ANP5002 Immunisation Nursing

Answer

Immunization Coverage in Australia:

Evidence based Script for the Poster:

Childhood Immunization Coverage is calculated as the percentage of children who have received all the vaccines according to their ages as per the National Immunization Program Schedule (Hu et al. 2015; Gibson et al. 2016). By measuring the immunization coverage rate it is possible to keep a track of how much the people are protected against preventable diseases. Vaccinations help the spread of diseases and help to develop ‘herd immunity’. This type of immunity helps to protect individuals who are not vaccinated (such as infants), people who cannot be vaccinated for medical conditions and people from whom the vaccination did not work (Metcalf et al. 2015; Bordon 2017). Australia has a target for immunization coverage of 95% which can help to develop herd immunity against diseases such as measles or other diseases that can be prevented through vaccines (health.gov.au 2018a).

According to the Department of Health of the Australian Government, coverage of immunization for children between the age of one and five years have increased since 2008, however the target of 95% have not yet been met. As of September, 2018, the national coverage rates were estimated to be 94.02% for one year old children, 90.63% for two year old children and 94.62% for five year old children (health.gov.au 2018b). This has been shown in the diagram below:

                              (Figure 1 National Coverage Rates from 2008 to 2018; source: health.gov.au 2018b)

The figure shows that for 1 year olds the immunization rates have significantly increased since 2008, with major improvements being made between 2008 to 2011 after which the rate of increase of immunization coverage have declined, while for 2 year olds, the rates of immunization have slightly reduced since 2008 and immunization coverage of 5 year olds have remained more or less constant (health.gov.au 2018b).

Analysis of the coverage rates based on state and territories show that for 1 year old children the states of South Australia, Australian Capital Territory, Tasmania and Victoria had immunization coverage rates that were above the national target, while the national average was estimated to be at 94.02% (health.gov.au 2018b). This is depicted in the diagram below:

                                                  (Figure 2: Coverage rates for 1 year olds. source: health.gov.au 2018b)

The immunization coverage was found to be low for 2 year olds, especially because the recent changes to the immunization plan. The national average was estimated to be at 90.63% which has been shown in the diagram below:

                                                  (Figure 3: Coverage rates for two year olds. source: health.gov.au 2018b)

For five year olds, the coverage rates for immunization have been the highest in Capital Territory, Tasmania and Victoria with a national average of 94.63%, close to the national target. This has been shown in the diagram below:

                                               (Figure 4: coverage rate for five year olds. source: health.gov.au 2018b)

According to the Australian Institute of Health and Welfare (AIHW), the immunization rate for one year old children have shown an increase between 1999 to 2001 after which it stayed relatively stable until 2012. A slight fall in immunization rates between 2013 and 2014 was because of the addition of new vaccines within the national vaccination schedule. From 2014 to 2017 there was an increase in the immunization rates to reach 94%. For two year old children, the immunization rates had a significant increase between 1999 to 2004 (increasing from 74% to 92%) and remained stable between 2004 to 2013, rising by only 1% (to reach 93%). However by 2015, the coverage rates fell to 89% and by 2016 it rose again to 91% and by 2017 it again fell to 90%. These variations have been due to the addition of the new vaccines in the national schedule. For five year olds, the rates of immunization steadily increased since 2005, from 74% to 94% (as of 2017). It is also reported that the rates of immunization among the indigenous children in Australia was lower than the immunization rates of the non-indigenous Australian children of the same age at 92% for 1 year olds, 88% for two year olds, while for five year olds, the immunization rates was higher for the indigenous children at 96% (aihw.gov.au 2018; National Centre for Immunisation Research and Surveillance 2017). Such statistics shows that the discrepancies in the immunization rates still exists between the indigenous and non indigenous children of Australia, thereby supporting the health gap between the two populations.  The diagram below shows the AIHW statistics:

                                     (Figure 5 Immunization rates for vaccines in the national schedule. Source: aihw.gov.au 2018)

Thus from the above data it can be concluded that the immunization rates have improved in Australia over the last two decades, especially for children of 1 year age. However, the immunization rates is still lagging behind the national target of 95% which implies that further improvements are required to reach the target. Additionally, the rates of immunization have been found to be lower among the Indigenous Australian Children of 1 and 2 years age compared to Non Indigenous children of the same age in Australia which implies that the immunization in the Indigenous communities needs further improvement.

Reflective Paper:

The aim of this segment is to present a reflective paper using the Rolfe’s reflective model to identify the target audience and where the poster on ‘immunization coverage’ be posted for maximum impact on the target crowd. The model was developed by Rolfe et al. (2001) that uses three simple questions: What? So What? And Now What? Each of these elements can be used to develop specific questions to address a particular point of concern and identify the important information associated with them and thereby understand the best actions that can be used for these concerns. The diagram below shows the Rolf model of reflection:

What?

The statistics on the Immunization rates in Australia shows that even though there has been an improvement in the immunization coverage rate over the last two decades, Australia is still falling short to achieve its national target of 95%. Currently the vaccination coverage rate for 1 year old is 94.02%, for 2 year olds 90.63% and for 5 year olds 94.62%. This shows that the immunization coverage is falling short by less than 1% for 1 and 5 year olds and by almost 5% for 2 year olds. Moreover, the coverage rates is lower for children from the Indigenous communities in Australia for 1 year (92%) and 2 years old children (88%) showing an even lower coverage in these communities.  

Conducting the study, I was able to understand that the immunization coverage is still lagging behind, especially within the Indigenous Australian communities. However, for 5 year olds, the immunization rates in the Indigenous have been higher than the national average and for Non Indigenous Communities it has almost reached the national average. It is important therefore that the gap in vaccination among the one and two year olds be addressed soon, both in the indigenous as well as the non indigenous communities so that the coverage rates for vaccination can reach the national target.

It has been suggested by Taddio et al. (2015) that educating the parents on the importance of vaccination on the increase of vaccination rates among children as well as for the management of pain. According to the author, when the parents are informed about the importance of immunization and how to manage pain experienced by their infants while vaccination can help them to be more proactive in immunizing their children against the diseases. Kepka et al. (2015) also pointed out that a lack of understanding about vaccines (such as the Human Pappiloma Virus) by the parents can lead to a low vaccination for HPV and therefore increase the risks of these diseases in the community.  

So What?

It can be suggested that the poster be targeted for the parents to inform them about the current vaccination coverage in Australia, the vaccination program. This can impress upon the parents about the current national trends in vaccination for diseases. Moreover, informing about the national Vaccination program can improve their knowledge about the various vaccines needed for their children and therefore adhere to the program in a better manner.

According to Khan et al. (2015), the knowledge, perceptions and attitudes of the parents towards vaccines played a significant role in the immunization of children against polio virus. A misconception among the parents that polio immunization can adversely impact the health of their children as well as a lack of trust on the healthcare industry have resulted in lower immunization against polio in Pakistan. This shows how the misconceptions held by the parents can negatively impact the immunization coverage within the country. From such study it can be assumed that by improving the understanding of vaccination and immunization program among the parents can help them overcome such misconceptions and therefore facilitate the improvement of the immunization coverage. The parents can also be educated about the consequences of not immunizing the child against the preventable diseases, and how it can impact the health and wellbeing of the children as well as that of the community if the vaccines are not given on time. Involvement of the health educators is also important to facilitate the education of the parents and to help them understand how the vaccines would safeguard their children against various preventable diseases.

Based on such aspects, I believe that by targeting the parents in the poster, it is possible to help them understand the importance of the national immunization program, and how by achieving the national immunization target they can help to protect the health and wellbeing of not only their children but also other children as well. To ensure best access to the parents, the posters can be placed on the school notice boards, public places, and school gates as well as through handouts from the school.

Now What?

In order to further reinforce the success of the immunization coverage, it is also essential to address the misconceptions and myths about the vaccinations as well as improve the vaccination rates among the indigenous communities. According to Schmidt (2018) debunking the myths and misconceptions about vaccinations is essential strategy to facilitate the success of a vaccination program. The World Health Organization have outlined six common misconceptions about vaccinations such as 1) better sanitation and hygiene have helped to reduce the incidence of diseases before vaccines were developed and therefore they are adequate measures to prevent diseases, 2) people who get vaccinated still can get sick and therefore vaccines are not really effective, 3) there are several vaccines that have caused adverse health effects and even death, therefore parents do not want their children to be immunized with those vaccines, 4) vaccines can have several harmful side effects (short term and long term), 5) rates of vaccine preventable diseases have been drastically reduced in many countries and therefore such vaccines are not really required, 6) giving multiple vaccinations for different types of diseases at the same time can greatly increase the risks of side effects and therefore multiple vaccines are not good (who.int 2018).

These myths reduces the propensity of the parents to immunization their children against various diseases out of fear for any possible side effects or harmful effects from the vaccines. It is therefore vital that such myths be debunked in any educational medium targeted for the parents for them to understand that such information is not correct and to understand the importance of the vaccines.

References:

aihw.gov.au (2018). Australia’s health 2018, Immunisation rates for vaccines in the national schedule (children) – Australian Institute of Health and Welfare. [online] Australian Institute of Health and Welfare. Available at: https://www.aihw.gov.au/reports/australias-health/australias-health-2018/contents/indicators-of-australias-health/immunisation-rates-for-vaccines-in-the-national-schedule-children [Accessed 4 Dec. 2018].

Bordon, Y., 2017. Antibodies: Herd immunity. Nature Reviews Immunology, 17(9), p.530.

Gibson, D.G., Kagucia, E.W., Ochieng, B., Hariharan, N., Obor, D., Moulton, L.H., Winch, P.J., Levine, O.S., Odhiambo, F., O’Brien, K.L. and Feikin, D.R., 2016. The Mobile Solutions for Immunization (M-SIMU) Trial: a protocol for a cluster randomized controlled trial that assesses the impact of mobile phone delivered reminders and travel subsidies to improve childhood immunization coverage rates and timeliness in western Kenya. JMIR research protocols, 5(2).

health.gov.au (2018a). Childhood immunisation coverage | Australian Government Department of Health. [online] Australian Government Department of Health. Available at: https://beta.health.gov.au/health-topics/immunisation/childhood-immunisation-coverage [Accessed 4 Dec. 2018].

health.gov.au (2018b). Immunisation coverage rates for all children | Australian Government Department of Health. [online] Australian Government Department of Health. Available at: https://beta.health.gov.au/health-topics/immunisation/childhood-immunisation-coverage/immunisation-coverage-rates-for-all-children [Accessed 4 Dec. 2018].

Hu, Y., Chen, E., Li, Q., Chen, Y. and Qi, X., 2015. Immunization coverage and its determinants among children born in 2008-2009 by questionnaire survey in Zhejiang, China. Asia Pacific Journal of Public Health, 27(2), pp.NP1132-NP1143.

Kepka, D., Warner, E.L., Kinney, A.Y., Spigarelli, M.G. and Mooney, K., 2015. Low human papillomavirus (HPV) vaccine knowledge among Latino parents in Utah. Journal of immigrant and minority health, 17(1), pp.125-131.

Khan, M.U., Ahmad, A., Aqeel, T., Salman, S., Ibrahim, Q., Idrees, J. and Khan, M.U., 2015. Knowledge, attitudes and perceptions towards polio immunization among residents of two highly affected regions of Pakistan. BMC Public Health, 15(1), p.1100.

Metcalf, C.J.E., Ferrari, M., Graham, A.L. and Grenfell, B.T., 2015. Understanding herd immunity. Trends in immunology, 36(12), pp.753-755.

National Centre for Immunisation Research and Surveillance (NCIRS) 2017, Immunisation coverage, Author, Westmead NSW, viewed 17 January 2018, https://www.ncirs.edu.au/surveillance/immunisation-coverage/

Schmidt, S., 2018. The flu vaccine: debunking the myths. SA Pharmacist’s Assistant, 18(2), pp.16-18.

Taddio, A., Parikh, C., Yoon, E.W., Sgro, M., Singh, H., Habtom, E., Ilersich, A.F., Riddell, R.P. and Shah, V., 2015. Impact of parent-directed education on parental use of pain treatments during routine infant vaccinations: a cluster randomized trial. Pain, 156(1), pp.185-191.

who.int (2018). WHO | Six common misconceptions about immunization. [online] Who.int. Available at: https://www.who.int/vaccine_safety/initiative/detection/immunization_misconceptions/en/ [Accessed 4 Dec. 2018].