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Nasser A, de Zwart BJ, Stewart DJ, Zielke AM, Blazek K, Heywood AE, Craig AT. Risk factors predicting the need for intensive care unit admission within forty-eight hours of emergency department presentation: A case-control study. Aust Crit Care 2024:S1036-7314(24)00028-6. [PMID: 38584063 DOI: 10.1016/j.aucc.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/10/2024] [Accepted: 01/14/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Patients admitted from the emergency department to the wards, who progress to a critically unwell state, may require expeditious admission to the intensive care unit. It can be argued that earlier recognition of such patients, to facilitate prompt transfer to intensive care, could be linked to more favourable clinical outcomes. Nevertheless, this can be clinically challenging, and there are currently no established evidence-based methods for predicting the need for intensive care in the future. OBJECTIVES We aimed to analyse the emergency department data to describe the characteristics of patients who required an intensive care admission within 48 h of presentation. Secondly, we planned to test the feasibility of using this data to identify the associated risk factors for developing a predictive model. METHODS We designed a retrospective case-control study. Cases were patients admitted to intensive care within 48 h of their emergency department presentation. Controls were patients who did not need an intensive care admission. Groups were matched based on age, gender, admission calendar month, and diagnosis. To identify the associated variables, we used a conditional logistic regression model. RESULTS Compared to controls, cases were more likely to be obese, and smokers and had a higher prevalence of cardiovascular (39 [35.1%] vs 20 [18%], p = 0.004) and respiratory diagnoses (45 [40.5%] vs 25 [22.5%], p = 0.004). They received more medical emergency team reviews (53 [47.8%] vs 24 [21.6%], p < 0.001), and more patients had an acute resuscitation plan (31 [27.9%] vs 15 [13.5%], p = 0.008). The predictive model showed that having acute resuscitation plans, cardiovascular and respiratory diagnoses, and receiving medical emergency team reviews were strongly associated with having an intensive care admission within 48 h of presentation. CONCLUSIONS Our study used emergency department data to provide a detailed description of patients who had an intensive care unit admission within 48 h of their presentation. It demonstrated the feasibility of using such data to identify the associated risk factors to develop a predictive model.
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Affiliation(s)
- Ahmad Nasser
- Intensive Care Unit, Queen Elizabeth II Jubilee Hospital, Coopers Plains, Queensland, Australia; Faculty of Medicine, University of Queensland, Herston, Queensland, Australia.
| | - Blake J de Zwart
- Intensive Care Unit, Queen Elizabeth II Jubilee Hospital, Coopers Plains, Queensland, Australia
| | - David J Stewart
- Intensive Care Unit, Queen Elizabeth II Jubilee Hospital, Coopers Plains, Queensland, Australia; School of Medicine, Griffith University, Meadowbrook, Queensland, Australia
| | - Anne M Zielke
- Intensive Care Unit, Queen Elizabeth II Jubilee Hospital, Coopers Plains, Queensland, Australia
| | - Katrina Blazek
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, New South Wales, Australia
| | - Anita E Heywood
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, New South Wales, Australia
| | - Adam T Craig
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia; School of Population Health, Faculty of Medicine and Health, UNSW Sydney, New South Wales, Australia
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Seale H, Harris-Roxas B, Heywood AE, Abdi I, Mahimbo A, Woodland L, Waller E. "It's no use saying it in English": A qualitative study exploring community leaders' perceptions of the challenges and opportunities with translating and interpreting COVID-19 related public health messaging to reach ethnic minorities in Australia. PLoS One 2024; 19:e0284000. [PMID: 38422070 PMCID: PMC10903877 DOI: 10.1371/journal.pone.0284000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The Australian Government implemented a range of public health response strategies and communication approaches to reduce the spread of COVID-19; however, concerns have been raised around a failure to sufficiently consider culturally and linguistically diverse (CaLD) communities in these processes. This research aimed to understand the factors that have impacted COVID-19 communication and engagement efforts during the pandemic from the perspective of key CaLD community and faith-based leaders. A further aim was to understand the processes that could be adopted to support future communication strategies, including promoting pandemic-related vaccines. APPROACH This study included 29 key informant interviews with community and faith-based leaders in New South Wales, Australia. RESULTS The overwhelming message from community leaders was a sense of shared responsibility between their organisations and governments in communicating pertinent and accurate COVID-19 related information to CaLD communities. They expressed a sense of duty to keep their community members safe. However, community leaders and others shouldered significant costs related to resources and time that need to be acknowledged by governments in preparing for future disease outbreaks. They felt that governments should consider: 1) improving communication between governments and CaLD organisations; 2) responding to the specific CaLD needs with greater agility; 3) foregrounding social media in their communication strategy; 4) reinvesting in local public health units to know their population; 5) developing a health ambassadors model program; 6) preparing a hybrid model of translators/interpreters to fill the gap; and, 7) reimagining vaccine information campaigns to target CaLD communities better. CONCLUSION Given the technical details about the COVID-19 virus conveyed in government information campaigns and the media, ensuring the most vulnerable populations, including people from CaLD backgrounds, access clear, concise and timely public health messaging from governments and community organisations requires further attention.
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Affiliation(s)
- Holly Seale
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales (NSW), Australia
| | - Ben Harris-Roxas
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales (NSW), Australia
| | - Anita E. Heywood
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales (NSW), Australia
| | - Ikram Abdi
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
- The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Abela Mahimbo
- School of Public Health, Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - Lisa Woodland
- NSW Multicultural Health Communication Service, South Eastern Sydney Local Health District, NSW Health, Sydney, NSW, Australia
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia
| | - Emily Waller
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales (NSW), Australia
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Dyda A, Broome A, Rawlinson W, Mahimbo A, Saha A, Kefalas B, Seale H, Macintyre CR, Zwar N, Gidding HF, Heywood AE. Measles, mumps, rubella and varicella antibodies among international and domestic university students. J Travel Med 2024; 31:taae004. [PMID: 38195239 DOI: 10.1093/jtm/taae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 01/11/2024]
Abstract
BACKGROUND Vaccine-preventable infections are generally well controlled in Australia. However, gaps in immunity can lead to outbreaks and are important to identify. Young adults are a highly mobile population and a potential source of imported infections. We aimed to evaluate anti- measles, mumps, rubella and varicella (MMR&V) IgG seroprevalence and explore factors relating to antibody seropositivity. METHODS A cross-sectional online survey was conducted among students from a large Australian university to collect demographic, vaccination, infection and travel characteristics. Blood samples were collected to measure MMR&V seroprevalence. Logistic regression was used to identify factors associated with seropositivity. RESULTS Among 804 university students, seroprevalence (positive or equivocal) for measles was 82.3% (95% CI 79.6-84.8%), mumps 79.5% (95% CI 76.7-82.3%), rubella 91.5% (95% CI 89.6-93.5%) and varicella 86.2% (95% CI 84.1-88.8%), with 452 (56.2%, 95% CI 52.8-59.6) seropositive to all four viruses. Varicella seropositivity was highest in the older birth cohort (born 1988-1991). Measles seropositivity was higher for international students compared to domestic students. Among international students, mumps seroprevalence was significantly lower than measles and rubella seroprevalence. International travel in the previous 12 months was reported by 63.1% of students, but only 18.2% of travellers reported seeking pre-travel health advice prior to most recent international travel. CONCLUSIONS Overall, this study suggests immunity to MMR&V is sub-optimal. We found the university student population to be highly mobile and unlikely to seek pre-travel advice; thus, they are a potential source of infection importation. The implementation of university immunization policies could address the gaps identified and our findings can inform the development of targeted vaccination campaigns.
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Affiliation(s)
- Amalie Dyda
- School of Public Health, University of Queensland, Brisbane, QLD 4072, Australia
| | - Audrey Broome
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - William Rawlinson
- Serology and Virology Division (SAViD), NSW Health Pathology, Randwick, NSW 2031, Australia
| | - Abela Mahimbo
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Amit Saha
- The Kirby Institute, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Bill Kefalas
- UNSW Health Service, University of New South Wales, Sydney, NSW 2052, Australia
| | - Holly Seale
- School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - C Raina Macintyre
- The Kirby Institute, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Nicholas Zwar
- School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD 4226, Australia
| | - Heather F Gidding
- School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Anita E Heywood
- School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia
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Wood JG, Heywood AE, Dennington PM, Lloyd AR, Ziegler JB. Trends in intravenous immunoglobulin use in New South Wales, Australia. Intern Med J 2024; 54:149-156. [PMID: 37488980 DOI: 10.1111/imj.16175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 06/25/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Intravenous immunoglobulin (IVIg) is a critical replacement therapy for immunodeficiencies and immunomodulatory treatment for autoimmune and inflammatory diseases. Adequate supply of IVIg is a global issue, necessitating supply restrictions. In Australia, despite strict criteria for use, demand for IVIg has increased over time and exceeds domestic supply. OBJECTIVE Factors associated with the upward trend in overall IVIg use were examined, including in the number of unique patients, IVIg dosing and treatment frequency and variations by prescribing discipline and disease group. METHODS De-identified data of IVIg dispensed in the largest Australian state (New South Wales) from 2007 to 2013 were provided by Australian Red Cross Lifeblood. Trends and projections were calculated using log-linear regression of unique patients, treatment episodes and grams of IVIg for overall use and use stratified by discipline and disease group. RESULTS During the study period, 169 453 treatment episodes were recorded for 12 547 unique patients accounting for 5 827 787 g of IVIg use. Overall, IVIg use increased by 12.0% (11.5-12.6%) per year representing a 97.7% increase (91.6-104%) over the study period. The highest growth was among neurological conditions (16.0% (14.9-17.1%) per year). An increase in the number of unique patients was the primary driver of this growth, augmented by increases in the frequency and average dose per treatment. CONCLUSIONS Clinically acceptable measures to improve management of IVIg supply are needed including optimising dose, frequency and duration of treatment. Formal evaluation of IVIg versus alternatives, including cost-effectiveness and comparative efficacy, is warranted.
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Affiliation(s)
- James G Wood
- School of Population Health, UNSW Sydney, Sydney, Australia
| | | | - Peta M Dennington
- Pathology Services, Australian Red Cross Lifeblood, Sydney, Australia
| | | | - John B Ziegler
- Department of Immunology & Infectious Diseases, Sydney Children's Hospital, Sydney, Australia
- School of Women's & Children's Health, UNSW Sydney, Sydney, Australia
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Kpozehouen EB, Heywood AE, Menzies R, Seale H, Brotherton J, Raina Macintyre C. Informing the design of a whole of life immunisation register for Australia. Vaccine 2023; 41:3011-3018. [PMID: 37037706 DOI: 10.1016/j.vaccine.2023.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 02/26/2023] [Accepted: 03/17/2023] [Indexed: 04/12/2023]
Abstract
INTRODUCTION In 2016, Australia launched a whole life immunisation register, the Australian Immunisation Register (AIR), building on a universal childhood register established in 1997. Immunisation Information Systems are well established in Europe, the US and elsewhere. However, a national system covering immunisation across the lifespan, with complete capture of the population and satisfactory data quality, is rare. METHODS A national workshop was convened in 2016 with key stakeholders from the government, new and existing vaccine users, and vaccine providers to review the ideal features of the AIR to ensure optimal effectiveness. This workshop focused on the functionality needed to identify population groups newly included in the register and support the achievement of high immunisation coverage in these groups eligible for National Immunisation Program vaccines. RESULTS Key recommendations included the need for bidirectional data flow between the AIR and providers; systematic approaches to the capture and recording of accurate and complete data to ascertain important denominators for subpopulations, includingAboriginal and Torres Strait Islander status, medical risk factors, occupation, ethnicity, country of birth, and vaccines given during pregnancy; linkage with other government datasets including notifiable diseases; the capture of adverse events following immunisation; ease of access by patients, providers; and by researchers. CONCLUSIONS Some recommendations from the workshop have informed the development and future utility of the AIR. Some recommendations from the workshop have been integrated into the current iteration of the AIR, which is more important than ever given the roll-out of COVID-19 vaccines. The accuracy and validity of data have subsequently improved through data entry controls, data integrity checks and reporting requirements. Access to AIR data for research remains protracted and costly, limitingresearch potential.
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Affiliation(s)
| | - Anita E Heywood
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Australia
| | - Robert Menzies
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Australia
| | - Holly Seale
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Australia
| | - Julia Brotherton
- Melbourne School of Population and Global Health, University of Melbourne, Australia; Formerly Australian Centre for the Prevention of Cervical Cancer, East Melbourne, Australia
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Sitaresmi MN, Seale H, Heywood AE, Padmawati RS, Soenarto Y, MacIntyre CR, Atthobari J. Maternal knowledge and attitudes towards rotavirus diarrhea and vaccine acceptance in Yogyakarta, Indonesia: a qualitative study. PI 2022. [DOI: 10.14238/pi62.5.2022.333-40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background Rotavirus is a leading cause of hospitalized diarrhea cases in Indonesia. Despite the rotavirus vaccine being recommended by the Indonesian Pediatric Society since 2011, it has yet to be been included in the Indonesian national immunization program (NIP) schedule.
Objective To explore maternal knowledge of and attitudes towards rotavirus diarrhea, as well as barriers to vaccine acceptance in Yogyakarta, Indonesia.
Methods We conducted 26 in-depth interviews in two districts (rural and urban areas) of Yogyakarta Province, Indonesia. Participants included women in their third trimester of pregnancy and mothers of infants younger than 14 weeks. We then proceeded with thematic analysis.
Results Participants did not perceive diarrhea as being a priority health problem. Very few had heard of rotavirus diarrhea or were aware of vaccine availability. While participants would accept vaccinating their children against rotavirus, some key barriers impacted vaccine use. As the rotavirus vaccine is not included in the Indonesian NIP, parents perceived it as not essential. Parents were concerned about the safety and benefit of the vaccine due to its perceived newness. Other concerns were cost and halal status. Participants expressed a need for more information on the vaccine's effectiveness and safety, with their primary healthcare providers (HCPs) considered to play the most important role in vaccine acceptance.
Conclusions In Yogyakarta, Indonesia, awareness of the seriousness of rotavirus disease and the availability of the rotavirus vaccine is low. Its newness, safety, efficacy, and cost, and doubts about its halal status, were barriers to vaccine acceptance. Information and recommendations from HCPs play an essential role in vaccine acceptance.
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7
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Alqahtani AS, Fakeerh M, Bondagji D, Park S, Heywood AE, Wiley KE, Booy R, Rashid H. Hand Hygiene Compliance and Effectiveness Against Respiratory Infections Among Hajj Pilgrims: A Systematic Review. Infect Disord Drug Targets 2021; 20:273-283. [PMID: 30277169 DOI: 10.2174/1871526518666181001145041] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 08/25/2018] [Accepted: 09/14/2018] [Indexed: 11/22/2022]
Abstract
The role of hand hygiene in the prevention of respiratory tract infections in Hajj pilgrims has not been assessed through a focussed systematic review of the literature. Considering this, a systematic review was undertaken to synthesize the up-to-date literature on the compliance and effectiveness of hand hygiene among Hajj attendees. Major databases, including OVID Medline, were searched by using a combination of MeSH terms and text words for potentially relevant articles. Data from identified articles were abstracted, quality assessed and combined into a summary effect. Twelve observational studies containing data of 6,320 pilgrims were included. The compliance of hand washing with non-alcoholic surfactants was 77.7% (ranged from 31.5% to 90.3% in individual studies) and the compliance of hand cleaning with alcoholic products was 44.9% (ranged from 30.7% to 67.4%). Education was a key influencer of hand hygiene practice. Only three of the six studies that assessed the effectiveness of hand hygiene against clinical disease found the practice to be effective, and only one of the two studies that evaluated its effectiveness against a laboratory-confirmed infection found it to be effective. This systematic review suggests that hand hygiene using non-alcoholic products is generally acceptable among Hajj pilgrims but there is no conclusive evidence on its effectiveness.
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Affiliation(s)
- Amani S Alqahtani
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children’s Hospital at Westmead, Westmead, NSW, Australia,School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Mutaz Fakeerh
- School of Public Health, The University of Sydney, Sydney, NSW, Australia,Ministry of Health, Makkah, Saudi Arabia
| | - Daniah Bondagji
- School of Public Health, The University of Sydney, Sydney, NSW, Australia,Ministry of Health, Makkah, Saudi Arabia
| | - Silvia Park
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Anita E Heywood
- School of Public Health and Community Medicine, UNSW, Sydney, NSW, Australia
| | - Kerrie E Wiley
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children’s Hospital at Westmead, Westmead, NSW, Australia,Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, The University of Sydney, Sydney, NSW, Australia,WHO Collaborating Centre for Mass Gatherings and High Consequence/High Visibility Events, Flinders University, Adelaide, Australia
| | - Harunor Rashid
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children’s Hospital at Westmead, Westmead, NSW, Australia,Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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8
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Seale H, Heywood AE, Leask J, Sheel M, Durrheim DN, Bolsewicz K, Kaur R. Examining Australian public perceptions and behaviors towards a future COVID-19 vaccine. BMC Infect Dis 2021; 21:120. [PMID: 33509104 PMCID: PMC7840792 DOI: 10.1186/s12879-021-05833-1] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/22/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND As immunisation program launches have previously demonstrated, it is essential that careful planning occurs now to ensure the readiness of the public for a COVID-19 vaccine. As part of that process, this study aimed to understand the public perceptions regarding a future COVID-19 vaccine in Australia. METHODS A national cross-sectional online survey of 1420 Australian adults (18 years and older) was undertaken between 18 and 24 March 2020. The statistical analysis of the data included univariate and multivariable logistic regression model analysis. RESULTS Respondents generally held positive views towards vaccination. Eighty percent (n = 1143) agreed with the statement that getting myself vaccinated for COVID-19 would be a good way to protect myself against infection. Females (n = 614, 83%) were more likely to agree with the statement than males (n = 529, 78%) (aOR = 1.4 (95% CI: 1.1-1.8); P = 0.03), while 91% of those aged 70 years and above agreed compared to 76% of 18-29-year-olds (aOR = 2.3 (95% CI:1.2-4.1); P = 0.008). Agreement was also higher for those with a self-reported chronic disease (aOR = 1.4 (95% CI: 1.1-2.0); P = 0.04) and among those who held private health insurance (aOR = 1.7 (95% CI: 1.3-2.3); P < 0.001). Beyond individual perceptions, 78% stated that their decision to vaccinate would be supported by family and friends. CONCLUSION This study presents an early indication of public perceptions towards a future COVID-19 vaccine and represents a starting point for mapping vaccine perceptions. To support an effective launch of these new vaccines, governments need to use this time to understand the communities concerns and to identify the strategies that will support engagement.
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Affiliation(s)
- Holly Seale
- Faculty of Medicine, School of Population Health, University of New South Wales, Level 2, Samuels Building, Sydney, NSW, 2052, Australia.
| | - Anita E Heywood
- Faculty of Medicine, School of Population Health, University of New South Wales, Level 2, Samuels Building, Sydney, NSW, 2052, Australia
| | - Julie Leask
- Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, NSW, Australia
- National Centre for Immunisation Research and Surveillance, Kids Research, Sydney Children's Hospitals Network, Westmead, NSW, Australia
| | - Meru Sheel
- National Centre for Epidemiology and Population Health, Research School of Population Health, ANU College of Health and Medicine, The Australian National University, Acton, ACT, Canberra, Australia
| | - David N Durrheim
- School of Medicine and Public Health, University of Newcastle, Wallsend, NSW, Australia
| | - Katarzyna Bolsewicz
- National Centre for Immunisation Research and Surveillance, Kids Research, Sydney Children's Hospitals Network, Westmead, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Wallsend, NSW, Australia
| | - Rajneesh Kaur
- Office of Medical Education, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Office of Medical Education, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
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Aik J, Turner RM, Kirk MD, Heywood AE, Newall AT. Evaluating food safety management systems in Singapore: A controlled interrupted time-series analysis of foodborne disease outbreak reports. Food Control 2020. [DOI: 10.1016/j.foodcont.2020.107324] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Heywood AE, Macintyre CR. Elimination of COVID-19: what would it look like and is it possible? Lancet Infect Dis 2020; 20:1005-1007. [PMID: 32771079 PMCID: PMC7831637 DOI: 10.1016/s1473-3099(20)30633-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 07/20/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Anita E Heywood
- School of Public Health and Community Medicine, University of New South Wales Sydney, Sydney, NSW 2052, Australia.
| | - C Raina Macintyre
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia
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11
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Alqahtani AS, Alsharif SA, Garnan MA, Tashani M, BinDhim NF, Heywood AE, Booy R, Wiley KE, Rashid H. The Impact of Receiving Pretravel Health Advice on the Prevention of Hajj-Related Illnesses Among Australian Pilgrims: Cohort Study. JMIR Public Health Surveill 2020; 6:e10959. [PMID: 32673259 PMCID: PMC7388052 DOI: 10.2196/10959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 04/23/2019] [Accepted: 11/08/2019] [Indexed: 11/20/2022] Open
Abstract
Background Pretravel health advice can play a crucial role in improving both travelers’ awareness about disease risk and compliance with preventive measures. General practitioners (GPs) and the internet have been reported internationally to be the main sources of health advice for travelers to non–mass gathering (MG) destinations. However, few studies have attempted to investigate the sources of health advice among travelers to MGs including the Hajj pilgrimage, and none of these studies further investigated the impact of pretravel advice on pilgrims’ health behaviors. Objective The objective of this study was to investigate the impact of the source of pretravel health advice (from GPs and specialized Hajj travel agents) on Hajj pilgrims’ awareness of and compliance with health recommendations, and the incidence of Hajj-associated illnesses. Methods A prospective cohort study (before and during Hajj) was conducted among Australian pilgrims aged ≥18 years in 2015. Results A total of 421 pilgrims participated prior to Hajj, and 391 (93%) provided follow-up data during Hajj. All participants obtained pretravel health advice from one or more sources, with Hajj travel agents (46%) and general practitioners (GPs; 40%) the most commonly reported sources. In total, 288 (74%) participants reported Hajj-related symptoms, of which 86% (248/288) were respiratory symptoms. Participants who obtained pretravel health advice from travel agents were more likely to be aware of the official Saudi recommendations (adjusted odds ratio [aOR] 2.1, 95% CI 1.2-3.8; P=.01), receive recommended vaccines before travel (aOR 2.4, 95% CI 1.4-3.9; P=.01), use hand sanitizers including soap (aOR 2.5, 95% CI 1.1-6.1; P=.03), and wash their hands after touching an ill person during Hajj (aOR 2.9, 95% CI 1.1-7.1; P=.01), compared to those who sought advice from GPs. However, neither advice from travel agents nor GPs was associated with a lower incidence of Hajj-related illnesses. Conclusions Advice from travel agents appeared to be accessed by more travelers than that from GPs, and was associated with an increased likelihood of positive travel health behaviors.
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Affiliation(s)
- Amani S Alqahtani
- Saudi Food and Drug Authority, Riyadh, Saudi Arabia.,School of Public Health, The University of Sydney, Sydney, Australia.,National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead, Sydney, Australia
| | | | | | - Mohamed Tashani
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead, Sydney, Australia.,The Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | | | - Anita E Heywood
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead, Sydney, Australia.,The Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney, Australia.,WHO Collaborating Centre for Mass Gatherings and High Consequence/High Visibility Events, Flinders University, Adelaide, Australia
| | - Kerrie E Wiley
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Harunor Rashid
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead, Sydney, Australia.,The Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney, Australia
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Craig AT, Heywood AE, Worth H. Measles epidemic in Samoa and other Pacific islands. Lancet Infect Dis 2020; 20:273-275. [PMID: 32112752 DOI: 10.1016/s1473-3099(20)30053-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 01/17/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Adam T Craig
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
| | - Anita E Heywood
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Heather Worth
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
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13
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Seale H, Heywood AE, Leask J, Sheel M, Thomas S, Durrheim DN, Bolsewicz K, Kaur R. COVID-19 is rapidly changing: Examining public perceptions and behaviors in response to this evolving pandemic. PLoS One 2020; 15:e0235112. [PMID: 32574184 PMCID: PMC7310732 DOI: 10.1371/journal.pone.0235112] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/02/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Since the emergence of SARS-CoV-2, the virus that causes coronavirus disease (COVID-19) in late 2019, communities have been required to rapidly adopt community mitigation strategies rarely used before, or only in limited settings. This study aimed to examine the attitudes and beliefs of Australian adults towards the COVID-19 pandemic, and willingness and capacity to engage with these mitigation measures. In addition, we aimed to explore the psychosocial and demographic factors that are associated with adoption of recommended hygiene-related and avoidance-related behaviors. METHODS A national cross-sectional online survey of 1420 Australian adults (18 years and older) was undertaken between the 18 and 24 March 2020. The statistical analysis of the data included univariate and multivariate logistic regression analysis. FINDINGS The survey of 1420 respondents found 50% (710) of respondents felt COVID-19 would 'somewhat' affect their health if infected and 19% perceived their level of risk as high or very high. 84·9% had performed ≥1 of the three recommended hygiene-related behaviors and 93·4% performed ≥1 of six avoidance-related behaviors over the last one month. Adopting avoidance behaviors was associated with trust in government/authorities (aOR: 6.0, 95% CI 2.6-11·0), higher perceived rating of effectiveness of behaviors (aOR: 4·0, 95% CI: 1·8-8·7), higher levels of perceived ability to adopt social distancing strategies (aOR: 5.0, 95% CI: 1·5-9.3), higher trust in government (aOR: 6.0, 95% CI: 2.6-11.0) and higher level of concern if self-isolated (aOR: 1.8, 95% CI: 1.1-3.0). INTERPRETATION In the last two months, members of the public have been inundated with messages about hygiene and social (physical) distancing. However, our results indicate that a continued focus on supporting community understanding of the rationale for these strategies, as well as instilling community confidence in their ability to adopt or sustain the recommendations is needed.
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Affiliation(s)
- Holly Seale
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Anita E. Heywood
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Julie Leask
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- National Centre for Immunisation Research and Surveillance, Kids Research, Sydney Children’s Hospitals Network, Westmead, NSW, Australia
| | - Meru Sheel
- National Centre for Epidemiology and Population Health, Research School of Population Health, ANU College of Health and Medicine, The Australian National University, Acton, ACT, Australia
| | - Susan Thomas
- School of Medicine and Public Health, University of Newcastle, Wallsend, NSW, Australia
| | - David N. Durrheim
- School of Medicine and Public Health, University of Newcastle, Wallsend, NSW, Australia
| | - Katarzyna Bolsewicz
- School of Medicine and Public Health, University of Newcastle, Wallsend, NSW, Australia
| | - Rajneesh Kaur
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Office of Medical Education, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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14
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Syiroj ATR, Pardosi JF, Heywood AE. Exploring parents' reasons for incomplete childhood immunisation in Indonesia. Vaccine 2019; 37:6486-6493. [PMID: 31522808 DOI: 10.1016/j.vaccine.2019.08.081] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 08/27/2019] [Accepted: 08/29/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Immunisation is one of the most successful interventions for controlling infectious diseases but relies on continuous high coverage. Parental vaccine refusal and logistical barriers to access are threats to the success of immunisation programs, with resultant population immunity gaps leading to outbreaks of vaccine-preventable diseases. In Indonesia, coverage of childhood vaccines is suboptimal, with poor coverage of diphtheria-tetanus-pertussis vaccine leading to a large diphtheria outbreak in 2017. METHODS To explore the underlying parents' reasons for incomplete childhood immunisation in Indonesia, semi-structured interviews were conducted in Tangerang Selatan, Banten Province, Indonesia. Sixteen purposively selected primary carers of partially and unimmunised children were interviewed. Transcripts were coded and analysed using inductive thematic analysis. RESULTS Parental reasons were categorised into three interrelated themes of belief barriers, safety concerns, and issues of trust and misinformation. Stark differences were evident in reasons provided by carers of unimmunised children compared to partially immunised children. For parents of unimmunised children, Islamic beliefs, belief in the strength of natural immunity, and the use of alternative medicines strongly influenced behaviours. Safety concerns, issues of trust including distrust in the government, misinformation, and trust in information obtained through social networks were also prominent. In contrast, concerns about mild side-effects and logistical barriers outweighed beliefs among carers of partially immunised children. CONCLUSIONS Our findings highlight the complexities in decision making for parents who decide not to vaccinate their children. In the Indonesian context, public health education and engagement of religious leaders to bridge the gap between religious beliefs and vaccine acceptance are needed to address vaccine refusal. Future research on the influence of social networks on vaccine hesitancy in the Indonesian context is also warranted. For parents of partially vaccinated children, interventions should focus on barriers of access to community health staff to encourage timely schedule completion.
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Affiliation(s)
- Agung Taufiqur Rokhman Syiroj
- National Population and Family Planning Board, East Java Province, Indonesia; School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia.
| | - Jerico Franciscus Pardosi
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia; School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia; National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
| | - Anita E Heywood
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia
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15
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Alqahtani AS, Tashani M, Heywood AE, Booy R, Rashid H, Wiley KE. Exploring Australian Hajj Tour Operators' Knowledge and Practices Regarding Pilgrims' Health Risks: A Qualitative Study. JMIR Public Health Surveill 2019; 5:e10960. [PMID: 31124464 PMCID: PMC6552451 DOI: 10.2196/10960] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 02/02/2019] [Accepted: 02/07/2019] [Indexed: 01/15/2023] Open
Abstract
Background Travel agents are known to be one of the main sources of health information for pilgrims, and their advice is associated with positive health behaviors. Objective This study aimed to investigate travel agents’ health knowledge, what health advice they provide to the pilgrims, and their sources of health information. Methods In-depth interviews were conducted among specialist Hajj travel agents in Sydney, Australia. Thematic analysis was undertaken. Results Of the 13 accredited Hajj travel agents, 9 (69%) were interviewed. A high level of awareness regarding gastrointestinal infections, standard hygiene methods, and the risk of injury was noted among the participants and was included in advice provided to pilgrims. However, very limited knowledge and provision of advice about the risk of respiratory infections was identified. Knowledge of the compulsory meningococcal vaccine was high, and all participated travel agents reported influenza vaccine (a recommended vaccine) as a second “compulsory” vaccine for Hajj visas. Conversely, participants reported very limited knowledge about other recommended vaccines for Hajj. The Ministry of Hajj website and personal Hajj experience were the main sources of information. Conclusions This study identifies a potential path for novel health promotion strategies to improve health knowledge among Hajj travel agents and subsequently among Hajj pilgrims.
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Affiliation(s)
| | - Mohamed Tashani
- Child and Adolescent Health, Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, Australia
| | | | - Robert Booy
- Child and Adolescent Health, Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, Australia
| | - Harunor Rashid
- Child and Adolescent Health, Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, Australia
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16
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Abstract
BACKGROUND migration has reached unprecedented levels, with 3.6% of the world's population living outside their country of birth. Migrants comprise a substantial proportion of high-income country populations, are at increased risk of a range of infectious diseases, compared to native-born populations and may experience worse health outcomes due to barriers accessing timely diagnoses and treatment. Poor access to essential healthcare services can be attributed to several factors, including language and cultural barriers and lack of specific inclusive health policies. METHODS This review draws on evidence from the immigrant health and travel medicine literature, with a focus on infectious disease risks. It presents strategies to reduce barriers to healthcare access through health promotion and screening programs both at the community and clinic level and the delivery of linguistically and culturally competent care. The Methods: Salud Entre Culturas (SEC) 'Health Between Cultures' project from the Tropical Medicine Unit at the Hospital Ramon y Cajal in Madrid is described as an effective model of care. RESULTS For those providing healthcare to migrant populations, the use of community-consulted approaches are considered best practice in the development of health education, health promotion and the delivery of targeted health services. At the clinic-level, strategies optimizing care for migrants include the use of bilingual healthcare professionals or community-based healthcare workers, cultural competence training of all clinic staff, the appropriate use of trained interpreters and the use of culturally appropriate health promotion materials. CONCLUSIONS Multifaceted strategies are needed to improve access, community knowledge, community engagement and healthcare provider training to provide appropriate care to migrant populations to reduce infectious disease disparities.
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Affiliation(s)
- Anita E Heywood
- Level 3, Samuels Building, School of Public Health and Community Medicine, UNSW Sydney, NSW, Australia
| | - Rogelio López-Vélez
- National Referral Unit for Tropical Diseases, Department of Infectious Diseases, Ramón y Cajal University Hospital, Madrid, Spain
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Jayasundara D, Hui BB, Regan DG, Heywood AE, MacIntyre CR, Wood JG. Modelling the decline and future of hepatitis A transmission in Australia. J Viral Hepat 2019; 26:199-207. [PMID: 30315680 DOI: 10.1111/jvh.13018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/23/2018] [Accepted: 09/17/2018] [Indexed: 12/13/2022]
Abstract
Hepatitis A incidence has declined in most countries through a combination of prevention measures, augmented through the use of a highly effective vaccine. In Australia, the proportion of the population susceptible to hepatitis A infection has declined over time due to high rates of opportunistic vaccination as well as the sustained inflow of seropositive immigrants from high-endemicity countries. These factors have contributed to a rapid decline in incidence. An age-structured hepatitis A transmission model incorporating demographic changes was fitted to seroprevalence and disease notification data and used to project incidence trends and transmission potential for hepatitis A in the general population. Robustness of findings was assessed through worst-case scenarios regarding vaccine uptake, migration and the duration of immunity. The decline in age-specific seroprevalence until the introduction of hepatitis A vaccine in 1994 was well explained through a declining basic reproduction number (R0 ) that remained >1. Accounting for existing immunity, we estimated that the effective reproduction number (Reff ) <1 in the general population of Australia since the early 1990s, declining more rapidly after the introduction of the hepatitis A vaccine. Future projections under a variety of scenarios support Reff remaining <1 with continued low incidence in the general population. In conclusion, our results suggest that sustained endemic transmission in the general Australian population is no longer possible although risks of sporadic outbreaks remain. This suggests potential for local elimination of hepatitis A infection in Australia, provided that elimination criteria can be defined and satisfied in risk groups. The methodology used here to investigate elimination potential can easily be replicated in settings such as in the USA where sequential seroprevalence studies are supported by routine notification data.
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Affiliation(s)
- Duleepa Jayasundara
- Faculty of Medicine, School of Public Health and Community Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Ben B Hui
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - David G Regan
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Anita E Heywood
- Faculty of Medicine, School of Public Health and Community Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - C Raina MacIntyre
- Faculty of Medicine, School of Public Health and Community Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - James G Wood
- Faculty of Medicine, School of Public Health and Community Medicine, UNSW Sydney, Sydney, New South Wales, Australia
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Aik J, Heywood AE, Newall AT, Ng LC, Kirk MD, Turner R. Climate variability and salmonellosis in Singapore - A time series analysis. Sci Total Environ 2018; 639:1261-1267. [PMID: 29929293 DOI: 10.1016/j.scitotenv.2018.05.254] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/03/2018] [Accepted: 05/21/2018] [Indexed: 05/16/2023]
Abstract
Climate change is expected to bring about global warming and an increase in the frequency of extreme weather events. This may consequently influence the transmission of food-borne diseases. The short term associations between climatic conditions and Salmonella infections are well documented in temperate climates but not in the tropics. We conducted an ecological time series analysis to estimate the short term associations between non-outbreak, non-travel associated reports of Salmonella infections and observed climatic conditions from 2005 to 2015 for Singapore. We used a negative binomial time series regression model to analyse the associations on a weekly scale, controlling for season, long term trend, delayed weather effects, autocorrelation and the period where Salmonella was made legally notifiable. There were a total of 11,324 Salmonella infections reported during our study period. A 1 °C increase in mean ambient air temperature was associated with a 4.3% increase (Incidence Rate Ratio [IRR]: 1.043, 95% confidence interval [CI] = 1.003, 1.084) in reported Salmonella infections in the same week and a 6.3% increase (IRR: 1.063, 95% CI = 1.022, 1.105) three weeks later. A 1% increase in the mean relative humidity was associated with a 1.3% decrease (IRR: 0.987, 95% CI = 0.981, 0.994) in cases six weeks later, while a 10 mm increase in weekly cumulative rainfall was associated with a 0.8% increase (IRR: 1.008, 95% CI = 1.002, 1.015) in cases 2 weeks later but a 0.9% decrease (IRR: 0.991, 95% CI = 0.984, 0.998) in cases 5 weeks later. No thresholds for these weather effects were detected. This study confirms the short-term influence of climatic conditions on Salmonella infections in Singapore and the potential impact of climate change on Salmonellosis in the tropics.
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Affiliation(s)
- Joel Aik
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Level 3, Samuels Building, Botany Road, Kensington, New South Wales 2052, Australia; National Environment Agency, 40 Scotts Road, #13-00, 228231, Singapore.
| | - Anita E Heywood
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Level 3, Samuels Building, Botany Road, Kensington, New South Wales 2052, Australia
| | - Anthony T Newall
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Level 3, Samuels Building, Botany Road, Kensington, New South Wales 2052, Australia
| | - Lee-Ching Ng
- National Environment Agency, 40 Scotts Road, #13-00, 228231, Singapore
| | - Martyn D Kirk
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 0200, Australia
| | - Robin Turner
- Biostatistics Unit, Dunedin School of Medicine, University of Otago, Ground Floor, Adams Building, 18 Frederick Street, Dunedin 9016, New Zealand
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MacIntyre CR, Kpozehouen E, Kunasekaran M, Harriman K, Conaty S, Rosewell A, Druce J, Martin N, Heywood AE, Gidding HF, Wood J, Nicholl S. Measles control in Australia - threats, opportunities and future needs. Vaccine 2018; 36:4393-4398. [PMID: 29934234 DOI: 10.1016/j.vaccine.2018.06.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 06/07/2018] [Accepted: 06/08/2018] [Indexed: 11/18/2022]
Abstract
Control of measles was the focus of a national workshop held in 2015 in Sydney, Australia, bringing together stakeholders in disease control and immunisation to discuss maintaining Australia's measles elimination status in the context of regional and global measles control. The global epidemiology of measles was reviewed, including outbreaks in countries that have achieved elimination, such as the Disneyland outbreak in the United States and large outbreaks in Sydney, Australia. Transmission of measles between Australia and New Zealand occurs, but has not been a focus of control measures. Risk groups, the genetic and seroepidemiology of measles as well as surveillance, modelling and waning vaccine-induced immunity were reviewed. Gaps in policy, research and practice for maintaining measles elimination status in Australia were identified and recommendations were developed. Elimination of measles globally is challenging because of the infectiousness of measles and the need for 2-dose vaccine coverage rates in excess of 95% in all countries to achieve it. Until this occurs, international travel will continue to permit measles importation from endemic countries to countries that have achieved elimination. When measles cases are imported, failure to diagnose and isolate cases places the health system at risk of measles outbreaks. Vaccine funding models can result in gaps in vaccine coverage for adults and migrants. Australia introduced a whole-of-life immunisation register in 2016 and catch-up vaccination for at-risk communities, which will improve measles control. Research on diagnosis, immunology, case management and modelling of vaccination strategies are important to ensure continued control of measles.
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Affiliation(s)
- C Raina MacIntyre
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia; Kirby Institute, Biosecurity Program, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Elizabeth Kpozehouen
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia.
| | - Mohana Kunasekaran
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | | | - Stephen Conaty
- Public Health Unit, South Western Sydney Local Health District, Australia
| | - Alexander Rosewell
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Julian Druce
- Victorian Infectious Diseases Reference Laboratory, Australia; VIDRL, Doherty Institute, Australia
| | - Nicolee Martin
- Victorian Infectious Diseases Reference Laboratory, Australia
| | - Anita E Heywood
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia; National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| | - Heather F Gidding
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia; National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| | - James Wood
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
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20
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Yin JK, Heywood AE, Georgousakis M, King C, Chiu C, Isaacs D, Macartney KK. Systematic Review and Meta-analysis of Indirect Protection Afforded by Vaccinating Children Against Seasonal Influenza: Implications for Policy. Clin Infect Dis 2018; 65:719-728. [PMID: 28475770 DOI: 10.1093/cid/cix420] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 04/28/2017] [Indexed: 11/12/2022] Open
Abstract
Background Universal childhood vaccination is a potential solution to reduce seasonal influenza burden. Methods We reviewed systematically the literature on "herd"/indirect protection from vaccinating children aged 6 months to 17 years against influenza. Results Of 30 studies included, 14 (including 1 cluster randomized controlled trial [cRCT]) used live attenuated influenza vaccine, 11 (7 cRCTs) used inactivated influenza vaccine, and 5 (1 cRCT) compared both vaccine types. Twenty of 30 studies reported statistically significant indirect protection effectiveness (IPE) with point estimates ranging from 4% to 66%. Meta-regression suggests that studies with high quality and/or sufficiently large sample size are more likely to report significant IPE. In meta-analyses of 6 cRCTs with full randomization (rated as moderate quality overall), significant IPE was found in 1 cRCT in closely connected communities where school-aged children were vaccinated: 60% (95% confidence interval [CI], 41%-72%; I2 = 0%; N = 2326) against laboratory-confirmed influenza, and 3 household cRCTs in which preschool-aged children were vaccinated: 22% (95% CI, 1%-38%; I2 = 0%; N = 1903) against acute respiratory infections or influenza-like illness. Significant IPE was also reported in a large-scale cRCT (N = 8510) that was not fully randomized, and 3 ecological studies (N > 10000) of moderate quality including 36% reduction in influenza-related mortality among the elderly in a Japanese school-based program. Data on IPE in other settings are heterogeneous and lacked power to draw a firm conclusion. Conclusions The available evidence suggests that influenza vaccination of children confers indirect protection in some but not all settings. Robust, large-scaled studies are required to better quantify the indirect protection from vaccinating children for different settings/endpoints.
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Affiliation(s)
- J Kevin Yin
- National Centre for Immunisation Research and Surveillance, Westmead.,The Children's Hospital at Westmead.,Sydney School of Public Health, Faculty of Medicine, University of Sydney
| | - Anita E Heywood
- School of Public Health and Community Medicine, University of New South Wales
| | - Melina Georgousakis
- National Centre for Immunisation Research and Surveillance, Westmead.,The Children's Hospital at Westmead.,Sydney School of Public Health, Faculty of Medicine, University of Sydney
| | - Catherine King
- National Centre for Immunisation Research and Surveillance, Westmead.,The Children's Hospital at Westmead.,Discipline of Child and Adolescent Health, Faculty of Medicine, University of Sydney, New South Wales, Australia
| | - Clayton Chiu
- National Centre for Immunisation Research and Surveillance, Westmead.,The Children's Hospital at Westmead.,Discipline of Child and Adolescent Health, Faculty of Medicine, University of Sydney, New South Wales, Australia
| | - David Isaacs
- The Children's Hospital at Westmead.,Discipline of Child and Adolescent Health, Faculty of Medicine, University of Sydney, New South Wales, Australia
| | - Kristine K Macartney
- National Centre for Immunisation Research and Surveillance, Westmead.,The Children's Hospital at Westmead.,Discipline of Child and Adolescent Health, Faculty of Medicine, University of Sydney, New South Wales, Australia
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Affiliation(s)
- Anita E Heywood
- School of Public Health and Community Medicine, Faculty of Medicine, UNSW Sydney, NSW, Australia
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22
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Affiliation(s)
| | - Anita E Heywood
- School of Public Health and Community Medicine, Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Harunor Rashid
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, NSW, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, The University of Sydney, Westmead, NSW, Australia
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23
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Heywood AE, Zwar N. Improving access and provision of pre-travel healthcare for travellers visiting friends and relatives: a review of the evidence. J Travel Med 2018; 25:4934909. [PMID: 29608738 DOI: 10.1093/jtm/tay010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 02/02/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Travellers visiting friends and relatives (VFR travellers) in their country of origin are at increased risk of a range of preventable infections. Risks are broadly related to circumstances of travel, risk misconceptions and access to health services. Despite nearly two decades of literature highlighting these increased risks little impact has been made on their risk disparity. METHODS This review draws on evidence from travel medicine literature, supplemented by evidence from the broader field of immigrant health, and is structured to include strategies that aim to reduce barriers at the patient, provider and health system level. RESULTS For the travel medicine provider, tailored risk communication that is cognisant of the unique health beliefs and barriers to travel health for VFR travellers is needed, including enhanced communication through the use of interpreters and supplementary written communication. Primary care providers are uniquely placed to identify future travel plans among immigrant patients, however, greater awareness of VFR traveller risks and training in travel medicine are required. Community health promotion interventions that are culturally appropriate, translated into multiple languages and takes into account the cumulative risk of multiple return visits are key to normalizing travel healthcare seeking behaviours and improving awareness of VFR travel risks. Currently, there are few examples of novel strategies to engage migrant communities in travel health with no formal evaluations of their effectiveness. Best practice includes the use of community-consulted approaches in collaboration with government, primary care and travel medicine. CONCLUSIONS Multifactorial barriers related to health beliefs and access to health services require a range of strategies and interventions in both reaching and providing advice to VFR travellers. To improve the evidence base, future research should focus on the evaluation of novel strategies that address these barriers and improve access and provision of pre-travel healthcare to VFR travellers.
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Affiliation(s)
- Anita E Heywood
- School of Public Health and Community Medicine, UNSW Sydney, Australia
| | - Nicholas Zwar
- School of Public Health and Community Medicine, UNSW Sydney, Australia.,School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Australia
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24
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Jayasundara D, Hui BB, Regan DG, Heywood AE, MacIntyre CR, Wood JG. Quantifying the population effects of vaccination and migration on hepatitis A seroepidemiology in Australia. Vaccine 2017; 35:5228-5234. [PMID: 28823619 DOI: 10.1016/j.vaccine.2017.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/05/2017] [Accepted: 08/09/2017] [Indexed: 11/24/2022]
Abstract
Since licensure of hepatitis A vaccine in Australia in 1994, infection rates have declined to record lows. Cross-sectional serosurveys conducted over this period meanwhile have shown rising population immunity, particularly in young to middle-aged Australians. In this study, we performed a retrospective birth cohort analysis to estimate the contributions of infection, migration and vaccination towards increased levels of age specific hepatitis A seroprevalence in Australia. When aggregated across age, we find that two-thirds of the increase in population seropositivity (67.04%) between 1994 and 2008 was due to vaccination, just under one-third due to migration, with a negligible contribution from infection (<1%). Comparisons with other data sources reflecting vaccine uptake suggest the magnitude of this effect is realistic. We suggest that these results primarily relate to opportunistic vaccination and indicate the level of population immunity achievable through opportunistic programs providing further evidence for policy considerations around universal hepatitis A vaccine recommendations.
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Affiliation(s)
- Duleepa Jayasundara
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Ben B Hui
- The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
| | - David G Regan
- The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
| | - Anita E Heywood
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - C Raina MacIntyre
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - James G Wood
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
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Mahimbo A, Seale H, Heywood AE. Immunisation for refugees in Australia: a policy review and analysis across all States and Territories. Aust N Z J Public Health 2017; 41:635-640. [PMID: 28898492 DOI: 10.1111/1753-6405.12710] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/01/2017] [Accepted: 06/01/2017] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Although people of refugee background are likely to be under-immunised before and after resettlement, no study to date has evaluated refugee specific immunisation policies in Australia. We developed a framework to analyse immunisation policies across Australia to highlight the strengths and gaps so as to inform development of more effective refugee specific immunisation policies. METHODS We sourced publicly available immunisation policy documents from state and territory government websites. Content analysis of seven policy documents was undertaken using a developed framework comprising crucial policy determinants. RESULTS Immunisation policy differed substantially across the jurisdictions. While most policies did not highlight the importance of data collection on immunisation for refugees and the public funding of vaccines for refugees, policy determinants such as accessibility and obligations were fulfilled by most jurisdictions. CONCLUSION Our findings indicate stark differences in immunisation policy for people of refugee background across Australia. Highlighted gaps demonstrate the need to revise current policies so that they are aligned with their intended outcome of enhancing uptake of vaccines and improving immunisation coverage among resettled refugees in Australia. Implications for public health: Immunisation policy development for refugees needs to be robust enough to ensure equitable health services to this group.
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Affiliation(s)
- Abela Mahimbo
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, New South Wales
| | - Holly Seale
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, New South Wales
| | - Anita E Heywood
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, New South Wales
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Paudel P, Raina C, Zwar N, Seale H, Worth H, Sheikh M, Heywood AE. Risk activities and pre-travel health seeking practices of notified cases of imported infectious diseases in Australia. J Travel Med 2017; 24:3954790. [PMID: 28931134 DOI: 10.1093/jtm/tax044] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2017] [Indexed: 11/13/2022]
Abstract
BACKGROUND Travellers are at risk of acquiring infectious diseases during travel, with risks differing by destination, travel and traveller characteristics. A pre-travel health consultation may minimize this risk. However, uptake of pre-travel health advice remains low. We investigated pre-travel health preparations and disease-specific risk behaviours among notified cases of selected travel-associated infectious diseases imported into Australia. METHODS Prospective enhanced surveillance of notified cases of typhoid, paratyphoid, measles, hepatitis A, hepatitis E, malaria and chikungunya was conducted in two Australian states between February 2013 and January 2014. Details of pre-travel health preparation and disease-specific risk behaviours were collected. RESULTS Among 180 cases associated with international travel, 28% were <18 years, 65% were VFR travellers and 22% were frequent travellers, having travelled ≥5 times in the past 5 years. 25% had sought pre-travel advice from a healthcare provider, and 16% reported a pre-travel vaccine. Seeking pre-travel health advice did not differ by immigrant status ( P = 0.22) or by reason for travel ( P = 0.13) but was more commonly sought by first time travellers ( P = 0.03). Travellers visiting friends and relatives were more likely to report at-risk activities of brushing teeth with tap water ( P < 0.001) and eating uncooked food ( P = 0.03) during travel compared to other travellers. CONCLUSIONS Pre-travel health advice seeking practices and vaccine uptake was suboptimal among cases of notified disease. The results of this study highlight the need for a better understanding of barriers to pre-travel health seeking, particularly among high risk travellers, to reduce the importation of infectious diseases into Australia.
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Affiliation(s)
- Prakash Paudel
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, New South Wales 2052, Australia
| | - C Raina
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, New South Wales 2052, Australia
| | - Nicholas Zwar
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, New South Wales 2052, Australia
| | - Holly Seale
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, New South Wales 2052, Australia
| | - Heather Worth
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, New South Wales 2052, Australia
| | - Mohamud Sheikh
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, New South Wales 2052, Australia
| | - Anita E Heywood
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, New South Wales 2052, Australia
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Khatun F, Heywood AE, Hanifi SMA, Rahman MS, Ray PK, Liaw ST, Bhuiya A. Gender differentials in readiness and use of mHealth services in a rural area of Bangladesh. BMC Health Serv Res 2017; 17:573. [PMID: 28821243 PMCID: PMC5563057 DOI: 10.1186/s12913-017-2523-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 08/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Traditional gender roles result in women lagging behind men in the use of modern technologies, especially in developing countries. Although there is rapid uptake of mobile phone use in Bangladesh, investigation of gender differences in the ownership, access and use of mobile phones in general and mHealth in particular has been limited. This paper presents gender differentials in the ownership of mobile phones and knowledge of available mHealth services in a rural area of Bangladesh. METHODS We interviewed 4915 randomly selected respondents aged 18 years and above. Associations between gender and knowledge of available mHealth services, use of existing mHealth services and intentions to use mHealth services in the future were examined by multivariate logistic regression analysis, controlling for the effect of categorised covariates. RESULTS Of the 4915 respondents to the survey, 61.8% of men (1213/1964) and 34.4% of women (1015/2951) owned a mobile phone. For men, mobile phone ownership was highest among those aged 18-29 years (n = 663, 76.3%), and for women among those aged 30-39 years (n = 825, 44.7%). A higher proportion of men owned phones compared to women, irrespective of socioeconomic status (SES) as indicated by asset index (p < 0.001). Although mobile phone ownership on average was lower among women, they were more likely to share their mobile phone with their family members (19.7%) compared to men (11.6%, p < 0.001). Greater number of men were more likely to be aware of the use of mobile phones for healthcare compared to women (38.5% vs 26.5%, p < 0.001). Knowledge about available mHealth services was lower among women than men; however, intention to use mHealth services in the future was high for both genders, irrespective of age, education and socioeconomic status. CONCLUSIONS Compared to men, women are less likely to own a mobile phone and less aware of available mHealth services, despite high intention to use mHealth among both genders. To optimise the use of mHealth services and to achieve equity of use, uptake strategies should target women, with a focus on the poorer and less educated groups.
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Affiliation(s)
- Fatema Khatun
- Universal Health Coverage, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. .,School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, 2052, Australia.
| | - Anita E Heywood
- School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, 2052, Australia
| | - Syed Manzoor Ahmed Hanifi
- Universal Health Coverage, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - M Shafiqur Rahman
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Pradeep K Ray
- School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, 2052, Australia
| | - Siaw-Teng Liaw
- School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, 2052, Australia.,General Practice Unit, South West Sydney Local Health District and Ingham Institute of Applied Medical Research, 1 Campbell Street, Liverpool, NSW, 2170, Australia
| | - Abbas Bhuiya
- Partners in Population and Development (PPD), Sher-E-Bangla Nagar, Agargaon, Dhaka, 1207, Bangladesh
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Neave PE, Nair B, Heywood AE. Student travel health and the role of universities and health clinics in New Zealand to prevent imported infections: a cross-sectional study. J Travel Med 2017; 24:3090350. [PMID: 28395034 DOI: 10.1093/jtm/tax009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND Tertiary students are at risk of acquiring infectious diseases during overseas travel as they visit low-income countries, have low perceptions of risk and are unlikely to access travel health advice. Some will visit friends and relatives abroad, a group identified as disproportionately affected by imported infections. There is no national student travel health policy in NZ. This study aimed to explore travel health training of university-based health providers; academics' practices and perceptions of travel health; reasons for travel and countries visited by NZ university students, their travel health uptake and factors affecting decision making about this. METHODS A cross-sectional study consisting of surveys sent in 2014 to university clinics, senior academics and students. RESULTS Surveys were completed by 251 respondents. Three of nine clinicians had only undertaken a short course in travel health. Competing resources and time constraints in health clinics were amongst the barriers to providing optimal services. Of the senior academics, only 14% were able to confirm their university collaborated with health clinics. Sixty seven percent of students were unaware that clinics provided travel health services and 19% had or intended to seek professional travel health advice. CONCLUSIONS A national policy is warranted involving all stakeholders, utilizing innovative technologies to increase uptake of student travel health services.
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Affiliation(s)
- Penny E Neave
- Department of Public Health, Auckland University of Technology, Auckland, New Zealand
| | - Balakrishnan Nair
- Department of Public Health, Auckland University of Technology, Auckland, New Zealand
| | - Anita E Heywood
- School of Public Health and Community Medicine, University of New South Wales, NSW, Sydney, Australia
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Kpozehouen E, Heywood AE, Kay M, Smith M, Paudel P, Sheikh M, MacIntyre CR. Improving access to immunisation for migrants and refugees: recommendations from a stakeholder workshop. Aust N Z J Public Health 2017; 41:118-120. [PMID: 27868296 PMCID: PMC5396309 DOI: 10.1111/1753-6405.12602] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Elizabeth Kpozehouen
- School of Public Health and Community Medicine, UNSW AustraliaNew South Wales
- NHMRC Centre for Research Excellence in Immunisation, UNSW AustraliaNew South Wales
| | - Anita E. Heywood
- School of Public Health and Community Medicine, UNSW AustraliaNew South Wales
- NHMRC Centre for Research Excellence in Immunisation, UNSW AustraliaNew South Wales
| | | | - Mitchell Smith
- New South Wales Refugee Health ServiceLiverpoolNew South Wales
| | - Prakash Paudel
- School of Public Health and Community Medicine, UNSW AustraliaNew South Wales
| | - Mohamud Sheikh
- School of Public Health and Community Medicine, UNSW AustraliaNew South Wales
- NHMRC Centre for Research Excellence in Immunisation, UNSW AustraliaNew South Wales
| | - C. Raina MacIntyre
- School of Public Health and Community Medicine, UNSW AustraliaNew South Wales
- NHMRC Centre for Research Excellence in Immunisation, UNSW AustraliaNew South Wales
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Walker L, Newall A, Heywood AE. Knowledge, attitudes and practices of Australian medical students towards influenza vaccination. Vaccine 2016; 34:6193-6199. [DOI: 10.1016/j.vaccine.2016.10.074] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 10/19/2016] [Accepted: 10/28/2016] [Indexed: 10/20/2022]
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Alqahtani AS, Yamazaki K, Alqahtani WH, Tashani M, Heywood AE, Booy R, Wiley KE, Rashid H. Australian Hajj pilgrims' perception about mass casualty incidents versus emerging infections at Hajj. Travel Med Infect Dis 2016; 15:81-83. [PMID: 27856351 PMCID: PMC7128702 DOI: 10.1016/j.tmaid.2016.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 10/25/2016] [Accepted: 11/09/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Amani S Alqahtani
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, New South Wales, Australia; School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Kaoruko Yamazaki
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Wejdan H Alqahtani
- King Khalid University, School of Applied Medical Science, Abha, Saudi Arabia
| | - Mohamed Tashani
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, New South Wales, Australia; The Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Anita E Heywood
- School of Public Health and Community Medicine, The University of New South Wales, Australia, Sydney, New South Wales, Australia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, New South Wales, Australia; The Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, New South Wales, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney, Australia; WHO Collaborating Centre for Mass Gatherings and High Consequence/High Visibility Events, Flinders University, Adelaide, Australia
| | - Kerrie E Wiley
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, New South Wales, Australia; School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Harunor Rashid
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, New South Wales, Australia; The Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, New South Wales, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney, Australia
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Karki S, Newall AT, MacIntyre CR, Heywood AE, McIntyre P, Banks E, Liu B. Healthcare Resource Utilisation Associated with Herpes Zoster in a Prospective Cohort of Older Australian Adults. PLoS One 2016; 11:e0160446. [PMID: 27483007 PMCID: PMC4970804 DOI: 10.1371/journal.pone.0160446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 07/19/2016] [Indexed: 12/30/2022] Open
Abstract
Background Herpes zoster (HZ) is a common condition that increases in incidence with older age but vaccines are available to prevent the disease. However, there are limited data estimating the health system burden attributable to herpes zoster by age. Methods In this study, we quantified excess healthcare resource usage associated with HZ during the acute/sub-acute period of disease (21days before to 90 days after onset) in 5952 cases and an equal number of controls matched on age, sex, and prior healthcare resource usage. Estimates were adjusted for potential confounders in multivariable regression models. Using population-based estimates of HZ incidence, we calculated the age-specific excess number of health service usage events attributable to HZ in the population. Results Per HZ case, there was an average of 0.06 (95% CI 0.04–0.08) excess hospitalisations, 1.61 (95% CI 1.51–1.69) excess general practitioner visits, 1.96 (95% CI 1.86–2.15) excess prescriptions filled and 0.11 (95% CI 0.09–0.13) excess emergency department visits. The average number of healthcare resource use events, and the estimated excess per 100,000 population increased with increasing age but were similar for men and women, except for higher rates of hospitalisation in men. The excess annual HZ associated burden of hospitalisations was highest in adults ≥80 years (N = 2244, 95%CI 1719–2767); GP visits was highest in those 60–69 years (N = 50567, 95%CI 39958–61105), prescriptions and ED visits were highest in 70–79 years (N = 50524, 95%CI 40634–60471 and N = 2891, 95%CI 2319–3449 respectively). Conclusions This study provides important data to establish the healthcare utilisation associated with HZ against which detailed cost-effectiveness analyses of HZ immunisation in older adults can be conducted.
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Affiliation(s)
- Surendra Karki
- School of Public Health and Community Medicine, University of New South Wales (UNSW), Sydney, Australia
- * E-mail: ;
| | - Anthony T. Newall
- School of Public Health and Community Medicine, University of New South Wales (UNSW), Sydney, Australia
| | - C. Raina MacIntyre
- School of Public Health and Community Medicine, University of New South Wales (UNSW), Sydney, Australia
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital Network, Westmead, NSW, Australia
| | - Anita E. Heywood
- School of Public Health and Community Medicine, University of New South Wales (UNSW), Sydney, Australia
| | - Peter McIntyre
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital Network, Westmead, NSW, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
- The Sax Institute, Sydney, Australia
| | - Bette Liu
- School of Public Health and Community Medicine, University of New South Wales (UNSW), Sydney, Australia
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Heywood AE, Nothdurft H, Tessier D, Moodley M, Rombo L, Marano C, De Moerlooze L. Pre-travel advice, attitudes and hepatitis A and B vaccination rates among travellers from seven countries†. J Travel Med 2016; 24:taw069. [PMID: 27738112 PMCID: PMC5063019 DOI: 10.1093/jtm/taw069] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Knowledge about the travel-associated risks of hepatitis A and B, and the extent of pre-travel health-advice being sought may vary between countries. METHODS An online survey was undertaken to assess the awareness, advice-seeking behaviour, rates of vaccination against hepatitis A and B and adherence rates in Australia, Finland, Germany, Norway, Sweden, the UK and Canada between August and October 2014. Individuals aged 18-65 years were screened for eligibility based on: travel to hepatitis A and B endemic countries within the past 3 years, awareness of hepatitis A, and/or combined hepatitis A&B vaccines; awareness of their self-reported vaccination status and if vaccinated, vaccination within the last 3 years. Awareness and receipt of the vaccines, sources of advice, reasons for non-vaccination, adherence to recommended doses and the value of immunization reminders were analysed. RESULTS Of 27 386 screened travellers, 19 817 (72%) were aware of monovalent hepatitis A or combined A&B vaccines. Of these 13 857 (70%) had sought advice from a healthcare provider (HCP) regarding combined hepatitis A&B or monovalent hepatitis A vaccination, and 9328 (67%) were vaccinated. Of 5225 individuals eligible for the main survey (recently vaccinated = 3576; unvaccinated = 1649), 27% (841/3111) and 37% (174/465) of vaccinated travellers had adhered to the 3-dose combined hepatitis A&B or 2-dose monovalent hepatitis A vaccination schedules, respectively. Of travellers partially vaccinated against combined hepatitis A&B or hepatitis A, 84% and 61%, respectively, believed that they had received the recommended number of doses. CONCLUSIONS HCPs remain the main source of pre-travel health advice. The majority of travellers who received monovalent hepatitis A or combined hepatitis A&B vaccines did not complete the recommended course. These findings highlight the need for further training of HCPs and the provision of reminder services to improve traveller awareness and adherence to vaccination schedules.
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Affiliation(s)
- Anita E Heywood
- School of Public Health and Community Medicine, Faculty of Medicine, UNSW Australia, Level 3, Samuels Building, Sydney 2052, Australia
| | | | - Dominique Tessier
- Family Medicine, Groupe Sante Voyage, Quebec, Canada Unité Hospitalière de Recherche, d'enseignement et de soins sur le sida, CHUM, University of Montreal, Montreal, Canada
| | | | - Lars Rombo
- Centre for Clinical Research, Sormland County Council and Uppsala University, Eskilstuna, Sweden
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Alqahtani AS, Wiley KE, Tashani M, Willaby HW, Heywood AE, BinDhim NF, Booy R, Rashid H. Exploring barriers to and facilitators of preventive measures against infectious diseases among Australian Hajj pilgrims: cross-sectional studies before and after Hajj. Int J Infect Dis 2016; 47:53-9. [PMID: 26875699 PMCID: PMC7110465 DOI: 10.1016/j.ijid.2016.02.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 01/29/2016] [Accepted: 02/05/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE For reasons that have yet to be elucidated, the uptake of preventive measures against infectious diseases by Hajj pilgrims is variable. The aim of this study was to identify the preventive advice and interventions received by Australian pilgrims before Hajj, and the barriers to and facilitators of their use during Hajj. METHODS Two cross-sectional surveys of Australians pilgrims aged ≥18 years were undertaken, one before and one after the Hajj 2014. RESULTS Of 356 pilgrims who completed the survey (response rate 94%), 80% had the influenza vaccine, 30% the pneumococcal vaccine, and 30% the pertussis vaccine. Concern about contracting disease at Hajj was the most cited reason for vaccination (73.4%), and not being aware of vaccine availability was the main reason for non-receipt (56%). Those who obtained pre-travel advice were twice as likely to be vaccinated as those who did not seek advice. Of 150 pilgrims surveyed upon return, 94% reported practicing hand hygiene during Hajj, citing ease of use (67%) and belief in its effectiveness (62.4%) as the main reasons for compliance; university education was a significant predictor of hand hygiene adherence. Fifty-three percent used facemasks, with breathing discomfort (76%) and a feeling of suffocation (40%) being the main obstacles to compliance. CONCLUSION This study indicates that there are significant opportunities to improve awareness among Australian Hajj pilgrims about the importance of using preventive health measures.
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Affiliation(s)
- Amani S Alqahtani
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia; School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Kerrie E Wiley
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia; School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mohamed Tashani
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia
| | - Harold W Willaby
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Anita E Heywood
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Nasser F BinDhim
- Health Informatics Department, College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; WHO Collaborating Centre for Mass Gatherings and High Consequence/High Visibility Events, Flinders University, Adelaide, Australia
| | - Harunor Rashid
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; WHO Collaborating Centre for Mass Gatherings and High Consequence/High Visibility Events, Flinders University, Adelaide, Australia
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Neave PE, Heywood AE, Gibney KB, Leder K. Imported infections: What information should be collected by surveillance systems to inform public health policy? Travel Med Infect Dis 2016; 14:350-9. [PMID: 27235839 PMCID: PMC7110684 DOI: 10.1016/j.tmaid.2016.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 05/10/2016] [Accepted: 05/17/2016] [Indexed: 11/17/2022]
Abstract
Background International travel carries the risk of imported diseases, which are an increasingly significant public health problem. There is little guidance about which variables should be collected by surveillance systems for strategy-based surveillance. Methods Surveillance forms for dengue, malaria, hepatitis A, typhoid and measles were collected from Australia and New Zealand and information on these compared with national surveillance forms from the UK and Canada by travel health experts. Variables were categorised by information relating to recent travel, demographics and disease severity. Results Travel-related information most commonly requested included country of travel, vaccination status and travel dates. In Australia, ethnicity information requested related to indigenous status, whilst in New Zealand it could be linked to census categories. Severity of disease information most frequently collected were hospitalisation and death. Conclusions Reviewing the usefulness of variables collected resulted in the recommendation that those included should be: overseas travel, reason for travel, entry and departure dates during the incubation period, vaccination details, traveller's and/or parents' country of birth, country of usual residence, time resident in current country, postcode, hospitalisation and death details. There was no agreement about whether ethnicity details should be collected. The inclusion of these variables on surveillance forms could enable imported infection-related policy to be formulated nationally and internationally.
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Affiliation(s)
- Penny E Neave
- School of Public Health and Psychosocial Studies, Auckland University of Technology, 90, Akoranga Drive, Northcote, Auckland, New Zealand.
| | - Anita E Heywood
- School of Public Health and Community Medicine, University of New South Wales, Kensington, New South Wales, Australia.
| | - Katherine B Gibney
- School of Public Health and Preventive Medicine, The Alfred Centre, Monash University, Commercial Road, Melbourne, Victoria, Australia.
| | - Karin Leder
- School of Public Health and Preventive Medicine, The Alfred Centre, Monash University, Commercial Road, Melbourne, Victoria, Australia.
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Seale H, Kaur R, Mahimbo A, MacIntyre CR, Zwar N, Smith M, Worth H, Heywood AE. Improving the uptake of pre-travel health advice amongst migrant Australians: exploring the attitudes of primary care providers and migrant community groups. BMC Infect Dis 2016; 16:213. [PMID: 27193512 PMCID: PMC4870764 DOI: 10.1186/s12879-016-1479-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 03/24/2016] [Indexed: 11/29/2022] Open
Abstract
Background Migrant travellers who return to their country of origin to visit family and friends (VFR) are less likely to seek travel-related medical care and are less likely to adhere to recommended medications and travel precautions. Through this study, we aimed to get an understanding of the views of stakeholders from community migrant centres and primary care providers on barriers for migrants, particularly from non-English speaking backgrounds, in accessing travel health advice and the strategies that could be used to engage them. Methods A qualitative study involving 20 semi-structured interviews was undertaken in Sydney, Australia between January 2013 and September 2014. Thematic analysis was undertaken. Results Language barriers, a lower perceived risk of travel-related infections and the financial costs of seeking pre-travel health care were nominated as being the key barriers impacting on the uptake of pre-travel health advice and precautions. To overcome pre-existing language barriers, participants advocated for the use of bilingual community educators, community radio, ethnic newspapers and posters in the dissemination of pre-travel health information. Conclusions Travel is a major vector of importation of infectious diseases into Australia, and VFR travellers are at high risk of infection. Collaboration between the Government, primary care physicians, migrant community groups and migrants themselves is crucial if we are to be successful in reducing travel-related risks among this subgroup of travellers.
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Affiliation(s)
- Holly Seale
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, Australia.
| | - Rajneesh Kaur
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Abela Mahimbo
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - C Raina MacIntyre
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, Australia.,National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Sydney, Australia
| | - Nicholas Zwar
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, Australia
| | | | - Heather Worth
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Anita E Heywood
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, Australia
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Alqahtani AS, Wiley KE, Mushta SM, Yamazaki K, BinDhim NF, Heywood AE, Booy R, Rashid H. Association between Australian Hajj Pilgrims' awareness of MERS-CoV, and their compliance with preventive measures and exposure to camels. J Travel Med 2016; 23:taw046. [PMID: 27432904 PMCID: PMC7107559 DOI: 10.1093/jtm/taw046] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 06/09/2016] [Indexed: 11/16/2022]
Abstract
Through a prospective cohort study the relationship between travellers' awareness of MERS-CoV, and compliance with preventive measures and exposure to camels was evaluated among Australian Hajj pilgrims who attended Hajj in 2015. Only 28% of Australian Hajj pilgrims were aware of MERS-CoV in Saudi Arabia. Those who were aware of MERS-CoV were more likely to receive recommended vaccines [odds ratio (OR) 3.1, 95% confidence interval (CI): 1.5-5.9, P < 0.01], but there was no significant difference in avoiding camels or their raw products during Hajj between those who were aware of MERS-CoV and those who were not (OR 1.2, 95% CI: 0.3-5.2, P = 0.7). Hajj pilgrims' awareness is reflected in some of their practices but not in all.
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Affiliation(s)
- Amani S Alqahtani
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), Australia, NSW.,School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kerrie E Wiley
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), Australia, NSW.,School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sami M Mushta
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Ministry of Health, Abha, Saudi Arabia
| | - Kaoruko Yamazaki
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nasser F BinDhim
- Health Informatics Department, Saudi Electronic University, Riyadh, Saudi Arabia
| | - Anita E Heywood
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), Australia, NSW.,Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney, Australia.,WHO Collaborating Centre for Mass Gatherings and High Consequence/High Visibility Events, Flinders University, Adelaide, Australia
| | - Harunor Rashid
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), Australia, NSW.,Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney, Australia
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Seale H, Sitaresmi MN, Atthobari J, Heywood AE, Kaur R, MacIntyre RC, Soenarto Y, Padmawati RS. Knowledge and attitudes towards rotavirus diarrhea and the vaccine amongst healthcare providers in Yogyakarta Indonesia. BMC Health Serv Res 2015; 15:528. [PMID: 26621140 PMCID: PMC4663724 DOI: 10.1186/s12913-015-1187-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 11/18/2015] [Indexed: 11/22/2022] Open
Abstract
Background Rotavirus has been identified as the most common pathogen associated with severe diarrhoea. Two effective vaccines against the pathogen have been licensed. However, many countries including Indonesia have yet to introduce the vaccine into their national immunisation programs. This study aimed to examine the attitudes of healthcare providers (HCPs) and other health stakeholders towards the pathogen and the vaccine. Methods Semi-structured in-depth interviews were undertaken in two districts of Yogyakarta Province, Indonesia with nurses, midwives, primary care providers, pediatricians and other health stakeholders. Thematic analysis was undertaken. Results Fourteen interviews were conducted between August and October 2013. We identified that while participants do not consider diarrhea to be an important problem in Indonesia, they do acknowledge that it can be serious if not properly treated. While the majority had some level of knowledge about rotavirus, not all participants knew that a vaccine was available. There were mixed feelings towards the need for the vaccine. Some felt that the vaccine is not ranked as a priority as it is not listed on the national program. However, others agreed there is a rationale for its use in Indonesia. The cost of the vaccine (when sold in the private sector) was perceived to be the primary barrier impacting on its use. Conclusions The high cost and the low priority given to this vaccine by the public health authorities are the biggest obstacles impacting on the acceptance of this vaccine in Indonesia. HCPs need to be reminded of the burden of disease associated with rotavirus. In addition, reminding providers about the costs associated with treating severe cases versus the costs associated with prevention may assist with improving the acceptance of HCPs towards the vaccine. Promotion campaigns need to target the range of HCPs involved in the provision of care to infants and pregnant women.
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Affiliation(s)
- Holly Seale
- School of Public Health & Community Medicine, Faculty of Medicine, University of New South Wales, Level 2, Samuels Building, Sydney, 2052, Australia.
| | - Mei Neni Sitaresmi
- Faculty of Medicine, Universitas Gadjah Mada (UGM), Yogyakarta, Indonesia.
| | - Jarir Atthobari
- Faculty of Medicine, Universitas Gadjah Mada (UGM), Yogyakarta, Indonesia.
| | - Anita E Heywood
- School of Public Health & Community Medicine, Faculty of Medicine, University of New South Wales, Level 2, Samuels Building, Sydney, 2052, Australia.
| | - Rajneesh Kaur
- School of Public Health & Community Medicine, Faculty of Medicine, University of New South Wales, Level 2, Samuels Building, Sydney, 2052, Australia.
| | - Raina C MacIntyre
- School of Public Health & Community Medicine, Faculty of Medicine, University of New South Wales, Level 2, Samuels Building, Sydney, 2052, Australia.
| | - Yati Soenarto
- Faculty of Medicine, Universitas Gadjah Mada (UGM), Yogyakarta, Indonesia.
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Heywood AE, Forssman BL, Seale H, MacIntyre CR, Zwar N. General Practitioners' Perception of Risk for Travelers Visiting Friends and Relatives. J Travel Med 2015; 22:368-74. [PMID: 26173496 DOI: 10.1111/jtm.12229] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 05/12/2015] [Accepted: 06/08/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND General practitioners (GPs) are an important source of pre-travel health advice for travelers; however, only a few studies have investigated primary healthcare provider-related barriers to the provision of pre-travel health advice, particularly to travelers visiting friends and relatives (VFR). We aimed to investigate Australian GPs' knowledge, attitudes, and practices with regard to VFR travelers. METHODS A postal survey was sent to randomly sampled GPs in Sydney, Australia, in 2012. The questionnaire investigated GPs' perception of risk and barriers to the provision of advice to VFR travelers. RESULTS Of 563 GPs, 431 (76.6%) spoke a language other than English (LOTE) with 361 (64.1%) consulting in a LOTE. Overall, 222 (39.4%) GPs considered VFR travelers to be at higher risk than holiday travelers, with GPs consulting in English only [adjusted odds ratio (aOR) 1.65, 95% confidence interval (CI) 1.11-2.44, p = 0.01] and GPs considering long-term migrants as VFR travelers (aOR 1.86 95% CI 1.07-3.23, p = 0.03) remaining significant on multivariate analysis. CONCLUSIONS Multilingual GPs are a valuable resource to reducing language and cultural barriers to healthcare. Targeted education of this subgroup of GPs may assist in promoting pre-travel health assessments for VFR travelers. Awareness of the need for opportunistic targeting of migrants for pre-travel consultation through routine identification of future travel is needed.
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Affiliation(s)
- Anita E Heywood
- School of Public Health & Community Medicine, UNSW Australia, Sydney, NSW, Australia
| | - Bradley L Forssman
- Public Health Unit, Nepean Blue Mountains Local Health District, Sydney, NSW, Australia
| | - Holly Seale
- School of Public Health & Community Medicine, UNSW Australia, Sydney, NSW, Australia
| | - C Raina MacIntyre
- School of Public Health & Community Medicine, UNSW Australia, Sydney, NSW, Australia
| | - Nicholas Zwar
- School of Public Health & Community Medicine, UNSW Australia, Sydney, NSW, Australia
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Barnes M, Heywood AE, Mahimbo A, Rahman B, Newall AT, Macintyre CR. Acute myocardial infarction and influenza: a meta-analysis of case-control studies. Heart 2015; 101:1738-47. [PMID: 26310262 PMCID: PMC4680124 DOI: 10.1136/heartjnl-2015-307691] [Citation(s) in RCA: 200] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 07/28/2015] [Accepted: 08/03/2015] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Acute myocardial infarction (AMI) is the leading cause of death and disability globally. There is increasing evidence from observational studies that influenza infection is associated with AMI. In patients with known coronary disease, influenza vaccination is associated with a lower risk of cardiovascular events. However, the effect of influenza vaccination on incident AMI across the entire population is less well established. METHOD The purpose of our systematic review of case-control studies is twofold: (1) to estimate the association between influenza infection and AMI and (2) to estimate the association between influenza vaccination and AMI. Cases included those conducted with first-time AMI or any AMI cases. Studies were appraised for quality and meta-analyses using random effects models for the influenza exposures of infection, and vaccination were conducted. RESULTS 16 studies (8 on influenza vaccination, 10 on influenza infection and AMI) met the eligibility criteria, and were included in the review and meta-analysis. Recent influenza infection, influenza-like illness or respiratory tract infection was significantly more likely in AMI cases, with a pooled OR 2.01 (95% CI 1.47 to 2.76). Influenza vaccination was significantly associated with AMI, with a pooled OR of 0.71 (95% CI 0.56 to 0.91), equating to an estimated vaccine effectiveness of 29% (95% CI 9% to 44%) against AMI. CONCLUSIONS Our meta-analysis of case-control studies found a significant association between recent respiratory infection and AMI. The estimated vaccine effectiveness against AMI was comparable with the efficacy of currently accepted therapies for secondary prevention of AMI from clinical trial data. A large-scale randomised controlled trial is needed to provide robust evidence of the protective effect of influenza vaccination on AMI, including as primary prevention.
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Affiliation(s)
- Michelle Barnes
- School of Public Health and Community Medicine, UNSW Australia, Sydney, New South Wales, Australia
| | - Anita E Heywood
- School of Public Health and Community Medicine, UNSW Australia, Sydney, New South Wales, Australia
| | - Abela Mahimbo
- School of Public Health and Community Medicine, UNSW Australia, Sydney, New South Wales, Australia
| | - Bayzid Rahman
- School of Public Health and Community Medicine, UNSW Australia, Sydney, New South Wales, Australia
| | - Anthony T Newall
- School of Public Health and Community Medicine, UNSW Australia, Sydney, New South Wales, Australia
| | - C Raina Macintyre
- School of Public Health and Community Medicine, UNSW Australia, Sydney, New South Wales, Australia
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Khatun F, Heywood AE, Ray PK, Hanifi SMA, Bhuiya A, Liaw ST. Determinants of readiness to adopt mHealth in a rural community of Bangladesh. Int J Med Inform 2015; 84:847-56. [DOI: 10.1016/j.ijmedinf.2015.06.008] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/20/2015] [Accepted: 06/25/2015] [Indexed: 11/15/2022]
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Alqahtani AS, Sheikh M, Wiley K, Heywood AE. Australian Hajj pilgrims' infection control beliefs and practices: Insight with implications for public health approaches. Travel Med Infect Dis 2015; 13:329-34. [PMID: 26028307 DOI: 10.1016/j.tmaid.2015.05.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 05/09/2015] [Accepted: 05/11/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hajj is one of the largest annual mass gatherings around the world. Although the Saudi Arabian health authority recommends vaccination and other infection control measures, studies identified variable uptake of these measures among pilgrims, and the reasons behind this variability remain unclear. This qualitative study aimed to addresses this knowledge gap. METHODS In-depth interviews were conducted with pilgrims over 18 years of age. RESULTS A total of 10 participants took part in the study. There was low perception of the potential severity of respiratory conditions and the need for influenza vaccination during Hajj. Different attitudes were found by age group with elderly participants believing that they were under Allah's protection, and were fatalistic about the risk of illness. While younger participants described the impact infections would have on their worship. Facemask use was infrequent with discomfort; difficulty in breathing and a feeling of isolation were commonly cited barriers to use of facemasks. Participants accepted and trusted preventative health advice from travel agents and friends who had previously undertaken the Hajj more so than primary care practitioners. CONCLUSIONS This study extended our understanding of how health beliefs influence uptake of preventive measures during the Hajj, and the gaps in the provision of Hajj-specific health information to pilgrims.
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Affiliation(s)
- Amani S Alqahtani
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, NSW, Australia; School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Mohamud Sheikh
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Kerrie Wiley
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, NSW, Australia; School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Anita E Heywood
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
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Alqahtani AS, Wiley KE, Willaby HW, BinDhim NF, Tashani M, Heywood AE, Booy R, Rashid H. Australian Hajj pilgrims' knowledge, attitude and perception about Ebola, November 2014 to February 2015. ACTA ACUST UNITED AC 2015; 20. [PMID: 25846489 DOI: 10.2807/1560-7917.es2015.20.12.21072] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Upon return from Hajj 2014, 150 Australian pilgrims were interviewed about their understanding of the Ebola epidemic. Most (89%, 134/150) knew of the epidemic before travelling and 60% (80/134) of those knew Ebola transmits through body fluids. Pilgrims who received pre-travel health advice were more conscious of Ebola (69% vs 31%, p = 0.01) and adhered better to hand hygiene after touching an ill person (68% vs 31%, p < 0.01). Mass media was the main information source (78%).
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Affiliation(s)
- A S Alqahtani
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children s Hospital at Westmead, and the Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Australia
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Alqahtani AS, Rashid H, Heywood AE. Vaccinations against respiratory tract infections at Hajj. Clin Microbiol Infect 2014; 21:115-27. [PMID: 25682277 DOI: 10.1016/j.cmi.2014.11.026] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 11/27/2014] [Accepted: 11/27/2014] [Indexed: 02/08/2023]
Abstract
The transmission of respiratory tract infections (RTIs) is very high among the Hajj congregation in Mecca, Saudi Arabia. Despite recommendations for vaccinations, pilgrims remain at increased risk of RTIs. In this paper we systematically reviewed available studies assessing the uptake and effectiveness of vaccinations against RTIs among Hajj pilgrims and enumerated important demographic factors, if described, associated with vaccine uptake. Of the 42 included studies, 29 reported on the uptake and effectiveness of influenza vaccine among pilgrims, eight studies reported the uptake of other vaccines, notably pneumococcal, diphtheria and bacillus Calmette-Guérin vaccines, and the remaining five studies described both influenza and non-influenza vaccines. The uptake of seasonal influenza vaccine ranged from 0.7% to 100% across the study populations, with coverage highest in the elderly and those with pre-existing co-morbidities. The effectiveness of influenza vaccine was variable across studies but was significantly effective against laboratory-confirmed influenza (risk ratio 0.56; 95% CI 0.41-0.75; p <0.001) in pooled metadata from six studies. Uptake of diphtheria and pneumococcal vaccines was low, and the only study reporting pertussis among Hajj pilgrims found the presence of pre-Hajj immunity to be significantly protective against disease. Despite favourable evidence of effectiveness, our review shows variable uptake of vaccines across a number of studies with few data available on the uptake of non-influenza vaccines. Mixed-method studies are needed to gauge knowledge, attitudes and practices of Hajj pilgrims regarding vaccination, and randomized controlled trials are required to confirm the efficacy of vaccines and improve uptake in this vulnerable travelling population.
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Affiliation(s)
- A S Alqahtani
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospitals at Westmead, NSW, Australia; School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - H Rashid
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospitals at Westmead, NSW, Australia.
| | - A E Heywood
- School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, Australia
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Ridda I, Heywood AE, Hueston L, Dwyer DE, MacIntyre CR. The Burden of Pertussis in Patients with and without Recurrent Ischaemic Vascular Events. Infect Disord Drug Targets 2014; 14:101-9. [PMID: 25313102 DOI: 10.2174/1871526514666141014145229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 07/01/2014] [Accepted: 07/03/2014] [Indexed: 11/22/2022]
Abstract
Pertussis seroepidemiology and associated factors in older adults aged ≥40 years with and without acute myocardial infarction (AMI) were studied to investigate whether unrecognised pertussis may precipitate AMI. Sera were obtained from a previous case-control study investigating the role of influenza in precipitating AMIs. Baseline sera were considered pertussis toxin (PT) IgG seropositive at levels ≥5 IU/mL. Levels ≥v62.5 IU/mL were considered indicative of infection in the previous year, and recent infection was indicative at levels ≥125 IU/mL. Of the serum samples tested, 55% (122/222) were seropositive for PT IgG, 5% (11/222) had evidence of infection in the past year and 1.4% (3/222) had evidence of recent infection. Evidence of infection in the past year was found in 3.2% of those aged 65-74 years. Overall, 47.8% of 40-64 year olds and 43.2% of those aged ≥65 years were seronegative for pertussis. Serological evidence of pertussis was not associated with AMI (46/92, 50.0% cases vs. 76/130, 58.5% controls, p=0.2). After adjusting for age, AMI and self-reported pertussis and GP verified influenza vaccination, females (OR = 2.2, 95% CI = 1.1-4.1, p=0.02) were more likely to be seronegative. Just under half of participants had no detectable pertussis immunity and are therefore susceptible to infection. Our study supports the need for an adult pertussis booster to supplement current recommendations.
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Affiliation(s)
| | | | | | | | - Chandini R MacIntyre
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, Australia.
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MacIntyre RC, Heywood AE, Kovoor P. Influenza virus vaccine reduces risk of ischemic events: time for a large-scale randomized trial? Future Cardiol 2014; 10:35-7. [PMID: 24344660 DOI: 10.2217/fca.13.95] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Raina C MacIntyre
- School of Public Health & Community Medicine, UNSW Medicine, University of New South Wales, Australi
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Gardner LM, Rey D, Heywood AE, Toms R, Wood J, Travis Waller S, Raina MacIntyre C. A scenario-based evaluation of the Middle East respiratory syndrome coronavirus and the Hajj. Risk Anal 2014; 34:1391-400. [PMID: 25041625 PMCID: PMC4238841 DOI: 10.1111/risa.12253] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Between April 2012 and June 2014, 820 laboratory-confirmed cases of the Middle East respiratory syndrome coronavirus (MERS-CoV) have been reported in the Arabian Peninsula, Europe, North Africa, Southeast Asia, the Middle East, and the United States. The observed epidemiology is different to SARS, which showed a classic epidemic curve and was over in eight months. The much longer persistence of MERS-CoV in the population, with a lower reproductive number, some evidence of human-to-human transmission but an otherwise sporadic pattern, is difficult to explain. Using available epidemiological data, we implemented mathematical models to explore the transmission dynamics of MERS-CoV in the context of mass gatherings such as the Hajj pilgrimage, and found a discrepancy between the observed and expected epidemiology. The fact that no epidemic occurred in returning Hajj pilgrims in either 2012 or 2013 contradicts the long persistence of the virus in human populations. The explanations for this discrepancy include an ongoing, repeated nonhuman/sporadic source, a large proportion of undetected or unreported human-to-human cases, or a combination of the two. Furthermore, MERS-CoV is occurring in a region that is a major global transport hub and hosts significant mass gatherings, making it imperative to understand the source and means of the yet unexplained and puzzling ongoing persistence of the virus in the human population.
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Affiliation(s)
- Lauren M. Gardner
- School of Civil and Environmental EngineeringThe University of New South WalesSydneyNSW2052Australia
- NICTASydneyNSW2052Australia
| | - David Rey
- School of Civil and Environmental EngineeringThe University of New South WalesSydneyNSW2052Australia
| | - Anita E. Heywood
- School of Public Health and Community MedicineFaculty of MedicineUniversity of New South WalesSydneyNSW2052Australia
| | - Renin Toms
- School of Public Health and Community MedicineFaculty of MedicineUniversity of New South WalesSydneyNSW2052Australia
| | - James Wood
- School of Public Health and Community MedicineFaculty of MedicineUniversity of New South WalesSydneyNSW2052Australia
| | - S. Travis Waller
- School of Civil and Environmental EngineeringThe University of New South WalesSydneyNSW2052Australia
- NICTASydneyNSW2052Australia
| | - C. Raina MacIntyre
- School of Public Health and Community MedicineFaculty of MedicineUniversity of New South WalesSydneyNSW2052Australia
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Heywood AE, Wang H, Macartney KK, McIntyre P. Varicella and herpes zoster hospitalizations before and after implementation of one-dose varicella vaccination in Australia: an ecological study. Bull World Health Organ 2014; 92:593-604. [PMID: 25177074 DOI: 10.2471/blt.13.132142] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 02/20/2014] [Accepted: 03/05/2014] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To examine trends in varicella and herpes zoster (HZ) hospitalization following the availability and subsequent National Immunization Programme funding of one-dose varicella vaccination in Australia. METHODS Varicella vaccination coverage for children born between 2001 and 2009 was obtained from the Australian Childhood Immunization Register. Principal or any coded varicella or HZ hospitalizations were retrieved from the national hospital morbidity database from 1998 to 2010. Trends in hospitalization rates in different age groups and indigenous status were assessed. Incidence rate ratios (IRR) were calculated between periods before and after implementation of immunization programme funding. FINDINGS In the first year of the funded immunization programme, varicella vaccine coverage reached 75% in children aged 24 months and more than 80% in children aged 60 months. Compared with the pre-vaccine period, varicella hospitalization rates during the funded programme were significantly lower for age groups younger than 40 years; with the greatest reduction in children aged 18-59 months (IRR: 0.25; 95% confidence interval, CI: 0.22-0.29). Indigenous children had a higher varicella hospitalization rate compared with non-indigenous children before vaccine implementation (IRR: 1.9; 95% CI: 1.4-2.7), but afterwards reached equivalence (IRR: 1.1; 95% CI: 0.7-1.6). The age-standardized HZ hospitalization rate declined between the periods (IRR: 0.95; 95% CI: 0.92-0.97). CONCLUSION Rapid attainment of high coverage reduced varicella hospitalizations in the targeted age group, particularly for indigenous children, but also in non-targeted age groups, with no increase in HZ hospitalizations. This suggests high one-dose varicella vaccine coverage can have a substantial impact on severe disease.
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Affiliation(s)
- Anita E Heywood
- School of Public Health and Community Medicine, University of New South Wales, Level 3, Samuels Building, Botany Road, Kensington, NSW 2052, Australia
| | - Han Wang
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, Australia
| | - Kristine K Macartney
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, Australia
| | - Peter McIntyre
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, Australia
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Macintyre CR, Heywood AE, Kovoor P, Ridda I, Seale H, Tan T, Gao Z, Katelaris AL, Siu HWD, Lo V, Lindley R, Dwyer DE. Ischaemic heart disease, influenza and influenza vaccination: a prospective case control study. Heart 2013; 99:1843-8. [PMID: 23966030 PMCID: PMC3841753 DOI: 10.1136/heartjnl-2013-304320] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Abundant, indirect epidemiological evidence indicates that influenza contributes to all-cause mortality and cardiovascular hospitalisations with studies showing increases in acute myocardial infarction (AMI) and death during the influenza season. Objective To investigate whether influenza is a significant and unrecognised underlying precipitant of AMI. Design Case-control study. Setting Tertiary referral hospital in Sydney, Australia, during 2008 to 2010. Patients Cases were inpatients with AMI and controls were outpatients without AMI at a hospital in Sydney, Australia. Main outcome measures Primary outcome was laboratory evidence of influenza. Secondary outcome was baseline self-reported acute respiratory tract infection. Results Of 559 participants, 34/275 (12.4%) cases and 19/284 (6.7%) controls had influenza (OR 1.97, 95% CI 1.09 to 3.54); half were vaccinated. None were recognised as having influenza during their clinical encounter. After adjustment, influenza infection was no longer a significant predictor of recent AMI. However, influenza vaccination was significantly protective (OR 0.55, 95% CI 0.35 to 0.85), with a vaccine effectiveness of 45% (95% CI 15% to 65%). Conclusions Recent influenza infection was an unrecognised comorbidity in almost 10% of hospital patients. Influenza did not predict AMI, but vaccination was significantly protective but underused. The potential population health impact of influenza vaccination, particularly in the age group 50–64 years, who are at risk for AMI but not targeted for vaccination, should be further explored. Our data should inform vaccination policy and cardiologists should be aware of missed opportunities to vaccinate individuals with ischaemic heart disease against influenza.
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Affiliation(s)
- C Raina Macintyre
- School of Public Health and Community Medicine, UNSW Medicine, the University of New South Wales, , Sydney, New South Wales, Australia
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Smith BB, Hazelton BJ, Heywood AE, Snelling TL, Peacock KM, Macartney KK. Disseminated tuberculosis and tuberculous meningitis in Australian-born children; case reports and review of current epidemiology and management. J Paediatr Child Health 2013; 49:E246-50. [PMID: 23252965 DOI: 10.1111/jpc.12035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2012] [Indexed: 11/29/2022]
Abstract
We present two cases of tuberculous meningitis in Australian-born children. We review the current literature surrounding management of paediatric tuberculosis and disseminated disease, emphasising the importance of prompt diagnosis and intervention. We discuss the epidemiology of tuberculosis in the Australian paediatric population and highlight the sentinel role of childhood infection in public health surveillance.
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Affiliation(s)
- Benjamin B Smith
- Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia.
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