Strategies to improve vaccination uptake in Australia
Summary of included studies by intervention category
Increase community demand (n=20)
Primary
author
a
(year)
Location
Ballestas
(2009)
Evaluation
b
design
Vaccine(s) and
target group(s)
Fremantle,
Western
Australia
Descriptive
(cross
sectional,
c
pre/post )
Influenza
Australian
Capital
Territory
Descriptive
c
(pre/post )
NIP
Perth, Western
Australia
Analytic
e
(RCT )
J
Banks
(2008)
Intervention(s)
Outcomes
Conclusion
Limitations
Over 11,000 staff
in 5 hospitals
Social marketing
campaign + education
Vaccination coverage
Increased
coverage
Variation in data
collection methods
Coverage could be
overestimated
Respondent bias
Health care
workers (HCWs)
d
n vaccinated = 6,387
Coverage = 55%
877 parents of
children aged <5
years overdue for
immunisation
Recall letters +
updating records
78% of initially overdue children
were up to date
Increased
coverage
None stated
NIP
150 children
Children
Intervention = 75
Control = 75
Home visits +
education for women
post-partum
No significant differences were
detected in immunisations at 2
months (p=0.757), 4 months
(p=0.477) or 6 months (p=0.283)
post-partum between intervention
group and control group
No significant
differences in
coverage
between
intervention
group and
control group
Self-report bias
Insufficient power to
detect clinically
significant differences
Measurement bias
Selection bias
Descriptive
(cohort,
c
pre/post )
Influenza
580 patients
Reminder letters +
free appointments +
nurse-led
immunisation
Vaccination coverage
Increased
coverage
Potential temporal
confounders
Small sample
Descriptive
(cross
sectional, post
f
only )
Influenza
Multi-component
interventions:
education programs;
mobile vaccination
cart; declination
forms; incentives;
promotions;
communication
Average coverage Victorian public
hospitals = 48.3%
Study hospitals = 54.3%
Support and
resources are a
more important
barrier to
achieving high
coverage rates
than the failure
to use evidencebased strategies
Small sample
Subjective
assessments
Measurement tools
not validated
Difficulty in obtaining
accurate coverage
estimates
Highly correlated
nature of the
variables limited
statistical analysis
Children
C
Bartu
(2006)
Sample size
d
J
Byrnes
(2006)
Bundaberg,
Queensland
Older people
J
Victoria
HCWs
De Alwis
(2010)
J
17 hospitals
2004 = 77%
2005 = 83%
Less than half (5/17) the study
hospitals achieved state target of
60%
Inverse relationship between
vaccination coverage and number
of acute beds – smaller hospitals
achieved higher coverage
Summary of strategies to increase vaccination uptake in Australia
Page 1 of 13
Primary
author
a
(year)
Location
Evaluation
b
design
Vaccine(s) and
target group(s)
Sample size
Intervention(s)
Outcomes
Conclusion
Limitations
Devine
(2007)
St Albans and
Maldon,
Victoria
Descriptive
(cohort,
c
pre/post )
Hepatitis B
204 prisoners
Integrate vaccination
with health
assessments
Vaccination coverage
Achieved high
coverage
Small sample
Measurement bias
Activities limited due
to challenging
population
Sydney, New
South Wales
Analytic
(retrospective
cohort)
Influenza
Patient education +
reminder letter to
general practitioner
(GP)
Vaccination coverage
Higher coverage
in intervention
group than
control group
Selection bias
Small sample
Social desirability bias
Self-report bias
Not all interventions
evaluated
Descriptive
(cohort,
c
pre/post )
Influenza
State-wide
coordination of
influenza vaccine for
HCWs incl. staff
education and
promotional material
Vaccination coverage
Increased
coverage
None stated
Analytic
e
(RCT )
Measles-mumps
259 parents
Vaccination coverage
Children
Intervention = 124
Control = 135
Reminder postcard
based on Health
Belief Model
Higher coverage
in intervention
group than
control group
Measurement bias
Confounding
Selection bias
Human
papillomavirus
(HPV)
159 students
Two different
information leaflets
with information about
the HPV vaccine
framed as protecting
against (1) cervical
cancer (2) cervical
cancer + genital warts
Vaccination coverage
Vaccine
intention does
not equate to
behaviour
Participants may be
interested in the
vaccine
Recall letters
Percentage up to date
J
Ferguson
(2010)
J
Fullerton
(2010)
Across
Queensland
Behaviourally at
risk (prisoners)
205 children
Medically at risk
(haematopoietic
stem cell
transplant
[HSCT] patients
and their
families)
Around 7,400
employees
HCWs
C
Hawe
(1998)
Ballarat,
Victoria
J
Sydney, New
South Wales
Analytic
e
(RCT )
Juraskova
(2011)
First year
university
students,
female, aged
under 27
J
Kirby
(2010)
C
Sydney, New
South Wales
Descriptive
(cross
sectional,
c
pre/post )
d
NIP
Children
Summary of strategies to increase vaccination uptake in Australia
Cervical cancer
leaflet = 81
Cervical cancer +
genital warts
leaflet = 78
Not stated
dose 1 = 83%
dose 2 = 93%
dose 3 = 84%
Participants = 71%
Non-participants = 30%
2006 = 26%
2009 = 58%
Intervention = 79%
Control = 67%
37% of total participants received
vaccine 2 months after
intervention
Small sample
Low HPV knowledge (22%) and
high vaccination intention (79%)
which was not influenced by
information framing
High attrition
Increased
coverage
None stated
July 2009 = 55%
December 2009 = 70%
Page 2 of 13
Primary
author
a
(year)
Location
Queensland
Evaluation
b
design
Vaccine(s) and
target group(s)
Analytic
e
(RCT )
Tetanusdiphtheria +
hepatitis B +
influenza
Lennox
(2007)
Sample size
Intervention(s)
Outcomes
Conclusion
Limitations
459 adults
Integrate vaccination
with health
assessments
Vaccination coverage
Higher coverage
in intervention
group than
control group
Limited
generalisability
Potential information
bias
High staff turnover
Higher coverage
in intervention
group than
control group
Contamination of the
sample –
underestimated
effects
Coverage higher
than
jurisdictional
average
Limited
generalisability
No formal evaluation
activities undertaken
No significant
differences in
coverage
between
intervention
group and
control group
Limited
generalisability
Measurement
deficiencies
Intervention = 234
Control = 219
Medically at risk
(adults with
intellectual
disability)
J
Tetanus-diphtheria
Intervention = 25%
Control = 3%
Hepatitis B
Intervention = 16%
Control = 7%
Influenza
Intervention = 60%
Control = 56%
Puech
(1998)
Sydney, New
South Wales
Analytic
e
(RCT )
Influenza
325 elderly
Older people
Intervention = 154
Control = 171
Influenza
Not stated
J
Melbourne,
Victoria
Scott
(2010)
Descriptive
(cohort, post
f
only )
HCWs
Reminder postcard
Vaccination coverage
Intervention = 64%
Control = 46%
(p=0.05)
Staff education +
promotional material
+ mass vaccination
clinics
C
Number of vaccines administered
to staff
Seasonal influenza: 2,268 (65%
uptake); average Victorian uptake
= 53%
Pandemic 2009 (H1N1) influenza
vaccine: 1,548 (48% uptake)
Melbourne,
Victoria
Skinner
(2000)
Analytic
e
(RCT )
Hepatitis B
17,411 students
Adolescents
(11–13 years of
age)
Intervention =
7,588
Control = 9,823
J
Summary of strategies to increase vaccination uptake in Australia
Education +
promotional materials
for students
Vaccination coverage, knowledge
and attitudes towards hepatitis B
vaccination
(1) 93% completed the 3-dose
course (similar for intervention
and control schools)
(2) Coverage increased by 4–10%
between low vs high
implementation in intervention
schools
Page 3 of 13
Primary
author
a
(year)
Thomas
(2008)
Location
Sydney, New
South Wales
J
Perth, Western
Australia
Evaluation
b
design
Vaccine(s) and
target group(s)
Descriptive
(cross
sectional,
c
pre/post )
Pneumococcal
Descriptive
(cohort,
c
pre/post )
NIP
Sample size
Intervention(s)
Outcomes
Conclusion
Limitations
GPs = 23
Babies = 13
Staff education +
reminder stickers +
patient promotion
materials + Aboriginal
Liaison Officers
Vaccination coverage
Increased
coverage
Activities limited by
the available
resources
Limited
generalisability
Recall letters +
promotional materials
– based on a mascot
Vaccination coverage, provider
and consumer feedback
Increased
coverage
None stated
A targeted
media campaign
can increase
vaccine uptake if
it reinforces the
seriousness of
influenza illness
and addresses
community
myths about the
disease and
vaccine. The
use of dedicated
vaccination
clinics can also
increase uptake.
Limited
generalisability
Self-report bias
Non-random sample
Influence of the
‘healthy participant’
effect
Influence of parental
memory of childhood
death cluster on
vaccine uptake (not
measured)
Assessing the
attributable benefit of
mass marketing
campaigns against
high background
coverage rates
Increased
coverage
Limited
generalisability
No formal evaluation
activities undertaken
Aboriginal and
Torres Strait
Islander children
d
35 general
practices
Children
Increased from 30% to 40%
(average for Sydney babies =
50%)
Pilot program – 54.2%
participating practices recorded a
rise in ACIR coverage
Tomney
(2010)
C
First year post-pilot – 46%
participating practices recorded an
increase in ACIR coverage
Western
Australia
Descriptive
(cross
sectional, post
f
only )
Influenza
546 parents
Children aged
6–59 months
Van Buynder
(2010)
J
Free vaccine
available from GPs
and large public clinic
in metropolitan area
AND
public marketing
campaign targeting
parents/guardians (2
waves) using mass
media and targeted
promotional letters
The peak uptake of vaccine
occurred in the week the program
commenced though there was no
evidence of a boost in uptake
following the second phase of the
campaign (6 weeks post launch)
Vaccination coverage differed
slightly by measurement method:
CATI recruited
dose 1 = 52%
dose 2 = 47%
WAIVE and sentinel GP recruited
dose 1 = 52%
dose 2 = 36%
WaddingtonPowell
(2008)
Across South
Australia
Descriptive
(cohort
c
pre/post )
Influenza
HCWs
Not stated
Staff education +
policy + promotional
material
Vaccination coverage
2006 = 51%
2007 = 57%
C
Summary of strategies to increase vaccination uptake in Australia
Page 4 of 13
Primary
author
a
(year)
Wallace
(2008)
J
Location
Evaluation
b
design
Vaccine(s) and
target group(s)
Sample size
Intervention(s)
Outcomes
Conclusion
Limitations
North Coast,
New South
Wales
Descriptive
(cohort,
c
pre/post )
Pneumococcal
Not stated
Mass media (TV
advertisements)
Vaccine ordering patterns
Increased
orders for this
vaccine
Differences in effect
not measured by
target group
Proxy measure used
to estimate coverage
No assessment of
participant awareness
or factors impacting
program
implementation
Aboriginal and
Torres Strait
Islander people
and older
people
Summary of strategies to increase vaccination uptake in Australia
Significantly higher (p<0.001)
proportion of vaccines ordered
33% increase compared to the
same period in the previous year
Page 5 of 13
Enhance access (n=15)
Primary
author
a
(year)
Location
Evaluation
b
design
Vaccine(s) and
target group(s)
Melbourne,
Victoria
Analytic
e
(RCT )
dTpa and
h
MMR
Bond
(1998)
g
Sample size
Intervention(s)
Outcomes
Conclusion
Limitations
169 children
Home visits
Vaccination coverage and number
of newborns up to date
Higher coverage
in intervention
group than
control group
Randomisation
strategy may have led
to respondent bias
Moderate
increases in
coverage
Small sample
No formal evaluation
activities undertaken
Increased
coverage
Limited
generalisability
No formal evaluation
activities undertaken
Intervention = 81
Control = 88
Children
dTpa
Intervention = 56%
Control = 33%
J
MMR
Intervention = 57%
Control = 23%
Brown
(2010)
Logan City,
Queensland
Descriptive
c
(pre/post )
DTPa-IPV
h
MMR
g
Children
2008–2009 = 13
schools
Influenza
Not stated
C
Melbourne,
Victoria
Elia
(2010)
Descriptive
(cross
sectional, post
f
only )
2007–2008 = 9
schools
All age groups
Catch-up vaccines
provided in primary
schools
Number of students vaccinated
Mass vaccination
clinic (hospital) +
promotional materials
Number of vaccines administered
Consented = 490 (33%)
Vaccinated previously = 350
(71%)
Targeted for vaccination = 140
N targeted vaccinated = 97 (69%)
2005 = <500
2009 = 2,338
Types of target groups
vaccinated: patients (71%),
siblings (12%), parents (12%),
staff (5%)
C
Summary of strategies to increase vaccination uptake in Australia
Page 6 of 13
Primary
author
a
(year)
Location
Evaluation
b
design
Vaccine(s) and
target group(s)
Western
Australia
Analytic
(cohort)
Hepatitis A and
B (combined or
monovalent, 3
doses, varying
schedules)
Sample size
Intervention(s)
Outcomes
Conclusion
Limitations
1,209 notified
hepatitis C cases
Government funded
vaccine could be
ordered by GPs upon
notification of newly
diagnosed hepatitis C
cases
Notified cases ordering first dose
of vaccine during study period =
37%
Higher uptake of
these vaccines
compared to
previous studies
Measurement bias
Low course
completion
Unlikely to have
ordered vaccine(s) or
completed course if
patient was known to
be immune to
hepatitis A or B virus
or had been partially
vaccinated
Not effective in
increasing
coverage
None stated
Achieved high
coverage
Sample may not be
representative of the
population
Small sample
Unknown
comparators (i.e.
population rate of
AEFI)
Medically at risk
(adults newly
diagnosed with
hepatitis C)
Fredericks
(2010)
J
Of those who ordered an initial
dose, 30% placed final dose
orders
Older patients, those with
unknown Indigenous status and
non-Indigenous patients were
more likely to order at least one
vaccine
Administration of
ordered vaccine
Vaccine uptake in this study
higher than the 8–9% reported in
previous studies
Gill
(2010)
Hobart,
Tasmania
Descriptive
(cross
sectional, post
f
only )
Pandemic
influenza
All age groups
C
Gold
(2000)
J
Adelaide,
South
Australia;
Sydney, New
South Wales;
Melbourne,
Victoria
Descriptive
(cohort, post
f
only )
d
NIP
Medically at risk
(children with a
previous history
of an adverse
event following
immunisation
[AEFI])
Summary of strategies to increase vaccination uptake in Australia
All Tasmanians in
Launceston and
those attending
the Taste of
Tasmania in
Hobart in 2009
Mass vaccination
clinics (public
gatherings)
970 children
Vaccination clinic for
children with history
of AEFI
Descriptive data about likelihood
of reaching younger and deprived
populations
Uptake was low in those aged
<40 years and among
disadvantaged residents
Vaccination coverage
90%
Page 7 of 13
Primary
author
a
(year)
Location
Evaluation
b
design
Vaccine(s) and
target group(s)
Sunshine
Coast,
Queensland
Descriptive
(cohort,
c
pre/post )
NIP +
pneumococcal +
adult diphtheriatetanus (ADT) +
hepatitis B +
h
MMR +
influenza
Grant
(2005)
R
d
Sample size
Intervention(s)
Outcomes
Conclusion
Limitations
1,344
(20% of the
Indigenous
population in the
Health Service
District)
Mass vaccination
clinics (public places)
+ home visits
Number of people vaccinated
Increased
coverage
Intervention activities
changed over time –
measurement of
outcomes challenging
Free vaccine
Vaccination coverage
Increased
coverage
Lack information on
intention to vaccinate
pre-intervention
Accelerated
vaccination schedule
Some increase
in coverage
Impact of other
aspects of service
delivery on coverage
not evaluated
Source of intention to
vaccinate unknown
Increased
coverage
None stated
Achieved high
coverage
Limited
generalisability
No formal evaluation
activities undertaken
Before the program = 332
After = 1,344
All Aboriginal
and Torres Strait
Islander persons
Howe
(2009)
Western
Australia
Descriptive
(cohort, post
f
only )
Influenza
HCWs
399 General
Practice Network
staff
Analytic
(cohort)
Hepatitis B
2,085 patients
54% vaccinated, of which 34%
had not received the vaccine
previously
R
Sydney, New
South Wales
Behaviourally at
risk
(‘high risk’
patient attending
sexual health
centre)
Macdonald
(2007)
J
Piper
(2008)
Descriptive
(cohort, post
f
only )
NIP
Mt Isa,
Queensland
Descriptive
(cohort, post
f
only )
Human
papillomavirus
(HPV)
C
Reeve
(2008)
J
d
Tweed Heads,
New South
Wales
2 doses
Standard schedule = 45%
Accelerated schedule = 50%
3 doses
Standard schedule = 16%
Accelerated schedule = 22%
276 children
Aboriginal and
Torres Strait
Islander children
≤7 years of age
Adolescents
(10–13 years)
Summary of strategies to increase vaccination uptake in Australia
Vaccination coverage
304 students
Reminder letters sent
+ personalised followup if no response
Vaccination coverage
School-based
vaccination program
delivered by GPs
Consent form return rate = 94%
Consent rate = 90%
34% completed
46% currently completing
0.5% conscientious objectors
93% up to date with scheduled
vaccinations
Vaccine uptake
dose 1 = 89%
dose 2 = 88%
dose 3 = 79%
Page 8 of 13
Primary
author
a
(year)
Location
Evaluation
b
design
Vaccine(s) and
target group(s)
Sydney, New
South Wales
Analytic
(cohort)
NIP
d
Sample size
Intervention(s)
Outcomes
Conclusion
Limitations
539 children
Hospital-based catchup plan
Vaccination coverage within a
time-frame
Improved
timeliness of
catch-up
immunisation
Recall bias
Limited by use of
retrospective data
Reasons for delayed
vaccination not given
Achieved
moderate
coverage
Limited by use of
retrospective data
Measurement bias
Measurement deficit
– seroprotection data
Increased
coverage
Study did not detect
temporal associations
Confounding
Improved
provision of
immunisation by
GPs
None stated
Children
Ressler
(2008)
Children with catch-up plan sig.
more likely to be vaccinated within
30 days of admission (p=0.005)
and within 90 days (p=0.04)
compared to those without catchup plan
J
Rogers
(2005)
Melbourne,
Victoria
Descriptive
(cohort, post
f
only )
Hepatitis B
Descriptive
(cohort,
c
pre/post )
NIP
J
Albury, New
South Wales
Smith
(2010)
90 injecting drug
users
Behaviourally at
risk (injecting
drug users)
d
Not stated
Children
Accelerated
vaccination schedule
+ personalised
reminders
Vaccination coverage
Mass vaccination
clinics (library setting)
+ promotional
material
Vaccination coverage and
attendance records
C
3 doses = 71%
2 doses = 11%
1 dose = 18%
Two clinics run with total of 29
children attending (average in
routine clinics = 6–8)
Vaccination coverage increased
by 14% in 6 months
SESIAHS
(2008)
Wollongong
and Illawarra
area, New
South Wales
Descriptive
(cohort,
c
pre/post )
Adult and
childhood
vaccines
Medically at risk
(refugees)
123 newly arrived
refugees
Hospital and general
practice collaborative
care model + staff
education
Consultation coverage
All 64 (100%) children and 59
(95%) adults were seen by GPs
and had recommended screening
tests
R
55% of children were underimmunised and received catch-up
vaccines
Summary of strategies to increase vaccination uptake in Australia
Page 9 of 13
Provider-based interventions (n=8)
Primary
author
(year)a
Ali
(2009)
Location
Sydney, New
South Wales
Evaluation
design b
Vaccine(s) and
target group(s)
Descriptive
(cohort,
c
pre/post )
NIP
Descriptive
(cross
sectional,
c
pre/post )
Routine
vaccinations for
Australian
Defence Force
personnel –
g
dTpa , polio,
hepatitis A,
hepatitis B,
h
typhoid, MMR ,
varicella
d
Sample size
Intervention(s)
Outcomes
Conclusion
Limitations
42 general
practices
Provider education +
support at the general
practice
Vaccination coverage
Increased
coverage
Measurement bias
An audit of an
electronic patient
management
database to
determine vaccination
currency of patients
and accuracy of
vaccination records
% due at least one vaccination =
9.75%
Increased
coverage and
awareness of
those who were
due for routine
vaccination
Audit only included
those ‘due/overdue’
for vaccination.
It is possible that the
electronic vaccination
records of ‘up to date’
patients are
erroneous thus
artificially inflating
coverage.
12 aged care
facility staff
630 residents
Staff education +
promotional materials
Vaccination coverage of residents
Increased
coverage
None identified
10,507 adults
Provider reminders
Significantly
increased
coverage
None identified
Increased
provision of
vaccines
None identified
Children
J
Sydney, New
South Wales
Colgrave
(2010)
J
800 patients at the
Tobruk Lines
Health Centre
Proportion of general practices
with >90% coverage increased
from 30% to 68%
Most commonly due vaccine =
typhoid (n=73/94)
The audit reduced the proportion
of overdue vaccinations by 42%
and increased coverage by 2%.
Occupationally
at risk
(Australian
Defence Force
personnel)
Finlay
(2008)
Albury, New
South Wales
C
Frank
(2004)
Adelaide,
South
Australia
Descriptive
(cross
sectional,
c
pre/post )
Influenza
Older people
e
Quasi-RCT
(non-blinded)
J
Tetanuscontaining
h
vaccine + MMR
+ influenza +
pneumococcal
2007 = 87.5%
2008 = 92%
Intervention =
5,118
Control = 5,389
Tetanus = 2.8% (p<0.05)
Pneumococcal = 2.8% (p<0.05)
MMR = 10.3% (p>0.05)
Influenza = 26.2% (p>0.05)
Adults
Irwin
(2002)
C
Melbourne,
Victoria
Descriptive
(cohort,
c
pre/post )
Influenza +
pneumococcal
Medically at risk
(children with ‘at
risk’ conditions)
Summary of strategies to increase vaccination uptake in Australia
Not stated
% increase in vaccination
coverage
Reminders (hospital
based) + staff
education
Provision of vaccines
Influenza = 2.5%
Pneumococcal = 3.4%
Page 10 of 13
Primary
author
(year)a
Kerse
(1999)
Location
Evaluation
design b
Vaccine(s) and
target group(s)
Sample size
Intervention(s)
Outcomes
Conclusion
Limitations
Melbourne,
Victoria
Analytic
e
(RCT )
Influenza
42 GPs
Education (for GPs) +
provider reminders
Vaccination coverage of patients
Older people
Intervention = 21
Control = 21
Significantly
increased
coverage
Measurement bias
Limited
generalisability
Selection bias
Increased
coverage
No use of comparator
No significant
differences
between
reminder
systems – both
increased
uptake
Selection bias
Lack of
generalisability
Insufficient power to
detect differences in
effect
Increased from 66% to 73%
(p=0.14)
J
Patients = 267
Lake
(2008)
Adelaide,
South
Australia
Descriptive
(cohort, post
f
only )
Influenza
HCWs
C
26 residential
aged care
facilities (RACFs)
10 RACFs
participated
Staff training + policy
(standing orders for
nurses) + free
vaccine
Vaccination coverage
Residents = 80%
Staff = 41%
Vaccine provision also increased
in participating RACFs
Melbourne,
Victoria
MacIntyre
(2003)
Analytic
e
RCT )
Influenza +
pneumococcal
Older people
J
131 elderly
Intervention = 70
Control = 61
Reminders for
hospital staff vs GPs
Vaccination coverage
Influenza
Intervention = 63%
Control = 53%
Pneumococcal
Intervention = 67%
Control = 55%
Summary of strategies to increase vaccination uptake in Australia
Page 11 of 13
Regulatory interventions (n=6)
Primary
author
a
(year)
Bond
(2002)
Location
Melbourne,
Victoria
Evaluation
b
design
Vaccine(s) and
target group(s)
Analytic
(cross
sectional)
NIP
Descriptive
(cohort,
c
pre/post )
Hepatitis B
(0, 2, 6 months
schedule)
d
Sample size
Intervention(s)
Outcomes
Conclusion
Limitations
1997 = 1,578
2000 = 1,793
National policy –
maternity
immunisation
allowance (MIA) +
child care benefit
(CCB)
Vaccination coverage
Increased
coverage
Measurement bias
Study design not
sufficient to detect
temporal associations
Limited
generalisability
Jurisdictional policy –
vaccination of infants
born after August
1990
Vaccination coverage in hospitals
Some increase
in coverage
Measurement bias
Jurisdictional policy –
mandatory
vaccination against
specified diseases for
HCWs
Full compliance = 39–73%
Increases in
coverage
following this
policy have
been modest
and difficult to
quantify
Absence of baseline
data prior to policy
implementation
Increased
coverage
Measurement bias
Increased
coverage
Recall bias
Potential data
contamination
Measurement bias
Children
J
Connors
(1998)
Darwin,
Northern
Territory
J
1993 = 2,054
1994 = 2,111
Increased from 84% to 93%
1993 – Hos A: 96%; Hos B: 71%
1994 – Hos A: 93%; Hos B: 77%
Newborns
New South
Wales
Helms
(2011)
Descriptive
(cross
sectional, post
f
only )
g
h
dTpa + MMR +
varicella +
hepatitis B
58 HCWs and
executive staff
(qualitative
interviews)
HCWs
Number of unprotected staff
reassigned or risk managed = 0–3
Proportion of students rejected for
failure of compliance = 0–8%
J
No health region/service(s)
completed implementation by
target date (Dec 2008)
Lam
(1998)
Sydney, New
South Wales
Analytic
(cross
sectional)
Hepatitis B
Descriptive
(cross
sectional,
c
pre/post )
dTpa +
hepatitis B +
i
OPV + varicella
+ influenza +
h
j
MMR + BCG
678 students
Newborns
J
Melbourne,
Victoria
Smithers
(2003)
J
g
HCWs
Summary of strategies to increase vaccination uptake in Australia
287 HCWs
Jurisdictional policy –
vaccination of
neonates born to
hepatitis B virus
(HBV) carrier mothers
Self-reported vaccination rates
Hospital HCWs
vaccination policy +
part-time
immunisation
coordinator at the
hospital
Vaccination coverage
Born before program = 31%
Born after program = 68%
Fully vaccinated: baseline = 19%
vs follow-up = 24% (non-sig.)
Vaccines with significant
increases in coverage: (baseline;
follow-up)
OPV: 82%; 86%
Hepatitis B booster: 25%; 33%
BCG: 62%; 76%
Page 12 of 13
Primary
author
a
(year)
Location
Melbourne,
Victoria
Stewart
(2002)
J
Evaluation
b
design
Vaccine(s) and
target group(s)
Descriptive
(cross
sectional,
c
pre/post )
dTpa +
hepatitis B +
i
OPV + varicella
+ influenza +
h
j
MMR + BCG
g
Sample size
Intervention(s)
Outcomes
Conclusion
Limitations
Baseline = 308
Follow-up = 209
Hospital HCWs
vaccination policy
Vaccination coverage
No increase in
coverage
Sample size lower at
follow-up
Potential
overestimation of
effects
Recall bias
Insufficient time to
observe effects
HCWs
New HCWs were significantly less
likely to be immunised against
hepatitis B
No other significant differences
with respect to vaccination
coverage
a.
J = Journal
C = Conference abstract
R = Report
b.
Evaluation design as described in the article is classified according to Irwig and Cumming study types in population health research (Irwig and Cumming, 1988)
c.
Coverage measured in the same target group before and after the intervention
d.
Vaccines recommended on the Australian National Immunisation Program for children under the age of 7 years
e.
Randomised control trial
f.
Coverage measured in the same target group following the intervention only
g.
Diphtheria-tetanus-acellular pertussis vaccine (dTpa = reduced antigen content vaccine; DTPa-IPV = DTPa and inactivated polio virus (IPV) combination vaccine
h.
Measles-mumps-rubella vaccine
i.
Oral polio vaccine
j.
Bacille Calmette-Guérin vaccine
Complete findings from this systematic review available in Ward K, Chow MYK, King C, Leask J. Strategies to improve vaccination uptake in
Australia, a systematic review of types and effectiveness. Australian and New Zealand Journal of Public Health 2012; 36(4):369–77. doi 10.1111/j.17536405.2012.00897.x.
Summary of strategies to increase vaccination uptake in Australia
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