Vaccine preventable diseases in adults: burden and vaccine coverage

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1 Vaccine preventable diseases in adults: burden and vaccine coverage A/Prof Be9e Liu School of Public Health and Community Medicine UNSW ImmunisaFon CoaliFon 29 June 2017

2 Outline NHMRC-funded program of work into common vaccine-preventable diseases in Australian adults Commenced 2013 Various studies on burden from common vaccine preventable diseases and vaccinafon coverage Focus on defining risk groups

3 Number of nofficafons in adults (>=20 years) in 2016, Australia Influenza Varicella zoster* Pertussis Invasive Pneumococcal Disease Q-fever Mumps Meningococcal disease Acute hepaffs B Acute hepaffs A Typhoid Measles Rubella Tetanus Number of no+fica+ons *Varicella not noffiable in NSW; human papillomavirus not noffiable NNDSS

4 NoFficaFon rates of vaccinepreventable diseases by age, 2016 Rate per 100,000 popula+on Influenza (lab confirmed) Invasive pneumococcal disease Shingles Unspecified zoster pertussis Age (years) NNDSS

5 NoFficaFon rates of vaccinepreventable diseases by age, 2016 Rate per 100,000 popula+on Influenza (lab confirmed) Invasive pneumococcal disease Shingles Unspecified zoster pertussis Age (years) NNDSS

6 NoFfiable fracfon NNDSS Annual Report Working Group, CDI 2016

7 Pneumonia hospitalisafons and invasive pneumococcal disease nofficafons Rate per 100,000 popula+on Pneumonia hospitalisafons IPD nofficafons Age AIHW datacubes; NNDSS

8 267,000 men and women aged 45 years and older recruited through in NSW Recruited through Medicare 45% aged >65 years 15% aged >75 years Completed quesfonnaire on entry and subsequent quesfonnaire about 5 years aier recruitment; Extensive linkages to administrafve databases - disease nofficafons, hospitalisafon, deaths - MBS, PBS Consented to be re-contacted Enrich disease no+fica+on data BeAer define risk groups

9 16 Incidence of zoster Incidence of zoster diagnosis per 1000 person-years (95% CI) Male Female Age group Liu, Epi Infect 2015

10 Comparison with other studies Incidence per 1000 person years and Up Chiappe 2010 Insinga 2005 Opstelten 2002 Oxman 2005 (placebo) Stein GP 2009 Stein PBS 2009 Tseng 2011 (unvaccinated) Ultsch 2011 Weitzman Age (years) Liu, Epi Infect 2015

11 Risk of zoster according to various characterisfcs Liu, Epi Infect 2015 HRs adjusted for all other factors listed and age

12 Health service use related to zoster Karki, PLoS One 2016

13 EsFmated excess health service use due to zoster Adjusted excess events/100,000 b (95% CI) Excess events in Australian population c (95%CI) Hospitalisations Age groups years 19 (15-22) 860 ( ) years 60 (47-73) 1430 ( ) years 136 ( ) 1947 ( ) 80 years 248 ( ) 2244 ( ) General practitioner visits Age groups years 917 ( ) ( ) years 2121 ( ) ( ) years 2526 ( ) ( ) 80 years 3075 ( ) ( ) Prescriptions Age groups years 764 ( ) ( ) years 1954 ( ) ( ) years 3530 ( ) ( ) 80 years 5023 ( ) ( ) Emergency department visits Age groups years 51 (41-60) 2310 ( ) years 108 (85-130) 2575 ( ) years 202 ( ) 2891 ( ) 80 years 233 ( ) 2108 ( ) Karki, PLoS One 2016

14 Pertussis hospitalisafons in older adults ~ 267,000 adults Recruited Average age 62 yrs Resident in NSW NoFficaFons of pertussis HospitalisaFons Recruitment years follow-up 915 pertussis nofficafons - 15 pertussis coded hospitalisafon (1.6%) - 18 respiratory infecfon hospitalisafon (2.0%) Pertussis hospitalisafons in adults under-reported Liu Clin Infect Dis 2012; Karki Vaccine 2015

15 Risk factors: pertussis hospitalisafon Supports current recommenda+ons for adults age >=65 years to get immunised Karki Vaccine 2015

16 Exis+ng adult programs in 2013 Influenza >=65 years and high risk groups (Aboriginal and Torres Strait Islanders, pregnant, medical condifons) Pneumococcal >=65 years and high risk groups (Aboriginal and Torres Strait Islander >=50 yrs, medical condifons) November 2016 Herpes zoster 70 years (catch up years unfl 2021) States and territories funded adult pertussis vaccine programs to protect infants cocooning programs aimed at carers of children. Gradually replaced from 2013 onwards with vaccinaeon in third trimester of pregnancy hxp:// 5403D77C07E1973ACA257D49001E3775/$File/NIP-schedule2016.pdf hxp://

17 What do we know about vaccine coverage in adults?

18 Meta-analysis of influenza and pneumococcal coverage in >=65 year olds in Australia Pneumococcal 56% Influenza 75% Dyda BMC Infect Dis 2016

19 45 and Up Study parfcipants were surveyed QuesFonnaire included quesfons on influenza and pertussis vaccinafon To date, responses from over 100,000 parfcipants have been received and processed

20 CharacterisFcs associated with influenza vaccinafon in adults <65 years >=65 years Adjusted Prevalence ratio Adjusted Prevalence ratio Sex men women 1.16 ( ) 1.04 ( ) Place of residence cities inner regional 0.94 ( ) 0.99 ( ) outer regional/remote 0.95 ( ) 0.97 ( ) Education non-university educated university educated 1.13 ( ) 1.01 ( ) Annual household income < $ >$ ( ) 1.01 ( ) unknown 1.11 ( ) 0.99 ( ) Smoking never smoked previously smoked 1.01 ( ) 1.04 ( ) current smoker 0.86 ( ) 0.91 ( ) BMI (kg/m 2 ) < ( ) 0.97 ( ) 25-< ( ) 1.03 ( ) > ( ) 1.08 ( ) Medical indication for influenza vaccination * no yes 1.49 ( ) 1.07 ( ) Adjusted for age, sex, country of birth, place of residence, level of educafon, annual household income, work status, carer status, smoking, alcohol consumpfon, BMI, and medical indicafon for influenza vaccinafon Dyda Vaccine 2015

21 Influenza vaccinafon according to country of birth in >=65 years Overseas-born adults coverage 6% less than Australian-born Karki Vaccine 2016

22 Influenza vaccinafon according to country of birth and language 2016 census >25% Australian populafon born overseas Karki Vaccine 2016

23 Summary Described studies that have be9er quanffied risk groups, and health service from common vaccine preventable diseases and also differences in vaccine uptake in adults Measuring disease burden in specific age groups and at-risk populafons is important as new compeftor vaccines become available for adults IdenFfying adult populafons with lower vaccine uptake is the first step to improving coverage in adults