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Wang B, Andraweera P, Danchin M, Blyth CC, Vlaev I, Ong J, Dodd JM, Couper J, Sullivan TR, Karnon J, Spurrier N, Cusack M, Mordaunt D, Simatos D, Dekker G, Carlson S, Tuckerman J, Wood N, Whop LJ, Marshall H. Nudging towards COVID-19 and influenza vaccination uptake in medically at-risk children: EPIC study protocol of randomised controlled trials in Australian paediatric outpatient clinics. BMJ Open 2024; 14:e076194. [PMID: 38367966 PMCID: PMC10875525 DOI: 10.1136/bmjopen-2023-076194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 01/23/2024] [Indexed: 02/19/2024] Open
Abstract
INTRODUCTION Children with chronic medical diseases are at an unacceptable risk of hospitalisation and death from influenza and SARS-CoV-2 infections. Over the past two decades, behavioural scientists have learnt how to design non-coercive 'nudge' interventions to encourage positive health behaviours. Our study aims to evaluate the impact of multicomponent nudge interventions on the uptake of COVID-19 and influenza vaccines in medically at-risk children. METHODS AND ANALYSES Two separate randomised controlled trials (RCTs), each with 1038 children, will enrol a total of approximately 2076 children with chronic medical conditions who are attending tertiary hospitals in South Australia, Western Australia and Victoria. Participants will be randomly assigned (1:1) to the standard care or intervention group. The nudge intervention in each RCT will consist of three text message reminders with four behavioural nudges including (1) social norm messages, (2) different messengers through links to short educational videos from a paediatrician, medically at-risk child and parent and nurse, (3) a pledge to have their child or themselves vaccinated and (4) information salience through links to the current guidelines and vaccine safety information. The primary outcome is the proportion of medically at-risk children who receive at least one dose of vaccine within 3 months of randomisation. Logistic regression analysis will be performed to determine the effect of the intervention on the probability of vaccination uptake. ETHICS AND DISSEMINATION The protocol and study documents have been reviewed and approved by the Women's and Children's Health Network Human Research Ethics Committee (HREC/22/WCHN/2022/00082). The results will be published via peer-reviewed journals and presented at scientific meetings and public forums. TRIAL REGISTRATION NUMBER NCT05613751.
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Affiliation(s)
- Bing Wang
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Prabha Andraweera
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Margaret Danchin
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- The Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
- Department of Microbiology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre (QEIIMC), Perth, Western Australia, Australia
| | - Ivo Vlaev
- School of Business, Warwick University, Warwick, UK
| | - Jason Ong
- Melbourne Sexual Health Clinic & LSHTM, Monash University, Carlton, Victoria, Australia
| | - Jodie M Dodd
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Women's and Babies Division, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Jennifer Couper
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Division of Paediatrics, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Thomas R Sullivan
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, Adelaide, South Australia, Australia
| | - Jonathan Karnon
- Discipline of Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Nicola Spurrier
- SA Health, South Australian Government, Adelaide, South Australia, Australia
- Discipline of Paediatrics, Flinders University, Adelaide, South Australia, Australia
| | - Michael Cusack
- SA Health, South Australian Government, Adelaide, South Australia, Australia
| | - Dylan Mordaunt
- Discipline of Paediatrics, Flinders University, Adelaide, South Australia, Australia
| | - Dimi Simatos
- Discipline of Paediatrics Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Gustaaf Dekker
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Discipline of Women's Health, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Samantha Carlson
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Jane Tuckerman
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nicholas Wood
- Discipline of Paediatrics, University of Sydney, Sydney, New South Wales, Australia
- Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Lisa J Whop
- Discipline of Public Health, Australian National University, Canberra, ACT, Australia
| | - Helen Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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Dias CS, Diniz LM, Oliveira MCL, Simões E Silva AC, Colosimo EA, Mak RH, Pinhati CC, Galante SC, Veloso IY, Martelli-Júnior H, Oliveira EA. Outcomes of SARS-CoV-2 and Seasonal Viruses Among Children Hospitalized in Brazil. Pediatrics 2024; 153:e2023064326. [PMID: 38213278 DOI: 10.1542/peds.2023-064326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Understanding how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) interacts with other respiratory viruses is crucial for developing effective public health strategies in the postpandemic era. This study aimed to compare the outcomes of SARS-CoV-2 and seasonal viruses in children and adolescents hospitalized with severe acute respiratory infection (SARI). METHODS This population-based, retrospective cohort study included children and adolescents hospitalized with SARI from February 2020 to February 2023 in Brazil. The main exposure of interest was viral etiology. The primary outcome was in-hospital mortality. Competing risk analysis was used to account for time dependency and competing events. RESULTS A total of 235 829 patients had available results of the viral tests, with SARS-CoV-2 predominance. According to the competing-risk survival analysis, the estimated probability of a fatal outcome at 30 days of hospitalization according to the viral strain was 6.5%, 3.4%, 2.9%, 2.3%, 2.1%, and 1.8%, for SARS-CoV-2, coinfection, adenovirus, influenza, other viruses, and respiratory syncytial virus, respectively. Individuals with a positive test for SARS-CoV-2 had hazard of death 3 times higher than subjects with a negative test (hazard ratio, 3.3; 95% confidence interval, 3.1-3.5). After adjustment by the competing-risk multivariable analysis, admission in Northeast and North regions, oxygen saturation <95%, and the presence of comorbidities were risk factors for death in all viral strains. CONCLUSIONS SARS-CoV-2 infection had the highest hazard of in-hospital mortality in this pediatric cohort hospitalized with SARI. Regardless of viral etiology, the presence of underlying medical conditions was a risk factor for death.
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Affiliation(s)
- Cristiane S Dias
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine
| | - Lilian M Diniz
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine
| | | | | | - Enrico A Colosimo
- Department of Statistics, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Robert H Mak
- Department of Pediatrics, Rady Children's Hospital, University of California, San Diego
| | - Clara C Pinhati
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine
| | - Stella C Galante
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine
| | - Isadora Y Veloso
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine
| | - Hercílio Martelli-Júnior
- Health Science/Primary Care Postgraduate Program, State University of Montes Claros (Unimontes), Montes Claros, Minas Gerais, Brazil
| | - Eduardo A Oliveira
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine
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Dawa J, Jalang'o R, Mirieri H, Kalani R, Marwanga D, Lafond KE, Muriuki MM, Ejoi J, Chiguba F, Patta S, Amoth P, Okunga E, Tabu C, Chaves SS, Ebama MS, Muthoka P, Njenga V, Kiptoo E, Jewa I, Mwanyamawi R, Bresee J, Njenga MK, Osoro E, Mecca L, Emukule GO. Comparing performance of year-round and campaign-mode influenza vaccination strategies among children aged 6-23 months in Kenya: 2019-2021. Vaccine 2023:S0264-410X(23)01380-4. [PMID: 38105140 DOI: 10.1016/j.vaccine.2023.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/03/2023] [Accepted: 11/18/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION In 2016, the Kenya National Immunization Technical Advisory Group requested additional programmatic and cost effectiveness data to inform the choice of strategy for a national influenza vaccination program among children aged 6-23 months of age. In response, we conducted an influenza vaccine demonstration project to compare the performance of a year-round versus campaign-mode vaccination strategy. Findings from this demonstration project will help identify essential learning lessons for a national program. METHODS We compared two vaccine delivery strategies: (i) a year-round vaccination strategy where influenza vaccines were administered throughout the year at health facilities. This strategy was implemented in Njoro sub-county in Nakuru (November 2019 to October 2021) and Jomvu sub-county in Mombasa (December 2019 to October 2021), (ii) a campaign-mode vaccination strategy where vaccines were available at health facilities over four months. This strategy was implemented in Nakuru North sub-county in Nakuru (June to September 2021) and Likoni sub-county in Mombasa (July to October 2021). We assessed differences in coverage, dropout rates, vaccine wastage, and operational needs. RESULTS We observed similar performance between strategies in coverage of the first dose of influenza vaccine (year-round strategy 59.7 %, campaign strategy 63.2 %). The coverage obtained in the year-round sub-counties was similar (Njoro 57.4 %; Jomvu 63.1 %); however, more marked differences between campaign sub-counties were observed (Nakuru North 73.4 %; Likoni 55.2 %). The campaign-mode strategy exceeded the cold chain capacity of participating health facilities, requiring thrice monthly instead of once monthly deliveries, and was associated with a two-fold increase in workload compared to the year-round strategy (168 vaccines administered per day in the campaign strategy versus 83 vaccines administered per day in the year-round strategy). CONCLUSION Although both strategies had similar coverage levels, the campaign-mode strategy was associated with considerable operational needs that could significantly impact the immunization program.
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Affiliation(s)
- Jeanette Dawa
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya.
| | - Rose Jalang'o
- National Vaccines and Immunisation Program, Ministry of Health, Kenya
| | - Harriet Mirieri
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
| | - Rosalia Kalani
- Division of Disease Surveillance and Response, Ministry of Health, Kenya
| | - Doris Marwanga
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
| | - Kathryn E Lafond
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Joyce Ejoi
- Department of Health, Nakuru County, Kenya
| | | | - Shem Patta
- Department of Health, Mombasa County, Kenya
| | | | - Emmanuel Okunga
- Division of Disease Surveillance and Response, Ministry of Health, Kenya
| | - Collins Tabu
- National Vaccines and Immunisation Program, Ministry of Health, Kenya
| | - Sandra S Chaves
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA; Influenza Program, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Malembe S Ebama
- Partnership for Influenza Vaccine Introduction, Task Force for Global Health, Atlanta, GA, USA
| | | | | | | | - Isaac Jewa
- Department of Health, Mombasa County, Kenya
| | | | - Joseph Bresee
- Partnership for Influenza Vaccine Introduction, Task Force for Global Health, Atlanta, GA, USA
| | - M Kariuki Njenga
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya; Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, WA, USA
| | - Eric Osoro
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya; Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, WA, USA
| | - Lucy Mecca
- National Vaccines and Immunisation Program, Ministry of Health, Kenya
| | - Gideon O Emukule
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA; Influenza Program, Centers for Disease Control and Prevention, Nairobi, Kenya
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Blyth CC, Fathima P, Pavlos R, Jacoby P, Pavy O, Geelhoed E, Richmond PC, Effler PV, Moore HC. Influenza vaccination in Western Australian children: Exploring the health benefits and cost savings of increased vaccine coverage in children. Vaccine X 2023; 15:100399. [PMID: 37908895 PMCID: PMC10613898 DOI: 10.1016/j.jvacx.2023.100399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/02/2023] Open
Abstract
Introduction To assess potential benefits and direct healthcare cost savings with expansion of an existing childhood influenza immunisation program, we developed a dynamic transmission model for the state of Western Australia, evaluating increasing coverage in children < 5 years and routinely immunising school-aged children. Methods A deterministic compartmental Susceptible-Exposed-Infectious-Recovered age-stratified transmission model was developed and calibrated using laboratory-notification and hospitalisation data. Base case vaccine coverage estimates were derived from 2019 data and tested under moderate, low and high vaccine effectiveness settings. The impact of increased coverage on the burden of influenza, influenza-associated presentations and net costs were assessed using the transmission model and estimated health utilisation costs. Results Under base case vaccine coverage and moderate vaccine effectiveness settings, 225,460 influenza cases are expected annually across all ages. Direct healthcare costs of influenza were estimated to be A$27,608,286 per annum, dominated by hospital costs. Net cost savings of >$A1.5 million dollars were observed for every 10 % increase in vaccine coverage in children < 5 years. Additional benefits were observed by including primary school age children (5-11 years) in the funded influenza vaccination program - a reduction in cases, presentations, hospitalisations and approximately $A4 million net costs savings were observed for every 10 % increase in coverage. The further addition of older children (12-17 years) resulted in only moderate additional net cost savings figures, compared with a 5-11year-old program alone. Net costs savings were predominantly derived by a reduction in influenza-associated hospitalisation in adults. Conclusions Any increase in influenza vaccine coverage in children < 5 years, above a base case of 50 % coverage resulted in a substantive reduction in influenza cases, presentations, hospitalisations and net costs when applied to the West Australian population. However, the most impactful pediatric program, from both a disease prevention and costs perspective, would be one that increased vaccination coverage among primary-school aged children.
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Affiliation(s)
- Christopher C. Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- School of Medicine, University of Western Australia, Perth, WA, Australia
- Department of Infectious Diseases, Perth Children’s Hospital, Perth, WA, Australia
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, WA, Australia
| | - Parveen Fathima
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca Pavlos
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Peter Jacoby
- Telethon Kids Institute, Perth Children’s Hospital, Perth, WA, Australia
| | - Olivia Pavy
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Elizabeth Geelhoed
- Telethon Kids Institute, Perth Children’s Hospital, Perth, WA, Australia
| | - Peter C Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- School of Medicine, University of Western Australia, Perth, WA, Australia
- Department of Immunology, Perth Children’s Hospital, Perth, WA, Australia
- Department of General Paediatrics, Perth Children’s Hospital, Perth, WA, Australia
| | - Paul V. Effler
- Communicable Disease Control Directorate, Department of Health, Perth, WA, Australia
| | - Hannah C. Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
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Howell KB, Butcher S, Schneider AL, Russ-Hall S, Muzariri PR, Kerr R, Overmars I, Hayman M, Kornberg AJ, Danchin M, Crawford NW, Scheffer IE. Complications of Influenza A or B Virus Infection in Individuals With SCN1A-Positive Dravet Syndrome. Neurology 2023; 100:e435-e442. [PMID: 36323522 DOI: 10.1212/wnl.0000000000201438] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/06/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To determine the frequency and spectrum of complications of influenza infection in individuals with SCN1A-positive Dravet syndrome (SCN1A-DS). METHODS Individuals with SCN1A-DS were identified in neurologists' care at 2 hospitals in Melbourne, Australia, with additional searches of EEG databases, the Victorian PAEDS FluCan influenza database, and the University of Melbourne Epilepsy Genetics Research Program database. Medical records were searched and families questioned to identify individuals who had an influenza infection; reported infections were confirmed by pathology report. For these individuals, we obtained baseline clinical characteristics and clinical details of the influenza infection. RESULTS Twenty-one of 82 individuals (26%) had 24 documented influenza infections (17 influenza A and 7 influenza B) at age 0.5-25 years (median 4 years). All presented to hospital, 18/24 (75%) for status epilepticus or seizure exacerbations. Recovery was prompt in 18/24 (75%) infections, delayed but complete in 1/24 (4%) and incomplete in 5/24 (21%). One child died from influenza pneumonia, and long-term neurologic sequelae were seen with 4 infections. These individuals were poorly responsive after termination of status epilepticus. Brain imaging in 2 showed cerebral edema and 1 also having imaging features of laminar necrosis. All have ongoing neurologic deficits compared with their baseline, 1 having profound global impairment. DISCUSSION Our data show that patients with SCN1A-DS are highly susceptible to neurologic complications during and severe sequelae after influenza infection, including moderate to severe persistent neurologic impairments and death. Safe administration of the seasonal influenza vaccine should be prioritized for this population.
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Affiliation(s)
- Katherine B Howell
- From the Department of Neurology (K.B.H., S.B., M.H., A.J.K., I.E.S.), The Royal Children's Hospital; Department of Paediatrics (K.B.H., A.J.K., N.W.C., I.E.S.), The University of Melbourne; Murdoch Children's Research Institute (K.B.H., P.R.M., R.K., I.O., A.J.K., M.D., N.W.C., I.E.S.); Department of Medicine (A.L.S., S.R.-H., I.E.S.), Epilepsy Research Centre, Austin Health, The University of Melbourne; Immunisation Service (M.D., N.W.C., I.E.S.), The Royal Children's Hospital; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Australia.
| | - Sophie Butcher
- From the Department of Neurology (K.B.H., S.B., M.H., A.J.K., I.E.S.), The Royal Children's Hospital; Department of Paediatrics (K.B.H., A.J.K., N.W.C., I.E.S.), The University of Melbourne; Murdoch Children's Research Institute (K.B.H., P.R.M., R.K., I.O., A.J.K., M.D., N.W.C., I.E.S.); Department of Medicine (A.L.S., S.R.-H., I.E.S.), Epilepsy Research Centre, Austin Health, The University of Melbourne; Immunisation Service (M.D., N.W.C., I.E.S.), The Royal Children's Hospital; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Australia
| | - Amy L Schneider
- From the Department of Neurology (K.B.H., S.B., M.H., A.J.K., I.E.S.), The Royal Children's Hospital; Department of Paediatrics (K.B.H., A.J.K., N.W.C., I.E.S.), The University of Melbourne; Murdoch Children's Research Institute (K.B.H., P.R.M., R.K., I.O., A.J.K., M.D., N.W.C., I.E.S.); Department of Medicine (A.L.S., S.R.-H., I.E.S.), Epilepsy Research Centre, Austin Health, The University of Melbourne; Immunisation Service (M.D., N.W.C., I.E.S.), The Royal Children's Hospital; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Australia
| | - Sophie Russ-Hall
- From the Department of Neurology (K.B.H., S.B., M.H., A.J.K., I.E.S.), The Royal Children's Hospital; Department of Paediatrics (K.B.H., A.J.K., N.W.C., I.E.S.), The University of Melbourne; Murdoch Children's Research Institute (K.B.H., P.R.M., R.K., I.O., A.J.K., M.D., N.W.C., I.E.S.); Department of Medicine (A.L.S., S.R.-H., I.E.S.), Epilepsy Research Centre, Austin Health, The University of Melbourne; Immunisation Service (M.D., N.W.C., I.E.S.), The Royal Children's Hospital; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Australia
| | - Pearl R Muzariri
- From the Department of Neurology (K.B.H., S.B., M.H., A.J.K., I.E.S.), The Royal Children's Hospital; Department of Paediatrics (K.B.H., A.J.K., N.W.C., I.E.S.), The University of Melbourne; Murdoch Children's Research Institute (K.B.H., P.R.M., R.K., I.O., A.J.K., M.D., N.W.C., I.E.S.); Department of Medicine (A.L.S., S.R.-H., I.E.S.), Epilepsy Research Centre, Austin Health, The University of Melbourne; Immunisation Service (M.D., N.W.C., I.E.S.), The Royal Children's Hospital; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Australia
| | - Rachel Kerr
- From the Department of Neurology (K.B.H., S.B., M.H., A.J.K., I.E.S.), The Royal Children's Hospital; Department of Paediatrics (K.B.H., A.J.K., N.W.C., I.E.S.), The University of Melbourne; Murdoch Children's Research Institute (K.B.H., P.R.M., R.K., I.O., A.J.K., M.D., N.W.C., I.E.S.); Department of Medicine (A.L.S., S.R.-H., I.E.S.), Epilepsy Research Centre, Austin Health, The University of Melbourne; Immunisation Service (M.D., N.W.C., I.E.S.), The Royal Children's Hospital; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Australia
| | - Isabella Overmars
- From the Department of Neurology (K.B.H., S.B., M.H., A.J.K., I.E.S.), The Royal Children's Hospital; Department of Paediatrics (K.B.H., A.J.K., N.W.C., I.E.S.), The University of Melbourne; Murdoch Children's Research Institute (K.B.H., P.R.M., R.K., I.O., A.J.K., M.D., N.W.C., I.E.S.); Department of Medicine (A.L.S., S.R.-H., I.E.S.), Epilepsy Research Centre, Austin Health, The University of Melbourne; Immunisation Service (M.D., N.W.C., I.E.S.), The Royal Children's Hospital; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Australia
| | - Michael Hayman
- From the Department of Neurology (K.B.H., S.B., M.H., A.J.K., I.E.S.), The Royal Children's Hospital; Department of Paediatrics (K.B.H., A.J.K., N.W.C., I.E.S.), The University of Melbourne; Murdoch Children's Research Institute (K.B.H., P.R.M., R.K., I.O., A.J.K., M.D., N.W.C., I.E.S.); Department of Medicine (A.L.S., S.R.-H., I.E.S.), Epilepsy Research Centre, Austin Health, The University of Melbourne; Immunisation Service (M.D., N.W.C., I.E.S.), The Royal Children's Hospital; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Australia
| | - Andrew J Kornberg
- From the Department of Neurology (K.B.H., S.B., M.H., A.J.K., I.E.S.), The Royal Children's Hospital; Department of Paediatrics (K.B.H., A.J.K., N.W.C., I.E.S.), The University of Melbourne; Murdoch Children's Research Institute (K.B.H., P.R.M., R.K., I.O., A.J.K., M.D., N.W.C., I.E.S.); Department of Medicine (A.L.S., S.R.-H., I.E.S.), Epilepsy Research Centre, Austin Health, The University of Melbourne; Immunisation Service (M.D., N.W.C., I.E.S.), The Royal Children's Hospital; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Australia
| | - Margie Danchin
- From the Department of Neurology (K.B.H., S.B., M.H., A.J.K., I.E.S.), The Royal Children's Hospital; Department of Paediatrics (K.B.H., A.J.K., N.W.C., I.E.S.), The University of Melbourne; Murdoch Children's Research Institute (K.B.H., P.R.M., R.K., I.O., A.J.K., M.D., N.W.C., I.E.S.); Department of Medicine (A.L.S., S.R.-H., I.E.S.), Epilepsy Research Centre, Austin Health, The University of Melbourne; Immunisation Service (M.D., N.W.C., I.E.S.), The Royal Children's Hospital; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Australia
| | - Nigel W Crawford
- From the Department of Neurology (K.B.H., S.B., M.H., A.J.K., I.E.S.), The Royal Children's Hospital; Department of Paediatrics (K.B.H., A.J.K., N.W.C., I.E.S.), The University of Melbourne; Murdoch Children's Research Institute (K.B.H., P.R.M., R.K., I.O., A.J.K., M.D., N.W.C., I.E.S.); Department of Medicine (A.L.S., S.R.-H., I.E.S.), Epilepsy Research Centre, Austin Health, The University of Melbourne; Immunisation Service (M.D., N.W.C., I.E.S.), The Royal Children's Hospital; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Australia
| | - Ingrid E Scheffer
- From the Department of Neurology (K.B.H., S.B., M.H., A.J.K., I.E.S.), The Royal Children's Hospital; Department of Paediatrics (K.B.H., A.J.K., N.W.C., I.E.S.), The University of Melbourne; Murdoch Children's Research Institute (K.B.H., P.R.M., R.K., I.O., A.J.K., M.D., N.W.C., I.E.S.); Department of Medicine (A.L.S., S.R.-H., I.E.S.), Epilepsy Research Centre, Austin Health, The University of Melbourne; Immunisation Service (M.D., N.W.C., I.E.S.), The Royal Children's Hospital; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Australia
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