the national centre for immunisation research then and...
TRANSCRIPT
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
