Peer-reviewed article
Annual Immunisation Coverage Report 2023
Brynley Hull, Alexandra Hendry, Kristine Macartney, Frank Beard ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This report analyses Australian Immunisation Register data as at 4 February 2024 to describe vaccination coverage in 2023 for children, adolescents and adults. Coverage in children fell slightly at the 12-month, 24-month and 60-month milestones compared with 2022, following larger falls between the 2020 and 2022 reports. Adolescent HPV and meningococcal ACWY coverage also fell, and declines were generally larger for Indigenous children and adolescents. Adult results were mixed, with pneumococcal coverage up, zoster stable and influenza down. The authors call for continued monitoring and further work on why coverage is falling.
Key points
- Fully vaccinated coverage in all children was 92.8% at 12 months, 90.8% at 24 months and 93.3% at 60 months in 2023, each slightly lower than in 2022.
- Fully vaccinated coverage in Indigenous children was 89.7% at 12 months, 87.8% at 24 months and 95.0% at 60 months, all slightly lower than in 2022.
- By age 15, at least one HPV dose had been received by 84.2% of girls and 81.8% of boys (80.9% and 75.0% of Indigenous girls and boys); HPV coverage was 4–8 percentage points lower in socio-economically disadvantaged and remote areas.
- Meningococcal ACWY coverage in adolescents turning 17 was 72.8% overall and 62.3% in Indigenous adolescents, down 3.1 and 3.3 percentage points from 2022.
- Early data after the move to single-dose HPV in 2023 showed coverage by age 13 about 3 percentage points lower than in 2022, and 6 points lower in Indigenous girls.
Limitations
This is a descriptive analysis of register data, so it cannot show why coverage is falling or whether the move to single-dose HPV caused the 2023 drop. Coverage figures for 2023 mostly reflect vaccinations due in 2022 because of assessment lag.
Abstract
We analysed Australian Immunisation Register (AIR) data, predominantly for National Immunisation Program (NIP) funded vaccines, as at 4 February 2024 for children, adolescents and adults, focusing on the calendar year 2023 and trends from previous years. This report aims to provide comprehensive analysis and interpretation of vaccination coverage data to inform immunisation policy and programs. ChildrenFully vaccinated coverage in Australian children in 2023 was lower than in 2022 at the 12-month (92.8%, down from 93.3%), 24-month (90.8%, down from 91.0%) and 60-month (93.3%, down from 93.4%) age assessment milestones. This follows the 1.1–1.5 percentage point decrease at these three milestones between the 2020 and 2022 reports, which came after eight years of generally increasing coverage. Fully vaccinated coverage in Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) children was also slightly lower in 2023 than in 2022 at the 12-month (89.7%, down from 90.0%), 24-month (87.8%, down from 87.9%) and 60-month (95.0%, down from 95.1%) milestones, following a 1.9–3.3 percentage point decrease between the 2020 and 2022 reports. Due to the lag time involved in assessment, fully vaccinated coverage figures for 2023 predominantly reflect vaccinations due in 2022, when COVID-19 pandemic-related restrictions had largely been removed. Factors contributing to this ongoing decline in coverage in children include a combination of acceptance and access issues. AdolescentsAmong adolescents turning 15 years in 2023, 84.2% of girls and 81.8% of boys (80.9% and 75.0% of Indigenous girls and boys) had received at least one dose of human papillomavirus (HPV) vaccine by their fifteenth birthday, 1.1 and 1.3 percentage points lower than in 2022, respectively (2.1–3.1 percentage points lower for Indigenous adolescents). Coverage of an adolescent dose of meningococcal ACWY vaccine in adolescents turning 17 years in 2023 was 72.8% overall and 62.3% in Indigenous adolescents, 3.1 and 3.3 percentage points lower than in 2022, respectively. These decreases reflect impacts of the pandemic on school-based programs in 2020–2021. To provide an early insight into any immediate impacts on coverage of moving to the NIP single-dose HPV vaccine schedule in 2023 (offered in Year 7 in all jurisdictions), we calculated coverage of at least one dose of HPV vaccine by 31 December in adolescents turning 13 years, with South Australia excluded due to change of delivery from Year 8 in 2022, and found it to be around 3 percentage points lower in 2023 than 2022, and 6 percentage points lower in Indigenous girls, with patterns of diphtheria-tetanus-pertussis vaccination (also single-dose at this age) and HPV vaccination coverage broadly similar. This decrease in vaccinations due in school programs after pandemic restrictions had been removed could be due to impacts of the single-dose HPV transition (i.e. if fewer opportunities for vaccination are provided due to fewer school visits) or may be due to other factors that have changed or disrupted previous school immunisation program operations or reduced parental confidence in vaccination. It is important to promote catch-up vaccination and to monitor renewed efforts to ensure equitable coverage is achieved, particularly given HPV vaccine coverage by 15 years of age in 2023 was 4–8 percentage points lower in adolescents residing in socio-economically disadvantaged and remote areas. AdultsZoster vaccination coverage in adults turning 71 years was 41.0% overall in 2023, down from 41.3% in 2022, and 36.1% in Indigenous adults, down from 36.5%. However, the availability of the new (non-live) protein-based herpes zoster vaccine (Shingrix) from 1 November 2023 has resulted in increased uptake for the larger eligible cohort. Coverage of 13-valent pneumococcal conjugate vaccine (13vPCV) in adults turning 71 years was 37.6% in 2023, up from 33.8% in 2022, and 43.0% in Indigenous adults, up from 37.7%. Coverage of 13vPCV was lower among Indigenous adults turning 50–59 years (17.5%) and 60–69 years (23.4%) in 2023, despite this vaccine being funded under the NIP. Influenza vaccination coverage decreased across all adult age groups in 2023, both overall and in Indigenous adults, with decreases ranging from 5–11 percentage points. ConclusionsThere have continued to be modest but concerning declines in vaccination coverage in children and adolescents relative to pre-pandemic peaks, with decreases greater in Indigenous children and adolescents. Evidence suggests that the factors contributing to these ongoing declines are complex and variable but include both vaccine acceptance and access issues. The picture for adult coverage is more mixed, with coverage increasing for 13vPCV, stable for zoster and decreasing for influenza vaccination, though consistently suboptimal across all vaccines. Ongoing monitoring of vaccination coverage, and further exploration of the reasons underpinning these decreases and suboptimal coverage, are needed to inform approaches to address barriers effectively and to increase vaccine uptake and equity of coverage.