Evaluation of bacille Calmette-Guérin immunisation programs in Australia

Authors

  • Gulam Khandaker National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead, Westmead, New South Wales
; University of Sydney, Westmead, New South Wales
; The Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Westmead, New South Wales
  • Frank H Beard National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead, Westmead, New South Wales
; University of Sydney
  • Aditi Dey National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead, Westmead, New South Wales
; University of Sydney, Westmead, New South Wales
  • Chris Coulter Communicable Diseases Branch, Queensland Health, Herston, Queensland
  • Alexandra J Hendry National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead, Westmead, New South Wales
  • Kristine K Macartney National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead, Westmead, New South Wales
; University of Sydney, Westmead, New South Wales
;

DOI:

https://doi.org/10.33321/cdi.2017.41.6

Keywords:

adverse reaction, bacille Calmette-Guérin, immunisation, tuberculosis

Abstract

Background: bacille Calmette-Guérin (BCG) immunisation programs in Australia are funded and operated by the individual states and territories. In recent years BCG vaccine shortages have required use of unregistered products. We aimed to evaluate BCG immunisation programs in Australia, with particular reference to program implementation and national consistency.

Methods: Between September and November 2015, 12 key stakeholders, representing Australian states and territories, completed surveys. We analysed BCG vaccination coverage data from the Australian Childhood Immunisation Register (ACIR), and data on adverse events following immunisation (AEFI) with BCG vaccine from the Therapeutic Goods Administration's Adverse Drug Reactions System, for 2001 to 2014.


Results: Access to BCG vaccination varies between jurisdictions, with some states providing this only in major city locations. Analysis of ACIR data suggests significant differences in vaccine delivery between jurisdictions, but varying levels of under-reporting to the ACIR were also acknowledged. The rate of BCG AEFI appeared to increase between 2011 and 2014; however, these data need to be interpreted with caution due to small numbers, likely under-reporting of both numerator (AEFI) and denominator (vaccine doses administered), and the general increase in reporting of AEFI related to other vaccines in children over this period.


Conclusions: BCG immunisation programs aim to prevent severe forms of tuberculosis in young children who live in or travel to high burden settings. A range of factors, particularly inconsistent vaccine supply are leading to low, variable and inequitable vaccine delivery across Australian jurisdictions. Improved BCG vaccination uptake and AEFI data quality are required for accurate monitoring of program delivery and vaccine safety – this is particularly important given the current need to use unregistered vaccines. Improved and consistent access to BCG vaccine is suggested to optimise equity for at-risk children Australia-wide. Commun Dis Intell 2017;41(1):E33–E48.

Downloads

Download data is not yet available.

References

Trunz BB, Fine P, Dye C. Effect of BCG vaccination on childhood tuberculous meningitis and miliary tuberculosis worldwide: a meta-analysis and assessment of cost-effectiveness. Lancet 2006;367(9517):1173–1180.

Toms C, Stapledon R, Waring J, Douglas P. Tuberculosis notifications in Australia, 2012 and 2013. Commun Dis Intell 2015;39(2):E217–E235.

World Health Organization. Global Tuberculosis Report 2014. Geneva: World Health Organization; 2014.

Australian Bureau of Statistics, Migration, Australia, 2014–15, Media Release. Available from http://www.abs.gov.au/ausstats/abs@.nsf/lookup/3412.0Media%20Release12014-15 Accessed August 2016.

Brewer TF. Preventing tuberculosis with bacillus Calmette-Guérin vaccine: a meta-analysis of the literature. Clin Infect Dis 2000;31 Suppl 3:S64–S67.

Australian Technical Advisory Group on Immunisation. The Australian Immunisation Handbook. 10th edn. Canberra: Australian Government Department of Health and Ageing; 2013.

National Tuberculosis Advisory Committee. The BCG vaccine: information and recommendations for use in Australia: National Tuberculosis Advisory Committee Update October 2012. Commun Dis Intell 2013;37(1):E65–E72.

Australian Government Department of Health, National Immunisation Program Schedule (From 20 April 2015). Available from http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/national-immunisation-program-schedule Accessed August 2016.

Australian Government Department of Health, Therapeutic Goods Administration. Tuberculosis (BCG) vaccine: urgent medicine recall. 2012. Available from: https://www.tga.gov.au/product-recall/tuberculosis-bcg-vaccine Accessed on 10 April 2016.

Commonwealth of Australia. Therapeutic Goods Act 1989. Available from: http://www5.austlii.edu.au/au/legis/cth/consol_act/tga1989191/ Accessed November 2015.

Australian Government Department of Health, Therapeutic Goods Administration. Access to unapproved therapeutic goods via the Special Access Scheme November 2009. Available from https://www.tga.gov.au/sites/default/files/access-sas-guidelines.pdf Accessed August 2016.

Marais B, Seddon JA, Detjen AK, van der Werf MJ, Grzemska M, Hesseling AC, et al. Interrupted BCG vaccination is a major threat to global child health. Lancet Respir Med 2016;4(4):251–253.

World Health Organization. BCG vaccine. WHO position paper. Wkly Epidemiol Rec 2004;79(4):27–38.

Turnbull FM, McIntyre PB, Achat HM, Wang H, Stapeldon R, Gold M, et al. National study of adverse reactions after vaccination with bacille Calmette-Guérin. Clin Infect Dis 2002;34(4):447–453.

Ritz N, Hanekom WA, Robins-Browne R, Britton WJ, Curtis N. Influence of BCG vaccine strain on the immune response and protection against tuberculosis. FEMS Microbiol Rev 2008;32(5):821–841.

Mahajan D, Cook J, Dey A, Macartney K, Menzies RI. Surveillance of adverse events following immunisation in Australia annual report, 2011. Commun Dis Intell 2012;36(4):E315–E332.

Hull BP, Dey A, Menzies RI, Brotherton JM, McIntyre PB. Immunisation coverage, 2012. Commun Dis Intell 2014;38(3):E208–E231.

Uppsala Monitoring Centre. WHO Collaborating Centre Available from for International Drug Monitoring. Available from: http://www.who-umc.org/ Accessed November 2016.

NSW Ministry of Health. BCG Vaccination - Bacille Calmette Guerin. 2013. Available from: http://www0.health.nsw.gov.au/policies/pd/2013/pdf/PD2013_032.pdf Accessed July 2015.

NSW Ministry of Health. Request a BCG Vaccination 2016. Available from: http://www.health.nsw.gov.au/Infectious/tuberculosis/Pages/BCG-decision-tree.aspx Accessed June 2016.

Northern Territory Government, Centre for Disease Control. Tuberculosis Vaccination (BCG). August 2014. Available from: http://digitallibrary.health.nt.gov.au/prodjspui/handle/10137/993 Accessed July 2015.

Queensland Health.BCG Vaccination for Children Aged Less Than Five Years. 2013.

Government of South Australia, Central Northern Adelaide Health Service, Royal Adelaide Hospital. Patient information on BCG vaccination. 2008. Available from: https://www.rah.sa.gov.au/thoracic/health_programs/documents/TBEDUBCGVaccination_000.pdf Accessed July 2015.

Department of Health and Human Services, Victoria. Management, control and prevention of tuberculosis: Guidelines for health care providers. 2015. Available from: https://www2.health.vic.gov.au/about/publications/policiesandguidelines/tuberculosis-guidelines-2015 Accessed November 2015.

Government of Western Australia, Department of Health. Tuberculosis BCG vaccination. Available from: http://healthywa.wa.gov.au/Articles/S_T/Tuberculosis-BCG-Vaccination Accessed August 2016.

Mahajan D, Dey A, Cook J, et al. Surveillance of adverse events following immunisation in Australia annual report, 2013. Commun Dis Intell 2015;39:E369–E386.

Hendry AJ, Dey A, Beard FH, Khandaker G, Hill R, Macartney KK. Adverse events following immunisation with BCG vaccination: baseline data to inform monitoring in Australia following introduction of new unregistered BCG vaccine, 2016. Commun Dis Intell 2017;41(1):E470–E474.

Gwee A, Rodrigo R, Casalaz D, Ritz N, Curtis N. Infants born in Australia to mothers from countries with a high prevalence of tuberculosis: to BCG or not to BCG? Med J Aust 2013;199(5):324–326.

Beard F, Macartney K. Infants born in Australia to mothers from countries with a high prevalence of tuberculosis: to BCG or not to BCG? Med J Aust 2014;200(3):149.

Teo SS, Tay EL, Douglas P, Krause VL, Graham SM. The epidemiology of tuberculosis in children in Australia, 2003–2012. Med J Aust 2015;203(11):440.

Britton PN, Yeung V, Lowbridge C, Isaacs D, Marais BJ. Spectrum of disease in children treated for tuberculosis at a tertiary children's hospital in Australia. J Pediatric Infect Dis Soc 2013;2(3):224–231.

Downloads

Published

01/03/17

How to Cite

Khandaker, Gulam, Frank H Beard, Aditi Dey, Chris Coulter, Alexandra J Hendry, and Kristine K Macartney. 2017. “Evaluation of Bacille Calmette-Guérin Immunisation Programs in Australia”. Communicable Diseases Intelligence 41 (March):33-48. https://doi.org/10.33321/cdi.2017.41.6.

Issue

Vol. 41 (2017)

Section

Original article

Categories

License

Copyright (c) 2017 Communicable Diseases Intelligence

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Most read articles by the same author(s)

1 2 3 4 5 6 7 8 9 > >>