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Vaccine. 2019 Sep 16;37(39):5835-5843. doi: 10.1016/j.vaccine.2019.08.013. Epub 2019 Aug 20.

Timeliness and factors associated with rotavirus vaccine uptake among Australian Aboriginal and non-Aboriginal children: A record linkage cohort study.

Author information

1
Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia. Electronic address: parveen.fathima@telethonkids.org.au.
2
Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia; The University of Sydney Northern Clinical School, NSW, Australia; School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia; National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, NSW, Australia. Electronic address: heather.gidding@sydney.edu.au.
3
Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia; Department of Infectious Diseases, Perth Children's Hospital, Perth, WA, Australia; Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia; School of Public Health, Curtin University, Perth, WA, Australia. Electronic address: tom.snelling@telethonkids.org.au.
4
School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia. Electronic address: peter.mcintyre@health.nsw.gov.au.
5
Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia; Department of Infectious Diseases, Perth Children's Hospital, Perth, WA, Australia; School of Medicine, University of Western Australia, Perth, WA, Australia; Department of Microbiology, PathWest Laboratory Medicine WA, Princess Margaret Hospital, Perth, WA, Australia. Electronic address: christopher.blyth@telethonkids.org.au.
6
School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia. Electronic address: sarah.sheridan@unsw.edu.au.
7
School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia. Electronic address: bette.liu@unsw.edu.au.
8
Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia. Electronic address: nick.deKlerk@telethonkids.org.au.
9
Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia. Electronic address: hannah.moore@telethonkids.org.au.

Abstract

OBJECTIVES:

Rotavirus vaccines (RV), included in Australia's National Immunisation Program from mid-July 2007, are unique in strict time limits for administration. Here, we report on timeliness of RV uptake, compare cumulative RV coverage to age 12 months with DTPa, and assess factors associated with receipt of RV among Aboriginal and non-Aboriginal children.

METHODS:

Birth records for 681,456 children born in two Australian states in 2007-2012 were probabilistically linked to national immunisation records. We assessed on-time coverage (defined as receipt of vaccine dose between 4 days prior to scheduled date and the recommended upper limit) for RV and compared this to diphtheria-tetanus-pertussis (DTPa) vaccine. Logistic regression modelling was used to assess independent determinants of receipt of RV.

RESULTS:

Compared to non-Aboriginal infants, on-time RV coverage was lower for all doses among Aboriginal infants. Post the upper age limit of RV dose2, DTPa dose2 coverage increased by 9-16% to ≥90%, whereas RV coverage remained around 77% (Aboriginal) and 85% (non-Aboriginal). Compared to first-born children, the adjusted odds of receiving ≥1 RV dose if born to a mother with ≥3 previous births was 0.30 (95%CI: 0.27-0.34) among Aboriginal, and 0.53 (95%CI: 0.51-0.55) among non-Aboriginal children. Prematurity (<33 weeks), low birthweight (<1500 g), maternal age <20 years, maternal smoking during pregnancy and living in a disadvantaged area were independently associated with decreased vaccine uptake.

CONCLUSIONS:

Aboriginal children are at greater risk of rotavirus disease than non-Aboriginal children and delayed vaccine receipt is substantially higher. Although specific programs targeting groups at risk of delayed vaccination might improve RV coverage, relaxation of upper age restrictions is most readily implementable, and its overall risk-benefit should be evaluated.

KEYWORDS:

DTPa vaccine; Record-linkage; Rotavirus vaccine; Timeliness; Vaccine coverage

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