Childhood Immunisations

Despite childhood vaccination being recognised as ‘the single greatest contribution to infant survival over the past 50 years,’ Australia has seen a decline in childhood immunisation rates for the last three consecutive years.¹ Currently, over 94% of children are fully vaccinated at age one, two, and five, but this still falls short of the national target of 95% coverage.² For the Central Queensland, Wide Bay and Sunshine Coast regions, vaccination coverage for children aged one sits at 89%, which is below the 92% level required for herd immunity against highly infectious diseases.³

Unvaccinated children are at increased risk of contracting preventable diseases such as measles and whooping cough, which can lead to severe complications including hospitalization and, in some cases, death. For example, unvaccinated children are up to 35 times more likely to contract measles during an outbreak.⁴ These risks are further exacerbated by a lack of herd immunity, which protects vulnerable individuals, such as infants too young to be vaccinated and those with medical conditions preventing immunisation.

Primary care is ideally placed to improve childhood immunisation rates through its accessibility, continuity of care, and trusted relationships with families. General practices can proactively identify children behind on or due for vaccinations, address vaccine hesitancy, and provide timely, evidence-based care.

This activity focuses on how to address gaps in vaccination coverage and supports primary care to enhance vaccination rates and outcomes for children under five.

Setting a goal

Increase the number of children that are up to date with vaccinations.

Resources to support your QI

To achieve this goal, you can access a range of resources:

Review current best practice:

The Australian Government Department of Health, Disability and Ageing provides a range of resources, including up-to-date immunisation guidelines and patient resources.
Australian Immunisation Handbook provides clinical advice for health professionals on the safest and most effective use of vaccines.
Queensland Childhood Immunisation Schedule outlines the eligibility for NIP and state-funded immunisations.
HealthPathways: Explore locally tailored approaches. Simply enter “Childhood Immunisation” in the search bar to get started.

Bringing the team together

Kickstart your quality improvement activity by bringing together a quality improvement team. Together, you’ll identify the key challenges and come up with innovative solutions, ensuring you all share a clear understanding of the improvement objectives and strategies.

Engage with your Primary Health Coordinator from CCQ; they can offer tailored support, resources and guidance to enhance your QI efforts wherever you are in your QI journey. Your Primary Health Coordinator can support your practice to:
- Bring a QI team together to decide on an improvement idea
- Plan, start and finish a QI activity
- Facilitate QI meetings
- Create practice-wide systems improvement

Gather data and information. Review current practice data and processes for childhood immunisation.
Identify and discuss any common barriers to optimal childhood immunisation. Consider using process maps, flow charts or driver diagrams to generate change ideas and improve processes.

Maximising your data

What data might you need? You’ll need data to understand the problem and measure your outcomes. We suggest you start with:

Primary Sense can provide insight, detailed reports and targeted guidance on improving data quality, specifically in relation to childhood vaccination. The following functions are available within Primary Sense:
- Child Immunisations Report: Identifies patients between 0 to 5 who are currently due or have missed a vaccination.
- Child Due Vaccination Nurse Prompt: Will prompt for patients aged under 5 years who are currently due or overdue for a vaccination. Shows the due date and last dose date (where available).
Australia Immunisation Registrar (AIR): the AIR allows you to record immunisations given elsewhere into your practice clinical software. Before starting your QI, ensure the AIR is integrated with your practice software and,

Improvement ideas for inspiration

To achieve your goal, you can consider several improvement ideas such as:

Utilise the Primary Sense report “Child Immunisations” and add a reminder and/or vaccination recall to eligible patient records to maximise opportunistic immunisation appointments. You could also use this report to inform the development of a vaccination reminder system, ensuring timely, personalised reminders are sent.
Create a designated children’s immunisation clinic, considering your patient demographics and needs and plan accordingly. Promoting the clinic could include posters, SMS reminders and opportunistic discussion during other appointments.
Develop a process/procedure where the importance of childhood immunisations is discussed during routine antenatal appointments. Consider offering take-home resources on childhood immunisations.
Consider running an education campaign to address possible vaccine hesitancy. This could include waiting room information supported by an opportunity to discuss further with practice staff.
Utilise the Primary Sense nurse prompt “Child due vaccination” to provide opportunistic vaccination. Alternatively, review actions from this prompt to recall eligible patients.
Consider practice protocols and procedures for ensuring children with additional risk factors, such as Aboriginal and Torres Strait Islander background, prematurity or medical risk, receive the recommended additional vaccinations.
Routinely incorporate promoting childhood influenza immunisation into eligible vaccination appointments for children aged 6 months and over.

Remember to self-report your QI project as a CPD activity. QI is a great tool for measuring tangible outcomes and demonstrating improvement in patient care!

Share your results with your CCQ practice support team and with your patients. Ensure you document your quality improvement activity to meet PIP QI guidelines and for CPD purposes.

References

NCIRS (2024). Ongoing decline in childhood immunisation rates sparks concern, accessed 20 January 2025.
Australian Institute of Health and Welfare. (2024). Immunisation and vaccination. Retrieved from www.aihw.gov.au/reports/australias-health/immunisation-and-vaccination, accessed 9 January 2025.
Australian Government, Department of Health, Disability and Ageing (2024) 2024 PHN Childhood Immunisation Coverage Data, accessed 9 January 2025.
Australian Government Department of Health, Disability and Ageing. (2024). Immunisation exploratory research: Final report. Retrieved from www.health.gov.au/sites/default/files/2024-02/immunisation-exploratory-research-final-report_0.pdf, accessed 10 January 2025.

Ready to begin this QI activity?

CCQ acknowledges the Traditional Custodians of the land on which we work and live, and recognises their continuing connection to land, waters and community. We pay our respect to them and their cultures; and to Elders past, present and emerging.