Varicella immunisation practice: Implications for provision of a recommended, non-funded vaccine
Department of Paediatrics, Women's and Children's Hospital, North Adelaide, SA, Australia. Journal of Paediatrics and Child Health
(Impact Factor: 1.15).
06/2009; 45(5):297-303. DOI: 10.1111/j.1440-1754.2009.01494.x
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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Available from: Brian J Ward
- "Canada has had recent experience with a number of " recommended but unfunded vaccines " (RUVs) and is beginning to recognize an obligation to facilitate vaccine use outside of public programs. Placement of a newly licensed product in the RUV category has doomed some previous vaccines to limited uptake   , but improvements may be possible with supportive social changes. This review shares Canadian experiences with RUVs and offers suggestions that might have broad application for increasing public access to unfunded vaccines. "
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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.
Vaccine 12/2013; 32(7). DOI:10.1016/j.vaccine.2013.12.027 · 3.62 Impact Factor
Available from: Michaela A Riddell
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ABSTRACT: Varicella vaccine was licensed in Australia in 1999 and publicly funded in 2005. We examined trends in varicella and zoster hospitalisations and community consultations in Victoria during periods of no vaccine, private availability of vaccine and funded vaccination. Varicella hospitalisation rates declined 7% per year (95% CI 5-9%) from 2000 to 2007, predominately in children under five (12% per year, 95% CI 9-16%). A similar decline was seen in community data. The zoster hospitalisation rate increased from 1998 to 2007 (5% per year, 95% CI 3-6%), before introduction of varicella vaccine. Among those aged 80 and over the hospitalisation rate increased 5% per year (95% CI 3-7%) from 1998 to 2007. Zoster increased in community data from 2001.
Vaccine 03/2010; 28(13):2532-8. DOI:10.1016/j.vaccine.2010.01.036 · 3.62 Impact Factor
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ABSTRACT: Since 2004, general varicella vaccination has been recommended for all children 11-14 months of age in Germany. The objective of this study was to examine vaccination coverage in children and factors associated with parental acceptance during the first years after recommendation. In a regional surveillance area, cross-sectional parent surveys were conducted in 2006, 2007 and 2008 in random samples (n=600) of children aged 18-36 months; data were obtained for 372, 364 and 352 children, respectively. Parents were questioned on their child's varicella disease history, and on varicella vaccination status as recorded in the child's vaccination booklet. Overall coverage increased from 38% in 2006 to 51% in 2007 and stagnated at 53% in 2008; in susceptible children (without previous varicella disease until vaccination or time of survey) coverage was 42%, 61% and 59%, respectively. Recommendation by the paediatrician as reported by the parents increased from 48% (2006) to 57% (2007) and 60% (2008), and was the main independent factor associated with parental acceptance. In 32-35% of unvaccinated children parents had not yet decided whether to vaccinate against varicella. Additional programmes targeting paediatricians' and parents' acceptance of varicella vaccination are needed to achieve the WHO-defined goal of at least 85% coverage.
Vaccine 08/2010; 28(35):5738-45. DOI:10.1016/j.vaccine.2010.06.007 · 3.62 Impact Factor
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