Brynley P. Hull

The Australian Childhood Immunisation Register-A model for universal immunisation registers?

The Australian Childhood Immunisation Register (ACIR) was established in 1996 as an opt-out register built on the platform of Medicare, the universal national health insurance scheme. Introduction of financial incentives for providers and parents, linked to the ACIR, followed from 1998. Over the subsequent decade, national levels for receipt of all vaccines by 12, 24 and 72 months of age have risen to 91%, 93%, and 88%, respectively. Conscientious objection to immunisation can be registered, with retention of eligibility for incentives. The ACIR has been important in implementation of a range of measures to improve childhood immunisation coverage in Australia. Linkage of a universal childhood immunisation register to national health insurance schemes has potential applicability in a variety of settings internationally.

Immunisation coverage in Australia corrected for under-reporting to the Australian Childhood Immunisation Register

Objective: To assess the level of underreporting to the Australian Childhood Immunisation Register (ACIR) and the resulting underestimation of national immunisation coverage using ACIR data, and to correct national immunisation estimates for under‐reporting.

Hepatitis A vaccination options for Australia

Abstract:  The epidemiology of hepatitis A is changing, with an increasing proportion of the population becoming susceptible to infection. The burden of hepatitis A is comparable to that of other vaccine‐preventable diseases for which new vaccines are available. Options for vaccination include selective programmes for high‐risk groups, which could involve screening prior to vaccination, or universal programmes for infants and/or adolescents. Selective programmes have been shown to be highly cost‐effective if well implemented, but there is evidence that they might be poorly implemented. If a universal vaccination programme were considered for Australia, an infant programme, with doses at 18 months and 2 years, possibly with an additional adolescent programme, would be the recommended option. Universal hepatitis A vaccination for infants and/or adolescents is of comparable cost‐effectiveness compared with other preventive strategies, but needs to be considered in the context of competing vaccination options.

Factors associated with low uptake of measles and pertussis vaccines — an ecologic study based on the Australian Childhood Immunisation Register

Objective: To evaluate the relationships between socio‐economic and demographic variables and low immunisation coverage at the national level.

Coverage of work related fatalities in Australia by compensation and occupational health and safety agencies

Aims: To determine the levels of coverage of work related traumatic deaths by official occupational health and safety (OHS) and compensation agencies in Australia, to allow better understanding and interpretation of officially available statistics. Methods: The analysis was part of a much larger study of all work related fatalities that occurred in Australia during the four year period 1989 to 1992 inclusive and which was based on information from coroners’ files. For the current study, State, Territory, and Commonwealth OHS and compensation agencies were asked to supply unit record information for all deaths identified by the jurisdictions as being due to non-suicide traumatic causes and which were identified by them as being work related, using whatever definitions the agencies were using at the relevant time. This information was matched to cases identified during the main study. Results: The percentage of working deaths not covered by any agency was 34%. Only 35% of working deaths were covered by an OHS agency, while 57% were covered by a compensation agency. The OHS agencies had minimal coverage of work related deaths that occurred on the road (to workers (8%) or commuters (3%)), whereas the compensation system covered these deaths better than those of workers in incidents that occurred in a workplace (65% versus 53%). There was virtually no coverage of bystanders (less than 8%) by either type of agency. There was marked variation in the level of coverage depending on the industry, occupation, and employment status of the workers, and the type of injury event involved in the incident. Conclusions: When using data from official sources, the significant limitations in coverage identified in this paper need to be taken into account. Future surveillance, arising from a computerised National Coroners Information System, should result in improved coverage of work related traumatic deaths in Australia.

Unintentional fatal injuries arising from unpaid work at home

Objective: Unpaid work in and around the home is a common and potentially high risk activity, yet there is limited information about the circumstances surrounding resulting injuries. This study aimed to describe circumstances surrounding fatal injuries resulting from home duties activities, in order to identify and prioritise areas for prevention. Design and setting: Coroners’ reports on all unintentional deaths in Australia from 1989–92 inclusive were inspected to identify deaths of interest. Rates were calculated using population data and incorporating measures of time engaged in particular home duties activities. Results: There were 296 home duties deaths over the four year period. Most (83%) deaths were of males, and males had 10 times the risk of fatal injury compared with females. The most common activities resulting in fatal injuries were home repairs, gardening, and car care. The highest risk activities (deaths per million persons per year per hour of activity) were home repairs (49), car care (20), home improvements (18), and gardening (16). Being hit by inadequately braced vehicles during car maintenance, falls from inadequately braced ladders, contact with fire and flames while cooking, and contact with electricity during maintenance were the most common injury scenarios. Conclusions: Fatal injury of persons engaged in unpaid domestic work activities is a significant cause of death. Use of activity specific denominator data allows appropriate assessment of the degree of risk associated with each activity. The recurrence of similar circumstances surrounding many independent fatal incidents indicates areas where preventative interventions might be usefully targeted.

Burden of severe rotavirus disease in Australia

Aim:  To analyse the epidemiology of coded rotavirus hospitalisations in Australia from 1993 to 2002, with a view to understanding the pre‐vaccination burden of severe disease in Australia. This study also seeks to determine the burden of rotavirus‐related mortality.

The Australian Measles Control Campaign, 1998

The 1998 Australian Measles Control Campaign had as its aim improved immunization coverage among children aged 1-12 years and, in the longer term, prevention of measles epidemics. The campaign included mass school-based measles-mumps-rubella vaccination of children aged 5-12 years and a catch-up programme for preschool children. More than 1.33 million children aged 5-12 years were vaccinated at school: serological monitoring showed that 94% of such children were protected after the campaign, whereas only 84% had been protected previously. Among preschool children aged 1-3.5 years the corresponding levels of protection were 89% and 82%. During the six months following the campaign there was a marked reduction in the number of measles cases among children in targeted age groups.

Trends and patterns in vaccination objection, Australia, 2002-2013.

Objectives: To examine geographic and demographic trends in objection to vaccination in Australia.

Immunisation coverage reporting through the Australian Childhood Immunisation Register--an evaluation of the third-dose assumption.

Objective : The Australian Childhood Immunisation Register (ACIR) currently classifies those children who have the third dose recorded as fully immunised at 12 months of age, even if records of earlier doses are missing. This analysis assesses the impact this “third‐dose assumption” has on immunisation coverage estimates for children aged 12 months.