the national centre for immunisation research then and...

www.ncirs.usyd.edu.au www.ncirs.usyd.edu.au

Peter McIntyre

20th Anniversary Showcase

3 November 2017

The National Centre for

Immunisation Research –

then and now

“Me hoki whakamuri,

kia ahu whakamua, ka neke

“ In order to improve, evolve, and move forward,

we must reflect back to what has been.”

The way we were…1996

Coverage insufficient to prevent disease outbreaks:

• Pertussis deaths in young infants 1996/7

• Measles epidemic 1993

DTP immunisation at 12 months:

Australia 1989 to 2000

93

3

55.1

20.4

82.782.4

3

89.3

0

10

20

30

40

50

60

70

80

90

100

All DTP doses No DTP doses

1989 (ABS)

1995 (ABS)

1998 (ACIR)

2000 (ACIR)

2008 (ACIR)

Pre 1997 research for immunisation programs

Often not well-suited to grant applications

Surveillance data vs research studies

Social and policy related

ACIR data analysis needed

Immunise Australia: Seven Point Plan (from 1997)

Immunisations on the ACIR by reporting mechanism

2000 versus 2015, Australia

40.4

91.5

0

10

20

30

40

50

60

70

80

90

100

2000 2015

% o

f vaccin

ations r

eport

ed

Vaccination encounter years

Electronic/Internet*

Non-electronic†

Trends in ‘fully immunised’ vaccination coverage estimates,

Australia, 1997 to 2015

50

55

60

65

70

75

80

85

90

95

100

Covera

ge (

%)

Coverage assessment date for each cohort

Fully immunised by 12 mo

Fully immunised by 12 mo + PCV

Fully immunised by 24 mo - old definition

Fully immunised by 24 mo - new definition

Fully immunised by 72 mo

Fully immunised by 60 mo

Combination vaccinesintroduced leading

to less injections

Coverage algorithm changed to assess

children at 60mo, not 72mo

12-month coverage algorithmchanged to

to include pneumococcalconjugate vaccine

24-month coverage algorithm changed to to include MMR2, Men C and varicella vaccines

Interpreting “incomplete immunisation” Vaccine objection by socioeconomic status (SES) of area of residence

Children 12 months to <7 years, Australia, 2013 (born Jan 2007 – Dec 2012)*

Beard et al MJA 2016:204

Australian Immunsation Handbook – then and now

Rabies WP

Influenza WP

Special Risk

Groups WP

NCIRS supporting DoH & ATAGI*

14

ATAGI*

Pertussis WP

Pneumococcal WP

HPV WP

Other WPs

Australian Government

Department of Health

* Australian Technical Advisory Group on Immunisation

NCIR

S

NCIRS’ roles and activities include:

1.Undertake data analysis

2.Review, synthesise & summarise evidence

3.Draft policy documents for ATAGI/WPs

4.Draft ATAGI advice (for WPs) to DoH, PBAC providers & public

5.Monitor development of new vaccines

Indigenous Resources

DTPa at

18 mth + 4 yr

DTPa for

all doses

18 mth booster

reintroduced

DTPw

2,4,6 mth

15-18 mth booster

removed

DTPw 3,4,5 mth

+ 15-18 mth booster

dTpa 15-17 yr

18 mth booster

removed

dTpa cocoon dose

recommended

1975 1978 1982 1985 1994 1997 1999 2003 2008 2013 2015

Changes in Vaccination Schedule and Coverage

- Australia 1975-2015

4-5 yr booster

introduced

Whole cell

3-dose DTP

coverage

serology PCR

hospitals

PCR

community

~70% 85-90% 92%

Diagnosi

s method culture, clinical

State-funded

cocoon programs

2009-10

dTpa antepartum

State funded 2014-15

Quinn HE, et al. Pediatrics 2014; 134:713-20.

Evaluation of measles control campaign

Gilbert, GL et al Epidemiol Infect 2001; 127: 297-303

0

10

20

30

40

50

60

70

80

90

100

1 2 to 5 6 to 11 12 to 18

Pe

rcen

t s

ero

po

sit

ive

Age group (years)

PrePost

Reproduction number from 0.9 to 0.57

• Well below the epidemic threshold of 1

• MCC successful at interrupting endemic

transmission MacIntyre CR et al. Int J Infect Dis 2002

Actively targeted

Vaccine effectiveness:

ACIR-based case-control study

Quinn HE, et al. Pediatrics 2014; 133:513-9.

Severe AEFI surveillance: Intussusception

5 major paediatric hospitals:

Active surveillance of serious

childhood conditions

PAEDS Overview

Current conditions

Acute Flaccid Paralysis

Pertussis

Intussusception

Acute Encephalitis

Varicella and HZ

Influenza – collaboration with FluCAN

Febrile seizures

Meningococcal disease

Invasive Group A strep disease