Varicella immunisation practice: Implications for provision of a recommended, non-funded vaccine
ABSTRACT In Australia in 2003 a two-tiered immunisation schedule was introduced consisting of funded (National Immunisation Program) and non-funded but recommended vaccines (Best Practice Schedule), including varicella vaccine. The aim of this study was to examine immunisation practice when a vaccine is recommended but not funded by Government.
A survey was sent to 600 randomly selected general practitioners (GPs) in South Australia between June and August 2005, prior to provision of Federal funding for varicella vaccine.
Although varicella was considered an important disease to prevent by 89% of GPs, only 25% of GPs always discussed the non-funded immunisation with parents at the time of a routine immunisation visit. Female GPs were more likely to discuss immunisation with recommended, non-funded vaccines than male GPs. Those who were supportive of varicella prevention were more likely to discuss immunisation with the non-funded vaccine. GPs who always provided information about the disease were more likely to have parents accept their advice about varicella vaccine (62.7%) than those who never provided information (40%). GPs reported parental refusal of varicella vaccine was due to the cost and perception that varicella is a mild disease.
The results of this study showed variability in prescribing practices for a non-funded vaccine. Recommending a vaccine without provision of funding may lead to 'mixed messages' for immunisation providers and parents with resultant low coverage. Funding a vaccine is likely to reduce variability in provision of the vaccine and improve coverage in the community.
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ABSTRACT: Funded immunization programs are best able to achieve high participation rates, optimal protection of the target population, and indirect protection of others. However, in many countries public funding of approved vaccines can be substantially delayed, limited to a portion of the at-risk population or denied altogether. In these situations, unfunded vaccines are often inaccessible to individuals at risk, allowing potentially avoidable morbidity and mortality to continue to occur. We contend that private access to approved but unfunded vaccines should be reconsidered and encouraged, with recognition that individuals have a prerogative to take advantage of a vaccine of potential benefit to them whether it is publicly funded or not. Moreover, numbers of "approved but unfunded" vaccines are likely to grow because governments will not be able to fund all future vaccines of potential benefit to some citizens. New strategies are needed to better use unfunded vaccines even though the net benefits will fall short of those of funded programs. Canada, after recent delays funding several new vaccine programs, has developed means to encourage private vaccine use. Physicians are required to inform relevant patients about risks and benefits of all recommended vaccines, publicly funded or not. Likewise, some provincial public health departments now recommend and promote both funded and unfunded vaccines. Pharmacists are key players in making unfunded vaccines locally available. Professional organizations are contributing to public and provider education about unfunded vaccines (e.g. herpes zoster, not funded in any province). Vaccine companies are gaining expertise with direct-to-consumer advertising. However, major challenges remain, such as making unfunded vaccines more available to low-income families and overcoming public expectations that all vaccines will be provided cost-free, when many other recommended personal preventive measures are user-pay. The greatest need is to change the widespread perception that approved vaccines should be publicly funded or ignored.Vaccine 12/2013; 32(7). DOI:10.1016/j.vaccine.2013.12.027 · 3.49 Impact Factor
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ABSTRACT: Objectives: To determine factors influencing Family Physician (FP) uptake of non government-funded vaccines, and to explore FP attitudes towards the introduction and use of a new vaccine to protect against serogroup B meningococcal disease to inform its future introduction into the Australian Immunisation Schedule. Design setting and participants: Quantitative, self-administered state-wide questionnaire mailed to all FPs in South Australia (n = 1786). Results from 523 FP respondents in South Australia, collected between June and October 2013. Main outcome measures: Self-reported immunisation counselling practices; and knowledge, attitudes and barriers to prescribing of Meningococcal B (Men B) vaccine and other recommended, non-funded immunisations. Results: The response rate was 30% (n = 523). While most (59%) respondents had worked in general practice for over 20 years, only 39% of all respondents had ever had personal or professional experience with a case of invasive meningococcal disease (IMD). Most FPs (63%) were aware that a meningococcal B vaccine was being developed, and 93% of respondents agreed that this vaccine should be government-funded. FPs ranked Men B vaccine as the highest priority to receive funding of eight currently non-funded immunisation strategies. High vaccine cost and low patient socioeconomic status were identified as definite barriers to prescribing non-funded vaccines by 59% of respondents. Past IMD experience significantly affected attitudes and prescribing practices. Conclusions: IMD, while encountered rarely in clinical practice, is considered an important disease to vaccinate against by FPs. Cost and perceived low socioeconomic status of patients are substantial barriers to FPs prescribing Men B and other non-funded vaccines, and inclusion of such vaccines on the National Immunisation Program is likely to improve equity of access.Vaccine 06/2014; 32(33). DOI:10.1016/j.vaccine.2014.04.046 · 3.49 Impact Factor
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ABSTRACT: BACKGROUND:: Varicella in children, although usually mild, can cause hospitalization and rarely death. This study examined patterns of hospitalized children with varicella, and associated varicella genotypes, in four tertiary children's hospitals throughout Australia before and after varicella vaccine was introduced. METHODS:: We obtained coded data on discharge diagnoses from each hospital before (1999-2001) and after (2007-2010) varicella introduction in 2006, adding active surveillance to capture clinical features, complications and immunization history in the latter period. Varicella vesicles were swabbed and genotyping of varicella strains was performed by real-time PCR amplification. RESULTS:: Overall, a 68% reduction in coded hospitalizations [varicella; 73.2% (p<0.001), zoster; 40% (p=0.002)] occurred post-vaccine introduction. Of children with detailed clinical data (97 varicella and 18 zoster cases), 46 (40%) were immunocompromised. Only six of 32 (19%) age-eligible immunocompetent children were immunized. Complications, most commonly secondary skin infections (n=25) and neurologic conditions (n=14), occurred in 44% of children. There were no deaths; but three immunocompetent unimmunized children had severe multiple complications requiring intensive care. All strains genotyped were "wild-type" varicella, with Clade 1 (European origin) predominating. CONCLUSIONS:: Following varicella vaccine introduction, coverage of greater than 80% at 2 years of age was achieved, with varicella hospitalizations reduced by almost 70%. Of hospitalized children age-eligible for varicella vaccine, 80% were unimmunized, including all cases requiring intensive care.The Pediatric Infectious Disease Journal 12/2012; 32(5). DOI:10.1097/INF.0b013e31827e92b7 · 3.14 Impact Factor