K et al. Reduction inrotavirus-associated acute gastroenteritis following intro-duction of rotavirus vaccine into Australia's NationalChildhood vaccine schedule. Pediatr Infect Dis J 2011; 30(1):S25–9. doi:10.1097/INF.0b013e3181fefdee

32. Dey A, Wang H, Menzies R, Macartney K. Changes in hospi-talisations for acute gastroenteritis in Australia after thenational rotavirus vaccination program. Med J Aust 2012;197: 453–7. doi:10.5694/mja12.10062

33. Dalton L, Meder K, Beard F et al. Australian ImmunisationRegister Data Transfer Study – Stage 2 Final Report. 2018.Available from: http://www.ncirs.edu.au/surveillance/immunisation-coverage/

34. National Centre For Immunisation Research and Surveil-lance. Evaluation of the influenza immunisation programfor Aboriginal and Torres Strait Islander children aged6 months to ,5 years. 2018. Available from: http://www.ncirs.edu.au/assets/surveillance/evaluation/Evaluation-of-Indigenous-Flu-final.pdf (Accessed 29 August 2018).

34

http://www.ncirs.edu.au/surveillance/immunisation-coverage/




http://www.myhealthycommunities.gov.au/our-reports/immunisation-rates-for-children/march-2014



http://www.myhealthycommunities.gov.au/our-reports/immunisation-rates-for-children/february-2016



https://www.myhealthycommunities.gov.au/our-reports/immunisation-rates-for-children/june-2017



http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/expansion-registers

http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/expansion-registers

http://www.ncirs.edu.au/provider-resources/vaccination-history/

http://www.ncirs.edu.au/provider-resources/vaccination-history/

https://www.humanservices.gov.au/organisations/health-professionals/forms/im011



http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/67D8681A67167949CA257E2E000EE07D/$File/No-Jab-No-Pay-FSheet.pdf




https://beta.health.gov.au/topics/immunisation/immunisation-throughout-life/national-immunisation-program-schedule



https://beta.health.gov.au/news-and-events/news/clinical-update-atagi-advice-on-rotarixr-to-replace-rotateqr



http://dx.doi.org/10.1111/j.1467-842X.2000.tb00717.x

http://dx.doi.org/10.1111/j.1467-842X.2000.tb00717.x

https://www.adelaide.edu.au/hugo-centre/spatial_data/

https://www.adelaide.edu.au/hugo-centre/spatial_data/

http://www.abs.gov.au/websitedbs/d3310114.nsf/home/australian+statistical+geography+standard+&percnt;28asgs&percnt;29








http://www.abs.gov.au/AUSSTATS/[email protected]/Lookup/1270.0.55.006Main+Features1July&percnt;202011?OpenDocument





http://dx.doi.org/10.1111/1753-6405.12372

http://www.abs.gov.au/AUSSTATS/[email protected]/DetailsPage/3101.0Jun&percnt;202017?OpenDocument




http://dx.doi.org/10.1097/INF.0b013e3181fefdee

http://dx.doi.org/10.5694/mja12.10062



http://www.ncirs.edu.au/assets/surveillance/evaluation/Evaluation-of-Indigenous-Flu-final.pdf



35. Thompson C, Dey A, Fearnley E, Polkinghorne B, Beard F.Impact of the national targeted Hepatitis A immunisationprogram in Australia: 2000–2014. Vaccine 2017; 35: 170–6.doi:10.1016/j.vaccine.2016.11.002

36. Hull BP, McIntyre PB. What do we know about 7vPCVcoverage in Aboriginal and Torres Strait Islander children?Commun Dis Intell 2004; 28: 238–43.

37. Menzies R, Turnour C, Chiu C, McIntyre P. Vaccine prevent-able diseases and vaccination coverage in Aboriginal andTorres Strait Islander people, Australia 2003 to 2006. Com-mun Dis Intell 2008; 32: S2–67.

38. Naidu L, Chiu C, Habig A et al. Vaccine preventable diseasesand vaccination coverage in Aboriginal and Torres StraitIslander people, Australia 2006–2010. Commun Dis Intell QRep 2013; 37: S1–95.

39. Beard FHW. N. To sign or not to sign. Dealing with requestsfor vaccination exemption. Medicine Today; 2017. Availablefrom: https://medicinetoday.com.au/2017/april/regular-series/sign-or-not-sign-dealing-requests-vaccination-exemption (Accessed 13 December 2017).

40. Brotherton J, Gertig D, Chappell G, Rowlands L, Saville M.Catching up with the catch-up: HPV vaccination coveragedata for Australian women aged 18–26 years from theNational HPV Vaccination Program Register. Commun DisIntell Q Rep 2011; 35: 197–201.

41. Brotherton JM, Murray SL, Hall MA et al. Human papillo-mavirus vaccine coverage among female Australian

adolescents: success of the school-based approach. Med JAust 2013; 199: 614–7. doi:10.5694/mja13.10272

42. Machalek DA, Garland SM, Brotherton JML et al. Very lowprevalence of vaccine human papillomavirus types among18- to 35-year old Australian women 9 years followingimplementation of vaccination. J Infect Dis 2018; 217: 1590–600. doi:10.1093/infdis/jiy075

43. Garland SM, Cornall AM, Brotherton JML et al. Final analysisof a study assessing genital human papillomavirus geno-prevalence in young Australian women, following eightyears of a national vaccination program. Vaccine 2018; 36:3221–30. doi:10.1016/j.vaccine.2018.04.080

44. Australian Institute of Health and Welfare. Cervicalscreening in Australia 2018. Canberra: AIHW; 2018. Availablefrom: https://www.aihw.gov.au/reports/cancer-screening/cervical-screening-in-australia-2018/contents/table-of-contents (Accessed 31 August 2018).

45. World Health Organization. WHO Director-General calls forall countries to take action to help end the suffering causedby cervical cancer. Geneva: WHO; 2018. Available from:http://www.who.int/reproductivehealth/call-to-action-elimination-cervical-cancer/en/ (Accessed 31 August 2018).

46. Brisson M, Bénard É, Drolet M et al. Population-levelimpact, herd immunity, and elimination after human pap-illomavirus vaccination: a systematic review and meta-analysis of predictions from transmission-dynamicmodels. Lancet Public Health 2016; 1: e8–17. doi:10.1016/S2468-2667(16)30001-9


35

http://dx.doi.org/10.1016/j.vaccine.2016.11.002

https://medicinetoday.com.au/2017/april/regular-series/sign-or-not-sign-dealing-requests-vaccination-exemption



http://dx.doi.org/10.5694/mja13.10272

http://dx.doi.org/10.1093/infdis/jiy075

http://dx.doi.org/10.1016/j.vaccine.2018.04.080

https://www.aihw.gov.au/reports/cancer-screening/cervical-screening-in-australia-2018/contents/table-of-contents



http://www.who.int/reproductivehealth/call-to-action-elimination-cervical-cancer/en/

http://www.who.int/reproductivehealth/call-to-action-elimination-cervical-cancer/en/

http://dx.doi.org/10.1016/S2468-2667(16)30001-9

http://dx.doi.org/10.1016/S2468-2667(16)30001-9

Documents

Annual Immunisation Coverage Report 2017