Undertaking a Mass Vaccination Program in NSW Custody

Justice Health

Abstract

The risk of diseases transmission in custody is well documented. Overcrowding, poorer health status, higher prevalence of diseases and frequent movements between police cells, courts, correctional centres and the community provide ideal opportunities to spread diseases.

Vaccination is a public health initiative undertaken in NSW custody. Each year, Justice Health, along with the Department of Corrective Services and Department of Juvenile Justice, aims to vaccinate patients against seasonal influenza.

In previous years, various methods to increase vaccination numbers have been trialed. In 2008, a “mass vaccination” model was tested. This proved extremely successful resulting in an increase from 18% to 25% of patients being vaccinated for seasonal influenza. This equated to over 2,500 people vaccinated within a 2 week period.

Aim

To test Justice Health’s capacity to respond to emerging infectious diseases through a mass vaccination program thereby minimising the health impact on the custodial and community populations.

Nature of Problem

Overcrowding, poorer general health status, higher prevalence of infectious diseases and frequent movements of people in custody between police cells, courts, correctional centres and the community provide ideal opportunities to spread diseases. Additionally, greater importance is placed by patients on acute presentations rather than preventative health care.

Immunisation is an effective intervention to control vaccine preventable diseases. As Justice Health is a statewide service, and works collaboratively with the Department of Corrective Services and the Department of Juvenile Justice, an effective model for mass immunisation of at-risk individuals needed to be developed and tested.

Extent of Problem

Approximately 23,000 people enter custody each year and are managed by Justice Health. The majority (90%) stay less than 6 months and return to the community. Indigenous people are over-represented with 20% of adults and 50% of adolescents coming from Aboriginal or Torres Strait Islander background.

While the custodial environment is conducive to disease transmission, it also offers an opportunity for disease prevention programs. Justice Health undertakes an annual influenza vaccination program and had achieved modest numbers by vaccinating patients opportunistically throughout the winter period. Opportunistic vaccination proved resource intensive and was not well received by staff or patients.

Additionally, should a large number of patients need to be vaccinated in a short period of time, e.g. during a communicable diseases outbreak, there were inadequate systems and processes to manage this. This problem was addressed through the Infectious Diseases Emergency Planning group and a proposed “mass vaccination” program was suggested.

Strategic Importance

Strategic Direction 1: Make Prevention Everybody’s Business

People in custody are also members of the community. The majority of patients have short custodial sentences with 90% staying less than six months. Recidivism is high and this rapid cycling of people between custody and community poses a high risk for spreading infectious diseases in both populations.

Health interventions initiated by Justice Health impact directly on the custodial population, the community and the Area Health Services. Minimising illness through preventative health programs such as vaccination will ultimately improve the health of the custodial, community and Area Health Service populations.

Planning and Implementing Solutions

The “mass vaccination” program was a statewide project involving 3 major government organisations - Justice Health, Department of Corrective Services and Department of Juvenile Justice. It involved 37 adult and 9 adolescent custodial centres in metropolitan, rural and remote NSW.

Initial discussions regarding the necessity to test a “mass vaccination” program occurred at the Justice Health Infectious Diseases Emergency Planning group. A working group was established to plan and implement the program and determine the inter-departmental consultation and approval processes.

Justice Health led this process and wrote to the Commissioner, Department of Corrective Services and the Director General, Department of Juvenile Justice, seeking their approval and support for the program. The respective department heads wrote letters of support to each of the centre managers advising of the program and the local support required to ensure its success.

Justice Health conducted a series of teleconferences to inform all staff of the program. Each clinic manager was required to roster two nursing staff (one of whom was an accredited immuniser) for the vaccination clinic and to ensure a custodial staff member was allocated to arrange for patients to be bought to the clinic and provide security oversight.

Planning included the development of the necessary paperwork to order the vaccines and record patient data, logistical issues for ordering large quantities of vaccines, transporting them throughout the state, maintaining the correct temperature of the vaccines during transport and storage at the centre and ensuring sufficient supplies were on hand to undertake all vaccinations for the day.

On the day of the clinic, staff worked as a team with the custodial officer bringing patients to the clinic, one nurse doing pre vaccination checks and post vaccination observations and the other vaccinating patients.

Data was collected to assist reporting requirements including patient numbers and demographic data.

Outcome and Evaluation

37 adult and 9 adolescent centres participate annually in the influenza vaccination program. The number of patients vaccinated in the first two weeks of the program has been used as the benchmark to determine the effectiveness of the program each year.

During the first two weeks of the 2008 program over 2,500 patients were vaccinated for seasonal influenza. This equated to over 25% of that static population of Justice Health. In previous years, approximately 18% of patients were immunized; therefore this year’s program saw an increase of vaccination numbers by 7%.

As part of the 2008 program, all sites were surveyed to obtain feedback on the “mass vaccination” strategy. 15 of the 37 adults sites (41%) and 5 of the 9 adolescent sites (56%) responded. The cooperation and collaboration between health and custody resulting in smoother facilitation of the clinics, the majority of patients able to be vaccinated within shorter period, adequate allocation of resources to conduct the program and improved paperwork for data collection and reporting were all highlighted as improvements.

Patient feedback was also obtained. Many highlighted the efficient running of the clinics and the peer motivation to undergo vaccination as the benefits from this year’s program.

Sustaining Change

This project shows that inter-departmental collaboration can achieve significant health outcomes for patients in NSW custody. The “mass vaccination” model tested each organisation’s capacity to respond to emerging infectious diseases, which can spread rapidly through the custodial population.

Short term change has occurred at many centres where they have chosen to conduct monthly vaccination clinics rather than opportunistic vaccination. A more structured approach has been shown to increase vaccination numbers through increased organisation and collaboration.

Long term change has occurred as the mass vaccination model will be used for future influenza vaccination programs in Justice Health.

Future Scope

The success of this year’s influenza vaccination program has demonstrated Justice Health’s ability to undertake mass vaccination in the custodial environment. Justice Health is now well placed to respond effectively to emerging infectious diseases including pandemic influenza.

This year’s “mass vaccination” program was an actual exercise in determining the capacity of Justice Health, the Department of Corrective Services and the Department of Juvenile Justice to undertake this.

Justice Health aims to improve on this year’s efforts by further developing the mass vaccination model and increasing coverage for seasonal influenza during next year’s influenza vaccination program.

Contact

This project was entered in the 2008 NSW Health Awards, Making Prevention Everybody's Business category.

More about the 2008 NSW Health Awards