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Kardos P, Correia de Sousa J, Heininger U, Konstantopoulos A, MacIntyre CR, Middleton D, Nolan T, Papi A, Rendon A, Rizzo A, Sampson K, Sette A, Sobczyk E, Tan T, Weil-Olivier C, Weinberger B, Wilkinson T, Wirsing von König CH. Understanding the impact of adult pertussis and current approaches to vaccination: A narrative review and expert panel recommendations. Hum Vaccin Immunother 2024; 20:2324547. [PMID: 38564339 PMCID: PMC10989709 DOI: 10.1080/21645515.2024.2324547] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/25/2024] [Indexed: 04/04/2024] Open
Abstract
Pertussis has several notable consequences, causing economic burden, increased strain on healthcare facilities, and reductions in quality of life. Recent years have seen a trend toward an increase in pertussis cases affecting older children and adults. To boost immunity, and protect vulnerable populations, an enduring approach to vaccination has been proposed, but gaps remain in the evidence surrounding adult vaccination that are needed to inform such a policy. Gaps include: the true incidence of pertussis and its complications in adults; regional variations in disease recognition and reporting; and incidence of severe disease, hospitalizations, and deaths in older adults. Better data on the efficacy/effectiveness of pertussis vaccination in adults, duration of protection, and factors leading to poor vaccine uptake are needed. Addressing the critical evidence gaps will help highlight important areas of unmet need and justify the importance of adult pertussis vaccination to healthcare professionals, policymakers, and payers.
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Affiliation(s)
- Peter Kardos
- Group Practice & Center, Allergy, Respiratory and Sleep Medicine, Maingau Hospital of the Red Cross, Frankfurt am Main, Germany
| | - Jaime Correia de Sousa
- Life and Health Sciences Research Institute, School of Medicine, University of Minho School of Medicine, Braga, Portugal
| | - Ulrich Heininger
- Pediatric Infectious Diseases and Vaccinology, University of Basel Children’s Hospital, BaselSwitzerland
| | | | - C. Raina MacIntyre
- Kirby Institute, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Donald Middleton
- Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Terry Nolan
- Department of Infectious Diseases, University of Melbourne, Melbourne, Australia
| | - Alberto Papi
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Adrian Rendon
- Pulmonary/Critical Care Division, Autonomous University of Nuevo León, San Nicolás de los Garza, Mexico
| | | | - Kim Sampson
- Immunisation Coalition, Melbourne, Australia
| | - Alessandro Sette
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, San Diego, USA
| | - Elizabeth Sobczyk
- AMDA – The Society for Post-Acute and Long-Term Care Medicine, Denver, USA
| | - Tina Tan
- Feinberg School of Medicine, Northwestern University, Chicago, USA
| | | | - Birgit Weinberger
- Institute for Biomedical Aging Research, Universität Innsbruck, Innsbruck, Austria
| | - Tom Wilkinson
- Faculty of Medicine, University of Southampton, Southampton, UK
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Bowdle A, Brosseau LM, Tellier R, MacIntyre CR, Edwards M, Jelacic S. Reducing airborne transmissible diseases in perioperative environments. Br J Anaesth 2024:S0007-0912(24)00181-8. [PMID: 38677948 DOI: 10.1016/j.bja.2024.03.025] [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: 02/27/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/29/2024] Open
Abstract
The COVID-19 pandemic has transformed our understanding of aerosol transmissible disease and the measures required to minimise transmission. Anaesthesia providers are often in close proximity to patients and other hospital staff for prolonged periods while working in operating and procedure rooms. Although enhanced ventilation provides some protection from aerosol transmissible disease in these work areas, close proximity and long duration of exposure have the opposite effect. Surgical masks provide only minimal additional protection. Surgical patients are also at risk from viral and bacterial aerosols. Despite having recently experienced the most significant pandemic in 100 yr, we continue to lack adequate understanding of the true risks encountered from aerosol transmissible diseases in the operating room, and the best course of action to protect patients and healthcare workers from them in the future. Nevertheless, hospitals can take specific actions now by providing respirators for routine use, encouraging staff to utilise respirators routinely, establishing triggers for situations that require respirator use, educating staff concerning the prevention of aerosol transmissible diseases, and providing portable air purifiers for perioperative spaces with low levels of ventilation.
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Affiliation(s)
- Andrew Bowdle
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
| | - Lisa M Brosseau
- Center for Infectious Disease Research and Policy, University of Minnesota, Minneapolis, MN, USA
| | - Raymond Tellier
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - C Raina MacIntyre
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mark Edwards
- Department of Cardiothoracic and ORL Anaesthesia, Auckland City Hospital, Auckland, New Zealand
| | - Srdjan Jelacic
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
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Quigley AL, Kunasekaran M, Stone H, Honeyman D, Notaras A, Lim S, MacIntyre CR. The impact of the cruise ship coral princess on COVID-19 transmission in regional Western Australia in 2022. J Travel Med 2024:taae044. [PMID: 38470290 DOI: 10.1093/jtm/taae044] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/19/2024] [Indexed: 03/13/2024]
Abstract
Increased COVID-19 community transmission in regional areas with high Aboriginal populations, limited health infrastructure and low vaccination rates, could result in clusters of transmission with increased deaths rates. Pilbara, a regional community with a high Aboriginal population, showed a 34.8% increase in COVID-19 cases in the four-weeks post cruise-ship docking.
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Affiliation(s)
- Ashley L Quigley
- Biosecurity Research Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Mohana Kunasekaran
- Biosecurity Research Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Haley Stone
- Biosecurity Research Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Damian Honeyman
- Biosecurity Research Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Adriana Notaras
- Biosecurity Research Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Samsung Lim
- School of Civil and Environmental Engineering, Faculty of Engineering, University of New South Wales, Sydney, Australia
| | - C Raina MacIntyre
- Biosecurity Research Program, The Kirby Institute, University of New South Wales, Sydney, Australia
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Raina MacIntyre C, Lim S, Gurdasani D, Miranda M, Metcalf D, Quigley A, Hutchinson D, Burr A, Heslop DJ. Early detection of emerging infectious diseases - implications for vaccine development. Vaccine 2024; 42:1826-1830. [PMID: 37271702 DOI: 10.1016/j.vaccine.2023.05.069] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/04/2023] [Accepted: 05/26/2023] [Indexed: 06/06/2023]
Abstract
Vast quantities of open-source data from news reports, social media and other sources can be harnessed using artificial intelligence and machine learning, and utilised to generate valid early warning signals of emerging epidemics. Early warning signals from open-source data are not a replacement for traditional, validated disease surveillance, but provide a trigger for earlier investigation and diagnostics. This may yield earlier pathogen characterisation and genomic data, which can enable earlier vaccine development or deployment of vaccines. Early warning also provides a more feasible prospect of stamping out epidemics before they spread. There are several of such systems currently, but they are not used widely in public health practice, and only some are publicly available. Routine and widespread use of open-source intelligence, as well as training and capacity building in digital surveillance, will improve pandemic preparedness and early response capability.
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Affiliation(s)
- C Raina MacIntyre
- The Biosecurity Program, Kirby Institute, Faculty of Medicine and Health Sciences, University of New South Wales, New South Wales, Australia; College of Health Solutions and Watts College of Public Service and Community Services, Arizona State University, United States
| | - Samsung Lim
- The Biosecurity Program, Kirby Institute, Faculty of Medicine and Health Sciences, University of New South Wales, New South Wales, Australia
| | - Deepti Gurdasani
- The Biosecurity Program, Kirby Institute, Faculty of Medicine and Health Sciences, University of New South Wales, New South Wales, Australia
| | - Miguel Miranda
- The Biosecurity Program, Kirby Institute, Faculty of Medicine and Health Sciences, University of New South Wales, New South Wales, Australia
| | - David Metcalf
- The Biosecurity Program, Kirby Institute, Faculty of Medicine and Health Sciences, University of New South Wales, New South Wales, Australia
| | - Ashley Quigley
- The Biosecurity Program, Kirby Institute, Faculty of Medicine and Health Sciences, University of New South Wales, New South Wales, Australia
| | - Danielle Hutchinson
- The Biosecurity Program, Kirby Institute, Faculty of Medicine and Health Sciences, University of New South Wales, New South Wales, Australia.
| | - Allan Burr
- The Biosecurity Program, Kirby Institute, Faculty of Medicine and Health Sciences, University of New South Wales, New South Wales, Australia
| | - David J Heslop
- The School of Population Health, Faculty of Medicine and Health Sciences, University of New South Wales, New South Wales, Australia
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Wei J, Tan TC, Moa AM, MacIntyre CR. Cost-benefit of influenza vaccination in preventing sudden cardiac arrest amongst Australian adults. Vaccine 2024; 42:1593-1598. [PMID: 38341292 DOI: 10.1016/j.vaccine.2024.02.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/02/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE The objective of the study was to estimate the economic cost benefit of funding influenza vaccination to all Australian adults 50-64 years and predict its effect on sudden cardiac arrest (SCA) deaths and hospitalisation. METHODS We combined SCA hospitalisation data from the Australian Institute of Health and Welfare (AIHW) with survival, vaccination, and cost parameters from published literature to create a model estimating the cost benefit of universally funded influenza vaccinations to prevent SCA deaths and hospitalisation. Costs were considered from a government perspective and included cost of vaccines and GP consultations, whilst averted deaths were estimated through the age-adjusted value of a statistical life. RESULTS The target policy was estimated to prevent 278 SCA hospitalisations and 1269 SCA deaths. This would result in cost-savings of almost $4 billion annually, with an incremental benefit-cost ratio (BCR) of 59.94. The majority of savings were associate with averted deaths. When a sensitivity analysis was performed by altering statistical life year values and reducing life years left, the cost-saving remained significant with a minimum BCR of 29.97 derived. CONCLUSIONS Reducing SCA through extended vaccination including adults 50-64 years is likely to be a cost beneficial policy from a governmental perspective. SCA deaths account for a significant economic loss due to the high mortality rate, which was far greater than the costs saved through averted hospitalisations. More accurate parameters are needed to improve the reliability of these estimate; however, this model can be used as a basis for further research into the economic impact of SCA.
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Affiliation(s)
- Jenny Wei
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
| | - Timothy C Tan
- School of Medical Sciences, UNSW Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Aye M Moa
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia.
| | - C Raina MacIntyre
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
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Poland GA, Raina MacIntyre C. Celebrating vaccines: The 2023 Nobel prize in medicine or physiology. Vaccine 2024; 42:1409-1410. [PMID: 38365486 DOI: 10.1016/j.vaccine.2023.10.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/20/2023] [Indexed: 02/18/2024]
Affiliation(s)
- Gregory A Poland
- Mayo Vaccine Research Group, 200 First Street, SW, Guggenheim 611B, Mayo Clinic, Rochester, MN 55905, United States.
| | - C Raina MacIntyre
- Biosecurity Program, The Kirby Institute for Infection and Immunity, UNSW Sydney, Australia
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Chen R, Kezhekkekara SG, Kunasekaran MP, MacIntyre CR. Universal masking during COVID-19 outbreaks in aged care settings: A systematic review and meta-analysis. Ageing Res Rev 2024; 93:102138. [PMID: 38007047 DOI: 10.1016/j.arr.2023.102138] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 10/11/2023] [Accepted: 11/20/2023] [Indexed: 11/27/2023]
Abstract
Aged care facilities (ACF) are a high-risk COVID-19 transmission setting, and older residents are at greater risk of severe outcomes. This systematic review and meta-analysis assessed whether universal masking and COVID-19 vaccination reduce SARS-CoV-2 attack rates (ARs) in ACF. Articles published between 1 December 2019 and 28 February 2022 were screened across five databases (Medline, Embase, PubMed, Scopus, Web of Science and Cumulative Index to Nursing and Allied Health Literature (CINAHL)). Risk of bias was assessed using relevant Joanna Briggs Institute critical appraisal tools. Meta-analysis of single proportions, subgroup analysis, and meta-regression were performed to compare the effects of universal masking and vaccine doses on pooled SARS-CoV-2 ARs. Of 99 included articles, SARS-CoV-2 ARs for residents were available in 86 studies (representing 139 outbreaks), and for staff in 49 studies (78 outbreaks). Universal masking was associated with lower SARS-CoV-2 ARs in ACF outbreaks (AR = 34.9% [95% CI: 27.2-42.6%]) compared to facilities without universal masking (67.3% [54.2-80.4%], p < .0001). In ACF with universal masking prior to outbreak onset, facility-wide testing, and documentation of asymptomatic infection, the asymptomatic AR at time of testing was 11.4% (6.5-17.4%) in residents. Receipt of zero, one and two vaccination doses were associated with ARs of 64.9% (49.6-80.2%), 54.9% (33.7-76.1%) and 45.2% (29.2-61.3%), respectively. To protect residents from COVID-19, ACF should provide vaccination of residents and staff, universal masking for staff, and facility-wide testing during times of heightened community transmission.
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Affiliation(s)
- Rosalie Chen
- Kirby Institute, The University of New South Wales, Sydney, NSW, Australia; School of Population Health, The University of New South Wales, Sydney, NSW, Australia.
| | - Shwetha G Kezhekkekara
- Kirby Institute, The University of New South Wales, Sydney, NSW, Australia; School of Population Health, The University of New South Wales, Sydney, NSW, Australia; Australian Centre for Integration of Oral Health (ACIOH), Western Sydney University, Sydney, Australia
| | | | - C Raina MacIntyre
- Kirby Institute, The University of New South Wales, Sydney, NSW, Australia; Watts College of Public Service and Community Solutions, Arizona State University, Phoenix, AZ, United States
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Pearce R, Chen J, Chin KL, Guignard A, Latorre LA, MacIntyre CR, Schoeninger B, Shantakumar S. Population-Based Study of Pertussis Incidence and Risk Factors among Persons >50 Years of Age, Australia. Emerg Infect Dis 2024; 30:105-115. [PMID: 38146987 PMCID: PMC10756356 DOI: 10.3201/eid3001.230261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
Despite vaccination programs, pertussis has been poorly controlled, especially among older adults in Australia. This longitudinal, retrospective, observational study aimed to estimate the incidence and risk factors of pertussis among persons ≥50 years of age in Australia in the primary care setting, including those with underlying chronic obstructive pulmonary disease (COPD) or asthma. We used the IQVIA general practitioner electronic medical record database to identify patients ≥50 years of age with a clinical diagnosis of pertussis during 2015-2019. Pertussis incidence rates ranged from 57.6 to 91.4 per 100,000 persons and were higher among women and highest in those 50-64 years of age. Patients with COPD or asthma had higher incidence rates and an increased risk for pertussis compared with the overall population ≥50 years of age. Our findings suggest that persons ≥50 years of age in Australia with COPD or asthma have a higher incidence of and risk for pertussis diagnosis.
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Moa A, Kunasekaran M, Akhtar Z, Costantino V, MacIntyre CR. Systematic review of influenza vaccine effectiveness against laboratory-confirmed influenza among older adults living in aged care facilities. Hum Vaccin Immunother 2023; 19:2271304. [PMID: 37929779 PMCID: PMC10629430 DOI: 10.1080/21645515.2023.2271304] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023] Open
Abstract
We estimated the effectiveness of influenza vaccines in preventing laboratory-confirmed influenza among older adults in aged care. Electronic database searches were conducted using search terms, and studies were selected as per the selection criteria. Fourteen studies were included for final review. The studies exhibited considerable variation in reported vaccine effectiveness (VE) across different seasons. Among the observational studies, VE ranged from 7.2% to 89.8% against laboratory-confirmed influenza across different vaccines. Randomized clinical trials demonstrated a 17% reduction in infection rates with the adjuvanted trivalent vaccine. The limitations include the small number of included studies conducted in different countries or regions, varied seasons, variations in diagnostic testing methods, a focus on the A/H3N2 strain, and few studies available on the effectiveness of enhanced influenza vaccines in aged care settings. Despite challenges associated with achieving optimal protection, the studies showed the benefits of influenza vaccination in the elderly residents.
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Affiliation(s)
- Aye Moa
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Mohana Kunasekaran
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Zubair Akhtar
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Valentina Costantino
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - C. Raina MacIntyre
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
- College of Public Service and Community Solutions, Arizona State University, Phoenix, AZ, USA
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Raina MacIntyre C, Kevin Yin J, Felter C, Menzies RI, Thommes E, Largeron N, Moa AM, Trent M, Costantino V, Choi S, Alvarez FP. Estimated health and economic impact of using high-dose influenza vaccine on respiratory and circulatory plus respiratory hospitalizations of older adults in Australia. Vaccine X 2023; 15:100365. [PMID: 37609557 PMCID: PMC10440578 DOI: 10.1016/j.jvacx.2023.100365] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023] Open
Abstract
Background Standard dose influenza vaccine provides moderate protection from infection, but with lower effectiveness among the elderly. High dose and adjuvanted vaccines (HD-TIV and aTIV) were developed to address this. This study aims to estimate the incremental health and economic impact of using HD-TIV (high dose trivalent vaccine) instead of aTIV (adjuvanted trivalent vaccine) on respiratory and circulatory plus respiratory hospitalizations of older people (≥65 years) in Australia. Methods This is a modelling study comparing predicted hospitalization outcomes in people receiving HD-TIV or aTIV during an average influenza season in Australia. Hospitalization records of Australian adults ≥65 years of age from 01 April to 30 November during 15 influenza seasons (2002-2017 excluding 2009, which was a pandemic) were extracted from the Australian Institute of Health and Welfare [AIHW] and used to calculate hospitalisation rates during an average season. Relative vaccine effectiveness data for aTIV and HD-TIV were used to estimate morbidity burden related to influenza. Results Between 2002 and 2017, the average respiratory hospitalization rate among older people during influenza season (April-November) was 3,445/100,000 population-seasons, with an average cost of AU$ 7,175 per admission. The average circulatory plus respiratory hospitalization rate among older Australian people during that time was 10,393/100,000 population-seasons, with an average cost of AU$ 7829 per admission. For older Australians, HD-TIV may avert an additional 6,315-9,410 respiratory admissions each year, with an incremental healthcare cost saving of AU$ 15.9-38.2 million per year compared to aTIV. Similar results were also noted for circulatory plus respiratory hospitalizations. Conclusions From the modelled estimations, HD-TIV was associated with less economic burden and fewer respiratory, and circulatory plus respiratory hospitalizations than aTIV for older Australians.
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Affiliation(s)
| | - J. Kevin Yin
- Medical Department, Greater China, Sanofi Vaccines, Beijing, China
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | | | | | - Edward Thommes
- New Products and Innovation, Sanofi, Toronto, Ontario, Canada
- Department of Mathematics and Statistics, University of Guelph, Guelph, ON, Canada
| | | | - Aye M. Moa
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mallory Trent
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Seulki Choi
- Market Access, Sanofi, Sydney, NSW, Australia
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Seale H, Trent M, Marks GB, Shah S, Chughtai AA, MacIntyre CR. Exploring the use of masks for protection against the effects of wildfire smoke among people with preexisting respiratory conditions. BMC Public Health 2023; 23:2330. [PMID: 38001501 PMCID: PMC10668508 DOI: 10.1186/s12889-023-17274-3] [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: 03/22/2023] [Accepted: 11/20/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The impact of wildfire smoke is a growing public health issue, especially for those living with preexisting respiratory conditions. Understanding perceptions and behaviors relevant to the use of individual protective strategies, and how these affect the adoption of these strategies, is critical for the development of future communication and support interventions. This study focused on the use of masks by people living in the Australian community with asthma or chronic obstructive pulmonary disease (COPD). METHODS Semi-structured phone interviews were undertaken with people living in the community aged 18 years and over. Participants lived in a bushfire-prone area and reported having been diagnosed with asthma or COPD. RESULTS Twenty interviews were undertaken between July and September 2021. We found that, during wildfire episodes, there was an overwhelming reliance on closing windows and staying inside as a means of mitigating exposure to smoke. There was limited use of masks for this purpose. Even among those who had worn a mask, there was little consideration given to the type of mask or respirator used. Reliance on sensory experiences with smoke was a common prompt to adopting an avoidance behavior. Participants lacked confidence in the information available from air-quality apps and websites, however they were receptive to the idea of using masks in the future. CONCLUSIONS Whilst COVID-19 has changed the nature of community mask use over the last couple of years, there is no guarantee that this event will influence an individual's mask behavior during other events like bushfires. Instead, we must create social support processes for early and appropriate mask use, including the use of air quality monitoring.
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Affiliation(s)
- Holly Seale
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Level 2, Samuels Building, Sydney, NSW, 2052, Australia.
| | - M Trent
- The Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - G B Marks
- School of Clinical Medicine, UNSW Medicine & Health, University of New South Wales, Sydney, NSW, Australia
- Woolcock Institute of Medical Research, Sydney, NSW, Australia
| | - S Shah
- Research and Education Network, Western Sydney Local Health District, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - A A Chughtai
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Level 2, Samuels Building, Sydney, NSW, 2052, Australia
| | - C R MacIntyre
- The Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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12
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Chen X, Kunasekaran MP, Hutchinson D, Stone H, Zhang T, Aagerup J, Moa A, MacIntyre CR. Enhanced EPIRISK tool for rapid epidemic risk analysis. Public Health 2023; 224:159-168. [PMID: 37797562 DOI: 10.1016/j.puhe.2023.08.032] [Citation(s) in RCA: 1] [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: 02/22/2023] [Revised: 07/31/2023] [Accepted: 08/26/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVES This study aims to create an enhanced EPIRISK tool in order to correctly predict COVID-19 severity in various countries. The original EPIRISK tool was developed in 2018 to predict the epidemic risk and prioritise response. The tool was validated against nine historical outbreaks prior to 2020. However, it rated many high-income countries that had poor performance during the COVID-19 pandemic as having lower epidemic risk. STUDY DESIGN This study was designed to modify EPIRISK by reparameterizing risk factors and validate the enhanced tool against different outbreaks, including COVID-19. METHODS We identified three factors that could be indicators of poor performance witnessed in some high-income countries: leadership, culture and universal health coverage. By adding these parameters to EPIRISK, we created a series of models for the calibration and validation. These were tested against non-COVID outbreaks in nine countries and COVID-19 outbreaks in seven countries to identify the best-fit model. The COVID-19 severity was determined by the global incidence and mortality, which were equally divided into four levels. RESULTS The enhanced EPIRISK tool has 17 parameters, including seven disease-related and 10 country-related factors, with an algorithm developed for risk level classification. It correctly predicted the risk levels of COVID-19 for all seven countries and all nine historical outbreaks. CONCLUSIONS The enhanced EPIRSIK is a multifactorial tool that can be widely used in global infectious disease outbreaks for rapid epidemic risk analysis, assisting first responders, government and public health professionals with early epidemic preparedness and prioritising response to infectious disease outbreaks.
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Affiliation(s)
- X Chen
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
| | - M P Kunasekaran
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - D Hutchinson
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - H Stone
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - T Zhang
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - J Aagerup
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - A Moa
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - C R MacIntyre
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia; College of Public Service & Community Solutions, Arizona State University, Tempe, AZ 85004, United States
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Cornelisse VJ, Heath-Paynter D, Delpech V, Read P, Apostolellis A, Medland NA, MacIntyre CR, Giola M, Kidd M. How Australia and Aotearoa New Zealand avoided large-scale mpox (formerly monkeypox) outbreaks in 2022-2023. Intern Med J 2023; 53:1732-1738. [PMID: 37859543 DOI: 10.1111/imj.16236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/06/2023] [Indexed: 10/21/2023]
Affiliation(s)
- Vincent J Cornelisse
- Sydney Local Health District and Northern Sydney Local Health District, NSW Health, New South Wales, Sydney, Australia
- ASHM (the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine), Sydney, New South Wales, Australia
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- Monash University, Melbourne, Victoria, Australia
| | - Dash Heath-Paynter
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- Health Equity Matters, Sydney, New South Wales, Australia
| | - Valerie Delpech
- Mid North Coast Local Health District, Port Macquarie, New South Wales, Australia
| | - Phillip Read
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Alexis Apostolellis
- ASHM (the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine), Sydney, New South Wales, Australia
| | - Nicholas A Medland
- ASHM (the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine), Sydney, New South Wales, Australia
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - C Raina MacIntyre
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Massimo Giola
- Te Whatu Ora - Hauora a Toi and Lakes Districts, Aotearoa, New Zealand
| | - Michael Kidd
- Centre for Future Health Systems, University of New South Wales, Sydney, New South Wales, Australia
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
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14
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Hutchinson D, Kunasekaran M, Stone H, Chen X, Quigley A, Moa A, MacIntyre CR. Healthcare Workers' SARS-CoV-2 Infections in Four Hospital Outbreaks during Delta Variant Prevalence in Sydney, Australia. Nurs Res Pract 2023; 2023:1806909. [PMID: 37745813 PMCID: PMC10513866 DOI: 10.1155/2023/1806909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/07/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023] Open
Abstract
Background Healthcare workers (HCWs) are at risk of SARS-CoV-2 infections due to occupational exposure. The use of airborne personal protective equipment (PPE) significantly reduces this risk. In June 2021, an epidemic of the Delta variant began in New South Wales (NSW), Australia. Concurrent PPE guidelines, set by the Clinical Excellence Commission (CEC), restricted the use of respirators. Objective To understand the relationship of PPE guidelines with workplace-acquired HCW SARS-CoV-2 infections in different clinical settings and to examine the relationship between rates of community transmission and workplace-acquired HCW infections during the Delta outbreak in NSW. Methods Total SARS-CoV-2 HCW infections between 13 June and 30 October 2021 (first four months of the Delta wave) were estimated from the government COVID-19 surveillance reports and compared with the surveillance reports of community transmission. In the absence of a detailed reporting of HCW infections, open-source data including news articles, media releases, and epidemiological surveillance reports were also collected. Data were extracted on HCW cases of SARS-CoV-2 from four hospitals, including the number of HCW cases (per NSW Health definition), clinical setting, PPE guidelines, and evidence of increasing local transmission. Results SARS-CoV-2 infections in HCW identified as workplace-acquired infections (n = 177) and those without a known transmission source (n = 532) increased during the period of increasing community transmission (n = 75,014) in NSW. Four hospital COVID-19 clusters affecting 20 HCWs were identified between June and October 2021. HCW clusters occurred in general wards where staff were recommended to wear surgical masks. No workplace-acquired HCW infections were reported in these hospitals from critical care wards, where respirators were recommended during the same outbreak weeks. Conclusions Differences in PPE policy across different wards may leave healthcare staff at risk of SARS-CoV-2 infection. During periods of high community transmission, respirators should be provided to protect hospital staff. Formal reporting of HCW infections should occur.
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Affiliation(s)
- Danielle Hutchinson
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Mohana Kunasekaran
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Haley Stone
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Xin Chen
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Ashley Quigley
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Aye Moa
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - C. Raina MacIntyre
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- College of Public Service & Community Solutions, Arizona State University, Tempe, AZ 85004, USA
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15
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Dasgupta P, Amin J, Paris C, MacIntyre CR. News Coverage of Face Masks in Australia During the Early COVID-19 Pandemic: Topic Modeling Study. JMIR Infodemiology 2023; 3:e43011. [PMID: 37379362 PMCID: PMC10434701 DOI: 10.2196/43011] [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] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 04/20/2023] [Accepted: 05/02/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, web-based media coverage of preventative strategies proliferated substantially. News media was constantly informing people about changes in public health policy and practices such as mask-wearing. Hence, exploring news media content on face mask use is useful to analyze dominant topics and their trends. OBJECTIVE The aim of the study was to examine news related to face masks as well as to identify related topics and temporal trends in Australian web-based news media during the early COVID-19 pandemic period. METHODS Following data collection from the Google News platform, a trend analysis on the mask-related news titles from Australian news publishers was conducted. Then, a latent Dirichlet allocation topic modeling algorithm was applied along with evaluation matrices (quantitative and qualitative measures). Afterward, topic trends were developed and analyzed in the context of mask use during the pandemic. RESULTS A total of 2345 face mask-related eligible news titles were collected from January 25, 2020, to January 25, 2021. Mask-related news showed an increasing trend corresponding to increasing COVID-19 cases in Australia. The best-fitted latent Dirichlet allocation model discovered 8 different topics with a coherence score of 0.66 and a perplexity measure of -11.29. The major topics were T1 (mask-related international affairs), T2 (introducing mask mandate in places such as Melbourne and Sydney), and T4 (antimask sentiment). Topic trends revealed that T2 was the most frequent topic in January 2021 (77 news titles), corresponding to the mandatory mask-wearing policy in Sydney. CONCLUSIONS This study demonstrated that Australian news media reflected a wide range of community concerns about face masks, peaking as COVID-19 incidence increased. Harnessing the news media platforms for understanding the media agenda and community concerns may assist in effective health communication during a pandemic response.
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Affiliation(s)
- Pritam Dasgupta
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Janaki Amin
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Cecile Paris
- Commonwealth Scientific and Industrial Research Organisation Data61, Sydney, New South Wales, Australia
| | - C Raina MacIntyre
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
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16
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Stone H, Heslop D, Lim S, Sarmiento I, Kunasekaran M, MacIntyre CR. Open-Source Intelligence for Detection of Radiological Events and Syndromes Following the Invasion of Ukraine in 2022: Observational Study. JMIR Infodemiology 2023; 3:e39895. [PMID: 37379069 PMCID: PMC10365590 DOI: 10.2196/39895] [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] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 01/26/2023] [Accepted: 04/11/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND On February 25, 2022, Russian forces took control of the Chernobyl power plant after continuous fighting within the Chernobyl exclusion zone. Continual events occurred in the month of March, which raised the risk of potential contamination of previously uncontaminated areas and the potential for impacts on human and environmental health. The disruption of war has caused interruptions to normal preventive activities, and radiation monitoring sensors have been nonfunctional. Open-source intelligence can be informative when formal reporting and data are unavailable. OBJECTIVE This paper aimed to demonstrate the value of open-source intelligence in Ukraine to identify signals of potential radiological events of health significance during the Ukrainian conflict. METHODS Data were collected from search terminology for radiobiological events and acute radiation syndrome detection between February 1 and March 20, 2022, using 2 open-source intelligence (OSINT) systems, EPIWATCH and Epitweetr. RESULTS Both EPIWATCH and Epitweetr identified signals of potential radiobiological events throughout Ukraine, particularly on March 4 in Kyiv, Bucha, and Chernobyl. CONCLUSIONS Open-source data can provide valuable intelligence and early warning about potential radiation hazards in conditions of war, where formal reporting and mitigation may be lacking, to enable timely emergency and public health responses.
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Affiliation(s)
- Haley Stone
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Kensington, Australia
| | - David Heslop
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Samsung Lim
- School of Civil & Environmental Engineering, University of New South Wales, Sydney, Australia
| | - Ines Sarmiento
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Kensington, Australia
| | - Mohana Kunasekaran
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Kensington, Australia
| | - C Raina MacIntyre
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Kensington, Australia
- College of Public Service & Community Solutions, Arizona State University, Tempe, AZ, United States
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17
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Hutchinson D, Kunasekaran M, Quigley A, Moa A, MacIntyre CR. Could it be monkeypox? Use of an AI-based epidemic early warning system to monitor rash and fever illness. Public Health 2023; 220:142-147. [PMID: 37327561 DOI: 10.1016/j.puhe.2023.05.010] [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: 12/21/2022] [Revised: 05/03/2023] [Accepted: 05/10/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES The EPIWATCH artificial intelligence (AI) system scans open-source data using automated technology and can be used to detect early warnings of infectious disease outbreaks. In May 2022, a multicountry outbreak of Mpox in non-endemic countries was confirmed by the World Health Organization. This study aimed to identify signals of fever and rash-like illness using EPIWATCH and, if detected, determine if they represented potential Mpox outbreaks. STUDY DESIGN The EPIWATCH AI system was used to detect global signals for syndromes of rash and fever that may have represented a missed diagnosis of Mpox from 1 month prior to the initial case confirmation in the United Kingdom (7 May 2022) to 2 months following. METHODS Articles were extracted from EPIWATCH and underwent review. A descriptive epidemiologic analysis was conducted to identify reports pertaining to each rash-like illness, locations of each outbreak and report publication dates for the entries from 2022, with 2021 as a control surveillance period. RESULTS Reports of rash-like illnesses in 2022 between 1 April and 11 July (n = 656 reports) were higher than in the same period in 2021 (n = 75 reports). The data showed an increase in reports from July 2021 to July 2022, and the Mann-Kendall trend test showed a significant upward trend (P = 0.015). The most frequently reported illness was hand-foot-and-mouth disease, and the country with the most reports was India. CONCLUSIONS Vast open-source data can be parsed using AI in systems such as EPIWATCH to assist in the early detection of disease outbreaks and monitor global trends.
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Affiliation(s)
- D Hutchinson
- Kirby Institute, University of New South Wales, New South Wales, Australia.
| | - M Kunasekaran
- Kirby Institute, University of New South Wales, New South Wales, Australia
| | - A Quigley
- Kirby Institute, University of New South Wales, New South Wales, Australia
| | - A Moa
- Kirby Institute, University of New South Wales, New South Wales, Australia
| | - C R MacIntyre
- Kirby Institute, University of New South Wales, New South Wales, Australia
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18
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Abstract
COVID-19 is an independent risk factor for cardiovascular disease. COVID-19 vaccination may prevent this, but in some cases, COVID-19 vaccination may cause myocarditis or pericarditis. Patients with COVID-19 may present with non-specific symptoms that have a cardiac origin. This review examines the cardiovascular complications of COVID-19 infection and the impact of COVID-19 vaccination. COVID-19 cardiovascular complications include myocardial injury, pericarditis, coagulopathy, myocardial infarction, heart failure, arrhythmias, and persistent post-acute risk of adverse cardiovascular outcomes. Diagnostic and referral pathways for non-specific symptoms, such as dyspnoea and fatigue, remain unclear. COVID-19 vaccination is cardioprotective overall but is associated with myopericarditis in young males, though at a lower rate than following SARS-CoV-2 infection. Increased awareness among primary care physicians of potential cardiovascular causes of non-specific post-COVID-19 symptoms, including in younger adults, such as fatigue, dyspnoea, and chest pain, is essential. We recommend full vaccination with scheduled booster doses, optimal management of cardiovascular risk factors, rapid treatment of COVID-19, and clear diagnostic, referral, and management pathways for patients presenting with non-specific symptoms to rule out cardiac complications.
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Affiliation(s)
- Zubair Akhtar
- Biosecurity Program, The Kirby Institute, University of New South Wales (UNSW), 2052, SydneyAustralia
- Programme on Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh 1212
| | - Mallory Trent
- Biosecurity Program, The Kirby Institute, University of New South Wales (UNSW), 2052, SydneyAustralia
| | - Aye Moa
- Biosecurity Program, The Kirby Institute, University of New South Wales (UNSW), 2052, SydneyAustralia
| | - Timothy C Tan
- Department of Cardiology, Blacktown Hospital, University of Western Sydney, 2148, Blacktown, NSW, Australia
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, 2052, Sydney, NSW, Australia
- Department of Cardiology, Westmead Hospital, Sydney University, 2145, Westmead, NSW, Australia
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19
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MacIntyre CR, Lim S, Quigley A. Preventing the next pandemic: Use of artificial intelligence for epidemic monitoring and alerts. Cell Rep Med 2022; 3:100867. [PMID: 36543103 PMCID: PMC9798013 DOI: 10.1016/j.xcrm.2022.100867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/29/2022] [Revised: 11/15/2022] [Accepted: 11/20/2022] [Indexed: 12/24/2022]
Abstract
Emerging infections are a continual threat to public health security, which can be improved by use of rapid epidemic intelligence and open-source data. Artificial intelligence systems to enable earlier detection and rapid response by governments and health can feasibly mitigate health and economic impacts of serious epidemics and pandemics. EPIWATCH is an artificial intelligence-driven outbreak early-detection and monitoring system, proven to provide early signals of epidemics before official detection by health authorities.
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Affiliation(s)
| | - Samsung Lim
- Biosecurity Program, The Kirby Institute, UNSW, Sydney, Australia,School of Civil & Environmental Engineering, UNSW, Sydney, Australia
| | - Ashley Quigley
- Biosecurity Program, The Kirby Institute, UNSW, Sydney, Australia,Corresponding author
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20
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Affiliation(s)
- Mallory J Trent
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, Australia
| | - Aye Moa
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, Australia
| | - C Raina MacIntyre
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, Australia
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21
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Kunasekaran M, Moa A, Hooshmand E, Trent M, Poulos CJ, Chughtai AA, Heslop DJ, Raina MacIntyre C. Effectiveness estimates for enhanced trivalent influenza vaccines in an aged care summer outbreak. Vaccine 2022; 40:7170-7175. [PMID: 36328885 DOI: 10.1016/j.vaccine.2022.06.018] [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: 10/23/2021] [Revised: 05/26/2022] [Accepted: 06/05/2022] [Indexed: 11/11/2022]
Abstract
An influenza outbreak occurred during summer (February 2019) in an aged-care facility in Sydney, Australia. Residents had not received the annual 2019 influenza vaccine while 76.7% had received 2018 influenza vaccines about 9 months prior. Overall, 2018 influenza vaccine effectiveness during this outbreak was high (93.6%). The effectiveness of the high-dose trivalent vaccine (HD-TIV) and adjuvanted trivalent (a-TIV) vaccine were 89.8% (95% confidence interval: 18.8%-98.7%) and 72.5% (95% confidence interval: -106.7%-96.3%) respectively. The differences in effectiveness between HD-TIV, a-TIV and SD-QIV, during the summer outbreak were not significant.
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Affiliation(s)
- Mohana Kunasekaran
- The University of New South Wales, Kirby Institute, Biosecurity Program, Sydney, New South Wales, Australia.
| | - Aye Moa
- The University of New South Wales, Kirby Institute, Biosecurity Program, Sydney, New South Wales, Australia
| | - Elmira Hooshmand
- The University of New South Wales, Kirby Institute, Biosecurity Program, Sydney, New South Wales, Australia
| | - Mallory Trent
- The University of New South Wales, Kirby Institute, Biosecurity Program, Sydney, New South Wales, Australia
| | - Christopher J Poulos
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia; HammondCare, Sydney, New South Wales, Australia
| | - Abrar A Chughtai
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia
| | - David J Heslop
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia
| | - C Raina MacIntyre
- The University of New South Wales, Kirby Institute, Biosecurity Program, Sydney, New South Wales, Australia
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22
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Ricks T, Trent MJ, MacIntyre CR. Predictors of herpes zoster vaccination among Australian adults aged 65 and over. Vaccine 2022; 40:7182-7186. [PMID: 36336528 DOI: 10.1016/j.vaccine.2022.10.064] [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: 04/08/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE(S) To estimate HZ vaccine coverage in Australia among older Australians and to identify potential barriers to vaccination. DESIGN Analysis of data from three cross-sectional surveys administered online between 2019 and 2020. SETTING AND PARTICIPANTS Adults aged 65 and over residing in Australia. MAIN OUTCOME MEASURES Self-reported herpes zoster vaccination. RESULTS Among the 744 adults aged 65 and over in this sample, 32% reported being vaccinated for HZ, including 23% of participants aged 65-74, 55% of participants aged 75-84, and 0% for participants aged 85 and above. Those who are vaccinated with other immunisations are more likely to have received HZ vaccine, including seasonal influenza (OR = 4.41, 95 % CI: 2.44-7.98) and pneumococcal vaccines (OR = 4.43, 95 % CI: 2.92 - 6.75). Participants with a history of certain conditions, such as stroke (OR = 2.26, 95 % CI: 1.13-4.49), were more likely to be vaccinated against HZ. Participants that reported smoking tobacco daily were less likely to be vaccinated against HZ (OR = 0.48, 95 % CI: 0.26-0.89). Participants were less likely to be vaccinated against HZ if they preferred to develop immunity 'naturally' (OR = 0.29, 95 % CI: 0.15 - 0.57) or expressed distrust of vaccines (OR = 0.34, 95 % CI: 0.13-0.91). CONCLUSION(S) Further research is required to understand the barriers to HZ vaccine uptake. Increasing the funding eligibility for those who are at risk of complications from shingles, or lowering the age of eligibility, may increase vaccine coverage.
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Affiliation(s)
- Thomas Ricks
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Mallory J Trent
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia.
| | - C Raina MacIntyre
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
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23
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Kunasekaran M, Poulos CJ, Chughtai AA, Heslop DJ, MacIntyre CR. Factors associated with repeated influenza vaccine uptake among aged care staff in an Australian sample from 2017 to 2019. Vaccine 2022; 40:7238-7246. [PMID: 36328882 DOI: 10.1016/j.vaccine.2022.08.015] [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: 05/03/2022] [Revised: 07/13/2022] [Accepted: 08/08/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND/AIM Influenza vaccination is strongly recommended every year for aged care staff to protect themselves and minimise risk of transmission to residents. This study aimed to determine the factors associated with repeated annual influenza vaccine uptake among Australian aged care staff from 2017 to 2019. METHODS Demographic, medical and vaccination data collected from the staff, who participated in an observational study from nine aged care facilities under a single provider in Sydney Australia, were analysed retrospectively. Based on the pattern of repeated influenza vaccination from 2017 to 2019, three groups were identified: (1) unvaccinated all three years; (2) vaccinated occasionally(once or twice) over three years; and (3)vaccinated all threeyears. Multinomial logistic regression analysis was performed to better understand the factors associated with the pattern of repeated influenza vaccination. RESULTS From a total of 138 staff, between 2017 and 2019, 28.9 % (n = 40) never had a vaccination, while 44.2 % (n = 61) had vaccination occasionally and 26.8 % (n = 37) had vaccination all three years. In the multinomial logistic regression model, those who were<40 years old (OR = 0.57, 95 % CI: 0.19-0.90, p < 0.05) and those who were current smokers (OR = 0.20; 95 % CI: 0.03-0.76, p < 0.05) were less likely to have repeated vaccination for all three years compared to the unvaccinated group. Those who were<40 years old (OR = 0.61; 95 % CI: 0.22-0.68, p < 0.05) and those who were born overseas (OR = 0.50; 95 % CI:0.27-0.69, p < 0.05) were more likely to be vaccinated occasionally compared to the unvaccinated group. CONCLUSION The significant predictors of repeated vaccine uptake across the three-year study period among aged care staff were age, smoking status and country of birth (Other vs Australia). Targeted interventions towards the younger age group (<40 years old), smokers and those who were born overseas could improve repeated influenza vaccination uptake in the aged care workforce.
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Affiliation(s)
- Mohana Kunasekaran
- The University of New South Wales, Kirby Institute, Biosecurity Program, Sydney, New South Wales, Australia.
| | - Christopher J Poulos
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia; HammondCare, Sydney, New South Wales, Australia
| | - Abrar A Chughtai
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia
| | - David J Heslop
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia
| | - C Raina MacIntyre
- The University of New South Wales, Kirby Institute, Biosecurity Program, Sydney, New South Wales, Australia; College of Public Service and Community Solutions and College ofHealth Solutions, Arizona StateUniversity, Tempe, AZ, USA
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24
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MacIntyre CR, Costantino V, Bian L, Bethel C. Effectiveness of facemasks for opening a university campus in Mississippi, United States - a modelling study. J Am Coll Health 2022; 70:2505-2510. [PMID: 33605837 DOI: 10.1080/07448481.2020.1866579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/28/2020] [Revised: 11/10/2020] [Accepted: 12/13/2020] [Indexed: 06/12/2023]
Abstract
Background: Universities are at risk for COVID-19 and Fall semester begins in August 2020 for most campuses in the United States. The Southern States, including Mississippi, are experiencing a high incidence of COVID-19. Aims: The objective of this study is to model the impact of face masks and hybrid learning on the COVID-19 epidemic on Mississippi State University (MSU) campus. Methods: We used an age structured deterministic mathematical model of COVID-19 transmission within the MSU campus population, accounting for asymptomatic transmission. We modeled facemasks for the campus population at varying proportions of mask use and effectiveness, and Hyflex model of partial online learning with reduction of people on campus. Results: Facemasks can substantially reduce cases and deaths, even with modest effectiveness. Even 20% uptake of masks will halve the epidemic size. Facemasks combined with Hyflex reduces epidemic size even more. Conclusions: Universal use of face masks and reducing the number of people on campus may allow safer universities reopening.
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Affiliation(s)
- C Raina MacIntyre
- The Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
- College of Health Solutions, Arizona State University, Tempe, Arizona, USA
- College of Public Affairs and Community Solutions, Arizona State University, Tempe, Arizona, USA
| | - Valentina Costantino
- The Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Linkan Bian
- Mississippi State University, Starkville, Mississippi, USA
| | - Cindy Bethel
- Mississippi State University, Starkville, Mississippi, USA
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25
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MacIntyre CR, Grulich AE. Is Australia ready for monkeypox? Med J Aust 2022; 217:193-194. [DOI: 10.5694/mja2.51647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 11/17/2022]
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Quigley AL, Trent M, Seale H, Chughtai AA, MacIntyre CR. Cross-sectional survey of changes in knowledge, attitudes and practice of mask use in Sydney and Melbourne during the 2020 COVID-19 pandemic. BMJ Open 2022; 12:e057860. [PMID: 35732387 PMCID: PMC9226465 DOI: 10.1136/bmjopen-2021-057860] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Since mask uptake and the timing of mask use has the potential to influence the control of the COVID-19 pandemic, this study aimed to assess the changes in knowledge toward mask use in Sydney and Melbourne, Australia, during the 2020 COVID-19 pandemic. DESIGN An observational study, using a cross-sectional survey, was distributed to adults in Sydney and Melbourne, Australia, during July-August 2020 (survey 1) and September 2020 (survey 2), during the COVID-19 pandemic in Australia. SETTING AND PARTICIPANTS Participants aged 18 years or older and living in either Sydney or Melbourne. PRIMARY AND SECONDARY OUTCOME MEASURES Demographics, risk measures, COVID-19 severity and perception, mask attitude and uptake were determined in this study. RESULTS A total of 700 participants completed the survey. In both Sydney and Melbourne, a consistent decrease was reported in almost all risk-mitigation behaviours between March 2020 and July 2020 and again between March 2020 and September 2020. However, mask use and personal protective equipment use increased in both Sydney and Melbourne from March 2020 to September 2020. There was no significant difference in mask use during the pandemic between the two cities across both timepoints (1.24 (95% CI 0.99 to 1.22; p=0.072)). Perceived severity and perceived susceptibility of COVID-19 infection were significantly associated with mask uptake. Trust in information on COVID-19 from both national (1.77 (95% CI 1.29 to 2.44); p<0.000)) and state (1.62 (95% CI 1.19 to 2.22); p=0.003)) government was a predictor of mask use across both surveys. CONCLUSION Sydney and Melbourne both had high levels of reported mask wearing during July 2020 and September 2020, consistent with the second wave and mask mandates in Victoria, and cluster outbreaks in Sydney at the time. High rates of mask compliance may be explained by high trust levels in information from national and state government, mask mandates, risk perceptions, current outbreaks and the perceived level of risk of COVID-19 infection at the time.
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Affiliation(s)
| | - Mallory Trent
- The Kirby Institute, Kensington, New South Wales, Australia
| | - Holly Seale
- School of Population Health, UNSW, Sydney, New South Wales, Australia
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Bhattacharjee S, Bahl P, Chughtai AA, Heslop D, MacIntyre CR. Face masks and respirators: Towards sustainable materials and technologies to overcome the shortcomings and challenges. Nano Select 2022. [DOI: 10.1002/nano.202200101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Shovon Bhattacharjee
- Biosecurity Program The Kirby Institute, Faculty of Medicine University of New South Wales Kensington Sydney Australia
- Department of Applied Chemistry and Chemical Engineering Faculty of Engineering and Technology Noakhali Science and Technology University Noakhali Bangladesh
| | - Prateek Bahl
- School of Mechanical & Manufacturing Engineering University of New South Wales Sydney Australia
| | - Abrar Ahmad Chughtai
- School of Population Health Faculty of Medicine University of New South Wales Kensington Sydney Australia
| | - David Heslop
- School of Population Health Faculty of Medicine University of New South Wales Kensington Sydney Australia
| | - C. Raina MacIntyre
- Biosecurity Program The Kirby Institute, Faculty of Medicine University of New South Wales Kensington Sydney Australia
- College of Public Service and Community Solutions and College of Health Solutions Arizona State University Tempe Arizona USA
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Bhat A, Chen HHL, Khanna S, Mahajan V, Gupta A, Burdusel C, Wolfe N, Lee L, Gan GCH, Dobbins T, MacIntyre CR, Tan TC. Diagnostic And Prognostic Value Of Left Atrial Function In Identification Of Cardioembolism And Prediction Of Outcomes In Patients With Cryptogenic Stroke. J Am Soc Echocardiogr 2022; 35:1064-1076. [PMID: 35691457 DOI: 10.1016/j.echo.2022.05.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 09/28/2021] [Revised: 05/15/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Strokes of undetermined source, commonly termed cryptogenic stroke (CS), account for a significant proportion of ischemic stroke etiology and have high rates of stroke recurrence. The heterogeneous etiology of CS makes decisions regarding treatment for such patients challenging. We sought to evaluate the diagnostic and prognostic value of left atrial (LA) function in identification of cardioembolism and prediction of outcomes in patients with CS. METHODS Consecutive patients admitted to our tertiary institution with ischemic stroke or transient ischemic attack (TIA) who underwent transthoracic echocardiography were recruited with comprehensive evaluation of LA metrics including LA strain. Ischemic strokes / TIAs were classified as non-cardioembolic, cryptogenic and cardioembolic. A total of 709 patients (66.0±15.1 years, 55% male) were recruited. 291 patients had CS, 189 had non-cardioembolic stroke and 229 had cardioembolic stroke. Patients with CS were followed for 20.0±13.8 months for recurrent ischemic stroke / TIA. RESULTS Receiver-operating characteristic curves showed LA reservoir (LASr) and contractile (LASct) strains to be strong discriminators of cardioembolic strokes and log rank tests showed both measures to be significantly associated with the distribution of time to recurrent ischemic stroke / TIA in patients with CS. Multivariable hazards models showed LASr and LASct to be independent predictors of recurrent ischemic stroke / TIA in CS patients in addition to eGFR and active smoking. CONCLUSIONS LASr and LASct were strong discriminators of cardioembolic stroke and independently predicted recurrent ischemic stroke / TIA in patients with CS. Use of LA strain may improve risk stratification and decision-making in patients with CS, with particular regards to prolonged ambulatory heart rhythm monitoring and/or empiric anticoagulation.
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Affiliation(s)
- Aditya Bhat
- Department of Cardiology, Blacktown Hospital, Sydney, NSW 2148, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia; School of Medicine, Western Sydney University, Sydney, NSW 2148, Australia
| | - Henry H L Chen
- Department of Cardiology, Blacktown Hospital, Sydney, NSW 2148, Australia
| | - Shaun Khanna
- Department of Cardiology, Blacktown Hospital, Sydney, NSW 2148, Australia
| | - Vipul Mahajan
- Department of Cardiology, Blacktown Hospital, Sydney, NSW 2148, Australia
| | - Arnav Gupta
- Department of Cardiology, Blacktown Hospital, Sydney, NSW 2148, Australia
| | - Camelia Burdusel
- Stroke, Rehabilitation & Aged Care Services, Blacktown Hospital, Sydney, NSW 2148, Australia
| | - Nigel Wolfe
- Stroke, Rehabilitation & Aged Care Services, Blacktown Hospital, Sydney, NSW 2148, Australia
| | - Lina Lee
- Stroke, Rehabilitation & Aged Care Services, Blacktown Hospital, Sydney, NSW 2148, Australia
| | - Gary C H Gan
- Department of Cardiology, Blacktown Hospital, Sydney, NSW 2148, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia; School of Medicine, Western Sydney University, Sydney, NSW 2148, Australia
| | - Timothy Dobbins
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - C Raina MacIntyre
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Timothy C Tan
- Department of Cardiology, Blacktown Hospital, Sydney, NSW 2148, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia; School of Medicine, Western Sydney University, Sydney, NSW 2148, Australia.
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Quigley A, Nguyen PY, Stone H, Heslop DJ, Chughtai AA, MacIntyre CR. Estimated Mask Use and Temporal Relationship to COVID-19 Epidemiology of Black Lives Matter Protests in 12 Cities. J Racial Ethn Health Disparities 2022; 10:1212-1223. [PMID: 35543865 PMCID: PMC9092928 DOI: 10.1007/s40615-022-01308-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/05/2022] [Accepted: 04/16/2022] [Indexed: 11/26/2022]
Abstract
There is an increased risk of SARS-CoV-2 transmission during mass gatherings and a risk of asymptomatic infection. We aimed to estimate the use of masks during Black Lives Matter (BLM) protests and whether these protests increased the risk of COVID-19. Two reviewers screened 496 protest images for mask use, with high inter-rater reliability. Protest intensity, use of tear gas, government control measures, and testing rates were estimated in 12 cities. A correlation analysis was conducted to assess the potential effect of mask use and other measures, adjusting for testing rates, on COVID-19 epidemiology 4 weeks (two incubation periods) post-protests. Mask use ranged from 69 to 96% across protests. There was no increase in the incidence of COVID-19 post-protest in 11 cities. After adjusting for testing rates, only Miami, which involved use of tear gas and had high protest intensity, showed a clear increase in COVID-19 after one incubation period post-protest. No significant correlation was found between incidence and protest factors. Our study showed that protests in most cities studied did not increase COVID-19 incidence in 2020, and a high level of mask use was seen. The absence of an epidemic surge within two incubation periods of a protest is indicative that the protests did not have a major influence on epidemic activity, except in Miami. With the globally circulating highly transmissible Alpha, Delta, and Omicron variants, layered interventions such as mandated mask use, physical distancing, testing, and vaccination should be applied for mass gatherings in the future.
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Affiliation(s)
- Ashley Quigley
- Biosecurity Research Program, The Kirby Institute, UNSW, Wallace Wurth Building, UNSW, High St, Kensington Campus, Sydney, NSW, 2052, Australia.
| | - Phi Yen Nguyen
- School of Population Health, UNSW, Level 3, Samuels Building, UNSW, Sydney, NSW, 2052, Australia
| | - Haley Stone
- Biosecurity Research Program, The Kirby Institute, UNSW, Wallace Wurth Building, UNSW, High St, Kensington Campus, Sydney, NSW, 2052, Australia
| | - David J Heslop
- School of Population Health, UNSW, Level 3, Samuels Building, UNSW, Sydney, NSW, 2052, Australia
| | - Abrar Ahmad Chughtai
- School of Population Health, UNSW, Level 3, Samuels Building, UNSW, Sydney, NSW, 2052, Australia
| | - C Raina MacIntyre
- Biosecurity Research Program, The Kirby Institute, UNSW, Wallace Wurth Building, UNSW, High St, Kensington Campus, Sydney, NSW, 2052, Australia
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Bahl P, Doolan C, de Silva C, Chughtai AA, Bourouiba L, MacIntyre CR. Airborne or Droplet Precautions for Health Workers Treating Coronavirus Disease 2019? J Infect Dis 2022. [PMID: 32301491 DOI: 10.1093/infdis/jiaa189/5820886] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
Cases of coronavirus disease 2019 (COVID-19) have been reported in more than 200 countries. Thousands of health workers have been infected, and outbreaks have occurred in hospitals, aged care facilities, and prisons. The World Health Organization (WHO) has issued guidelines for contact and droplet precautions for healthcare workers caring for suspected COVID-19 patients, whereas the US Centers for Disease Control and Prevention (CDC) has initially recommended airborne precautions. The 1- to 2-meter (≈3-6 feet) rule of spatial separation is central to droplet precautions and assumes that large droplets do not travel further than 2 meters (≈6 feet). We aimed to review the evidence for horizontal distance traveled by droplets and the guidelines issued by the WHO, CDC, and European Centre for Disease Prevention and Control on respiratory protection for COVID-19. We found that the evidence base for current guidelines is sparse, and the available data do not support the 1- to 2-meter (≈3-6 feet) rule of spatial separation. Of 10 studies on horizontal droplet distance, 8 showed droplets travel more than 2 meters (≈6 feet), in some cases up to 8 meters (≈26 feet). Several studies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) support aerosol transmission, and 1 study documented virus at a distance of 4 meters (≈13 feet) from the patient. Moreover, evidence suggests that infections cannot neatly be separated into the dichotomy of droplet versus airborne transmission routes. Available studies also show that SARS-CoV-2 can be detected in the air, and remain viable 3 hours after aerosolization. The weight of combined evidence supports airborne precautions for the occupational health and safety of health workers treating patients with COVID-19.
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Affiliation(s)
- Prateek Bahl
- School of Mechanical and Manufacturing Engineering, UNSW Sydney, New South Wales, Australia
| | - Con Doolan
- School of Mechanical and Manufacturing Engineering, UNSW Sydney, New South Wales, Australia
| | - Charitha de Silva
- School of Mechanical and Manufacturing Engineering, UNSW Sydney, New South Wales, Australia
| | - Abrar Ahmad Chughtai
- School of Public Health and Community Medicine, UNSW Sydney, New South Wales, Australia
| | - Lydia Bourouiba
- The Fluid Dynamics of Disease Transmission Laboratory, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - C Raina MacIntyre
- The Kirby Institute, UNSW Sydney, New South Wales, Australia
- College of Public Service & Community Solutions, and College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
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Moa A, Tan T, Wei J, Hutchinson D, MacIntyre CR. Burden of influenza in adults with cardiac arrest admissions in Australia. Int J Cardiol 2022; 361:109-115. [PMID: 35490787 DOI: 10.1016/j.ijcard.2022.04.069] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/06/2022] [Accepted: 04/26/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cardiac arrest is the least preventable burden of cardiovascular disease, as treatment depends on timely resuscitation. The incidence of sudden cardiac arrest (SCA) is high, contributing 10-20% of cardiovascular mortality globally. The influenza vaccine reduces the risk of acute cardiovascular events. Little is known about the relationship of influenza infection to cardiac arrest. METHODS This study aimed to determine the estimated rate of SCA hospitalisations attributable to influenza in Australian adults. A generalised-additive statistical model was applied in the study. Weekly counts of laboratory-confirmed influenza notifications were used as independent variables in the model. RESULTS Our estimates showed that the yearly rate of SCA hospitalisations varied, and a significant association with influenza was observed in some years in older adults aged 65 years and over. On average, the annual estimated SCA hospitalisations rate due to influenza in adults aged 50-64 years and ≥ 65 years were 0.7 (95%CI: 0.4, 1.1) and 5.3 (95%CI: 4.4, 6.2) per 100,000 population, respectively. CONCLUSION The association between influenza and SCA is evident in adults and the disease burden is significant in older people. Prevention of influenza by vaccination may reduce SCA.
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Affiliation(s)
- Aye Moa
- Biosecurity Research Program, The Kirby Institute, UNSW, Sydney, Australia.
| | - Timothy Tan
- School of Medical Science, UNSW, Sydney, Australia; Biosecurity Research Program, The Kirby Institute, UNSW, Sydney, Australia
| | - Jenny Wei
- Biosecurity Research Program, The Kirby Institute, UNSW, Sydney, Australia
| | | | - C Raina MacIntyre
- Biosecurity Research Program, The Kirby Institute, UNSW, Sydney, Australia; School of Public Affairs, College of Public Service and Community Solutions, Arizona State University, USA
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Li X, Ding P, Deng F, Mao Y, Zhou L, Ding C, Wang Y, Luo Y, Zhou Y, MacIntyre CR, Tang S, Xu D, Shi X. Wearing time and respiratory volume affect the filtration efficiency of masks against aerosols at different sizes. Environ Technol Innov 2022; 25:102165. [PMID: 34926728 PMCID: PMC8665844 DOI: 10.1016/j.eti.2021.102165] [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] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/19/2021] [Accepted: 11/25/2021] [Indexed: 05/09/2023]
Abstract
Face masks are critical in preventing the spread of respiratory infections including coronavirus disease 2019 (COVID-19). Different types of masks have distinct filtration efficiencies (FEs) with differential costs and supplies. Here we reported the impact of breathing volume and wearing time on the inward and outward FEs of four different mask types (N95, surgical, single-use, and cloth masks) against various sizes of aerosols. Specifically, 1) Mask type was an important factor affecting the FEs. The FEs of N95 and surgical mask were better than those of single-use mask and cloth mask; 2) As particle size decreased, the FEs tended to reduce. The trend was significantly observed in FEs of aerosols with particle size < 1 μ m ; 3) After wearing N95 and surgical masks for 0, 2, 4, and 8 h, their FEs (%) maintained from 95.75 ± 0.09 to 100 ± 0 range. While a significant decrease in FEs were noticed for single-use masks worn for 8 h and cloth masks worn >2 h under deep breathing (30 L/min); 4) Both inward and outward FEs of N95 and surgical masks were similar, while the outward FEs of single-use and cloth masks were higher than their inward FEs; 5) The FEs under deep breathing was significantly lower than normal breathing with aerosol particle size <1 μ m. In conclusion, our results revealed that masks have a critical role in preventing the spread of aerosol particles by filtering inhalation, and FEs significantly decreased with the increasing of respiratory volume and wearing time. Deep breathing may cause increasing humidity and hence decrease FEs by increasing the airflow pressure. With the increase of wearing time, the adsorption capacity of the filter material tends to be saturated, which may reduce FEs. Findings may be used to provide information for policies regarding the proper use of masks for general public in current and future pandemics.
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Affiliation(s)
- Xia Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Pei Ding
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Fuchang Deng
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Yixin Mao
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Lin Zhou
- Dalian Center for Disease Control and Prevention, Dalian, Liaoning 116021, China
| | - Cheng Ding
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Youbin Wang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Yueyun Luo
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Yakun Zhou
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - C Raina MacIntyre
- The Kirby Institute, Faculty of Medicine, The University of New South Wales, Sydney, 2052, NSW, Australia
| | - Song Tang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China
| | - Dongqun Xu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Xiaoming Shi
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China
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Kunasekaran M, Quigley A, Rahman B, Chughtai AA, Heslop DJ, Poulos CJ, MacIntyre CR. Factors associated with SARS-COV-2 attack rates in aged care– a meta-analysis. Open Forum Infect Dis 2022; 9:ofac033. [PMID: 35194554 PMCID: PMC8807324 DOI: 10.1093/ofid/ofac033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/12/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has resulted in significant morbidity and mortality in aged-care facilities worldwide. The attention of infection control in aged care needs to shift towards the built environment, especially in relation to using the existing space to allow social distancing and isolation. Physical infrastructure of aged care facilities has been shown to present challenges to the implementation of isolation procedures. To explore the relationship of the physical layout of aged care facilities with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) attack rates among residents, a meta-analysis was conducted. Methods Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P), studies were identified from 5 databases using a registered search strategy with PROSPERO. Meta-analysis for pooled attack rates of SARS-CoV-2 in residents and staff was conducted, with subgroup analysis for physical layout variables such as total number of beds, single rooms, number of floors, number of buildings in the facility, and staff per 100 beds. Results We included 41 articles across 11 countries, reporting on 90 657 residents and 6521 staff in 757 facilities. The overall pooled attack rate was 42.0% among residents (95% CI, 38.0%–47.0%) and 21.7% in staff (95% CI, 15.0%–28.4%). Attack rates in residents were significantly higher in single-site facilities with standalone buildings than facilities with smaller, detached buildings. Staff-to-bed ratio significantly explains some of the heterogeneity of the attack rate between studies. Conclusions The design of aged care facilities should be smaller in size, with adequate space for social distancing.
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Affiliation(s)
- Mohana Kunasekaran
- Biosecurity Program, Kirby Institute, The University of New South Wales Sydney, New South Wales, Australia
| | - Ashley Quigley
- Biosecurity Program, Kirby Institute, The University of New South Wales Sydney, New South Wales, Australia
| | - Bayzidur Rahman
- Biosecurity Program, Kirby Institute, The University of New South Wales Sydney, New South Wales, Australia
- School of Medicine, The University of Notre Dame, Australia
| | - Abrar A Chughtai
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia
| | - David J Heslop
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia
| | - Christopher J Poulos
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia
- HammondCare, Sydney, New South Wales, Australia
| | - C Raina MacIntyre
- Biosecurity Program, Kirby Institute, The University of New South Wales Sydney, New South Wales, Australia
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Body A, Ahern E, Lal L, Gillett K, Abdulla H, Opat S, O'Brien T, Downie P, Turville S, Munier CML, Smith C, MacIntyre CR, Segelov E. Protocol for SARS-CoV-2 post-vaccine surveillance study in Australian adults and children with cancer: an observational study of safety and serological and immunological response to SARS-CoV-2 vaccination (SerOzNET). BMC Infect Dis 2022; 22:70. [PMID: 35057745 PMCID: PMC8771167 DOI: 10.1186/s12879-021-07019-1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer is associated with excess morbidity and mortality from coronavirus disease 2019 (COVID-19) following infection by the novel pandemic coronavirus SARS-CoV-2. Vaccinations against SARS-CoV-2 have been rapidly developed and proved highly effective in reducing the incidence of severe COVID-19 in clinical trials of healthy populations. However, patients with cancer were excluded from pivotal clinical trials. Early data suggest that vaccine response is less robust in patients with immunosuppressive conditions or treatments, while toxicity and acceptability of COVID-19 vaccines in the cancer population is unknown. Unanswered questions remain about the impact of various cancer characteristics (such as treatment modality and degree of immunosuppression) on serological response to and safety of COVID-19 vaccinations. Furthermore, as the virus and disease manifestations evolve, ongoing data is required to address the impact of new variants. METHODS SerOzNET is a prospective observational study of adults and children with cancer undergoing routine SARS-CoV-2 vaccination in Australia. Peripheral blood will be collected and processed at five timepoints (one pre-vaccination and four post-vaccination) for analysis of serologic responses to vaccine and exploration of T-cell immune correlates. Cohorts include: solid organ cancer (SOC) or haematological malignancy (HM) patients currently receiving (1) chemotherapy, (2) immune checkpoint inhibitors (3) hormonal or targeted therapy; (4) patients who completed chemotherapy within 6-12 months of vaccination; (5) HM patients with conditions associated with hypogammaglobulinaemia or immunocompromise; (6) SOC or HM patients with allergy to PEG or polysorbate 80. Data from healthy controls already enrolled on several parallel studies with comparable time points will be used for comparison. For children, patients with current or prior cancer who have not received recent systemic therapy will act as controls. Standardised scales for quality-of-life assessment, patient-reported toxicity and vaccine hesitancy will be obtained. DISCUSSION The SerOzNET study was commenced in June 2021 to prospectively study immune correlates of vaccination in specific cancer cohorts. The high proportion of the Australian population naïve to COVID-19 infection and vaccination at study commencement has allowed a unique window of opportunity to study vaccine-related immunity. Quality of life and patient-reported adverse events have not yet been reported in detail post-vaccination for cancer patients. Trial registration This trial is registered on the Australia New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621001004853. Submitted for registration 25 June 2021. Registered 30 July 2021 (Retrospectively registered). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382281&isReview=true.
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Affiliation(s)
- Amy Body
- Level 7, Monash Health Translational Precinct, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia.
- Monash University, Clayton, Melbourne, VIC, 3168, Australia.
| | - Elizabeth Ahern
- Level 7, Monash Health Translational Precinct, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia
- Monash University, Clayton, Melbourne, VIC, 3168, Australia
| | - Luxi Lal
- Level 7, Monash Health Translational Precinct, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia
- Monash University, Clayton, Melbourne, VIC, 3168, Australia
| | - Karen Gillett
- Level 7, Monash Health Translational Precinct, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia
| | - Hesham Abdulla
- Level 7, Monash Health Translational Precinct, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia
| | - Stephen Opat
- Level 7, Monash Health Translational Precinct, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia
- Monash University, Clayton, Melbourne, VIC, 3168, Australia
| | - Tracey O'Brien
- Kids Cancer Centre, Sydney Children's Hospital', Randwick, NSW, 2031, Australia
- School of Women's & Children's Health, Faculty of Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Peter Downie
- Children's Cancer Centre, Monash Children's Hospital, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia
| | - Stuart Turville
- Immunovirology and Pathogenesis Program, The Kirby Institute, University of New South Wales, Kensington, Sydney NSW, 2052, Australia
| | - C Mee Ling Munier
- Immunovirology and Pathogenesis Program, The Kirby Institute, University of New South Wales, Kensington, Sydney NSW, 2052, Australia
| | - Corey Smith
- QIMR Berghofer Centre for Immunotherapy and Vaccine Development and Translational and Human Immunology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - C Raina MacIntyre
- The Kirby Institute, University of New South Wales, Kensington, Sydney NSW, 2052, Australia
| | - Eva Segelov
- Level 7, Monash Health Translational Precinct, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia
- Monash University, Clayton, Melbourne, VIC, 3168, Australia
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Hanly MJ, Churches T, Fitzgerald O, Post JJ, MacIntyre CR, Jorm L. The impact of re-opening the international border on COVID-19 hospitalisations in Australia: a modelling study. Med J Aust 2022; 216:39-42. [PMID: 34633100 PMCID: PMC8662022 DOI: 10.5694/mja2.51291] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To estimate the numbers of COVID-19-related hospitalisations in Australia after re-opening the international border. DESIGN Population-level deterministic compartmental epidemic modelling of eight scenarios applying various assumptions regarding SARS-CoV-2 transmissibility (baseline R0 = 3.5 or 7.0), vaccine rollout speed (slow or fast), and scale of border re-opening (mean of 2500 or 13 000 overseas arrivals per day). SETTING Simulation population size, age structure, and age-based contact rates based on recent estimates for the Australian population. We assumed that 80% vaccination coverage of people aged 16 years or more was reached in mid-October 2021 (fast rollout) or early January 2022 (slow rollout). MAIN OUTCOME MEASURES Numbers of people admitted to hospital with COVID-19, December 2021 - December 2022. RESULTS In scenarios assuming a highly transmissible SARS-CoV-2 variant (R0 = 7.0), opening the international border on either scale was followed by surges in both infections and hospitalisations that would require public health measures beyond mask wearing and social distancing to avoid overwhelming the health system. Reducing the number of hospitalisations to manageable levels required several cycles of additional social and mobility restrictions. CONCLUSIONS If highly transmissible SARS-CoV-2 variants are circulating locally or overseas, large and disruptive COVID-19 outbreaks will still be possible in Australia after 80% of people aged 16 years or more have been vaccinated. Continuing public health measures to restrict the spread of disease are likely to be necessary throughout 2022.
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Affiliation(s)
- Mark J Hanly
- Centre for Big Data Research in HealthUniversity of New South WalesSydneyNSW
| | - Timothy Churches
- South Western Sydney Clinical SchoolUniversity of New South WalesSydneyNSW
- Ingham Institute for Applied Medical ResearchSydneyNSW
| | - Oisin Fitzgerald
- Centre for Big Data Research in HealthUniversity of New South WalesSydneyNSW
| | - Jeffrey J Post
- Prince of Wales HospitalSydneyNSW
- Prince of Wales Clinical SchoolUniversity of New South WalesSydneyNSW
| | | | - Louisa Jorm
- Centre for Big Data Research in HealthUniversity of New South WalesSydneyNSW
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Trent MJ, Salmon DA, MacIntyre CR. Predictors of pneumococcal vaccination among Australian adults at high risk of pneumococcal disease. Vaccine 2022; 40:1152-1161. [DOI: 10.1016/j.vaccine.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/04/2022] [Accepted: 01/08/2022] [Indexed: 01/31/2023]
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Quigley A, Stone H, Nguyen PY, Chughtai AA, MacIntyre CR. COVID-19 outbreaks in aged-care facilities in Australia. Influenza Other Respir Viruses 2021; 16:429-437. [PMID: 34866321 PMCID: PMC8983895 DOI: 10.1111/irv.12942] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/07/2021] [Indexed: 11/27/2022] Open
Abstract
Background Aged‐care facilities (ACF’s) provide unique challenges when implementing infection control methods for respiratory outbreaks such as COVID‐19. Research on this highly vulnerable setting is lacking and there was no national reporting data of COVID‐19 cases in ACFs in Australia early in the pandemic. We aimed to estimate the burden of aged‐care worker (ACW) infections and outbreaks of COVID‐19 in Australian aged‐care. Methods A line list of publicly available aged‐care related COVID‐19 reported cases from January 25 to June 10, 2020 was created and was enhanced by matching data extracted from media reports of aged‐care related COVID‐19 relevant outbreaks and reports. Rate ratios (RR) were used to predict risk of infection in ACW and aged‐care residents, and were calculated independently, by comparing overall cases to ACW and aged‐care residents' cases. Results A total of 14 ACFs with COVID‐19 cases were recorded by June 2020 nationwide, with a high case fatality rate (CFR) of 50% (n = 34) and 100% (n = 3) seen in two ACFs. Analysis on the resident risk found that the COVID‐19 risk is 1.27 times higher (unadjusted RR 1.27 95% confidence interval [CI] 1.00 to1.61; P = 0.047) as compared with the risk of infection in the general population. In over 60% of cases identified in ACFs, the source of infection in the index case was unknown. A total of 28 deaths associated within ACFs were reported, accounting for 54.9% of total deaths in New South Wales and 26.9% of total deaths in Australia. Conclusions This high‐risk population requires additional prevention and control measures, such as routine testing of all staff and patients regardless of symptoms. Prompt isolation and quarantine as soon as a case is confirmed within a facility is essential.
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Affiliation(s)
- Ashley Quigley
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Haley Stone
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Phi Yen Nguyen
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Abrar Ahmad Chughtai
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - C Raina MacIntyre
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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MacIntyre CR, Heslop DJ, Nguyen P, Adam D, Trent M, Gerber BJ. Pacific Eclipse - A tabletop exercise on smallpox pandemic response. Vaccine 2021; 40:2478-2483. [PMID: 34865873 DOI: 10.1016/j.vaccine.2021.10.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 10/19/2021] [Accepted: 10/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND In December 2019, we ran Pacific Eclipse, a pandemic tabletop exercise using smallpox originating in Fiji as a case study. Pacific Eclipse brought together international stakeholders from health, defence, law enforcement, emergency management and a range of other organisations. AIM To review potential gaps in preparedness and identify modifiable factors which could prevent a pandemic or mitigate the impact of a pandemic. METHODS Pacific Eclipse was held on December 9-10 in Washington DC, Phoenix and Honolulu simultaneously. The scenario began in Fiji and becomes a pandemic. Mathematical modelling of smallpox transmission was used to simulate the epidemic under different conditions and to test the effect of interventions. Live polling, using Poll Everywhere software that participants downloaded onto their smart phones, was used to gather participant decisions as the scenario unfolded. Stakeholders from state and federal government and non-government organisations from The United States, The United Kingdom, Australia, New Zealand, Canada, as well as industry and non-government organisations attended. RESULTS The scenario progressed in three phases and participants were able to make decisions during each phase using live polling. The polling showed very diverse and sometimes conflicting decision making. Factors influential to pandemic severity were identified and categorised as modifiable or unmodifiable. A series of recommendations were made on the modifiable determinants of pandemic severity and how these can be incorporated into pandemic planning. These included preventing an attack through intelligence, law enforcement and legislation, improved speed of diagnosis, speed and completeness of case finding and case isolation, speed and security of vaccination response (including stockpiling), speed and completeness of contact tracing, protecting critical infrastructure and business continuity, non-pharmaceutical interventions (social distancing, PPE, border control) and protecting first responders. DISCUSSION Pacific Eclipse illustrated the impact of a pandemic of smallpox under different response scenarios, which were validated to some extent by the COVID-19 pandemic. The framework developed from the scenario draws out modifiable determinants of pandemic severity which can inform pandemic planning for the ongoing COVID-19 pandemic and for future pandemics.
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Affiliation(s)
- C Raina MacIntyre
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, Australia
| | - David J Heslop
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Phi Nguyen
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, Australia
| | | | - Mallory Trent
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, Australia.
| | - Brian J Gerber
- Watts College of Public Service and Community Solutions, Arizona State University, United States
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Abstract
Yi Zhang and colleagues call for continued use of non-pharmaceutical interventions to control covid-19 during and after vaccine roll outs
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Affiliation(s)
- Yi Zhang
- Institute for Infectious Disease and Endemic Disease Control, Beijing Centre for Disease Prevention and Control and Beijing Research Centre for Preventive Medicine, Beijing, 100013, China
| | - Ashley Quigley
- Biosecurity Program, Kirby Institute, University of New South Wales, Kensington NSW 2052, Australia
| | - Quanyi Wang
- Institute for Infectious Disease and Endemic Disease Control, Beijing Centre for Disease Prevention and Control and Beijing Research Centre for Preventive Medicine, Beijing, 100013, China
| | - C Raina MacIntyre
- Biosecurity Program, Kirby Institute, University of New South Wales, Kensington NSW 2052, Australia
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40
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Bahl P, de Silva C, MacIntyre CR, Bhattacharjee S, Chughtai AA, Doolan C. Flow dynamics of droplets expelled during sneezing. Phys Fluids (1994) 2021; 33:111901. [PMID: 34803362 PMCID: PMC8597717 DOI: 10.1063/5.0067609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/09/2021] [Indexed: 05/15/2023]
Abstract
Respiratory infections transmit through droplets and aerosols generated by the infected individual during respiratory emissions. It is essential to study the flow dynamics of these emissions to develop strategies for mitigating the risk of infection. In particular, the dynamics of droplets expelled during violent exhalations such as sneezing is crucial, but has received little attention to date. Here, for the first time, we present the results of droplet dynamics of 35 sneezes, obtained from four volunteers, using particle tracking velocimetry experiments. Our results reveal a mean droplet velocity of 2-5.4 m/s across the different subjects. These values are significantly lower than what is usually assumed in the studies simulating or replicating sneezes. Furthermore, the large variation in droplet speeds, flow direction, spread angle, and head movement is also quantified. These findings will enable the refinement of models and simulations of sneezes toward improving infection control guidelines.
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Affiliation(s)
- Prateek Bahl
- School of Mechanical and Manufacturing Engineering, UNSW Sydney, Kensington NSW 2052, Australia
| | - Charitha de Silva
- School of Mechanical and Manufacturing Engineering, UNSW Sydney, Kensington NSW 2052, Australia
| | - C. Raina MacIntyre
- Biosecurity Program, The Kirby Institute, UNSW Sydney, Kensington, NSW 2052, Australia
| | - Shovon Bhattacharjee
- Biosecurity Program, The Kirby Institute, UNSW Sydney, Kensington, NSW 2052, Australia
| | | | - Con Doolan
- School of Mechanical and Manufacturing Engineering, UNSW Sydney, Kensington NSW 2052, Australia
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41
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Raina MacIntyre C, Costantino V, Chanmugam A. The use of face masks during vaccine roll-out in New YorkCity and impact on epidemic control. Vaccine 2021; 39:6296-6301. [PMID: 34538699 PMCID: PMC8443976 DOI: 10.1016/j.vaccine.2021.08.102] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/23/2021] [Accepted: 08/30/2021] [Indexed: 12/21/2022]
Abstract
Face masks were mandated in New York during the first wave in 2020, and in 2021 the first vaccine programs have commenced. We aimed to examine the impact of face mask and other NPIs use with a gradual roll out of vaccines in NYC on the epidemic trajectory. A SEIR mathematical model of SARS-CoV-2 transmission was developed for New York City (NYC), which accounted for decreased mobility for lockdown, testing and tracing. Varied mask’s usage and efficacy were tested, along with a gradual increase in vaccine uptake over five months. The model has been calibrated using notification data in NYC from March first to June 29. Masks and other NPIs result in immediate impact on the epidemic, while vaccination has a delayed impact, especially when implemented over a long period of time. A pre-emptive, early mandate for masks is more effective than late mask use, but even late mask mandates will reduce cases and deaths by over 20%. The epidemic curve is suppressed by at least 50% of people wearing a mask from the start of the outbreak but surges when mask wearing drops to 30% or less. With a slow roll out of vaccines over five months at uptake levels of 20–70%, NPIs use will still be needed and has a greater impact on epidemic control. When vaccine roll out is slow or partial in cities experiencing local transmission of COVID-19, masks and other NPIs will be necessary to mitigate transmission until vaccine coverage is high and complete. Vaccine alone cannot rapidly control an epidemic because of the time lag to two-dose immunity. Even after high coverage, the ongoing need for NPIs is unknown and will depend on long-term duration of vaccine efficacy, the use of boosters and optimized dosage scheduling and variants of concern.
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Affiliation(s)
- C Raina MacIntyre
- The Biosecurity Program, The Kirby Institute, University of New South Wales, Australia; College of Health Solutions, Arizona State University, AZ, USA; Watts College of Public Affairs and Community Solutions, Arizona State University, AZ, USA
| | - Valentina Costantino
- The Biosecurity Program, The Kirby Institute, University of New South Wales, Australia.
| | - Arjun Chanmugam
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MND, USA
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42
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Flanagan KL, MacIntyre CR, McIntyre PB, Nelson MR. SARS-CoV-2 Vaccines: Where Are We Now? J Allergy Clin Immunol Pract 2021; 9:3535-3543. [PMID: 34400116 PMCID: PMC8363243 DOI: 10.1016/j.jaip.2021.07.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 12/20/2022]
Abstract
The best and safest way to control the coronavirus disease 2019 (COVID-19) pandemic is by using vaccination to generate widespread immunity. The urgent need to develop safe and effective COVID-19 vaccines was met with unprecedented speed and action from the global community. There are now 289 vaccines in the development pipeline. More remarkably, there are 20 publicly available vaccines, and more than 3.3 billion doses of COVID-19 vaccines have been administered across 180 countries. This is just the beginning of our fight against the pandemic. Even at the current vaccination rate, it could take years to vaccinate the world's population; many high-income countries are focusing on their needs, whereas the poorer nations are waiting for vaccines. There is still much that we do not understand about immunity to this new disease, and we will have to contend with the emerging variants. In this commentary, we describe the current status of COVID-19 vaccine development and provide insights into how the development and approvals happened so quickly. We discuss the clinical trial data that led to rapid emergency use authorization and the many challenges of global rollout. We also comment on some of the key unanswered questions and future directions for COVID-19 vaccine development and deployment.
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Affiliation(s)
- Katie L Flanagan
- Tasmanian Vaccine Trial Centre, Clifford Craig Foundation, Launceston General Hospital, Launceston, Tas, Australia; School of Medicine, University of Tasmania, Launceston, Tas, Australia; School of Health and Biomedical Science, RMIT University, Bundoora, Vic, Australia; Department of Immunology and Pathology, Monash University, Melbourne, Vic, Australia.
| | - C Raina MacIntyre
- Biosecurity Research Program, Kirby Institute, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Peter B McIntyre
- Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Michael R Nelson
- Division of Asthma, Allergy and Immunology, University of Virginia, Charlottesville, Va
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43
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Moa AM, Menzies RI, Yin JK, MacIntyre CR. Modelling the influenza disease burden in people aged 50-64 and ≥65 years in Australia. Influenza Other Respir Viruses 2021; 16:132-141. [PMID: 34586749 PMCID: PMC8692809 DOI: 10.1111/irv.12902] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/12/2021] [Accepted: 08/15/2021] [Indexed: 11/30/2022] Open
Abstract
Background Estimation of influenza disease burden is necessary to monitor the impact of intervention programmes. This study aims to estimate the attributable fraction of respiratory and circulatory disease due to influenza among Australian adults 50–64 and ≥65 years of age. Methods A semi‐parametric generalised‐additive model was used to estimate annual and average rate of influenza‐attributable hospitalisation and death per 100,000 population under the principal diagnosis of influenza/pneumonia, respiratory, circulatory and myocardial infarction (MI) from 2001 through 2017. Results Over the study period, seasonal influenza accounted for an estimated annual average respiratory hospitalisation rate of 78.9 (95%CI: 76.3, 81.4) and 287.5 (95%CI: 279.8, 295.3) per 100,000 population in adults aged 50–64 and ≥65 years, respectively. The corresponding respiratory mortality rates were 0.9 (95%CI: 0.7, 1.2) and 18.2 (95%CI: 16.9, 19.4) per 100,000 population. The 2017 season had the highest influenza‐attributable respiratory hospitalisations in both age groups, and respiratory complications were estimated approximately 2.5 times higher than the average annual estimate in adults aged ≥65 years in 2017. For mortality, on average, influenza attributed 1,080 circulatory and 361 MI deaths in adults aged ≥65 years per year. Influenza accounted for 1% and 2.8% of total MI deaths in adults aged 50–64 and ≥65 years, respectively. Conclusion Rates of cardiorespiratory morbidity and mortality were high in older adults, whilst the younger age group contributed a lower disease burden. Extension of influenza vaccination programme beyond the targeted population could be an alternative strategy to reduce the burden of influenza.
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Affiliation(s)
- Aye M Moa
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Robert I Menzies
- Medical, Sanofi Pasteur Australia and New Zealand, Sydney, New South Wales, Australia
| | - J Kevin Yin
- Medical Department of Global Influenza Franchise, Sanofi Pasteur, Singapore.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - C Raina MacIntyre
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
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Van Buynder PG, Newbound A, MacIntyre CR, Kennedy AT, Clarke C, Anderson J. Australian experience of the SH21 flu vaccination program during the COVID-19 vaccine program. Hum Vaccin Immunother 2021; 17:4611-4616. [PMID: 34542384 PMCID: PMC8828056 DOI: 10.1080/21645515.2021.1967042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
| | | | - C Raina MacIntyre
- Biosecurity Research Program, The Kirby Institute, University of New South Wales, Sydney, Australia
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45
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Trent MJ, Salmon DA, MacIntyre CR. Using the health belief model to identify barriers to seasonal influenza vaccination among Australian adults in 2019. Influenza Other Respir Viruses 2021; 15:678-687. [PMID: 33586871 PMCID: PMC8404057 DOI: 10.1111/irv.12843] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 12/03/2020] [Revised: 01/03/2021] [Accepted: 01/12/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Each year tens of thousands of Australians become ill with influenza, resulting in thousands of severe infections that require hospitalisation. However, only 40% of adults receive the annual influenza vaccine. We surveyed Australian adults to provide up to date, population-specific data on the predictors and barriers of seasonal influenza vaccination. METHODS We administered an online survey to a nationally representative sample of Australian adults. We designed survey questions using the theoretical constructs of the health belief model. Using simple and multivariable Poisson regression, we identified attitudes and beliefs associated with influenza vaccination in 2019. RESULTS Among 1,444 respondents, 51.7% self-reported influenza vaccination in 2019. We estimated vaccine coverage to be 44% for adults under 45, 46% for adults aged 45 to 64 and 77% for adults aged 65 and over. The strongest individual predictors of self-reported vaccination were believing the vaccine is effective at preventing influenza (APR = 3.71; 95% CI = 2.87-4.80), followed by recalling their doctor recommending the vaccine (APR = 2.70; 95% CI = 2.31-3.16). Common perceived barriers that predicted self-reported vaccination included believing the vaccine could give you influenza (APR = 0.59; 95% CI = 0.52-0.67), believing the vaccine can make you ill afterwards (APR = 0.68; 95% CI = 0.62-0.74) and preferring to develop immunity "naturally" (APR = 0.38; 95% CI = 0.32-0.45). CONCLUSION Although vaccine uptake in 2019 appears to be higher than previous years, there are perceived barriers which may limit uptake among Australians. Tailored interventions are needed to combat widespread influenza vaccine hesitancy, particularly among high-risk groups.
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Affiliation(s)
- Mallory J. Trent
- Biosecurity ProgramThe Kirby InstituteUniversity of New South WalesSydneyNSWAustralia
| | - Daniel A. Salmon
- Departments of International Health and Health, Behavior and SocietyInstitute for Vaccine SafetyBloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMDUSA
| | - C. Raina MacIntyre
- Biosecurity ProgramThe Kirby InstituteUniversity of New South WalesSydneyNSWAustralia
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46
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MacIntyre CR, Nguyen PY, Trent M, Seale H, Chughtai AA, Shah S, Marks GB. Adverse Health Effects in People with and without Preexisting Respiratory Conditions during Bushfire Smoke Exposure in the 2019/2020 Australian Summer. Am J Respir Crit Care Med 2021; 204:368-371. [PMID: 33975534 PMCID: PMC8577279 DOI: 10.1164/rccm.202012-4471le] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 11/16/2022] Open
Affiliation(s)
- C. Raina MacIntyre
- The Kirby Institute at University of New South WalesSydney, New South Wales, Australia
- Arizona State University College of Public Affairsand Community SolutionsPhoenix, Arizona
| | - Phi-Yen Nguyen
- The Kirby Institute at University of New South WalesSydney, New South Wales, Australia
- University of New South Wales School of Population HealthSydney, New South Wales, Australia
| | - Mallory Trent
- The Kirby Institute at University of New South WalesSydney, New South Wales, Australia
| | - Holly Seale
- University of New South Wales School of Population HealthSydney, New South Wales, Australia
| | - Abrar Ahmad Chughtai
- University of New South Wales School of Population HealthSydney, New South Wales, Australia
| | - Smita Shah
- Western Sydney Local Health DistrictPrevention Education and Research UnitWestmead, New South Wales, Australia
- The University of Sydney Faculty of Medicine and HealthSydney, New South Wales, Australia
| | - Guy B. Marks
- Woolcock Institute of Medical ResearchGlebe, New South Wales, Australia
- University of New South Wales South Western Sydney Clinical SchoolLiverpool, New South Wales, Australia
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47
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Wark PA, MacIntyre CR, Bell S, Oliver B, Marks GB. We are not doing enough to prevent the spread of COVID-19 and other respiratory viruses in Australian hospitals. Med J Aust 2021; 215:152-153.e1. [PMID: 34291464 PMCID: PMC8447400 DOI: 10.5694/mja2.51183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Peter Ab Wark
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW
| | | | - Scott Bell
- QIMR Berghofer Medical Research Institute, Brisbane, QLD.,Adult Cystic Fibrosis Centre, Prince Charles Hospital, Brisbane, QLD
| | - Brian Oliver
- Respiratory Research Group, University of Technology Sydney, Sydney, NSW
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48
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Quigley AL, Stone H, Yen Nguyen P, Chughtai AA, Raina MacIntyre C. Erratum to "Estimating the burden of COVID-19 on the Australian healthcare workers and health system during the first six months of the pandemic" [International Journal of Nursing Studies, 114 (2021), 103811]. Int J Nurs Stud 2021; 121:104031. [PMID: 34301404 PMCID: PMC8292107 DOI: 10.1016/j.ijnurstu.2021.104031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Ashley L Quigley
- Biosecurity Research Program, The Kirby Institute, UNSW, Wallace Wurth Building, High St, Kensington Campus, NSW 2052, Australia.
| | - Haley Stone
- School of Public Health and Community Medicine, UNSW, Wallace Wurth Building, High St, Kensington Campus, NSW 2052, Australia
| | - Phi Yen Nguyen
- School of Public Health and Community Medicine, UNSW, Wallace Wurth Building, High St, Kensington Campus, NSW 2052, Australia
| | - Abrar Ahmad Chughtai
- International Health, UNSW, Samuels Building, F25, Samuel Terry Ave, UNSW, High St, Kensington Campus, NSW 2052, Australia
| | - C Raina MacIntyre
- Biosecurity Research Program, The Kirby Institute, UNSW, Wallace Wurth Building, High St, Kensington Campus, NSW 2052, Australia
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49
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Hanly M, Churches T, Fitzgerald O, MacIntyre CR, Jorm L. Vaccinating Australia: How long will it take? Vaccine 2021; 40:2491-2497. [PMID: 34284875 PMCID: PMC8285754 DOI: 10.1016/j.vaccine.2021.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/16/2021] [Accepted: 07/06/2021] [Indexed: 02/08/2023]
Abstract
The Australian Government began to roll out the national COVID-19 vaccination program in late February 2021, with the initial aim to vaccinate the Australian adult population by the end of October 2021. The task of vaccinating some 20 million people presents considerable logistic challenges, but a rapid rollout is essential to allow for the reopening of borders and is especially urgent as new more transmissible variants arise. Here, we run a series of projections to estimate how long it will take to vaccinate the Australian population under different assumptions about the rate of vaccine administration, the schedule for vaccine eligibility and prevalence of vaccine hesitancy. Our analysis highlights the number of vaccine doses that can be administered per day as the key factor determining the duration of the vaccine rollout. A rate of 200,000 doses per day would achieve 90% population coverage by the end of 2021; 80,000 doses a day would see the rollout extended until mid-2023. Vaccine hesitancy has the potential to greatly slow down the rollout and becomes the main limiting factor when the supply of vaccine doses is high. Speed is of the essence when it comes vaccinating populations against COVID-19: a rapid rollout will minimise the risk of sporadic and costly lockdowns and the potential for small, local clusters getting out of control and sparking new epidemic waves. In order to achieve rapid population coverage, the Australian government must ramp up vaccine administration to at least 200,000 doses per day as quickly as possible, while also promoting vaccine willingness in the community through clear public health messaging, especially to known hesitant demographics.
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Affiliation(s)
- Mark Hanly
- Centre for Big Data Research in Health, UNSW Sydney, Australia.
| | - Timothy Churches
- South Western Sydney Clinical School, Faculty of Medicine & Health, UNSW Sydney & Ingham Institute for Applied Medical Research, Australia.
| | | | - C Raina MacIntyre
- Biosecurity Research Program, The Kirby Institute UNSW Sydney, Australia.
| | - Louisa Jorm
- Centre for Big Data Research in Health, UNSW Sydney, Australia.
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Li X, Wang Q, Ding P, Cha Y, Mao Y, Ding C, Gu W, Wang Y, Ying B, Zhao X, Pan L, Li Y, Chang J, Meng C, Zhou J, Tang Z, Sun R, Deng F, Wang C, Li L, Wang J, MacIntyre CR, Wu Z, Feng Z, Tang S, Xu D. Risk factors and on-site simulation of environmental transmission of SARS-CoV-2 in the largest wholesale market of Beijing, China. Sci Total Environ 2021; 778:146040. [PMID: 33711597 PMCID: PMC7921786 DOI: 10.1016/j.scitotenv.2021.146040] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 10/20/2020] [Revised: 01/13/2021] [Accepted: 02/18/2021] [Indexed: 05/03/2023]
Abstract
From June 11, 2020, a surge in new cases of coronavirus disease 2019 (COVID-19) in the largest wholesale market of Beijing, the Xinfadi Market, leading to a second wave of COVID-19 in Beijing, China. Understanding the transmission modes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the personal behaviors and environmental factors contributing to viral transmission is of utmost important to curb COVID-19 rise. However, currently these are largely unknown in food markets. To this end, we completed field investigations and on-site simulations in areas with relatively high infection rates of COVID-19 at Xinfadi Market. We found that if goods were tainted or personnel in market was infected, normal transaction behaviors between sellers and customers, daily physiological activities, and marketing activities could lead to viral contamination and spread to the surroundings via fomite, droplet or aerosol routes. Environmental factors such as low temperature and high humidity, poor ventilation, and insufficient hygiene facilities and disinfection practices may contribute to viral transmission in Xinfadi Market. In addition, precautionary control strategies were also proposed to effectively reduce the clustering cases of COVID-19 in large-scale wholesale markets.
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Affiliation(s)
- Xia Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Qin Wang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Pei Ding
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Yu'e Cha
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Yixin Mao
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Cheng Ding
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Wen Gu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Youbin Wang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Bo Ying
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Xiaoning Zhao
- Section of Ecological Environment & Energy Resources, Beijing Institute of Metrology, Beijing 100012, China
| | - Lijun Pan
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Yunpu Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Junrui Chang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Congshen Meng
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Jun Zhou
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Zhigang Tang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Ruofeng Sun
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Fuchang Deng
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Chong Wang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Li Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Jiao Wang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - C Raina MacIntyre
- Kirby Institute, Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Zunyou Wu
- Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Zijian Feng
- Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Song Tang
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China.
| | - Dongqun Xu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China.
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