Vaccine-preventable child deaths in New South Wales from 2005 to 2014: How much is preventable?

Abstract:
Aim: To identify and describe potentially vaccine-preventable child deaths in New South Wales (NSW). Methods: Child deaths in NSW from 2005 to 2014 potentially preventable by vaccination were identified from the NSW Child Death Register (maintained by the NSW Ombudsman) and the Notifiable Conditions Information Management System (NSW Health). Medical and post-mortem records were reviewed. Cases were classified as vaccine-preventable based on the strength of evidence for the relevant infection causing death and likelihood that death was preventable through vaccination. A two-source capture-recapture method was used to estimate the true number of deaths. Age-specific mortality rate and number of deaths by disease, area of residence and comorbidity were analysed. Deaths were classified as preventable based on vaccine availability, eligibility under the National Immunisation Program, age and presence of any contraindications. Results: Fifty-four deaths were identified as definitely or probably due to diseases for which a vaccine was available, with a total average annual mortality rate of 0.33 per 100000 children and 2.1 per 100000 infants. Two thirds of deaths occurred in children with no identified comorbidities. Twenty-three deaths were classified as preventable or potentially preventable by vaccination, with influenza (12 deaths) and meningococcal disease (five deaths) most common. An additional 15 deaths would be potentially preventable as of August 2016 due to immunisation recommendation changes including maternal vaccination. Conclusion: Maternal vaccination along with increased uptake of childhood influenza vaccination could reduce child deaths, particularly from influenza