Report 29

Improving Immunisation Rates of Children in WA

Key findings

  • Health has achieved the national target to immunise more than 90% of children.[1] Since 2013, there has been a 1.15% increase in rates for children (0-5 years). Health meets the NPAEV requirement and protects a high number of WA children against preventable diseases. However, there are still at risk areas:
    • Aboriginal children, infants and toddlers, are immunised at a lower rate than non-Aboriginal children and are therefore at greater risk of preventable diseases. In June 2016, only 84.6% of Aboriginal infants and 84.5% of Aboriginal toddlers were immunised. This is less than the 90% national target and less than the national average for Aboriginal infants (90.5%) and toddlers (88.5%). However, a new approach introduced by Health in May 2016 is already showing results.
    • Infants and toddlers (0-2 years) are at higher risk of falling through the gaps. Health is missing opportunities to increase the immunisation rates for these children:
      • 24% (1,624 of 6,651) of all children aged 0-2 years do not have any GP details recorded in AIR. Health does not know if these children have been immunised and is limited in its ability to follow up
      • Health stops sending reminder letters to GPs of children overdue for their vaccinations after a child turns 2 years even if the child has not been fully immunised.
  • Significant improvement is required to achieve the NPAEV target to fully immunise 90% of adolescent girls with the HPV vaccine:
    • In 2015, 76% of adolescent girls were immunised. Only 74% of boys received the vaccine but they are not included in the target that was set in 2009.
    • In 2015, 80% of non-Aboriginals and 59% of Aboriginals received all 3 doses of the HPV vaccine. This number is skewed by the 5,452 adolescents that received all 3 doses but their consent form did not state if they were Aboriginal or not. This skewed data means Health cannot reliably target low adolescent HPV immunisation rates.

Read more – The national target has been met but ongoing efforts are needed

  • Since 2016, Health has had suitable strategies to ensure at-risk children like school absentees and dropouts, and children and adolescents in state care or prisons are immunised. Over time, targeting these at risk children should improve the adolescent rates and provide greater levels of protection against HPV.
  • The 2016 strategy acknowledges that immunisation rates for new migrant children need to improve. Approaches by Health include helping to translate overseas immunisation records for adding into AIR and offering catch-up vaccines. However, identifying these children in the first instance is not easy and unless identified, these children may miss essential vaccines.
  • There are no statewide targeted approaches to immunise children whose births are not registered (mostly Aboriginal), homeless children and children of conscientious objectors. Further, Health does not know how many children and adolescents are in these at risk categories. Without suitable strategies, these children remain at risk.
  • WACHS’ targeted planning and delivery of immunisation services has contributed to almost 2% higher immunisation rates in regional WA compared to metropolitan Perth.
    • WACHS’ practices include active monitoring of regional immunisation rates and development of action plans and projects when regions fall below the 90% target.
    • CAHS relies on Public Health and the Committee for advice on how to manage those suburbs in metropolitan Perth with historically low immunisation rates. It is still to fully implement the recommendations from its 2013 Improving immunisation outcomes 2013-2015 review.

Read more – Sections of the community are at risk of missing out

  • Under Health’s current service agreement with WACHS and CAHS, annual reporting of immunisation rates for fully immunised infants, Aboriginal infants, and adolescents is required but not for toddlers, school beginners, and other higher risk categories. This means Health cannot fully assess performance and take timely action to improve immunisation rates.
  • Health has been unable to access important information contained in the AIR to more effectively plan and deliver immunisation services:
    • The Commonwealth Department of Human Services has denied Health access to some AIR information. Although Health receives a range of high-level reports, the information is limited to age group and indigenous status. Child information is not included. Having access to date, place of birth and service provider information could allow Health to assess the effectiveness of strategies such as those for new migrants. The Department cited that it could not release the information because of confidentiality provisions in the Health Insurance Act 1973.
    • The AIR information that Health receives on children who are overdue for immunisations is split into 4 separate reports. Health uses this information to send out reminder letters to GPs but first must merge and cleanse the data – a time consuming process.
    • Service providers raised concerns about data validation and upload issues in AIR resulting in under-reporting of immunisation rates. For example in August 2016 and September 2016, CAHS found 44% of the 107 records it reconciled with its own system were out-of-date as the children had been immunised.

Read more – Success of the strategy depends on more timely and accurate information

[1] Immunisation rates for children in Christmas and Cocos Island are included in WA coverage rates.

Page last updated: December 21, 2016

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