Australia shouldn’t ‘open up’ before we vaccinate at least 80% of the population. Here’s why

Posted on July 31, 2021 by particularkev

Stephen Duckett, Grattan Institute and Will Mackey, Grattan InstituteEarlier this month National Cabinet released a four-phase COVID response plan. It wasn’t so much a plan – it had no dates and no thresholds – but more a back-of-the-napkin thought bubble. It was sensible, but vague.

National Cabinet now faces the hard task of converting vagueness into a real plan. To do this it must answer the question: what proportion of the Australian population needs to be vaccinated before we can open our international borders?

This means allowing stranded Australians to return, letting footloose people travel overseas, and welcoming international tourists and students again.

Well qualified experts differ on the requisite threshold for vaccination partly because there are so many unknowns, such as how quickly the Delta variant of COVID would spread through Australia if we open up, and how effective the different vaccines will prove to be in preventing transmission.

But new Grattan Institute modelling shows it would be dangerous for Australia to open up before at least 80% of the population is vaccinated.

Here’s what we found, and how we came to the 80% figure. Let’s start with the good news.

Vaccines offer substantial protection

Both vaccines on offer in Australia – Pfizer and AstraZeneca – are effective at preventing infections from the Delta strain. Two doses of Pfizer offers about 88% protection against infection, while two doses of AstraZeneca offers about 67% protection.

Vaccinated people can still catch COVID, but those that do pass it on to about half as many others compared to the unvaccinated.

Evidence from the United Kingdom, Canada, and the European Union – areas with higher vaccination levels than Australia – also suggests both vaccines offer substantial protection against hospitalisation and death from COVID. A vaccinated person is about 95% less likely than an unvaccinated person to end up in hospital with COVID.

Now for the bad news.

The delta strain is far more infectious

Researchers estimate the Delta variant is 50% to 100% more infectious than the Alpha variant, which itself was more transmissible than the variant that was dominant throughout 2020.

The effective reproduction number, or Reff, tells us how many people one infected person will spread the virus to, taking into account behaviour and public health measures in place designed to reduce transmission, such as masks and physical distancing.

A masked supermarket check out operator scans products. — The Reff changes according to the public health measures in place, such as mask mandates.
Shutterstock

If the Reff of the Delta variant in Australia is around 6 without vaccination, having 50% vaccination coverage will reduce the Reff to 3.

But the national goal must be to bring the Reff down to below 1, which would mean each person who was infected would infect less than one other person – and the virus would eventually peter out.

The higher the vaccination rate, the lower the effective reproduction number. Each person vaccinated offers a chance of breaking a chain of transmission that might lead to an outbreak.

Not only are vaccinated people less likely to become infected, they are also less likely to pass the virus onto others if they are.

The higher the vaccination rate, the lower the effective reproduction number

Effective reproduction number (Reff) by population vaccination rate.
Grattan Institute

So why do we need 80% of people vaccinated?

Grattan Institute’s model simulates the spread of COVID within a partially vaccinated population, and helps us peek into the future.

It uses age-based hospitalisation and intensive care unit (ICU) admission rates from more than a year of COVID data from Australian ICU units. It also assumes children under 16 are about one-fifth less likely to get COVID, and children over the age of two are able to be vaccinated.

In most of our simulations, older people have higher rates of vaccination, and no age group has more than 95% vaccine coverage.

We ran thousands of simulations of different vaccination rates, and different estimates of the Reff. The outcomes for 12 distinct scenarios are shown in the table below.

You can see why we recommend Australia not open up until at least 80% of the population is vaccinated – it is the only scenario where the virus is managed, with hospitalisations and deaths kept down to reasonable levels, even if the Reff is high.

Let’s break it down

Our simulations show that opening up at 50% vaccination rate (scenario 1) is a very bad idea, with many, many thousands of deaths.

Scenarios 2 and 3 are the optimist’s and gambler’s scenarios. If you are lucky and the Reff of Delta in Australia is 4 (with 70% vaccination rate) or 5 (with 75% vaccination rate), deaths and hospitalisations would not rise above moderate levels, and lockdowns could end and the borders could reopen.

But if you gambled on the wrong Reff, our hospitals would be overwhelmed and deaths would be unacceptably high. Opening the borders is a one-shot gamble: if you make the wrong call, the virus will quickly spread and all the good work and hard yards of living through lock-downs over the previous two years will have been wasted.

Public health decision-making is often risk averse, for the best of reasons. The difference in virus spread, hospitalisations and deaths between opening at 75% and at 80% are big, but the wait between the two thresholds may only be a month or two.
This is why we recommend an 80% vaccination rate (scenario 4) as the threshold for opening up.

Even if the Reff of Delta is 6, our hospital system will not be overwhelmed, and deaths will not rise above the number of deaths in a moderate flu season, such as 2010, when there were 2,364 flu deaths.

Stephen Duckett, Director, Health Program, Grattan Institute and Will Mackey, Senior Associate, Grattan Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Coronavirus Update: Australia

Posted on July 22, 2021 by particularkev

Pharmacists can vaccinate adults against whooping cough, measles and the flu, but it might cost you more

Posted on October 8, 2019 by particularkev

Pharmacist immunisers are gradually being allowed to give more types of vaccines.
FotoDuets/Shutterstock

Catherine Tran, University of Sydney; Clayton Chiu, and Kristine Macartney, University of Sydney

Vaccines have long been available from GPs and nurses. But in recent years, laws have changed to add pharmacists to the list of health professionals who can give select vaccines without a prescription.

This may improve vaccination coverage against the flu, whooping cough and measles. But there’s a chance it could cost you more than if your saw your GP for the same shot.

Overcoming resistance

Before 2014, pharmacists couldn’t give vaccinations in Australia. Then a pilot study allowed a select group of Queensland pharmacies to offer the flu vaccine.

By this time, pharmacists had been giving certain vaccines in Canada, New Zealand, the United States and the United Kingdom for some years.

But in Australia, pharmacists didn’t have the skills and the law didn’t allow it. Another barrier was the attitudes of other health professionals, such as doctors, that pharmacists couldn’t or shouldn’t give vaccinations.

The Queensland pilot study concluded pharmacists could safely and effectively administer certain vaccines to adults, once they were trained. This training included how to administer injections and what to do if something went wrong, such as managing anaphylaxis and performing CPR.

State and territory regulations have changed since 2014 and pharmacist vaccination services have quickly grown. In Victoria, for example, the number of pharmacies registered to give vaccines grew, from 36 in 2017 to 489 in July 2019.

What vaccines can you get at the pharmacy?

The rules vary in each state and territory. Generally, if you’re 16 and over, pharmacist immunisers can give you the following three vaccines:

influenza (flu)
diphtheria, tetanus and pertussis (whooping cough) – except Tasmania
measles, mumps and rubella (MMR) – except Tasmania and the ACT.

These are important vaccines that are sometimes needed if adults missed doses earlier in life or have waning immunity. The influenza vaccine needs to be given every year in a short time frame.

There are some further exceptions.

In the Australian Capital Territory, pregnant women can’t be vaccinated by a pharmacist.

In Tasmania and Western Australia, the flu vaccine can be given by a pharmacist to those aged ten and over.

Pharmacist immunisers are gradually being allowed to give more types of vaccines. In Western Australia, for example, pharmacists can now deliver the meningococcal ACWY vaccine to those aged 16 and over. This vaccine protects against around half of the strains that cause meningococcal disease in Australia.

It might cost you more

Some vaccines that would be free from your GP, practice nurse or immunisation clinic will need to be paid for if given at a community pharmacy. That’s because pharmacist immunisers aren’t able to access the government-funded vaccines that your clinic can.

Victoria is an exception – pharmacists can give select government-funded vaccines. And in the ACT and WA, the over-65s can access government-funded flu vaccines at pharmacies.

Pharmacists can’t usually access government-funded vaccines, aside from in Victoria.
Dragana Gordic/Shutterstock

The cost of vaccines at pharmacies varies. In Victoria, for example, the total fee charged for people not eligible for a government-funded vaccination is around A$20 for influenza and A$43 for pertussis (whooping cough).

Even if the vaccine is free, the pharmacy may still charge a consultation fee.

If you see your GP, they may either bulk bill you for the appointment or charge a consultation fee.

The best thing is to check ahead about any out-of-pocket expenses for vaccination when you make your booking.

Do you need to see a GP?

Pharmacy vaccination increases access to preventative health care, especially for those living in rural and remote areas, where it’s difficult to visit a doctor or clinics are infrequent.

Having pharmacists as immunisers also increases the immunisation workforce capacity for public health responses. To help address an outbreak of meningococcal disease last year in Tasmania, pharmacist immunisers administered the meningococcal ACWY vaccine to people aged 10 to 21.

Going to the pharmacist for some vaccines may take some pressure off family doctors and free GPs to deliver more complex care that only they can perform.

But there may be instances when it’s better to go to your GP for a vaccination, for example, if you’re pregnant, have a chronic health condition or need some blood tests related to vaccination. Or you might have other things to discuss with your doctor other than vaccines.

Catherine Tran, Senior Research Officer and Pharmacist, National Centre for Immunisation Research and Surveillance, University of Sydney; Clayton Chiu, Public Health Physician, and Kristine Macartney, Professor, Discipline of Paediatrics and Child Health, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

How other countries get parents to vaccinate their kids (and what Australia can learn)

Posted on September 20, 2019 by particularkev

Different countries take different approaches to get parents to vaccinate their children. But saying which one works best is difficult.
from www.shutterstock.com

Katie Attwell, University of Western Australia and Mark Navin, Oakland University

Countries around the world, including Australia, are using different ways to get parents to vaccinate their children.

Our new research, published this week in the journal Milbank Quarterly, looks at diverse mandatory vaccination policies across the world. We explore whether different countries mandate many vaccines, or just a few; if there are sanctions for not vaccinating, such as fines; and how easy it is for parents to get out of vaccinating.

This is part of ongoing research to see what Australia could learn from other countries’ attempts to increase childhood vaccination rates.

The shift from voluntary vaccination

Until recently, many governments preferred vaccination to be voluntary. They relied on persuasion and encouragement to try to overcome parents’ hesitancy or refusal to vaccinate their children.

However, recent measles outbreaks have made those methods less politically tenable. The rise of pro-vaccination activism and the polarisation of public debate about immunisation policy has motivated governments to take a more hard-line approach.

Early evidence from Italy, France, California and Australia indicates this has led to higher vaccination rates. But different countries have pursued very different policies.

Australia’s federal “No Jab, No Pay” policy removes entitlements and childcare subsidies from unvaccinated families. Four Australian states also have “No Jab, No Play” policies to limit vaccine refusers’ access to childcare.

California bans unvaccinated children from school, and Italy fines their parents. France classifies vaccine refusal as “child endangerment” and can impose hefty fines.

Some governments can use more than one method at once, like Australia’s mix of state and federal policies. Italy’s new policy uses a combination of excluding unvaccinated children from daycare and fines for parents.

Making it hard to refuse

Australia, Italy, France and California make it difficult for parents to refuse vaccines by only permitting medical exemptions to their mandatory policies.

However, other jurisdictions ultimately allow parents to refuse vaccines, albeit using different methods. For example, Germany and the state of Washington require parents to be counselled by medical professionals before they obtain an exemption to vaccinating their child. In Michigan, public health staff provide a mandatory education course for parents seeking non-medical exemptions.

Which policy leads parents to vaccinate?

We can assess a policy to get parents to vaccinate using a notion called “salience”. Put simply, will a vaccination policy actually make parents vaccinate?

For example, Australia’s federal vaccine mandate has become more salient since parents can no longer obtain conscientious objections and risk losing benefits for not vaccinating.

But there are other factors to consider, such as whether a policy promotes timely vaccination.

Australia’s “No Jab, No Pay” policy applies to children from birth, so it motivates parents to vaccinate on time. But the United States has state-level policies that prompt parents to have their children up-to-date with their vaccinations when they start daycare or primary school.

Who doesn’t have to vaccinate?

Another important question is who gets to duck away from the hand of government. Australia’s “No Jab, No Pay” policy leaves wealthy vaccine refusers untouched as they are ineligible for the means-tested benefits docked from unvaccinated families.

And Australian states’ policies to exclude vaccine refusers’ children from daycare doesn’t affect families who don’t use daycare.

Since France and California exclude unvaccinated children from school, these countries have the capacity to reach parents more equitably (almost everyone wants to send their kids to school so more people are incentivised to vaccinate). In both places, you can homeschool if you really don’t want to vaccinate.

Addressing the many reasons for not vaccinating

Mandatory vaccination policies also need to recognise the two types of parent whose child might be unvaccinated. Much airtime focuses on vaccine refusers. However, at least half the children who are not up-to-date with their vaccines face barriers to accessing vaccination, such as social disadvantage or logistical problems getting to a clinic. They are the children of underprivileged parents, not vaccine refusers.

When it comes to the vaccination status of disadvantaged children entering daycare, Australian states have chosen a “light touch” as part of the “No Jab, No Play” policy. Existing state policies provide grace periods or exemptions for these families.

But the federal “No Jab, No Pay” hits all parents where it hurts, and offers no exemptions or grace periods to disadvantaged families. Likewise, California’s school entry mandate makes no such exceptions. Italy and France have daycare exclusions similar to “No Jab, No Play” in their policies, but we have not found any evidence they make exceptions for disadvantaged families.

Finally, mandatory vaccination policies vary on how much they cost for governments to deliver. Oversight of parents, such as inspections or implementing fines, can drain government resources. And educational programs for parents seeking exemptions are expensive to run.

Governments can outsource some of these costs to parents (for instance, parents may have to pay a fee to see a doctor for an exemption).

Governments can also hand over the tasks to medical professionals, but then they have less control over what these professionals do. For instance, California is now seeking tighter regulation of doctors who say children are eligible for medical exemptions. This monitoring will cost the state, but will allow greater oversight. Victoria also had problems with doctors who accommodated vaccine refusers.

So where does this leave us?

Our work investigating international strategies to get parents to vaccinate their children is ongoing. Australians seem strongly attached to our vaccine mandates. But both state and federal policies have undergone tweaks since their inception.

Any future adjustments should ensure all parents are targeted, that disadvantaged families are not further disadvantaged, and that we make it very easy for everybody to access vaccines in their communities and on time.

Globally, as more jurisdictions move away from voluntary child vaccination to mandatory policies, we need to get a clearer picture of how these policies work for families, government and the policy enforcers, including school staff and health professionals.

Katie Attwell, Senior Lecturer, University of Western Australia and Mark Navin, Professor, Department of Philosophy, Oakland University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Curing Vaccination Fake News

Posted on September 15, 2019 by particularkev

Health Check: are you up to date with your vaccinations?

Posted on May 30, 2019 by particularkev

The majority of people in Australia who haven’t had all the vaccinations they need are adults.
From shutterstock.com

Lucy Deng, University of Sydney; Kristine Macartney, University of Sydney, and Nicholas Wood, University of Sydney

About 4.1 million Australians are under-vaccinated, meaning they’ve received some vaccinations, but not all the ones they need.

While the vaccination debate generally centres around children, the majority of people who are under-vaccinated are actually adults.

This places them and others at unnecessary risk of preventable diseases. But it is possible to catch up on missed vaccinations.

Why might you have missed some?

It’s possible you were too afraid of needles as a child, or your parents had ideological concerns about vaccination and never took you to get vaccinated at all. This is probably something you would know about.

But even if you believe you had all your vaccines as a kid, there are many reasons you might not be 100% up to date:

new vaccines have been added to the immunisation schedule
if you’ve grown up in another country, you may not have received every vaccine recommended in Australia
previous ways of recording and reminding people to have vaccines were not as good as they are today, so you may have accidentally missed doses without knowing
you may have a medical condition that puts you at higher risk of certain diseases and therefore you need additional vaccine doses.

Whatever the reason and regardless of your age now, it’s worthwhile to check if you’re up to date with your vaccinations. You can do this by having a chat with your GP or an immunisation clinic nurse.

Measles cases show us why it’s important

Being fully up to date with vaccinations is important to protect against diseases such as measles, whooping cough (pertussis) and tetanus.

Globally we’ve seen a 300% rise in measles cases in the first three months of 2019 compared to the same period last year. There have been nearly as many measles cases in the first quarter of this year in Australia as in all of 2018.

The majority of these measles cases were introduced by healthy Australian travellers who were not fully vaccinated and caught the virus while travelling to countries where the measles is still common, such as India, Philipines, Brazil and Ukraine.

So what do you need to do?

Try to locate any written records of past vaccinations and take them to your GP. Your GP can also check your immunisation record on the Australian Immunisation Register, which has records of any childhood vaccinations from 1996 and some adult vaccinations from 2016.

You may be able to access your own immunisation records via your Medicare online account through myGov or the Express Plus Medicare mobile app. Using this information, your GP can work out what vaccines you’re missing.

Your GP can help you understand which vaccines you might need as an adult.
From shutterstock.com

If you can’t find your vaccination records, it’s generally safe to restart vaccinations from scratch. For example, if you’re already immune to measles, having an extra dose of a vaccine containing measles is safe. It will only further boost your immunity.

Sometimes your GP may do blood tests to check if you already have immunity to certain diseases, including hepatitis B and measles, mumps and rubella.

Which vaccines do adults need?

Catch-up vaccinations are free for young adults under 20 years old, and vary in price after that.

Healthy people aged ten and above should make sure they’re up to date with the following vaccinations:

diphtheria, tetanus and pertussis (whooping cough)
hepatitis B
polio
human papillomavirus (HPV)
measles, mumps and rubella
meningococcal
pneumococcal
varicella (chicken pox)
zoster (shingles).

As an adult, the number of extra vaccines needed is generally lower than what is listed in the childhood immunisation schedule. This is because young babies need more doses of the same vaccine to develop adequate immunity, and because some vaccines are not required by the time you reach adulthood.

If you’re planning on becoming pregnant, it’s vital to ensure you’re immune to viruses such as hepatitis B, rubella and chicken pox (varicella) as they can be passed on to and severely affect the development of an unborn baby.

Whooping cough (pertussis) boosters are important for pregnant women, new parents and grandparents to protect babies who are most at risk of dying from this condition.

Older people should also be getting a booster dose of whooping cough and tetanus vaccines, as immunity can wane over time and these diseases can be serious in older people.

There’s been a huge surge in measles cases in 2019. People who aren’t fully vaccinated might unknowingly bring measles back from a trip overseas.
From shutterstock.com

Other vaccines may be recommended depending on your health status, age, lifestyle and occupation – called the “HALO” principle. Certain medical conditions and medical treatments can increase your susceptibility to some vaccine-preventable diseases.

And depending on what you do for work, you may be at higher risk of being exposed to some vaccine-preventable diseases.

For example, the Q fever vaccine is recommended for people working closely with livestock. Q fever is a bacterial infection that often spreads from animals and can cause severe flu-like symptoms.

While guidelines available online are useful, to find out what vaccinations are going to be most appropriate for your personal circumstances, it’s best to chat to your GP.

What if you’ve had a reaction in the past?

If your parents told you not to have a certain vaccine due to a past reaction, it’s worth getting the details and discussing this with your GP.

Certain vaccines, such as the whooping cough vaccine, have changed over time. Some of the reactions seen with previous vaccines are no longer seen in the vaccines used today.

GPs can also discuss specific reactions with an immunisation specialist to develop a plan to safely vaccinate where possible.

The immunisation schedule in Australia is constantly changing. Changes are made in response to new scientific evidence, changes in the circulation of diseases in the community and the development of new vaccines.

For your own health and the health of those around you, it’s important to check in with your GP regularly to make sure your vaccinations are up to date.

Lucy Deng, Staff Specialist Paediatrician, National Centre for Immunisation Research and Surveillance; Clinical Associate Lecturer, Children’s Hospital Westmead Clinical School, University of Sydney; Kristine Macartney, Professor, Discipline of Paediatrics and Child Health, University of Sydney, and Nicholas Wood, Associate Professor, Discipline of Childhood and Adolescent Health, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Everyone can be an effective advocate for vaccination: here’s how

Posted on February 21, 2019 by particularkev

File 20190219 121729 4lwlw3.jpg?ixlib=rb 1.1 — Listening to people’s concerns is important when talking to someone who is hesitant about vaccination.
From shutterstock.com

Jessica Kaufman, Murdoch Children’s Research Institute and Margie Danchin, Murdoch Children’s Research Institute

The World Health Organisation (WHO) has named vaccine hesitancy as one of their top 10 threats to global health for 2019.

Last week, the wife of an NRL footballer made national headlines after posting on Instagram that the couple did not plan to vaccinate their children.

Indeed, there’s rarely a time vaccination isn’t a hot topic of public debate. What’s important to note is that anyone can use evidence-based communication techniques to be an advocate for vaccination – you don’t need to be an expert in the field.

Conversations between peers can be very influential, because our behaviours are shaped by social norms, or what other people in our network value and do.

Who do we need to talk to?

While the current measles outbreaks in the United States and Europe are concerning, much of the reporting has over-simplified the issue, with sensationalised headlines placing the blame almost solely on “anti-vax” parents.

In reality, the vast majority of people whose children are missing some or all doses of the recommended vaccines are not “anti-vaxxers”, and labelling them as such is unhelpful.

The ability to register for vaccination exemption based on conscientious objection was removed in 2016, but it was last recorded in December 2015 as affecting only 1.34% of eligible children.

Current childhood vaccination coverage in Australia is between 90.75-94.67%, depending on age.

This suggests that missed opportunities and access barriers, such as parents being unable to get to the GP or a council immunisation session, are much more substantial contributors to under-vaccination.

Under-vaccination is regarded as a threat to global health.
From shutterstock.com

Communication about vaccines is unlikely to impact the behaviour of firm refusers and those facing access barriers. However, communication has enormous influence when it comes to the 43% of parents who have some questions or concerns about vaccines.

Aggressive or dismissive language can make people less likely to vaccinate, while open, respectful discussion with a trusted individual can encourage hesitant parents towards vaccination.

Tips for discussing vaccination

Many people struggle with how to discuss vaccination when confronted with a friend, relative or acquaintance who expresses hesitancy.

Simply providing lots of facts or dismissing their views is not effective.

Instead, these are some tips everyone can use when talking about vaccines, drawing from evidence-based communication techniques. Studies in the United States and Canada have trained healthcare providers to use techniques like these to increase uptake of adolescent HPV vaccination and infant vaccines, and more studies are currently underway.

Ask about, and listen to, people’s concerns: not everyone is driven by the same issues or experiences. Find out what specifically is concerning the person. Is it safety? Effectiveness? Side effects?

Acknowledge their concerns: remember, everyone loves their children. No one is refusing to vaccinate because they want their child to get sick, or because they wilfully hope other children will get sick. Acknowledging that you see where someone is coming from can go a long way in establishing trust.

Provide information to respond to their concerns: share what you know, and try to provide reliable sources for your information. Be careful not to debunk myths too aggressively, as this can actually backfire.

Share personal stories: emotive stories tend to have more impact than facts. This is one reason stories of rare vaccine adverse events can seem to carry more weight than overwhelming safety figures. Share your own stories of positive experiences with vaccines, or better yet, discuss your experience with the diseases they prevent.

Don’t pass judgment: people may discuss vaccination many times with many different people before they decide to vaccinate, especially if they are very hesitant. Your goal should be to establish yourself as a trusted, non-judgmental person with whom they can share their questions and concerns. Berating them won’t convince them to vaccinate, but it will convince them never to speak to you about vaccines again.

These communication tips can help support discussions about vaccines with someone who is hesitant, but open to discussing their position. If, however, you find yourself publicly debating a “vocal vaccine denier”, the WHO has developed a toolkit to help guide your responses.

In such a situation, your intended audience is not the vaccine denier themselves, but the public who may be watching or reading your debate.

The techniques used by a vaccine denier could include referring to conspiracies, fake experts, selective or misrepresented evidence, or impossible expectations (such as 100% safety). The WHO recommends you identify the techniques the denier uses and then correct their content.

If you’re a strong supporter of vaccination, you can become a powerful ally in the effort to sustain high coverage rates in your community. Listen and share your views respectfully, build and maintain open and trusting relationships, and yours may be the words that encourage another person to vaccinate.

Jessica Kaufman, Postdoctoral researcher in vaccine acceptance and communication, Murdoch Children’s Research Institute and Margie Danchin, Senior Research Fellow and General Paediatrician, Murdoch Children’s Research Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The flu vaccine is being oversold – it’s not that effective

Posted on June 7, 2018 by particularkev

File 20180605 119875 oo518i.jpg?ixlib=rb 1.1 — The protection of the flu vaccine is minimal, and may not be worth it.
from shutterstock.com

Chris Del Mar and Peter Collignon, Australian National University

Winter has started, and with it, flu season. Inevitably, all of us (young, old and sick) have been implored to be immunised against influenza, with some eligible for a subsidised vaccine. And people are heeding the message, to the point that there is now a shortage of available vaccines.

At the same time, findings from three important Cochrane reviews on the effectiveness of the influenza vaccination aren’t consistent with the advice we’re been given.

Cochrane reviews are independent systematic reviews, which are comprehensive analyses of most of the literature relevant to a research topic. Cochrane reviews summarise the results in a multitude of studies, and are regularly updated to absorb new research.

These three Cochrane reviews have been recently updated, as well as stabilised, which is what happens when it looks as if it seems unlikely new research would be published that would change the conclusions.

What the reviews found

The first Cochrane review looked at the effects of the influenza vaccine in healthy adults from 25 studies conducted over single influenza seasons in North America, South America, and Europe between 1969 and 2009. It found the vaccine reduced the chance of getting laboratory confirmed influenza from 23 cases out of 1,000 to 9 cases out of 1,000.

While this seems to be a reduction of more than 50%, that seems less optimistic expressed in absolute terms.

The infection rate in adults drops from 2% per year to 1%. You could say that’s halved, but it effectively only drops by 1%. So this means that out of every 100 healthy adults vaccinated, 99 get no benefit against laboratory confirmed influenza.

The second Cochrane review – which looked at trials in children over single influenza seasons in the US, Western Europe, Russia, and Bangladesh between 1984 and 2013 – found similar results.

The third Cochrane review looked at vaccines for the elderly in nursing homes. It found much less good evidence, with only one randomised trial – considered the gold standard in clinical trials as it establishes causation rather than correlation.

While observational studies (that draw inferences from a population to establish associations) have been done to show benefits of the vaccines, bias means we cannot rely on their results.

There are also potential harms from influenza vaccines noted in the reviews. They range from serious (a neurological disease called Guillain Barre) through to moderate (fevers, in children especially – some of which will cause febrile convulsions), and trivial (a sore arm for a couple of days).

Why are we so scared of the flu?

There is a special concern about influenza from a public health point of view. This comes about from its potential to cause pandemics. The first in modern history was the Spanish influenza pandemic of 1918-19, when tens of millions of people died worldwide.

There’s good evidence to show face masks protect against influenza.
from shutterstock.com

There have also been been several, less severe pandemics. These include the most recent swine flu that, although while affecting some (unexpected) groups of people (including pregnant women, those who were obese, and had asthma), caused little more effect on the overall population than the usual seasonal influenza.

Public health experts worry about another pandemic that can be more harmful and contagious, which could be devastating. But it’s important to note the vast majority of deaths from Spanish influenza were from secondary bacterial infections and predated the antibiotic era.

The reasons influenza virus has this ability to cause new pandemics comes from its instability – it changes genetically easily, making it more difficult for our immune systems to recognise newer strains. The effect is that new vaccines must be prepared every year for a best-guess at next year’s virus, and we need vaccination every year.

Influenza can also undergo a more radical change, such as when a new form of the virus emerges from an animal host (wild or domesticated birds or pigs, for example). This moving target makes it more difficult to vaccinate against – especially with the genetic shifts of pandemics. Just when we need protection most, vaccines can provide it least.

So what, if not the vaccine?

There are physical barriers that can prevent the spread of influenza. These are the masks (to reduce the spread of aerosol-borne virus particles), hand washing (to reduce the spread if virus from hands onto shared surfaces), and quarantine measures (isolating infected people to reduce their infectivity).

There is now reasonable evidence such measures reduce infections considerably. It might take a bit of effort to change the psyche of Australians to make wearing a facemask acceptable if you have an acute respiratory infection. Even the heroic “soldiering on to work” (or school) with your virus needs to be reversed as a public health act.

Chris Del Mar, Professor of Public Health and Peter Collignon, Professor, infectious diseases and microbiology, Australian National University

This article was originally published on The Conversation. Read the original article.

Here’s why flu vaccinations should be mandatory for Aussie health workers in high-risk areas

Posted on May 20, 2018 by particularkev

File 20180509 4803 via7fs.jpg?ixlib=rb 1.1 — Despite the numerous campaigns promoting the flu vaccine to Australian health workers, uptake has been documented to range from only 16-60%.
Tatiana Chekryzhova/Shutterstock

C Raina MacIntyre, UNSW and Holly Seale, UNSW

On June 1, health workers in New South Wales will be required to have a flu vaccination if they work in high-risk clinical areas, such as wards for neonatal care, transplants and cancer. Otherwise staff are required to wear surgical masks during the flu season or risk being redeployed.

NSW is the only state to make flu vaccination mandatory for some health workers. It aims to protect vulnerable patients and the health system from another disastrous flu season like in 2017. While the federal government has told aged care providers they must offer the flu vaccine to their staff this winter, there is no requirement for staff to accept the vaccine.

Despite the numerous campaigns promoting the flu vaccine to Australian health workers, uptake has been documented to range from only 16-60%, with an even lower rate reported among aged-care workers.

The most effective way to improve vaccination rates among health workers is to make it mandatory. State, territory and Commonwealth governments should consider making the flu shot mandatory for all health workers in high-risk clinical areas and aged care facilities.

Why health workers need to be vaccinated

For most of us, vaccination is for individual protection. In the case of those caring for sick and vulnerable people such as children and the elderly, vaccination protects others from devastating illness, complications and even death.

Hospitals and aged care facilities can experience explosive outbreaks of influenza.
Aged care facilities may have to close their doors to new admissions, which can also have a significant economic impact. It’s also important that staff absenteeism in hospitals is kept low, especially in areas with limited specialist expertise.

Some argue vaccination of health workers is a moral duty, while others state individual freedom of choice is more important than protection of patients.

Mandating vaccination

The use of immunisation mandates for health-care workers is not new in Australia. In most states and territories, staff are required to have vaccines for (or show evidence of protection against) measles, mumps, rubella, diphtheria, tetanus, pertussis, hepatitis B, and varicella (chicken pox).

NSW, for example, introduced mandatory vaccination of health care workers for several vaccines (but not the flu) in 2007. NSW health workers generally accepted this change in policy, with only 4% objecting.

Making the flu shot mandatory, as NSW has done this year, would simply add the the list of vaccinations health workers are required to have.

NSW is the only state to make flu vaccination mandatory for some health workers.
from http://www.shutterstock.com

The evidence suggests it’s worth it; a five-year study in one hospital in the United States showed mandatory hospital policies can raise coverage rates to close to 100%.

Institutions that have implemented a mandatory policy have dramatically reduced employee sick days as well as flu in hospitals, thereby improving patient safety and reducing health care costs.

Staff vaccination programs

Most workplaces run intensive vaccination programs, which may include mass immunisation clinics, mobile carts, posters and email reminders. But in most cases, these programs aren’t successful at boosting vaccination levels above 60%.

Some hospitals have been able to achieve higher vaccination rates in the short term through easy access to vaccines, education, reminders and multiple opportunities for vaccination. But these initiatives require ongoing resources and continual efforts – a one-off vaccination day is not enough.

The Victorian health system used a slightly different approach in 2014 when it made high rates of flu vaccination a hospital performance target. The government also provided the vaccine free to all Victorian hospitals.

This raised vaccination rates among Victorian hospital staff from 60% to 75% overall (higher in some hospitals). But higher rates may be achieved through mandatory flu vaccination.

But it’s not always the best policy

For each situation, we need to consider the overall risks and benefits of mandatory vaccination, as well as the gains in protection and vaccination coverage.

For infant vaccination, for example, vaccination rates are already at a high baseline of more than 93%. So, the risk of coercive policies may be greater than the relatively small gains achieved by coercive methods. Similar results may be achieved through other methods.

There’d be little point mandating vaccines for infants since they already have high rates of vaccination.
from http://www.shutterstock.com

In the case of health and aged-care workers, however, we start with a lower base of vaccine coverage, of 16-60%. Adding financial incentives or disincentives, or making it mandatory, would result in much larger gains in vaccination rates.

Vaccinating health-care workers also has benefits beyond their individual protection: it reduces the risk of their patients contracting influenza and maintains the health workforce capacity. This shifts the balance in favour of mandatory vaccination.

Given large potential gains and low resource requirements, mandatory flu vaccination for all health workers in high-risk areas is a good idea. Governments should consider this and other strategies to improve flu vaccination rates health and aged care workers.

C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, UNSW and Holly Seale, Senior Lecturer, UNSW

This article was originally published on The Conversation. Read the original article.

Health Check: which vaccinations should I get as an adult?

Posted on September 8, 2017 by particularkev

File 20170810 4244 1cw5cph — Vaccines are one of the greatest public health achievements in history.
from shutterstock.com

C Raina MacIntyre, UNSW and Rob Menzies, UNSW

Before vaccines were developed, infectious diseases such as diphtheria, tetanus and meningitis were the leading cause of death and illness in the world. Vaccines are one of the greatest public health achievements in history, having drastically reduced deaths and illness from infectious causes.

There is a large gap between vaccination rates for funded vaccines for adults in Australia and those for infants. More than 93% of infants are vaccinated in Australia, while in adults the rates are between 53-75%. Much more needs to be done to prevent infections in adults, particularly those at risk.

If you are an adult in Australia, the kinds of vaccines you need to get will depend on several factors, including whether you missed out on childhood vaccines, if you are Aboriginal or Torres Strait Islander, your occupation, how old you are and whether you intend to go travelling.

For those born in Australia

Children up to four years and aged 10-15 receive vaccines under the National Immunisation Schedule. These are for hepatitis B, whooping cough, diphtheria, tetanus, measles, mumps, rubella, polio, haemophilus influenzae B, rotavirus, pneumococcal and meningococcal disease, chickenpox and the human papillomavirus (HPV).

Immunity following vaccination varies depending on the vaccine. For example, the measles vaccine protects for a long duration, possibly a lifetime, whereas immunity wanes for pertussis (whooping cough). Boosters are given for many vaccines to improve immunity.

Measles, mumps, rubella, chickenpox, diphtheria and tetanus

People born in Australia before 1966 likely have natural immunity to measles as the viruses were circulating widely prior to the vaccination program. People born after 1965 should have received two doses of a measles vaccine. Those who haven’t, or aren’t sure, can safely receive a vaccine to avoid infection and prevent transmission to babies too young to be vaccinated.

Measles vaccine can be given as MMR (measles-mumps-rubella) or MMRV, which includes varicella (chickenpox). The varicella vaccine on its own (not combined in MMRV) is advised for people aged 14 and over who have not had chickenpox, especially women of childbearing age.

Booster doses of diphtheria, tetanus and whooping cough vaccines, are available free at age 10-15, and recommended at 50 years old and also at 65 years and over if not received in the previous ten years. Anyone unsure of their tetanus vaccination status who sustains a tetanus-prone wound (generally a deep puncture or wound) should get vaccinated. While tetanus is rare in Australia, most cases we see are in older adults.

In July 2017, the government announced free catch-up vaccinations for all newly arrived refugees. This covers any childhood vaccine on the National Immunisation Schedule which has been missed.
Information sourced from betterhealth.vic.gov.au and healthdirect.gov.au/The Conversation, CC BY-ND

Whooping cough

Pregnant women are recommended to get the diphtheria-tetanus-acellular pertussis vaccine in the third trimester to protect the vulnerable infant after it is born, and influenza vaccine at any stage of the pregnancy (see below under influenza).

Pertussis (whooping cough) is a contagious respiratory infection dangerous for babies. One in every 200 babies who contract whooping cough will die.

It is particularly important for women from 28 weeks gestation to ensure they are vaccinated, as well as the partners of these women and anyone else who is taking care of a child younger than six months old. Deaths from pertussis are also documented in elderly Australians.

Pneumococcal disease and influenza

The pneumococcal vaccine is funded for everyone aged 65 and over, and recommended for anyone under 65 with risk factors such as chronic lung disease.

Anyone from the age of six months can get the flu (influenza) vaccine. The vaccine can be given to any adult who requests it, but is only funded if they fall into defined risk groups such as pregnant women, Indigenous Australians, peopled aged 65 and over, or those with a medical condition such as chronic lung, cardiac or kidney disease.

Flu vaccine is matched every year to the anticipated circulating flu viruses and is quite effective. The vaccine covers four strains of influenza. Pregnant women are at increased risk of the flu and recommended for influenza vaccine any time during pregnancy.

Health workers, childcare workers and aged-care workers are a priority for vaccination because they care for sick or vulnerable people in institutions at risk of outbreaks. Influenza is the most important vaccine for these occupational groups, and some organisations provide free staff vaccinations. Otherwise, you can ask your doctor for a vaccination.

Any person whose immune system is weakened through medication or illness (such as HIV) is at increased risk of infections. However, live viral or bacterial vaccines must not be given to immunosuppressed people. They must seek medical advice on which vaccines can be safely given.

Hepatitis

Australian-born children receive four shots of the hepatitis B vaccine, but some adults are advised to get vaccinations for hepatitis A or B. Those recommended to receive the hepatitis A vaccine are: travellers to hepatitis A endemic areas; people whose jobs put them at risk of acquiring hepatitis A including childcare workers and plumbers; men who have sex with men; injecting drug users; people with developmental disabilities; those with chronic liver disease, liver organ transplant recipients or those chronically infected with hepatitis B or hepatitis C.

Those recommended to get the hepatitis B vaccine are: people who live in a household with someone infected with hepatitis B; those having sexual contact with someone infected with hepatitis B; sex workers; men who have sex with men; injecting drug users; migrants from hepatitis B endemic countries; healthcare workers; Aboriginal and Torres Strait Islanders; and some others at high risk at their workplace or due to a medical condition.

Read more – Explainer: the A, B, C, D and E of hepatitis

Human papillomavirus

The human papillomavirus (HPV) vaccine protects against cervical, anal, head and neck cancers, as well as some others. It is available for boys and girls and delivered in high school, usually in year seven. There is benefit for older girls and women to be vaccinated, at least up to their mid-to-late 20s.

The elderly

With ageing comes a progressive decline in the immune system and a corresponding increase in risk of infections. Vaccination is the low-hanging fruit for healthy ageing. The elderly are advised to receive the influenza, pneumococcal and shingles vaccines.

Influenza and pneumonia are major preventable causes of illness and death in older people. The flu causes deaths in children and the elderly during severe seasons.

The most common cause of pneumonia is streptococcus pneumonia, which can be prevented with the pneumococcal vaccine. There are two types of pneumococcal vaccines: pneumococcal conjugate vaccine (PCV) and pneumococcal polysaccharide vaccine (PPV). Both protect against invasive pneumococcal disease (such as meningitis and the blood infection referred to as septicemia), and the conjugate vaccine is proven to reduce the risk of pneumonia.

The government funds influenza (annually) and pneumococcal vaccines for people aged 65 and over.

Vaccination is the low-hanging fruit for healthy ageing.
from shutterstock.com

Shingles is a reactivation of the chickenpox virus. It causes a high burden of disease in older people (who have had chickenpox before) and can lead to debilitating and chronic pain. The shingles vaccine is recommended for people aged 60 and over. The government funds it for people aged 70 to 79.

Australian travellers

Travel is a major vector for transmission of infections around the world, and travellers are at high risk of preventable infections. Most epidemics of measles, for example, are imported through travel. People may be under-vaccinated for measles if they missed a dose in childhood.

Anyone travelling should discuss vaccines with their doctor. If unsure of measles vaccination status, vaccination is recommended. This will depend on where people are travelling, and may include vaccination for yellow fever, Japanese encephalitis, cholera, typhoid, hepatitis A or influenza.

Travellers who are visiting friends and relatives overseas often fail to take precautions such as vaccination and do not perceive themselves as being at risk. In fact, they are at higher risk of preventable infections because they may be staying in traditional communities rather than hotels, and can be exposed to risks such as contaminated water, food or mosquitoes.

Aboriginal Australians and Torres Strait Islanders

Indigenous Australians are at increased risk of infections and have access to funded vaccines against influenza (anyone over six months old) and pneumococcal disease (for infants, everyone over 50 years and those aged 15-49 with chronic diseases).

They are also advised to get hepatitis B vaccine if they haven’t already received it. Unfortunately, overall vaccine coverage for these groups is low – between 13% and 50%, representing a real lost opportunity.

Migrants and refugees

Migrants and refugees are at risk of vaccine-preventable infections because they may be under-vaccinated and come from countries with a high incidence of infection. There is no systematic means for GPs to identify people at risk of under-vaccination, but the new Australian Immunisation Register will help if GPs can check the immunisation status of their patients.

The funding of catch-up vaccination has also been a major obstacle until now. In July 2017 the government announced free catch-up vaccinations for children aged 10-19 and for all newly arrived refugees. This covers any childhood vaccine on the National Immunisation Schedule that has been missed.

While this does not cover all under-vaccinated refugees, it is a welcome development. If you are not newly arrived but a migrant or refugee, check with your doctor about catch-up vaccination.

C Raina MacIntyre, Professor of Infectious Diseases Epidemiology, Head of the School of Public Health and Community Medicine, UNSW and Rob Menzies, Senior Lecturer, UNSW

This article was originally published on The Conversation. Read the original article.

Sharing my thoughts with the world from a Particular Baptist perspective

Vaccines offer substantial protection

The delta strain is far more infectious

So why do we need 80% of people vaccinated?

Let’s break it down

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Overcoming resistance

What vaccines can you get at the pharmacy?

It might cost you more

Do you need to see a GP?

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The shift from voluntary vaccination

Making it hard to refuse

Which policy leads parents to vaccinate?

Who doesn’t have to vaccinate?

Addressing the many reasons for not vaccinating

So where does this leave us?

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Why might you have missed some?

Measles cases show us why it’s important

So what do you need to do?

Which vaccines do adults need?

What if you’ve had a reaction in the past?

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Who do we need to talk to?

Tips for discussing vaccination

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What the reviews found

Why are we so scared of the flu?

So what, if not the vaccine?

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Why health workers need to be vaccinated

Mandating vaccination

Staff vaccination programs

But it’s not always the best policy

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For those born in Australia

The elderly

Australian travellers

Aboriginal Australians and Torres Strait Islanders

Migrants and refugees

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