Measuring the public health impact of vaccines: disease burden, vaccine coverage, safety and effectiveness

Abstract

This thesis has eight chapters describing inter-relationships between work in 66 papers published between 1999 and 2020 relevant to the over-arching topic of public health impact of vaccines: measurement of disease burden, vaccine coverage, safety and effectiveness Chapter 1 outlines the key data sources used: 1. routinely collected administrative data (disease notifications, ICD coded hospitalisations and mortality data) and 2. additional data sources the author had a key role in developing (National Serosurveillance. Paediatric Active Enhanced Surveillance (PAEDS). In chapter 4, development of analysis and reporting of data from the Australian Immunisation Register and in chapter 6 development of platforms for vaccine safety evaluation are described. In Chapter 5, how this work culminated in pilot initiatives to link data sources relevant to public health impact of vaccines in a birth cohort from New South Wales and Western Australia, with the aim of demonstrating the potential for an all-age national capacity, is outlined. Chapter 2 focuses on disease due to Bordetella pertussis and research under the headings of measuring prevalence and severity of pertussis, the effectiveness and impact of pertussis vaccines and clinical trials conducted to evaluate the immunogenicity and safety of acellular pertussis vaccine given within 4 days of birth. Chapter 3 focuses on disease due to Streptococcus pneumoniae and research measuring pneumococcal disease, effectiveness and impact of pneumococcal vaccines and a randomised trial comparing immune responses to pneumococcal conjugate and polysaccharide vaccines in the frail elderly. Chapter 7 includes studies of vaccine impact against Hepatitis B, varicella, meningococcal C disease, mumps and Q fever and Chapter 8 includes four major international reviews of vaccine programs and impact.