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• W1605479211 abstract "Immunisation against infectious diseases has been more effective in preventing disease and death than any other medical intervention. The Royal Australasian College of Physicians (RACP) supports the immunisation policies and programs of the Australian and New Zealand governments for both routine immunisation and specific immunisation of at-risk groups. In the Australian and New Zealand context, primary care providers (general practitioners, practice nurses and community nurses) deliver almost all childhood immunisations and are the cornerstone of successful immunisation programs. Their roles and responsibilities are delineated and supported by regional and national governments and by their own professional organisations. Childhood immunisation rates in Australia and New Zealand have risen over the last decade to levels comparable to almost any other Western country. Polio has been eliminated from the Western Pacific region since 2000, and measles is approaching elimination.2-4 Diphtheria has become rare.5 However, if vaccination rates drop before diseases are eliminated, the diseases will return. For example, recent measles outbreaks have occurred in Australia, New Zealand and other countries in under-vaccinated populations. Some vaccine-preventable diseases (e.g. tetanus and diphtheria) are not eradicable. Currently more than 90% of Australian and New Zealand children aged 2 years are recorded as being fully immunised.6, 7 This level is considered an acceptable target level nationally, in practical terms as well as for maintaining herd immunity for most vaccine-preventable diseases. It demonstrates that current vaccine delivery programs are effective but is not grounds for complacency, nor is it fully informative, as broad general statistics conceal regions and groups with suboptimal coverage.6 They include children experiencing socio-economic disadvantage, Aboriginal and Torres Strait Islander children, Māori children, some children born overseas and those whose families actively reject some or all vaccines.6, 8 This section adds to and extends the responsibilities of paediatricians in childhood vaccination; many of these principles also apply to other health professionals. Communication is especially important, as trust in health professionals is a major factor in maintaining public confidence in vaccines and high vaccination rates.9 Good communication is a two-way process involving listening, responsiveness and information transfer. It requires sensitivity to vaccine issues in dealing with families. It may involve accessing or developing information resources to suit differing needs. There are a range of materials already available (Current Information Resources section) and doctors should remain abreast of program changes, alerts over diseases and vaccine side effects. Established systems exist to support the monitoring and safety of vaccines. However vaccines do carry a risk of side effects. Most are minor, rarely serious. Serious AEFIs require appropriate reporting (according to individual state/territory or country requirements) and management. AEFIs may be vaccine related or coincidental; paediatricians and other physicians may be involved in making the distinction. Good communication is particularly important at this stage, and parents' concerns should not be dismissed. Future immunisations may need to be carried out under close supervision; clinics exist for this purpose. Expert advice can also be sought in major capital cities (see Current Information Resources section). Sub-specialty paediatricians and physicians need to keep abreast of any special requirements of their patients and ensure adherence to them. Many patients with risk factors for severe illness will have particular vaccine requirements, including those with chronic medical conditions and immunosuppression.1 In general, children with allergy can receive vaccines (e.g. the measles, mumps and rubella vaccine, or MMR). Refer to guidelines for specific advice (see Practical Approaches for Optimising Immunisation section). Children may be under-vaccinated because of socio-economic disadvantage, logistical barriers or unresolved fears and doubts about the value and safety of vaccines. Only about 2–3% of all children overall are not vaccinated due to active parental refusal of some or all vaccines, but these families often live in localities where up to a third of children receive no vaccines.6 This results in sporadic outbreaks of vaccine-preventable diseases. The national immunisation schedules now cover up to 16 diseases. Many parents and some doctors consider this too many, often based on unfounded concerns about ‘immune system overload’.14, 15 The prevalence of this opinion may be a factor influencing immunisation uptake. Paediatricians have an important role in advocating the benefits of vaccination – both proactive and at times reactive – in countering anti-immunisation activism (see also below). Their role can involve informing local communities or wider audiences, providing support for local primary care providers, and teaching trainees and qualified health professionals. In areas outside capital cities especially, paediatricians may be called upon to be media spokespersons. Some may use social media. Use of mainstream media is often best done in collaboration with local public health authorities. Anti-immunisation activists have for years attracted followers.20 Alarmist rumour and misinformation is now disseminated more quickly via the media, including Internet and social media.12 Exposure to vivid narratives about children allegedly injured by vaccines has the potential to put parents off vaccination.21 Balance in response to this activism is required – the worst misinformation needs to be countered should it have the potential for broad dissemination, while generally it may be most effective to advocate positively and avoid confrontations. Since immunisation benefits the population as well as the individual, it is entirely just and reasonable that society as a whole accepts vaccine damage compensation for affected individuals and their families. This has long been the case in New Zealand; it is yet to be accepted in Australia. The RACP strongly supports introduction of an Australian no-fault vaccine compensation scheme, either as part of a national disability scheme or injury insurance scheme, or separately. The Australian Childhood Immunisation Register has been a key component of the success of the Australian childhood immunisation program. However, it does not record immunisations after 7 years of age, omitting adolescent and adult immunisations. With the extension of many routine and ‘special-risk’ immunisations well past the age of 7, developing a register that captures these immunisations is recommended by the RACP. Paediatricians and other physicians have a responsibility to ensure that they and their staff are appropriately vaccinated – to reduce occupational exposure, to reduce the risk of infecting patients and to provide an example to patients and to the broader community. National immunisation program schedules Australia: http://www.immunise.health.gov.au/ New Zealand: http://www.health.govt.nz/our-work/preventative-health-wellness/immunisation Immunisation handbooks for each country and updates where needed: Australia: http://www.immunise.health.gov.au/ New Zealand: http://www.health.govt.nz/our-work/preventative-health-%20wellness/immunisation Australia: Understanding Childhood Immunisation: http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/IMM52-cnt The National Centre for Immunisation Research and Surveillance has a variety of resources for both health professionals and the general public. Information includes an MMR Decision Aid for parents and fact sheets for providers on vaccines and vaccine-preventable diseases and vaccine safety, as well as a number of other resources, at http://www.ncirs.edu.au New Zealand: Diseases and vaccines http://www.health.govt.nz/publication/immunisation-making-choice-your-children The Immunisation Advisory Centre based at the University of Auckland in New Zealand provides a wide range of resources for both health professionals and the general public including fact sheets and other resources: http://www.immune.org.nz New Zealand: 0800 466863 (0800 IMMUNE) Leask J, Kinnersley P, Jackson C, Cheater F, Bedford H, Rowles G. Communicating with parents about vaccination. A framework for health professionals. BMC Pediatrics 2012,12:154 http://www.biomedcentral.com/1471-2431/12/154/abstract Physicians should contact the state or territory health provider about the clinic in their locality. Refer to immunisation handbooks for each country listed above. Australian Society of Clinical Immunology and Allergy (ASCIA) http://www.allergy.org.au/ ASCIA Guidelines for medical practitioners: Influenza vaccination of the egg-allergic individual http://www.allergy.org.au/health-professionals/papers/influenza-vaccination-of-the-egg-allergic-individual This position statement was developed over several months with wide consultation and valuable contributions from clinicians, experts, RACP staff and regulators from both Australia and New Zealand. Of these, particular note needs to be made of the contributions of Associate Professor Kristine Macartney, Professor Peter McIntyre and Dr Nick Wood. The Paediatric Policy & Advocacy Committee of The RACP has responsibility for this position statement: Dr Jacqueline Small (Chair), Dr Stewart Birt, Associate Professor Simon Clarke, Professor Paul Colditz, Dr Stuart Dalziel, Dr Terence Donald, Associate Professor Madlen Gazarian, Associate Professor Sharon Goldfeld, Ms Sue Hawes, Associate Professor Henry Kilham, Dr Alison Poulton; supported by Dr Lisa Dive, RACP Senior Policy Officer." @default.
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