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Holland C, Baker M, Bates A, Hughes C, Richmond PC, Carlson S, Moore HC. Parental awareness and attitudes towards prevention of respiratory syncytial virus in infants and young children in Australia. Acta Paediatr 2024; 113:786-794. [PMID: 38299226 DOI: 10.1111/apa.17127] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/07/2023] [Accepted: 01/17/2024] [Indexed: 02/02/2024]
Abstract
AIM To assess parental awareness of respiratory syncytial virus (RSV) and the level of acceptance of future RSV prevention strategies. METHODS A cross-sectional online survey was implemented targeting "future" and "current" parents of children aged ≤5 years in Australia. RESULTS From 1992 eligible participants, two non-mutually exclusive subgroups were formed: "current" parents (N = 1931) and "pregnant/planning" parents (N = 464: 403 also "current" parents and 61 "future" parents). Participants were predominantly (86.6%) aged 25-39 years and 68.5% with university education. The majority (89.6% current; 78.7% future) had heard of RSV. Of those, 64.2% (current) and 50.0% (future) were aware that pneumonia is associated with RSV; 71.8% (current) and 52.1% (future) were aware that bronchiolitis is associated with RSV. In multivariable logistic regression analyses, Australian-born parents (aOR = 2.47 [95% CI: 1.48-4.12]), living in the eastern states (e.g., New South Wales: aOR = 6.15 [95% CI:2.10-18.04]), with a university-level education (aOR = 2.61 [95% CI:1.38-4.94]) and being a current parent (aOR = 12.26 [95% CI:2.82-53.28]) were associated with higher RSV awareness. There was a high level of acceptance for maternal vaccines (future: 79.3%) and infant immunisation (all: 81.7%). CONCLUSION While RSV awareness and immunisation acceptance were high, there was limited knowledge of severity of RSV, especially in future parents. Education campaigns need to be developed to increase RSV knowledge.
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Affiliation(s)
- Charlie Holland
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Megan Baker
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Amber Bates
- Tiny Sparks Western Australia, Perth, Western Australia, Australia
| | - Catherine Hughes
- The Immunisation Foundation of Australia, Sydney, New South Wales, Australia
| | - Peter C Richmond
- Discipline of Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Vaccine Trials Group, Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- Perth Children's Hospital, Child and Adolescent Health Service, Perth, Western Australia, Australia
- Department of Immunology, Perth Children's Hospital, Child and Adolescent Health Service, Perth, Western Australia, Australia
| | - Samantha Carlson
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- School of Social Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Hannah C Moore
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
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McHugh L, D'Antoine HA, Sarna M, Binks MJ, Moore HC, Andrews RM, Pereira GF, Blyth CC, Van Buynder P, Lust K, Regan AK. The effectiveness of maternal pertussis vaccination for protecting Aboriginal and Torres Strait Islander infants against infection, 2012-2017: a retrospective cohort study. Med J Aust 2024; 220:196-201. [PMID: 38353124 DOI: 10.5694/mja2.52220] [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: 05/25/2023] [Accepted: 09/10/2023] [Indexed: 03/04/2024]
Abstract
OBJECTIVES To evaluate the effectiveness of maternal pertussis vaccination for preventing pertussis infections in Aboriginal and Torres Strait Islander infants under seven months of age. STUDY DESIGN Retrospective cohort study; analysis of linked administrative health data. SETTING, PARTICIPANTS Mother-infant cohort (Links2HealthierBubs) including all pregnant women who gave birth to live infants (gestational age ≥ 20 weeks, birthweight ≥ 400 g) in the Northern Territory, Queensland, and Western Australia during 1 January 2012 - 31 December 2017. MAIN OUTCOME MEASURES Proportions of women vaccinated against pertussis during pregnancy, rates of pertussis infections among infants under seven months of age, and estimated effectiveness of maternal vaccination for protecting infants against pertussis infection, each by Indigenous status. RESULTS Of the 19 892 Aboriginal and Torres Strait Islander women who gave birth to live infants during 2012-2017, 7398 (37.2%) received pertussis vaccine doses during their pregnancy, as had 137 034 of 259 526 non-Indigenous women (52.8%; Indigenous v non-Indigenous: adjusted odds ratio, 0.66; 95% confidence interval [CI], 0.62-0.70). The annual incidence of notified pertussis infections in non-Indigenous infants declined from 16.8 (95% CI, 9.9-29) in 2012 to 1.4 (95% CI, 0.3-8.0) cases per 10 000 births in 2017; among Aboriginal and Torres Strait Islander infants, it declined from 47.6 (95% CI, 16.2-139) to 38.6 (95% CI, 10.6-140) cases per 10 000 births. The effectiveness of maternal vaccination for protecting non-Indigenous infants under seven months of age against pertussis infection during 2014-17 was 68.2% (95% CI, 51.8-79.0%); protection of Aboriginal and Torres Strait Islander infants was not statistically significant (36.1%; 95% CI, -41.3% to 71.1%). CONCLUSIONS During 2015-17, maternal pertussis vaccination did not protect Aboriginal and Torres Strait Islander infants in the NT, Queensland, and WA against infection. Increasing the pertussis vaccination rate among pregnant Aboriginal and Torres Strait Islander women requires culturally appropriate, innovative strategies co-designed in partnership with Indigenous organisations and communities.
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Affiliation(s)
| | - Heather A D'Antoine
- National Aboriginal and Torres Strait Islander Research Network, University of Queensland, Brisbane, QLD
| | - Mohinder Sarna
- Curtin University, Perth, WA
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA
| | - Michael J Binks
- Menzies School of Health Research, Darwin, NT
- Telethon Institute for Child Health Research, University of Western Australia, Perth, WA
| | - Hannah C Moore
- Telethon Institute for Child Health Research, University of Western Australia, Perth, WA
| | - Ross M Andrews
- Office of the Chief Health Officer, Queensland Health, Brisbane, QLD
| | - Gavin F Pereira
- Curtin University, Perth, WA
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Christopher C Blyth
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA
- The University of Western Australia, Perth, WA
| | | | - Karin Lust
- Royal Brisbane and Woman's Hospital Health Service District, Brisbane, QLD
| | - Annette K Regan
- Curtin University, Perth, WA
- University of San Francisco, San Francisco, CA, United States of America
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Pérez Chacón G, Fathima P, Jones M, Estcourt MJ, Gidding HF, Moore HC, Richmond PC, Snelling T. Infant Whole-Cell Versus Acellular Pertussis Vaccination in 1997 to 1999 and Risk of Childhood Hospitalization for Food-Induced Anaphylaxis: Linked Administrative Databases Cohort Study. J Allergy Clin Immunol Pract 2024; 12:670-680. [PMID: 38182097 DOI: 10.1016/j.jaip.2023.12.048] [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] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Evidence suggests that children who had received an initial priming dose of whole-cell pertussis (wP) vaccine, rather than acellular pertussis (aP) vaccine, had a lower risk of developing IgE-mediated food allergy, the most common cause of anaphylaxis-related hospital presentations of childhood. OBJECTIVE To assess the association between wP versus aP vaccination in infancy and subsequent hospital presentations for anaphylaxis. METHODS This study was preregistered under PMID 34874968. Perinatal records for a cohort of New South Wales-born children (1997-1999) receiving their first dose of pertussis-containing vaccine before age 4 months were probabilistically linked to hospital and immunization records. We used adjusted Cox models to estimate hazard ratios (aHRs) and 95% CIs for anaphylaxis-coded hospitalizations. RESULTS There were 218,093 New South Wales-born children who received a first dose of wP or aP before age 4 months. Among these children, 86 experienced at least one hospitalization for food-induced anaphylaxis at age 5-15 years (range of events per patient, one to three). The person-time of follow-up was 1,476,969 years, and 665,519 years for children vaccinated with wP as a first dose (wP-1 children) and aP as a first dose (aP-1 children), respectively. The incidence rates for first hospitalization for food anaphylaxis were 3.5 (95% CI, 2.6-4.6) and 5.1 (95% CI, 3.5-7.1) per 100,000 child-years among wP-1 children and aP-1 children, respectively (aHR for wP vs aP = 0.47; 95% CI, 0.26-0.83). For first admission for venom anaphylaxis, the incidence rate was 4.9 (95% CI, 3.9-6.2) per 100,000 child-years among wP-1 children and 5.1 (95% CI, 3.5-7.1) per 100,000 child-years among aP-1 children (aHR for wP vs aP = 0.92; 95% CI, 0.53-1.60), and for all-cause anaphylaxis, the incidence rate was 10.6 (95% CI, 9.0-12.4) per 100,000 child-years among wP-1 children and 12.8 (95% CI, 10.2-15.8) per 100,000 child-years among aP-1 children (aHR for wP vs aP = 0.92; 95% CI, 0.53-1.60). CONCLUSION Vaccination with wP in infancy was associated with a lower risk of hospitalizations for food-induced anaphylaxis (and therefore severe IgE-mediated food allergy) occurring in childhood.
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Affiliation(s)
- Gladymar Pérez Chacón
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia; Faculty of Health Science, Curtin School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Parveen Fathima
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia; Health and Clinical Analytics, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Mark Jones
- Health and Clinical Analytics, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Marie J Estcourt
- Health and Clinical Analytics, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Heather F Gidding
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; Women and Babies Health Research, Kolling Institute, Northern Sydney Local Health District, Sydney, New South Wales, Australia; National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Children's Hospital at Westmead, Sydney, New South Wales, Australia; School of Public Health and Community Medicine, University of New South Wales Medicine, Sydney, New South Wales, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia; Faculty of Health Science, Curtin School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Peter C Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia; Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Tom Snelling
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia; Faculty of Health Science, Curtin School of Population Health, Curtin University, Bentley, Western Australia, Australia; Health and Clinical Analytics, School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
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Gebremedhin AT, Hogan AB, Blyth CC, Glass K, Moore HC. Author Correction: Developing a prediction model to estimate the true burden of respiratory syncytial virus (RSV) in hospitalised children in Western Australia. Sci Rep 2024; 14:2411. [PMID: 38286849 PMCID: PMC10825169 DOI: 10.1038/s41598-024-52791-0] [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: 01/31/2024] Open
Affiliation(s)
- Amanuel Tesfay Gebremedhin
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, 6872, Australia.
| | - Alexandra B Hogan
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, 6872, Australia
- School of Medicine, The University of Western Australia, Perth, WA, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, WA, Australia
- PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, Perth, WA, Australia
| | - Kathryn Glass
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, 6872, Australia
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Foley DA, Minney-Smith CA, Lee WH, Oakes DB, Hazelton B, Ford TJ, Wadia U, Sikazwe C, Moore HC, Nicol MP, Levy A, Blyth CC. Respiratory Syncytial Virus Reinfections in Children in Western Australia. Viruses 2023; 15:2417. [PMID: 38140658 PMCID: PMC10747877 DOI: 10.3390/v15122417] [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: 11/16/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Respiratory syncytial virus (RSV) reinfection in children is poorly understood. We examined the incidence, characteristics, and outcomes of hospital-attended RSV reinfections in children <16 years in Western Australia between 2012 and 2022. Individuals with repeat RSV detections ≥56 days apart were identified using laboratory data. The incidence of reinfection in the first five years of life was estimated using the total birth population from 2012 to 2017. Clinical data on a subset of reinfection episodes were obtained from two metropolitan pediatric centers. A total of 466 children with hospital-attended reinfections were identified. The median interval between RSV detections was 460 days (interquartile range: 324, 812), with a reinfection rate of 95 per 100,000 individuals (95% confidence interval: 82, 109). Reinfection was most common in children who experienced their first RSV detection <6 months of age. Predisposing factors were identified in 56% of children; children with predisposing factors were older at first and second detections, were more likely to be admitted, and had a longer length of stay. This study highlights the significant burden of hospital-attended RSV reinfections in children with and without predisposing factors. Expanded surveillance with in-depth clinical data is required to further characterize the impact of RSV reinfection.
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Affiliation(s)
- David A. Foley
- Department of Microbiology, PathWest Laboratory Medicine WA, Nedlands, WA 6009, Australia (A.L.); (C.C.B.)
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia (H.C.M.); (M.P.N.)
- School of Medicine, University of Western Australia, Perth, WA 6009, Australia
| | - Cara A. Minney-Smith
- Department of Microbiology, PathWest Laboratory Medicine WA, Nedlands, WA 6009, Australia (A.L.); (C.C.B.)
| | - Wei Hao Lee
- School of Medicine, University of Western Australia, Perth, WA 6009, Australia
- Department of General Paediatrics, Perth Children’s Hospital, Nedlands, WA 6009, Australia
| | - Daniel B. Oakes
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia (H.C.M.); (M.P.N.)
| | - Briony Hazelton
- Department of Microbiology, PathWest Laboratory Medicine WA, Nedlands, WA 6009, Australia (A.L.); (C.C.B.)
- Department of Infectious Diseases, Perth Children’s Hospital, Nedlands, WA 6009, Australia
| | - Timothy J. Ford
- School of Medicine, University of Western Australia, Perth, WA 6009, Australia
- Department of Infectious Diseases, Perth Children’s Hospital, Nedlands, WA 6009, Australia
| | - Ushma Wadia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia (H.C.M.); (M.P.N.)
- Department of Infectious Diseases, Perth Children’s Hospital, Nedlands, WA 6009, Australia
- Department of General Paediatrics, Fiona Stanley Hospital, Murdoch, WA 6150, Australia
| | - Chisha Sikazwe
- Department of Microbiology, PathWest Laboratory Medicine WA, Nedlands, WA 6009, Australia (A.L.); (C.C.B.)
- Marshall Centre for Infectious Diseases, School of Biomedical Sciences, University of Western Australia, Perth, WA 6009, Australia
| | - Hannah C. Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia (H.C.M.); (M.P.N.)
- School of Population Health, Curtin University, Perth, WA 6009, Australia
| | - Mark P. Nicol
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia (H.C.M.); (M.P.N.)
- Marshall Centre, Biomedical Sciences, University of Western Australia, Perth, WA 6009, Australia
| | - Avram Levy
- Department of Microbiology, PathWest Laboratory Medicine WA, Nedlands, WA 6009, Australia (A.L.); (C.C.B.)
- Marshall Centre for Infectious Diseases, School of Biomedical Sciences, University of Western Australia, Perth, WA 6009, Australia
| | - Christopher C. Blyth
- Department of Microbiology, PathWest Laboratory Medicine WA, Nedlands, WA 6009, Australia (A.L.); (C.C.B.)
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia (H.C.M.); (M.P.N.)
- School of Medicine, University of Western Australia, Perth, WA 6009, Australia
- Department of Infectious Diseases, Perth Children’s Hospital, Nedlands, WA 6009, Australia
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Rice E, Oakes DB, Holland C, Moore HC, Blyth CC. Respiratory syncytial virus in children: epidemiology and clinical impact post-COVID-19. Curr Opin Infect Dis 2023; 36:522-528. [PMID: 37830952 DOI: 10.1097/qco.0000000000000967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
PURPOSE OF REVIEW Respiratory syncytial virus (RSV) remains a leading cause of mortality and morbidity worldwide. RSV seasonality was disrupted by COVID-19-associated nonpharmaceutical interventions (NPIs). We review RSV seasonality, molecular epidemiology, clinical manifestations, and community awareness to inform future prevention strategies. RECENT FINDINGS An initial reduction of RSV disease observed with NPIs, and subsequent global resurgence was associated with a collapse in genetic diversity. A lack of immunity is suggested to have contributed to the resurgence of RSV cases experienced post COVID-19. The median age of children admitted with RSV increased during the resurgence, likely secondary to the expanded cohort of RSV-immune naive children. The pandemic also played a role in increased community awareness, which can be utilized as part of a coordinated public health effort to introduce prevention strategies. Further education on signs and symptoms of RSV is still required. SUMMARY mAbs and maternal vaccines targeting RSV have the potential to reduce paediatric morbidity, however this new era of RSV prevention will require ongoing research to facilitate community awareness and engagement, and better respiratory surveillance. Tackling the global burden of RSV will require a coordinated effort and measures to ensure access and affordability of new prevention strategies.
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Affiliation(s)
- Emily Rice
- Department of General Paediatrics, Perth Children's Hospital, Hospital Avenue
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia
| | - Daniel B Oakes
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia
| | - Charlie Holland
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia
- School of Population Health, Curtin University
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia
- School of Population Health, Curtin University
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia
- Department of Infectious Diseases, Perth Children's Hospital, Hospital Avenue
- School of Medicine, University of Western Australia
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, Western Australia
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Blyth CC, Fathima P, Pavlos R, Jacoby P, Pavy O, Geelhoed E, Richmond PC, Effler PV, Moore HC. Influenza vaccination in Western Australian children: Exploring the health benefits and cost savings of increased vaccine coverage in children. Vaccine X 2023; 15:100399. [PMID: 37908895 PMCID: PMC10613898 DOI: 10.1016/j.jvacx.2023.100399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/02/2023] Open
Abstract
Introduction To assess potential benefits and direct healthcare cost savings with expansion of an existing childhood influenza immunisation program, we developed a dynamic transmission model for the state of Western Australia, evaluating increasing coverage in children < 5 years and routinely immunising school-aged children. Methods A deterministic compartmental Susceptible-Exposed-Infectious-Recovered age-stratified transmission model was developed and calibrated using laboratory-notification and hospitalisation data. Base case vaccine coverage estimates were derived from 2019 data and tested under moderate, low and high vaccine effectiveness settings. The impact of increased coverage on the burden of influenza, influenza-associated presentations and net costs were assessed using the transmission model and estimated health utilisation costs. Results Under base case vaccine coverage and moderate vaccine effectiveness settings, 225,460 influenza cases are expected annually across all ages. Direct healthcare costs of influenza were estimated to be A$27,608,286 per annum, dominated by hospital costs. Net cost savings of >$A1.5 million dollars were observed for every 10 % increase in vaccine coverage in children < 5 years. Additional benefits were observed by including primary school age children (5-11 years) in the funded influenza vaccination program - a reduction in cases, presentations, hospitalisations and approximately $A4 million net costs savings were observed for every 10 % increase in coverage. The further addition of older children (12-17 years) resulted in only moderate additional net cost savings figures, compared with a 5-11year-old program alone. Net costs savings were predominantly derived by a reduction in influenza-associated hospitalisation in adults. Conclusions Any increase in influenza vaccine coverage in children < 5 years, above a base case of 50 % coverage resulted in a substantive reduction in influenza cases, presentations, hospitalisations and net costs when applied to the West Australian population. However, the most impactful pediatric program, from both a disease prevention and costs perspective, would be one that increased vaccination coverage among primary-school aged children.
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Affiliation(s)
- Christopher C. Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- School of Medicine, University of Western Australia, Perth, WA, Australia
- Department of Infectious Diseases, Perth Children’s Hospital, Perth, WA, Australia
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, WA, Australia
| | - Parveen Fathima
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca Pavlos
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Peter Jacoby
- Telethon Kids Institute, Perth Children’s Hospital, Perth, WA, Australia
| | - Olivia Pavy
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Elizabeth Geelhoed
- Telethon Kids Institute, Perth Children’s Hospital, Perth, WA, Australia
| | - Peter C Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- School of Medicine, University of Western Australia, Perth, WA, Australia
- Department of Immunology, Perth Children’s Hospital, Perth, WA, Australia
- Department of General Paediatrics, Perth Children’s Hospital, Perth, WA, Australia
| | - Paul V. Effler
- Communicable Disease Control Directorate, Department of Health, Perth, WA, Australia
| | - Hannah C. Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
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Regan AK, Moore HC, Binks MJ, McHugh L, Blyth CC, Pereira G, Lust K, Sarna M, Andrews R, Foo D, Effler PV, Lambert S, Van Buynder P. Maternal Pertussis Vaccination, Infant Immunization, and Risk of Pertussis. Pediatrics 2023; 152:e2023062664. [PMID: 37807881 PMCID: PMC10598625 DOI: 10.1542/peds.2023-062664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVES Following the introduction of jurisdictional maternal pertussis vaccination programs in Australia, we estimated maternal vaccine effectiveness (VE) and whether maternal pertussis vaccination modified the effectiveness of the first 3 primary doses of pertussis-containing vaccines. METHODS We conducted a population-based cohort study of 279 418 mother-infant pairs using probabilistic linkage of administrative health records in 3 Australian jurisdictions. Infants were maternally vaccinated if their mother had a documented pertussis vaccination ≥14 days before birth. Jurisdictional immunization records were used to identify receipt of the first 3 infant doses of pertussis-containing vaccines. Infant pertussis infections were identified using notifiable disease records. VE was estimated using Cox proportional hazard models. RESULTS Pertussis was administered during 51.7% (n = 144 429/279 418) of pregnancies, predominantly at 28-31 weeks' gestation. VE of maternal pertussis vaccination declined from 70.4% (95% confidence interval [CI], 50.5-82.3) among infants <2 months old to 43.3% (95% CI, 6.8-65.6) among infants 7-8 months old and was not significant after 8 months of age. Although we observed slightly lower VE point estimates for the third dose of infant pertussis vaccine among maternally vaccinated compared with unvaccinated infants (76.5% vs 92.9%, P = .002), we did not observe higher rates of pertussis infection (hazard ratio, 0.70; 95% CI, 0.61-3.39). CONCLUSIONS Pertussis vaccination near 28 weeks' gestation was associated with lower risk of infection among infants through 8 months of age. Although there was some evidence of lower effectiveness of infant vaccination among maternally vaccinated infants, this did not appear to translate to greater risk of disease.
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Affiliation(s)
- Annette K. Regan
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- School of Nursing and Health Professions, University of San Francisco, San Francisco, California
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Hannah C. Moore
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases
| | - Michael J. Binks
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Lisa McHugh
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Christopher C. Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases
- Division of Pediatrics, University of Western Australia, Nedlands, Western Australia, Australia
| | - Gavin Pereira
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Karin Lust
- Women’s and Newborn Services, Royal Brisbane Women’s Hospital, Brisbane, Queensland, Australia
| | - Mohinder Sarna
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases
| | - Ross Andrews
- Communicable Disease Control Branch, Queensland Health, Brisbane, Queensland, Australia
| | - Damien Foo
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases
- Yale School of Environment, Yale University, New Haven, Connecticut
| | - Paul V. Effler
- Department of Health Western Australia, Communicable Disease Control Directorate, Perth, Western Australia, Australia
| | - Stephen Lambert
- Communicable Disease Control Branch, Queensland Health, Brisbane, Queensland, Australia
- National Centre for Immunization Research and Surveillance, Westmead, New South Wales, Australia
| | - Paul Van Buynder
- School of Medicine, Griffith University, Southport, Queensland, Australia
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Pérez Chacón G, Fathima P, Jones M, Estcourt MJ, Gidding HF, Moore HC, Richmond PC, Snelling T. Association between pertussis vaccination in infancy and childhood asthma: A population-based record linkage cohort study. PLoS One 2023; 18:e0291483. [PMID: 37792889 PMCID: PMC10550153 DOI: 10.1371/journal.pone.0291483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/30/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Asthma is among the commonest noncommunicable diseases of childhood and often occurs with other atopic comorbidities. A previous case-control study found evidence that compared to children who received acellular pertussis (aP) vaccines in early infancy, children who received one or more doses of whole-cell pertussis (wP) vaccine had lower risk of developing IgE-mediated food allergy. We hypothesized that wP vaccination in early infancy might protect against atopic asthma in childhood. METHODS Retrospective record-linkage cohort study of children between 5 and < 15 years old and born between January 1997, and December 1999, in the Australian states of Western Australia (WA) and New South Wales (NSW), receiving wP versus aP vaccine as the first pertussis vaccine dose. The main outcome and measures were first and recurrent hospitalizations for asthma; hazard ratios (HRs) and 95% confidence intervals (CIs) were computed by means of Cox and Andersen and Gill models. RESULTS 274,405 children aged between 5 and < 15 years old (78.4% NSW-born) received a first dose of either wP (67.8%) or aP vaccine before 4 months old. During the follow-up period, there were 5,905 hospitalizations for asthma among 3,955 children. The incidence rate for first hospitalization was 1.5 (95% CI 1.4-1.5) per 1,000 child-years among children receiving wP vaccine as a first dose, and 1.5 (95% CI 1.4-1.6) among those vaccinated with aP vaccine as a first dose. The adjusted HRs for those who received wP vaccine versus aP vaccine as the first dose were 1.02 (95% CI 0.94-1.12) for first hospitalizations and 1.07 (95% CI 0.95-1.2) for recurrent hospitalizations for asthma. CONCLUSIONS We found no convincing evidence of a clinically relevant association between receipt of wP versus aP vaccines in early infancy and hospital presentations for asthma in childhood.
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Affiliation(s)
- Gladymar Pérez Chacón
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Faculty of Health Science, Curtin School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Parveen Fathima
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Health and Clinical Analytics, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Mark Jones
- Health and Clinical Analytics, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Marie J. Estcourt
- Health and Clinical Analytics, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Heather F. Gidding
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
- Women and Babies Health Research, Kolling Institute, Northern Sydney Local Health District, Sydney, New South Wales, Australia
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
- School of Public Health and Community Medicine, University of New South Wales Medicine, Sydney, New South Wales, Australia
| | - Hannah C. Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Faculty of Health Science, Curtin School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Peter C. Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Division of Pediatrics, University of Western Australia, Perth, Western Australia, Australia
| | - Tom Snelling
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Faculty of Health Science, Curtin School of Population Health, Curtin University, Bentley, Western Australia, Australia
- Health and Clinical Analytics, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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Sarna M, Gebremedhin A, Richmond PC, Glass K, Levy A, Moore HC. Factors Predicting Secondary Respiratory Morbidity Following Early-Life Respiratory Syncytial Virus Infections: Population-Based Cohort Study. Open Forum Infect Dis 2023; 10:ofad450. [PMID: 37790944 PMCID: PMC10544950 DOI: 10.1093/ofid/ofad450] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/27/2023] [Indexed: 10/05/2023] Open
Abstract
Background The association between early-life respiratory syncytial virus (RSV) infections and later respiratory morbidity is well established. However, there is limited evidence on factors that influence this risk. We examined sociodemographic and perinatal factors associated with later childhood respiratory morbidity requiring secondary care following exposure to a laboratory-confirmed RSV episode in the first 2 years. Methods We used a probabilistically linked whole-of-population-based birth cohort including 252 287 children born in Western Australia between 2000 and 2009 with follow-up to the end of 2012. Cox proportional hazards models estimated adjusted hazard ratios (aHRs) of the association of various risk factors with the first respiratory episode for asthma, wheezing, and unspecified acute lower respiratory infection beyond the age of 2 years. Results The analytic cohort included 4151 children with a confirmed RSV test before age 2 years. The incidence of subsequent respiratory morbidity following early-life RSV infection decreased with child age at outcome (highest incidence in 2-<4-year-olds: 41.8 per 1000 child-years; 95% CI, 37.5-46.6), increased with age at RSV infection (6-<12-month-olds: 23.6/1000 child-years; 95% CI, 19.9-27.8; 12-<24-month-olds: 22.4/1000 child-years; 95% CI, 18.2-22.7) and decreasing gestational age (50.8/1000 child-years; 95% CI, 33.5-77.2 for children born extremely preterm, <28 weeks gestation). Risk factors included age at first RSV episode (6-<12 months: aHR, 1.42; 95% CI, 1.06-1.90), extreme prematurity (<28 weeks: aHR, 2.22; 95% CI, 1.40-3.53), maternal history of asthma (aHR, 1.33; 95% CI, 1.04-1.70), and low socioeconomic index (aHR, 1.76; 95% CI, 1.03-3.00). Conclusions Our results suggest that in addition to preterm and young infants, children aged 12-<24 months could also be potential target groups for RSV prevention to reduce the burden of later respiratory morbidities associated with RSV.
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Affiliation(s)
- Mohinder Sarna
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Curtin School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Amanuel Gebremedhin
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Curtin School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Peter C Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Nedlands, Western Australia, Australia
- Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Kathryn Glass
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- National Centre for Epidemiology and Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Avram Levy
- PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, Perth, Western Australia, Australia
- School of Biomedical Sciences, University of Western Australia, Nedlands, Perth, Western Australia, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Curtin School of Population Health, Curtin University, Bentley, Western Australia, Australia
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Kabir A, Randall D, Newall AT, Moore HC, Jayasinghe S, Fathima P, Liu B, McIntyre P, Gidding HF. Incremental effectiveness of 23-valent pneumococcal polysaccharide vaccine against pneumonia hospitalisation among Australian Indigenous children: A record linkage study. Vaccine 2023; 41:5454-5460. [PMID: 37507273 DOI: 10.1016/j.vaccine.2023.07.042] [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: 05/30/2023] [Revised: 07/20/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND The impact of pneumococcal conjugate vaccines (PCVs) on pneumonia in children is well-documented but data on 23-valent pneumococcal polysaccharide vaccine (PPV23) are lacking. Between 2001 and 2011, Indigenous children in Western Australia (WA) were recommended to receive PPV23 at 18-24 months of age following 3 doses of 7-valent PCV. We evaluated the incremental effectiveness of PPV23 against pneumonia hospitalisation. METHODS Indigenous children born in WA between 2001 and 2012 who received PCV dose 3 by 12 months of age were followed from 18 to 60 months of age for the first episode of pneumonia hospitalisation (all-cause and 3 subgroups: presumptive pneumococcal, other specified causes, and unspecified). We used Cox regression modelling to estimate hazard ratios (HRs) for pneumonia hospitalisation among children who had, versus had not, received PPV23 between 18 and 30 months of age after adjustment for confounders. RESULTS 11,120 children had 327 first episodes of all-cause pneumonia hospitalisation, with 15 (4.6%) coded as presumptive pneumococcal, 46 (14.1%) as other specified causes and 266 (81.3%) unspecified. No statistically significant reduction in all-cause pneumonia was seen with PPV23 (HR 1.11; 95% CI: 0.87-1.43), but the direction of the association differed for presumptive pneumococcal (HR 0.47; 95% CI: 0.16-1.35) and specified (HR 0.89; 95% CI: 0.49-1.62) from unspecified causes (HR 1.13; 95% CI: 0.86-1.49). During the baseline period before PPV23 vaccination (12-18 months), all-cause pneumonia risk was higher among PPV23-vaccinated than unvaccinated children (RR: 1.73; 95% CI: 1.30-2.28). CONCLUSION In this high-risk population, no statistically significant incremental effect of a PPV23 booster at 18-30 months was observed against hospitalised all-cause pneumonia or the more specific outcome of presumptive pneumococcal pneumonia. Confounding by indication may explain the slight trend towards an increased risk against all-cause pneumonia. Larger studies with better control of confounding are needed to further inform PPV23 vaccination.
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Affiliation(s)
- Alamgir Kabir
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; The University of Sydney Northern Clinical School, NSW, Australia; Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia; Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia.
| | - Deborah Randall
- The University of Sydney Northern Clinical School, NSW, Australia; Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Anthony T Newall
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, WA, Australia; School of Population Health, Curtin University, Perth, Western, Australia
| | - Sanjay Jayasinghe
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia; Discipline of Child and Adolescent Health, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Australia
| | - Parveen Fathima
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, WA, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Australia
| | - Bette Liu
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Peter McIntyre
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| | - Heather F Gidding
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; The University of Sydney Northern Clinical School, NSW, Australia; Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia; National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Australia
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Sarna M, Gebremedhin A, Richmond P, Levy A, Glass K, Moore HC. Determining the true incidence of seasonal respiratory syncytial virus-confirmed hospitalizations in preterm and term infants in Western Australia. Vaccine 2023; 41:5216-5220. [PMID: 37474407 DOI: 10.1016/j.vaccine.2023.07.014] [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: 03/12/2023] [Revised: 07/07/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023]
Abstract
Respiratory syncytial virus contributes to significant global infant morbidity and mortality. We applied a previously developed statistical prediction model incorporating pre-pandemic RSV testing data and hospital admission data to estimate infant RSV-hospitalizations by birth month and prematurity, focused on infants aged <1 year. The overall predicted RSV-hospitalization incidence rates in infants <6 months were 32.7/1,000 child-years (95 % CI: 31.8, 33.5) and 3.1/1,000 child-years (95 % CI: 3.0, 3.1) in infants aged 6-<12 months. Predicted RSV-hospitalization rates for infants aged <6 months were highest for infants born in April/May. Predicted rates for preterm infants born 29-32 weeks gestation were highest in March-May, whereas infants born >33 weeks had peak RSV-hospitalization rates from May-June, similar to late preterm or term births. RSV-hospitalization rates in the pre-pandemic era were highly seasonal, and seasonality varied with degree of prematurity. Accurate estimates of RSV-hospitalization in high-risk sub-groups are essential to understand preventable burden of RSV especially given the current prevention landscape.
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Affiliation(s)
- Mohinder Sarna
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia; Curtin School of Population Health, Curtin University, Bentley, WA, Australia.
| | - Amanuel Gebremedhin
- Curtin School of Population Health, Curtin University, Bentley, WA, Australia
| | - Peter Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia; School of Medicine, University of Western Australia and Perth Children's Hospital, Nedlands, WA, Australia
| | - Avram Levy
- PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, Perth, WA, Australia; School of Biomedical Sciences, University of Western Australia, Nedlands, Perth, WA, Australia
| | - Kathryn Glass
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia; National Centre for Epidemiology and Population Health, ANU College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia; Curtin School of Population Health, Curtin University, Bentley, WA, Australia
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Foley DA, Yeoh DK, Minney-Smith CA, Shin C, Hazelton B, Hoeppner T, Moore HC, Nicol M, Sikazwe C, Borland ML, Levy A, Blyth CC. A surge in human metapneumovirus paediatric respiratory admissions in Western Australia following the reduction of SARS-CoV-2 non-pharmaceutical interventions. J Paediatr Child Health 2023; 59:987-991. [PMID: 37219060 DOI: 10.1111/jpc.16445] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/24/2023]
Abstract
AIM Western Australian laboratory data demonstrated a decrease in human metapneumovirus (hMPV) detections through 2020 associated with SARS-CoV-2-related non-pharmaceutical interventions (NPIs), followed by a subsequent surge in metropolitan region in mid-2021. We aimed to assess the impact of the surge in hMPV on paediatric hospital admissions and the contribution of changes in testing. METHODS All respiratory-coded admissions of children aged <16 years at a tertiary paediatric centre between 2017 and 2021 were matched with respiratory virus testing data. Patients were grouped by age at presentation and by ICD-10 AM codes into bronchiolitis, other acute lower respiratory infection (OALRI), wheeze and upper respiratory tract infection (URTI). For analysis, 2017-2019 was utilised as a baseline period. RESULTS hMPV-positive admissions in 2021 were more than 2.8 times baseline. The largest increase in incidence was observed in the 1-4 years group (incidence rate ratio (IRR) 3.8; 95% confidence interval (CI): 2.5-5.9) and in OALRI clinical phenotype (IRR 2.8; 95% CI: 1.8-4.2). The proportion of respiratory-coded admissions tested for hMPV in 2021 doubled (32-66.2%, P < 0.001), with the greatest increase in wheeze (12-75% in 2021, P < 0.001). hMPV test percentage positivity in 2021 was higher than in the baseline period (7.6% vs. 10.1% in 2021, P = 0.004). CONCLUSION The absence and subsequent surge underline the susceptibility of hMPV to NPIs. Increased hMPV-positive admissions in 2021 can be partially attributable to testing, but test-positivity remained high, consistent with a genuine increase. Continued comprehensive testing will help ascertain true burden of hMPV respiratory diseases.
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Affiliation(s)
- David A Foley
- Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Daniel K Yeoh
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Cara A Minney-Smith
- Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
| | | | - Briony Hazelton
- Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Tobias Hoeppner
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Mark Nicol
- Marshall Centre, Biomedical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Chisha Sikazwe
- Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
- Marshall Centre, Biomedical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Meredith L Borland
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Avram Levy
- Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
- Marshall Centre, Biomedical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Chris C Blyth
- Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
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Foo D, Sarna M, Pereira G, Moore HC, Regan AK. Association between maternal influenza vaccination and neurodevelopmental disorders in childhood: a longitudinal, population-based linked cohort study. Arch Dis Child 2023; 108:647-653. [PMID: 37001967 PMCID: PMC10423464 DOI: 10.1136/archdischild-2022-324269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 03/02/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVE To assess the association between in utero exposure to seasonal inactivated influenza vaccine (IIV) and the risk of a diagnosis of a neurodevelopmental disorder in early childhood. DESIGN Retrospective cohort study. SETTING Population-based birth registry linked with health administrative databases in Western Australia (WA). PARTICIPANTS Singleton, liveborn children born between 1 April 2012 and 1 July 2016 in WA. EXPOSURE Receipt of seasonal IIV during pregnancy obtained from a state-wide antenatal vaccination database. MAIN OUTCOME MEASURES Clinical diagnosis of a neurodevelopmental disorder was recorded from hospital inpatient and emergency department records. We used Cox proportional hazard regression, weighted by the inverse-probability of treatment (vaccination), to estimate the hazard ratio (HR) of neurodevelopmental disorders associated with in utero exposure to seasonal IIV. RESULTS The study included 140 514 children of whom, 15 663 (11.2%) were exposed to seasonal IIV in utero. The prevalence of neurodevelopmental disorders was 5.4%, including mental or behavioural (0.4%), neurological (5.1%), seizure (2.2%) and sleep disorders (2.7%). Maternal IIV was not associated with increased risk of neurodevelopmental disorders (HR 1.00; 95% CI 0.91 to 1.08). Children exposed in the first trimester had a lower risk of seizure disorders (adjusted HR [aHR] 0.73; 95% CI 0.54 to 0.998), and preterm children exposed any time during pregnancy had a lower risk of sleep disorders (aHR 0.63; 95% CI 0.41 to 0.98). CONCLUSIONS We did not observe increased risk of neurodevelopmental disorders following in utero exposure to seasonal IIV. Although we observed some evidence for lower risk of seizure and sleep disorders, additional studies are required to confirm.
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Affiliation(s)
- Damien Foo
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Mohinder Sarna
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- eNable Institute, Curtin University, Perth, Western Australia, Australia
| | - Hannah C Moore
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Annette K Regan
- School of Nursing and Health Professions, University of San Francisco, San Francisco, California, USA
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
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Giannini F, Cannon JW, Cadarette D, Bloom DE, Moore HC, Carapetis J, Abbas K. Author Correction: Modeling the potential health impact of prospective Strep A vaccines. NPJ Vaccines 2023; 8:104. [PMID: 37454195 DOI: 10.1038/s41541-023-00704-z] [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: 07/18/2023] Open
Affiliation(s)
- Fiona Giannini
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia.
| | - Jeffrey W Cannon
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
- Harvard T.H. Chan School of Public Health, Boston, USA
| | | | - David E Bloom
- Harvard T.H. Chan School of Public Health, Boston, USA
| | - Hannah C Moore
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
- School of Population Health, Curtin University, Perth, Australia
| | - Jonathan Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
- Perth Children's Hospital, Perth, Australia
| | - Kaja Abbas
- London School of Hygiene & Tropical Medicine, London, UK
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Le H, de Klerk N, Blyth CC, Gidding H, Fathima P, Moore HC. Non-specific benefit of seasonal influenza vaccine on respiratory syncytial virus-hospitalisations in children: An instrumental variable approach using population-based data. Vaccine 2023:S0264-410X(23)00788-0. [PMID: 37407408 DOI: 10.1016/j.vaccine.2023.06.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Seasonal influenza vaccine is effective against influenza hospitalisations, but little is known about non-specific effects of the vaccine on other respiratory pathogens with similar seasonal patterns. We aimed to assess the causal impact of seasonal influenza vaccine on laboratory-confirmed hospitalisations for respiratory syncytial virus (RSV) in children using an instrumental variable (IV) strategy. METHODS We used probabilistically linked population-based data on childhood immunisations, births, deaths, hospitalisations, perinatal factors, and microbiology test results (2000-2013) of all Western Australian (WA) children born 2000-2012, observed longitudinally until the earliest of 7 years of age or 31 December 2013. We exploited a unique natural experiment created from the WA's state-funded preschool influenza vaccination policy commencing in 2008 and used this as an instrument for children's seasonal influenza vaccination status. We estimated a system of two simultaneous probit equations: determinants of influenza vaccine uptake, and determinants of RSV-confirmed hospitalisation. RESULTS Influenza vaccine coverage was low prior to 2008 but increased to 36 % in children aged 6-23 months in 2009. The majority (90 %) of RSV-hospitalisations occurred in children <2 years. Receipt of influenza vaccine reduced RSV-hospitalisations, especially in those <2 years with a rate reduction of 2.27 per 1000 (95 % CI: -3.26; -1.28), and a smaller rate reduction of 0.53 per 1000 (95 % CI: -1.04; -0.02) in those 2-7 years. Over the 5-year period (2008-2013), the state-funded preschool-influenza vaccine program resulted in 1,193 fewer RSV-hospitalisations. Of these, 793 (67 %) were in young children <2 years. CONCLUSIONS To our knowledge, this is the first analysis utilising an IV estimation strategy on a population level to assess the causal impact of seasonal influenza vaccine on risk of RSV-hospitalisations. We estimated a small protective effect that warrants further investigation.
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Affiliation(s)
- Huong Le
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia; School of Population Health, Curtin University, Perth, Australia.
| | - Nicholas de Klerk
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Infectious Diseases, Perth Children's Hospital, Perth, Australia; PathWest Laboratory Medicine, Perth, Australia; School of Medicine, University of Western Australia, Perth, Australia
| | - Heather Gidding
- The University of Sydney Northern Clinical School, St Leonards, NSW, Australia; Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia; School of Population Health, UNSW Medicine, University of NSW, Sydney, NSW, Australia; National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, NSW, Australia
| | - Parveen Fathima
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Health, Government of Western Australia, Perth, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia; School of Population Health, Curtin University, Perth, Australia
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Stevenson PG, Cooper MN, Billingham W, de Klerk N, Simpson SJ, Strunk T, Moore HC. Health service utilisation for acute respiratory infections in infants graduating from the neonatal intensive care unit: a population-based cohort study. BMC Pediatr 2023; 23:335. [PMID: 37393229 PMCID: PMC10314380 DOI: 10.1186/s12887-023-04152-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/24/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Despite advances in neonatal intensive care, babies admitted to Neonatal Intensive Care Units (NICU) suffer from adverse outcomes. We aim to describe the longer-term respiratory infectious morbidity of infants discharged from NICU using state-wide population-based linked data in Western Australia. STUDY DESIGN We used probabilistically linked population-based administrative data to analyse respiratory infection morbidity in a cohort of 23,784 infants admitted to the sole tertiary NICU, born 2002-2013 with follow up to 2015. We analysed incidence rates of secondary care episodes (emergency department presentations and hospitalisations) by acute respiratory infection (ARI) diagnosis, age, gestational age and presence of chronic lung disease (CLD). Poisson regression was used to investigate the differences in rates of ARI hospital admission between gestational age groups and those with CLD, after adjusting for age at hospital admission. RESULTS From 177,367 child-years at risk (i.e., time that a child could experience an ARI outcome), the overall ARI hospitalisation rate for infants and children aged 0-8 years was 71.4/1000 (95% confidence interval, CI: 70.1, 72.6), with the highest rates in infants aged 0-5 months (242.9/1000). For ARI presentations to emergency departments, equivalent rates were 114/1000 (95% CI: 112.4, 115.5) and 337.6/1000, respectively. Bronchiolitis was the most common diagnosis among both types of secondary care, followed by upper respiratory tract infections. Extremely preterm infants (< 28 weeks gestation at birth) were 6.5 (95% CI: 6.0, 7.0) times more likely and those with CLD were 5.0 (95% CI: 4.7, 5.4) times more likely to be subsequently admitted for ARI than those in NICU who were not preterm or had CLD after adjusting for age at hospital admission. CONCLUSIONS There is an ongoing burden of ARI in children who graduate from the NICU, especially those born extremely preterm, that persists into early childhood. Early life interventions to prevent respiratory infections in these children and understanding the lifelong impact of early ARI on later lung health are urgent priorities.
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Affiliation(s)
- Paul G Stevenson
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Matthew N Cooper
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Wesley Billingham
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Nicholas de Klerk
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Shannon J Simpson
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- Wal-yan Respiratory Centre, Telethon Kids Institute, Perth, WA, Australia
- School of Allied Health, Curtin University, Perth, WA, Australia
| | - Tobias Strunk
- Neonatal Directorate, Child and Adolescent Health Service, Perth, WA, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, PO Box 855, West Perth, WA, 6872, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, PO Box 855, West Perth, WA, 6872, Australia.
- School of Population Health, Curtin University, Perth, WA, Australia.
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Giannini F, Cannon JW, Cadarette D, Bloom DE, Moore HC, Carapetis J, Abbas K. Modeling the potential health impact of prospective Strep A vaccines. NPJ Vaccines 2023; 8:90. [PMID: 37301930 DOI: 10.1038/s41541-023-00668-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 05/10/2023] [Indexed: 06/12/2023] Open
Abstract
The World Health Organization published the preferred product characteristics for a Group A Streptococcus (Strep A) vaccine in 2018. Based on these parameters for the age of vaccination, vaccine efficacy, duration of protection from vaccine-derived immunity, and vaccination coverage, we developed a static cohort model to estimate the projected health impact of Strep A vaccination at the global, regional, and national levels and by country-income category. We used the model to analyse six strategic scenarios. Based on Strep A vaccine introduction between 2022 and 2034 for the primary scenario, we estimated vaccination at birth for 30 vaccinated cohorts could avert 2.5 billion episodes of pharyngitis, 354 million episodes of impetigo, 1.4 million episodes of invasive disease, 24 million episodes of cellulitis, and 6 million cases of rheumatic heart disease globally. Vaccination impact in terms of burden averted per fully vaccinated individual is highest in North America for cellulitis and in Sub-Saharan Africa for rheumatic heart disease.
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Affiliation(s)
- Fiona Giannini
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia.
| | - Jeffrey W Cannon
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
- Harvard T.H. Chan School of Public Health, Boston, USA
| | | | - David E Bloom
- Harvard T.H. Chan School of Public Health, Boston, USA
| | - Hannah C Moore
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
- School of Population Health, Curtin University, Perth, Australia
| | - Jonathan Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
- Perth Children's Hospital, Perth, Australia
| | - Kaja Abbas
- London School of Hygiene & Tropical Medicine, London, UK
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McHugh L, Regan AK, Sarna M, Moore HC, Van Buynder P, Pereira G, Blyth CC, Lust K, Andrews RM, Crooks K, Massey P, Binks MJ. Inequity of antenatal influenza and pertussis vaccine coverage in Australia: the Links2HealthierBubs record linkage cohort study, 2012-2017. BMC Pregnancy Childbirth 2023; 23:314. [PMID: 37150828 PMCID: PMC10164451 DOI: 10.1186/s12884-023-05574-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/04/2023] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Pregnancy and early infancy are increased risk periods for severe adverse effects of respiratory infections. Aboriginal and/or Torres Strait Islander (respectfully referred to as First Nations) women and children in Australia bear a disproportionately higher burden of respiratory diseases compared to non-Indigenous women and infants. Influenza vaccines and whooping cough (pertussis) vaccines are recommended and free in every Australian pregnancy to combat these infections. We aimed to assess the equity of influenza and/or pertussis vaccination in pregnancy for three priority groups in Australia: First Nations women; women from culturally and linguistically diverse (CALD) backgrounds; and women living in remote areas or socio-economic disadvantage. METHODS We conducted individual record linkage of Perinatal Data Collections with immunisation registers/databases between 2012 and 2017. Analysis included generalised linear mixed model, log-binomial regression with a random intercept for the unique maternal identifier to account for clustering, presented as prevalence ratios (PR) and 95% compatibility intervals (95%CI). RESULTS There were 445,590 individual women in the final cohort. Compared with other Australian women (n = 322,848), First Nations women (n = 29,181) were less likely to have received both recommended antenatal vaccines (PR 0.69, 95% CI 0.67-0.71) whereas women from CALD backgrounds (n = 93,561) were more likely to have (PR 1.16, 95% CI 1.10-1.13). Women living in remote areas were less likely to have received both vaccines (PR 0.75, 95% CI 0.72-0.78), and women living in the highest areas of advantage were more likely to have received both vaccines (PR 1.44, 95% CI 1.40-1.48). CONCLUSIONS Compared to other groups, First Nations Australian families, those living in remote areas and/or families from lower socio-economic backgrounds did not receive recommended vaccinations during pregnancy that are the benchmark of equitable healthcare. Addressing these barriers must remain a core priority for Australian health care systems and vaccine providers. An extension of this cohort is necessary to reassess these study findings.
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Affiliation(s)
- Lisa McHugh
- School of Public Health, Division of Medicine, University of Queensland, Brisbane, Qld, 4001, Australia.
| | - Annette K Regan
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
- Wesfarmers Centre for Vaccines & Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
| | - Mohinder Sarna
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
- Wesfarmers Centre for Vaccines & Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
| | - Hannah C Moore
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
- Wesfarmers Centre for Vaccines & Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
| | - Paul Van Buynder
- School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
- enAble Institute, Curtin University, Perth, WA, Australia
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Christopher C Blyth
- Wesfarmers Centre for Vaccines & Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
- School of Medicine, The University of Western Australia, Perth, WA, Australia
- Department of Paediatric Infectious Diseases, Perth Children's Hospital, Perth, WA, Australia
- Department of Microbiology, PathWest Laboratory Medicine, Perth, WA, Australia
| | - Karin Lust
- Women's and Newborn Service, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Department of Medicine, The University of Queensland, Brisbane Queensland, Australia
| | - Ross M Andrews
- Australian National University Canberra, Canberra, Australia
| | - Kristy Crooks
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Peter Massey
- College of Medicine and Dentistry, James Cook University, Queensland, Australia
| | - Michael J Binks
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
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Le H, Gidding H, Blyth CC, Richmond P, Moore HC. Pneumococcal Conjugate Vaccines Are Protective Against Respiratory Syncytial Virus Hospitalizations in Infants: A Population-Based Observational Study. Open Forum Infect Dis 2023; 10:ofad199. [PMID: 37125230 PMCID: PMC10135427 DOI: 10.1093/ofid/ofad199] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/17/2023] [Indexed: 05/02/2023] Open
Abstract
Background Pneumococcal conjugate vaccines (PCV) reduced the risk of respiratory syncytial virus (RSV) in a randomized clinical trial. We aimed to assess the real-world effectiveness of PCV on RSV-hospitalizations among Western Australian infants. Methods We conducted a population-based cohort study of births during 2000-2012, using probabilistically linked individual-level immunization, hospitalization, respiratory microbiology testing, and perinatal data. We performed Cox proportional hazard models with time-varying exposure (receipt of infant PCV doses) against the first RSV-confirmed hospitalization 0-12 months adjusted for perinatal and sociodemographic factors. Results From 360 994 children, 3-dose PCV coverage in Aboriginal infants ranged from 29% to 51% in 2001-2004 when PCV was funded for Aboriginal children only. Following universal funding in 2005, coverage increased to 85% for Aboriginal and 73% for non-Aboriginal infants. RSV-hospitalization rates were highest in young infants aged 0-5 months (22.5/1000 child-years) and >2 times higher in Aboriginal infants than in non-Aboriginal infants. Receipt of ≥3 PCV doses in the universal funded period was associated with a 30% reduction in RSV-hospitalization in Aboriginal infants (adjusted hazard ratio, aHR 0.70 [95% confidence interval, CI 0.46-1.06]) and 21% reduction in non-Aboriginal infants (aHR 0.79 [95% CI 0.63-0.99]) compared with unvaccinated infants. Conclusions Prior to the introduction of RSV vaccines, our study suggests that universal childhood PCV vaccination may result in a reduction in severe RSV infections in children and may be important for countries that are yet to consider PCV programs.
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Affiliation(s)
- Huong Le
- Correspondence: Hannah Moore, PhD, Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, PO Box 855 West Perth, Perth, WA 6872, Australia (); Huong Le, PhD, Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, PO Box 855 West Perth, Perth, WA 6872, Australia ()
| | - Heather Gidding
- Northern Clinical School, University of Sydney, St Leonards, New South Wales, Australia
- Women and Babies Research, Kolling Institute, St Leonards, New South Wales, Australia
- School of Population Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, New South Wales, Australia
| | - Christopher C Blyth
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Australia
- PathWest Laboratory Medicine, Perth, Australia
- School of Medicine, University of Western Australia, Perth, Australia
| | - Peter Richmond
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
- School of Medicine, University of Western Australia, Perth, Australia
| | - Hannah C Moore
- Correspondence: Hannah Moore, PhD, Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, PO Box 855 West Perth, Perth, WA 6872, Australia (); Huong Le, PhD, Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, PO Box 855 West Perth, Perth, WA 6872, Australia ()
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21
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Mchugh L, Van Buynder P, Sarna M, Andrews RM, Moore HC, Binks MJ, Pereira G, Blyth CC, Lust K, Foo D, Regan AK. Timing and temporal trends of influenza and pertussis vaccinations during pregnancy in three Australian jurisdictions: The Links2HealthierBubs population-based linked cohort study, 2012-2017. Aust N Z J Obstet Gynaecol 2023; 63:27-33. [PMID: 35696340 PMCID: PMC10952684 DOI: 10.1111/ajo.13548] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 05/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Antenatal inactivated influenza (IIV) and pertussis-containing vaccines (dTpa) offer protection against severe respiratory infections for pregnant women and infants <6 months of age. Both vaccines are recommended in pregnancy; however, little is known about temporal or jurisdictional trends and predictors of uptake. AIMS To identify gaps and predictors of IIV and/or dTpa vaccinations in Australian pregnancies from 2012 to 2017. MATERIALS AND METHODS We conducted a probabilistically linked, multi-jurisdictional population-based cohort study, drawing from perinatal data collections and immunisation databases. We used a generalised linear mixed model with a random effect term to account for clustering of multiple pregnancies within mothers, to calculate vaccination uptake, and identify predictors of uptake by maternal demographic, pregnancy, and health characteristics. RESULTS Of 591 868 unique pregnancies, IIV uptake was 15%, dTpa 27% and 12% received both vaccines. Pertussis vaccinations in First Nations pregnancies were 20% lower than non-Indigenous pregnancies; dTpa was strongly associated with IIV uptake (risk ratio (RR): 8.60, 95% CI 8.48-8.73). This trend was temporally and jurisdictionally consistent. First Nations women were more likely to have had IIV in pregnancy before the introduction of dTpa in the pregnancy program: (RR: 1.48, 95% CI 1.40-1.57), but less likely after dTpa implementation (RR: 0.78, 95% CI 0.76-0.80). CONCLUSIONS Inequity in vaccine uptake between First Nations and non-Indigenous pregnancies, and dismal rates of vaccination in pregnancy overall need urgent review, particularly before the next influenza pandemic or pertussis outbreak. If antenatal dTpa is driving IIV uptake, changes in antenatal healthcare practices are needed to ensure vaccines are offered equitably and optimally to protect against infection.
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Affiliation(s)
- Lisa Mchugh
- School of Public HealthUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Paul Van Buynder
- School of Medicine and DentistryGriffith UniversitySouthportQueenslandAustralia
| | - Mohinder Sarna
- Curtin School of Population HealthCurtin UniversityPerthWestern AustraliaAustralia
- Wesfarmers Centre for Vaccines & Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
| | - Ross M. Andrews
- Australian National UniversityCanberraAustralian Capital TerritoryAustralia
| | - Hannah C. Moore
- Curtin School of Population HealthCurtin UniversityPerthWestern AustraliaAustralia
- Wesfarmers Centre for Vaccines & Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
| | - Michael J. Binks
- Menzies School of Health ResearchDarwinNorthern TerritoryAustralia
| | - Gavin Pereira
- Curtin School of Population HealthCurtin UniversityPerthWestern AustraliaAustralia
- Wesfarmers Centre for Vaccines & Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
- enAble InstituteCurtin UniversityPerthWestern AustraliaAustralia
- Centre for Fertility and Health (CeFH)Norwegian Institute of Public HealthOsloNorway
| | - Christopher C. Blyth
- Wesfarmers Centre for Vaccines & Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
- School of MedicineThe University of Western AustraliaPerthWestern AustraliaAustralia
- Department of Paediatric Infectious DiseasesPerth Children's HospitalPerthWestern AustraliaAustralia
- Department of MicrobiologyPathWest Laboratory MedicinePerthWestern AustraliaAustralia
| | - Karin Lust
- Women's and Newborn ServiceRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- Department of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - Damien Foo
- Curtin School of Population HealthCurtin UniversityPerthWestern AustraliaAustralia
- Wesfarmers Centre for Vaccines & Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
| | - Annette K. Regan
- Curtin School of Population HealthCurtin UniversityPerthWestern AustraliaAustralia
- Wesfarmers Centre for Vaccines & Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
- School of Nursing and Health ProfessionsUniversity of San FranciscoSan FranciscoCaliforniaUSA
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22
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Norman DA, Danchin M, Blyth CC, Palasanthiran P, Tran D, Macartney KK, Wadia U, Moore HC, Seale H. Australian hospital paediatricians and nurses' perspectives and practices for influenza vaccine delivery in children with medical comorbidities. PLoS One 2022; 17:e0277874. [PMID: 36508402 PMCID: PMC9744269 DOI: 10.1371/journal.pone.0277874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 11/06/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Influenza vaccination of children with medical comorbidities is critical due their increased risks for severe influenza disease. In Australia, hospitals are an avenue for influenza vaccine delivery to children with comorbidities but are not always effectively utilised. Qualitative enquiry sought to ascertainment the barriers and enablers for influenza vaccination recommendation, delivery, and recording of these children at Australian hospitals. METHODS Semi-structured interviews and discussion group sessions were conducted with paediatricians and nurses at four tertiary paediatric specialist hospitals and two general community hospitals in three Australian states. Transcripts from interviews and group sessions were inductively analysed for themes. The Capability, Opportunity, Motivation, and Behaviour (COM-B) model was used to explore the elements of each theme and identify potential interventions to increase influenza vaccination recommendation and delivery behaviours by providers. RESULTS Fifteen discussion sessions with 28 paediatricians and 26 nurses, and nine in-depth interviews (five paediatricians and four nurses) were conducted. Two central thematic domains were identified: 1. The interaction between hospital staff and parents/patients for influenza vaccine recommendation, and 2. Vaccination delivery and recording in the hospital environment. Six themes across these domains emerged detailing the importance of dedicated immunisation services, hospital leadership, paediatricians' vaccine recommendation role, the impact of comorbidities, vaccination recording, and cocooning vaccinations. Supportive hospital leadership, engaged providers, and dedicated immunisation services were identified as essential for influenza vaccination of children with comorbidities in Australian hospital. CONCLUSION Recommendation of influenza vaccination for Australian children with comorbidities is impacted by the beliefs of paediatricians and the perceived impact of influenza disease on children's comorbidities. Dedicated immunisation services and supportive hospital leadership were drivers for influenza vaccine delivery at hospitals. Future interventions targeting hospital-based influenza vaccine delivery for children with comorbidities should take a rounded approach targeting providers' attitudes, the hospital environment and leadership support.
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Affiliation(s)
- Daniel A. Norman
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Crawley, Western, Australia
- School of Medicine, University of Western Australia, Crawley, Western, Australia
- * E-mail:
| | - Margie Danchin
- Department of General Medicine, The Royal Children’s Hospital, Parkville, Victoria, Australia
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher C. Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Crawley, Western, Australia
- School of Medicine, University of Western Australia, Crawley, Western, Australia
- Department of Infectious Diseases, Perth Children’s Hospital, Nedlands, Western, Australia
- Department of Microbiology, PathWest Laboratory Medicine, Nedlands, Western, Australia
| | - Pamela Palasanthiran
- School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia
- Infectious Diseases Service, Sydney Children’s Hospitals Network, Randwick, New South Wales, Australia
| | - David Tran
- Department of Paediatrics, Northern Health, Epping, Victoria, Australia
| | - Kristine K. Macartney
- National Centre for Immunisation Research and Surveillance, University of Sydney, Sydney, New South Wales, Australia
- Department of Infectious Diseases and Microbiology, Children’s Hospital Westmead, Westmead, New South Wales, Australia
- School of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Ushma Wadia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Crawley, Western, Australia
- Department of Paediatrics, Fiona Stanley Hospital, Murdoch, Western, Australia
| | - Hannah C. Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Crawley, Western, Australia
| | - Holly Seale
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
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Foley DA, Sikazwe CT, Minney-Smith CA, Ernst T, Moore HC, Nicol MP, Smith DW, Levy A, Blyth CC. An Unusual Resurgence of Human Metapneumovirus in Western Australia Following the Reduction of Non-Pharmaceutical Interventions to Prevent SARS-CoV-2 Transmission. Viruses 2022; 14:2135. [PMID: 36298690 PMCID: PMC9612024 DOI: 10.3390/v14102135] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 08/30/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 09/25/2023] Open
Abstract
Non-pharmaceutical interventions (NPIs) to reduce SARS-CoV-2 transmission disrupted respiratory virus seasonality. We examined the unusual return of human metapneumovirus (hMPV) in Western Australia following a period of absence in 2020. We analysed hMPV laboratory testing data from 1 January 2017 to 31 December 2021. Whole-genome sequencing of selected hMPV-positive samples was performed using a tiled-amplicon approach. Following an absence in spring 2020, an unusual hMPV surge was observed during the wet summer season in the tropical Northern region in late 2020. Following a six-month delay, an intense winter season occurred in the subtropical/temperate Southern and Metropolitan regions. Compared to 2017-2019, hMPV incidence in 2021 increased by 3-fold, with a greater than 4-fold increase in children aged 1-4 years. There was a collapse in hMPV diversity in 2020, with the emergence of a single subtype. NPIs contributed to an absent 2020 season and a clonal hMPV resurgence. The summer surge and delayed winter season suggest that prevailing temperature and humidity are keys determinant of hMPV transmission. The increased incidence in 2021 was linked to an expanded cohort of hMPV-naïve 1-4-year-old children and waning population immunity. Further intense and unusual respiratory virus seasons are expected as COVID-19 associated NPIs are removed.
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Affiliation(s)
- David Anthony Foley
- Department of Microbiology, PathWest Laboratory Medicine, Perth 6009, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth 6009, Australia
- School of Medicine, University of Western Australia, Perth 6009, Australia
| | - Chisha T. Sikazwe
- Department of Microbiology, PathWest Laboratory Medicine, Perth 6009, Australia
- Infection and Immunity, School of Biomedical Sciences, University of Western Australia, Perth 6009, Australia
| | | | - Timo Ernst
- Infection and Immunity, School of Biomedical Sciences, University of Western Australia, Perth 6009, Australia
| | - Hannah C. Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth 6009, Australia
- Faculty of Health Sciences, School of Population Health, Curtin University, Perth 6102, Australia
| | - Mark P. Nicol
- Infection and Immunity, School of Biomedical Sciences, University of Western Australia, Perth 6009, Australia
| | - David W. Smith
- Department of Microbiology, PathWest Laboratory Medicine, Perth 6009, Australia
- School of Medicine, University of Western Australia, Perth 6009, Australia
| | - Avram Levy
- Department of Microbiology, PathWest Laboratory Medicine, Perth 6009, Australia
- Infection and Immunity, School of Biomedical Sciences, University of Western Australia, Perth 6009, Australia
| | - Christopher C. Blyth
- Department of Microbiology, PathWest Laboratory Medicine, Perth 6009, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth 6009, Australia
- School of Medicine, University of Western Australia, Perth 6009, Australia
- Department of Infectious Diseases, Perth Children’s Hospital, Perth 6009, Australia
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Miller KM, Lamagni T, Hay R, Cannon JW, Marks M, Bowen AC, Kaslow DC, Cherian T, Seale AC, Pickering J, Daw JN, Moore HC, Van Beneden C, Carapetis JR, Manning L. Standardization of Epidemiological Surveillance of Group A Streptococcal Cellulitis. Open Forum Infect Dis 2022; 9:S25-S30. [PMID: 36128406 PMCID: PMC9474943 DOI: 10.1093/ofid/ofac267] [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: 02/27/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Cellulitis is an acute bacterial infection of the dermis and subcutaneous tissue usually found complicating a wound, ulcer, or dermatosis. This article provides guidelines for the surveillance of cellulitis. The primary objectives of cellulitis surveillance are to (1) monitor trends in rates of infection, (2) describe the demographic and clinical characteristics of patients with cellulitis, (3) estimate the frequency of complications, and (4) describe the risk factors associated with primary and recurrent cellulitis. This article includes case definitions for clinical cellulitis and group A streptococcal cellulitis, based on clinical and laboratory evidence, and case classifications for an initial and recurrent case. It is expected that surveillance for cellulitis will be for all-cause cellulitis, rather than specifically for Strep A cellulitis. Considerations of the type of surveillance are also presented, including identification of data sources and surveillance type. Minimal surveillance necessary for cellulitis is facility-based, passive surveillance. Prospective, active, facility-based surveillance is recommended for estimates of pathogen-specific cellulitis burden. Participant eligibility, surveillance population, and additional surveillance considerations such as active follow-up of cases, the use of International Classification of Disease diagnosis codes, and microbiological sampling of cases are discussed. Finally, the core data elements to be collected on case report forms are presented.
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Affiliation(s)
- Kate M Miller
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
| | | | - Roderick Hay
- St John’s Institute of Dermatology, King’s College London , London , United Kingdom
| | - Jeffrey W Cannon
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health , Boston, Massachusetts , USA
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious Diseases, London School of Hygiene & Tropical Medicine , London , United Kingdom
- Hospital for Tropical Diseases and Division of Infection and Immunity, University College London Hospitals , London , United Kingdom
- Division of Infection and Immunity, University College London , London , United Kingdom
| | - Asha C Bowen
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
- Department of Infectious Diseases, Perth Children’s Hospital , Nedlands, Western Australia , Australia
- Faculty of Health and Medicine, University of Western Australia , Nedlands, Western Australia , Australia
| | | | | | - Anna C Seale
- UK Health Security Agency , London , United Kingdom
- London School of Hygiene & Tropical Medicine , London , United Kingdom
- University of Warwick , Coventry , United Kingdom
| | - Janessa Pickering
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
| | - Jessica N Daw
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
| | | | - Jonathan R Carapetis
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
- Faculty of Health and Medicine, University of Western Australia , Nedlands, Western Australia , Australia
| | - Laurens Manning
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
- Infectious Diseases Department, Fiona Stanley Hospital , Perth, Western Australia , Australia
- School of Medicine and Pharmacology, Harry Perkins Research Institute, Fiona Stanley Hospital, University of Western Australia , Perth, Western Australia , Australia
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25
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Miller KM, Tanz RR, Shulman ST, Carapetis JR, Cherian T, Lamagni T, Bowen AC, Pickering J, Fulurija A, Moore HC, Cannon JW, Barnett TC, Van Beneden CA, Carapetis J, Van Beneden C, Kaslow DC, Cherian T, Lamagni T, Engel M, Cannon J, Moore HC, Bowen A, Seale A, Kang G, Watkins D, Kariuki S. Standardization of Epidemiological Surveillance of Group A Streptococcal Pharyngitis. Open Forum Infect Dis 2022; 9:S5-S14. [PMID: 36128410 PMCID: PMC9474939 DOI: 10.1093/ofid/ofac251] [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] [Indexed: 11/14/2022] Open
Abstract
Pharyngitis, more commonly known as sore throat, is caused by viral and/or bacterial infections. Group A Streptococcus (Strep A) is the most common bacterial cause of pharyngitis. Strep A pharyngitis is an acute, self-limiting disease but if undertreated can lead to suppurative complications, nonsuppurative poststreptococcal immune-mediated diseases, and toxigenic presentations. We present a standardized surveillance protocol, including case definitions for pharyngitis and Strep A pharyngitis, as well as case classifications that can be used to differentiate between suspected, probable, and confirmed cases. We discuss the current tests used to detect Strep A among persons with pharyngitis, including throat culture and point-of-care tests. The type of surveillance methodology depends on the resources available and the objectives of surveillance. Active surveillance and laboratory confirmation is the preferred method for case detection. Participant eligibility, the surveillance population and additional considerations for surveillance of pharyngitis are addressed, including baseline sampling, community engagement, frequency of screening and season. Finally, we discuss the core elements of case report forms for pharyngitis and provide guidance for the recording of severity and pain associated with the course of an episode.
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Affiliation(s)
- Kate M Miller
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth , Australia
| | - Robert R Tanz
- Northwestern University Feinberg School of Medicine and Ann and Robert H. Lurie Children’s Hospital of Chicago , Chicago, Illinois , USA
| | - Stanford T Shulman
- Northwestern University Feinberg School of Medicine and Ann and Robert H. Lurie Children’s Hospital of Chicago , Chicago, Illinois , USA
| | - Jonathan R Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth , Australia
- Perth Children’s Hospital , Perth , Australia
| | | | - Theresa Lamagni
- United Kingdom Health Security Agency , London , United Kingdom
| | - Asha C Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth , Australia
- Perth Children’s Hospital , Perth , Australia
| | - Janessa Pickering
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth , Australia
| | - Alma Fulurija
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth , Australia
| | - Hannah C Moore
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth , Australia
| | - Jeffrey W Cannon
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth , Australia
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health , Boston, Massachusetts , USA
| | - Timothy C Barnett
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth , Australia
| | - Chris A Van Beneden
- CDC Foundation, Centers for Disease Control and Prevention , Atlanta, Georgia , USA
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26
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Miller KM, Van Beneden C, McDonald M, Hla TK, Wong W, Pedgrift H, Kaslow DC, Cherian T, Carapetis JR, Scheel A, Seale A, Bowen AC, Moore HC, Lamagni T, Rodriguez-Iturbe B. Standardization of Epidemiological Surveillance of Acute Poststreptococcal Glomerulonephritis. Open Forum Infect Dis 2022; 9:S57-S64. [PMID: 36128411 PMCID: PMC9474944 DOI: 10.1093/ofid/ofac346] [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: 04/25/2022] [Accepted: 07/12/2022] [Indexed: 11/22/2022] Open
Abstract
Acute poststreptococcal glomerulonephritis (APSGN) is an immune complex-induced glomerulonephritis that develops as a sequela of streptococcal infections. This article provides guidelines for the surveillance of APSGN due to group A Streptococcus (Strep A). The primary objectives of APSGN surveillance are to monitor trends in age- and sex-specific incidence, describe the demographic and clinical characteristics of patients with APSGN, document accompanying risk factors, then monitor trends in frequency of complications, illness duration, hospitalization rates, and mortality. This document provides surveillance case definitions for APSGN, including clinical and subclinical APSGN based on clinical and laboratory evidence. It also details case classifications that can be used to differentiate between confirmed and probable cases, and it discusses the current investigations used to provide evidence of antecedent Strep A infection. The type of surveillance recommended depends on the burden of APSGN in the community and the objectives of surveillance. Strategies for minimal surveillance and enhanced surveillance of APSGN are provided. Furthermore, a discussion covers the surveillance population and additional APSGN-specific surveillance considerations such as contact testing, active follow up of cases and contacts, frequency of reporting, surveillance visits, period of surveillance, and community engagement. Finally, the document presents core data elements to be collected on case report forms, along with guidance for documenting the course and severity of APSGN.
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Affiliation(s)
- Kate M Miller
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
| | | | | | - Thel K Hla
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
- University of Western Australia , Perth, Western Australia , Australia
- Fiona Stanley Hospital , Murdoch, Western Australia , Australia
| | - William Wong
- Starship Children’s Hospital , Auckland , New Zealand
| | | | | | | | - Jonathan R Carapetis
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
- Perth Children’s Hospital , Nedlands, Western Australia , Australia
| | - Amy Scheel
- Emory University School of Medicine , Atlanta, Georgia , USA
| | - Anna Seale
- London School of Hygiene & Tropical Medicine , London , United Kingdom
- University of Warwick , Coventry , United Kingdom
- UK Health Security Agency , London , United Kingdom
| | - Asha C Bowen
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
- Perth Children’s Hospital , Nedlands, Western Australia , Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
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27
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Miller KM, Carapetis JR, Cherian T, Hay R, Marks M, Pickering J, Cannon JW, Lamagni T, Romani L, Moore HC, Van Beneden CA, Barth DD, Bowen AC, Carapetis J, Van Beneden C, Kaslow D, Cherian T, Lamagni T, Engel M, Cannon J, Moore H, Bowen A, Seale A, Kang G, Watkins D, Kariuki S. Standardization of Epidemiological Surveillance of Group A Streptococcal Impetigo. Open Forum Infect Dis 2022; 9:S15-S24. [PMID: 36128409 PMCID: PMC9474945 DOI: 10.1093/ofid/ofac249] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Impetigo is a highly contagious bacterial infection of the superficial layer of skin. Impetigo is caused by group A Streptococcus (Strep A) and Staphylococcus aureus, alone or in combination, with the former predominating in many tropical climates. Strep A impetigo occurs mainly in early childhood, and the burden varies worldwide. It is an acute, self-limited disease, but many children experience frequent recurrences that make it a chronic illness in some endemic settings. We present a standardized surveillance protocol including case definitions for impetigo including both active (purulent, crusted) and resolving (flat, dry) phases and discuss the current tests used to detect Strep A among persons with impetigo. Case classifications that can be applied are detailed, including differentiating between incident (new) and prevalent (existing) cases of Strep A impetigo. The type of surveillance methodology depends on the burden of impetigo in the community. Active surveillance and laboratory confirmation is the preferred method for case detection, particularly in endemic settings. Participant eligibility, surveillance population and additional considerations for surveillance of impetigo, including examination of lesions, use of photographs to document lesions, and staff training requirements (including cultural awareness), are addressed. Finally, the core elements of case report forms for impetigo are presented and guidance for recording the course and severity of impetigo provided.
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Affiliation(s)
- Kate M Miller
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth, Western Australia , Australia
| | - Jonathan R Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth, Western Australia , Australia
- Perth Children’s Hospital , Perth, Western Australia , Australia
| | | | - Roderick Hay
- St John’s Institute of Dermatology, King’s College London , United Kingdom
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious Diseases, London School of Hygiene and Tropical Medicine , London , United Kingdom
- Hospital for Tropical Diseases, University College , London , United Kingdom
- Division of Infection and Immunity, University College London , London , United Kingdom
| | - Janessa Pickering
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth, Western Australia , Australia
| | - Jeffrey W Cannon
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth, Western Australia , Australia
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health , Boston, Massachusetts , USA
| | - Theresa Lamagni
- United Kingdom Health Security Agency , London , United Kingdom
| | - Lucia Romani
- The Kirby Institute, University of New South Wales Sydney , Sydney , Australia
- Murdoch Children’s Research Group , Melbourne , Australia
| | - Hannah C Moore
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth, Western Australia , Australia
| | - Chris A Van Beneden
- CDC Foundation, Centers for Disease Control and Prevention , Atlanta, Georgia , USA
| | - Dylan D Barth
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth, Western Australia , Australia
| | - Asha C Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth, Western Australia , Australia
- Perth Children’s Hospital , Perth, Western Australia , Australia
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28
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Scheel A, Beaton AZ, Katzenellenbogen J, Parks T, Miller KM, Cherian T, Van Beneden CA, Cannon JW, Moore HC, Bowen AC, Carapetis JR. Standardization of Epidemiological Surveillance of Acute Rheumatic Fever. Open Forum Infect Dis 2022; 9:S41-S49. [PMID: 36128408 PMCID: PMC9474936 DOI: 10.1093/ofid/ofac252] [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] [Indexed: 11/14/2022] Open
Abstract
Acute rheumatic fever (ARF) is a multiorgan inflammatory disorder that results from the body’s autoimmune response to pharyngitis or a skin infection caused by Streptococcus pyogenes (Strep A). Acute rheumatic fever mainly affects those in low- and middle-income nations, as well as in indigenous populations in wealthy nations, where initial Strep A infections may go undetected. A single episode of ARF puts a person at increased risk of developing long-term cardiac damage known as rheumatic heart disease. We present case definitions for both definite and possible ARF, including initial and recurrent episodes, according to the 2015 Jones Criteria, and we discuss current tests available to aid in the diagnosis. We outline the considerations specific to ARF surveillance methodology, including discussion on where and how to conduct active or passive surveillance (eg, early childhood centers/schools, households, primary healthcare, administrative database review), participant eligibility, and the surveillance population. Additional considerations for ARF surveillance, including implications for secondary prophylaxis and follow-up, ARF registers, community engagement, and the impact of surveillance, are addressed. Finally, the core elements of case report forms for ARF, monitoring and audit requirements, quality control and assurance, and the ethics of conducting surveillance are discussed.
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Affiliation(s)
- Amy Scheel
- Emory University School of Medicine , Atlanta, Georgia , USA
| | - Andrea Z Beaton
- Cincinnati Children’s Hospital Medical Center, The Heart Institute , Cincinnati, Ohio , USA
| | | | - Tom Parks
- Department of Infectious Disease, Imperial College London, Hammersmith Hospital
| | - Kate M Miller
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, The University of Western Australia , Nedlands , Western Australia
| | | | | | - Jeffrey W Cannon
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, The University of Western Australia , Nedlands , Western Australia
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health , Boston, Massachusetts , USA
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, The University of Western Australia , Nedlands , Western Australia
| | - Asha C Bowen
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, The University of Western Australia , Nedlands , Western Australia
- Perth Children’s Hospital , Nedlands , Western Australia
| | - Jonathan R Carapetis
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, The University of Western Australia , Nedlands , Western Australia
- Perth Children’s Hospital , Nedlands , Western Australia
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29
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Moore HC, Miller KM, Carapetis JR, Van Beneden CA. Harmonizing Surveillance Methodologies for Group A Streptococcal Diseases. Open Forum Infect Dis 2022; 9:S1-S4. [PMID: 36128412 PMCID: PMC9474938 DOI: 10.1093/ofid/ofac210] [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: 02/23/2022] [Accepted: 04/13/2022] [Indexed: 11/14/2022] Open
Abstract
Group A Streptococcus (Strep A) is responsible for a significant global health and economic burden. The recent prioritization of Strep A vaccine development by the World Health Organization has prompted global research activities and collaborations. To progress this prioritization, establishment of robust surveillance for Strep A to generate updated regional disease burden estimates and to establish platforms for future impact evaluation is essential. Through the activities of the Strep A Vaccine Global Consortium (SAVAC), we have refined and harmonized surveillance protocols for 7 Strep A disease endpoints with a view that these will form part of surveillance standards for ongoing research and public health activities.
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Affiliation(s)
- Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth, Western Australia , Australia
| | - Kate M Miller
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth, Western Australia , Australia
| | - Jonathan R Carapetis
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth, Western Australia , Australia
- Perth Children’s Hospital , Perth, Western Australia , Australia
| | - Chris A Van Beneden
- Centers for Disease Control and Prevention Foundation , Atlanta, Georgia , USA
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30
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Scheel A, Miller KM, Beaton A, Katzenellenbogen J, Parks T, Cherian T, Van Beneden CA, Cannon JW, Moore HC, Bowen AC, Carapetis JR. Standardization of Epidemiological Surveillance of Rheumatic Heart Disease. Open Forum Infect Dis 2022; 9:S50-S56. [PMID: 36128407 PMCID: PMC9474940 DOI: 10.1093/ofid/ofac250] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Rheumatic heart disease (RHD) is a long-term sequela of acute rheumatic fever (ARF), which classically begins after an untreated or undertreated infection caused by Streptococcus pyogenes (Strep A). RHD develops after the heart valves are permanently damaged due to ARF. RHD remains a leading cause of morbidity and mortality in young adults in resource-limited and low- and middle-income countries. This article presents case definitions for latent, suspected, and clinical RHD for persons with and without a history of ARF, and details case classifications, including differentiating between definite or borderline according to the 2012 World Heart Federation echocardiographic diagnostic criteria. This article also covers considerations specific to RHD surveillance methodology, including discussions on echocardiographic screening, where and how to conduct active or passive surveillance (eg, early childhood centers/schools, households, primary healthcare), participant eligibility, and the surveillance population. Additional considerations for RHD surveillance, including implications for secondary prophylaxis and follow-up, RHD registers, community engagement, and the negative impact of surveillance, are addressed. Finally, the core elements of case report forms for RHD, monitoring and audit requirements, quality control and assurance, and the ethics of conducting surveillance are discussed.
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Affiliation(s)
- Amy Scheel
- Emory University School of Medicine , Atlanta, Georgia , USA
| | - Kate M Miller
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
- Perth Children’s Hospital , Nedlands, Western Australia , Australia
| | - Andrea Beaton
- The Heart Institute, Cincinnati Children’s Hospital Medical Center , Cincinnati, Ohio , USA
- Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati, Ohio , USA
| | - Judith Katzenellenbogen
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
- School of Population and Global Health, University of Western Australia , Nedlands, Western Australia , Australia
| | - Tom Parks
- Department of Infectious Disease, Imperial College London, Hammersmith Hospital , London , United Kingdom
| | | | - Chris A Van Beneden
- CDC Foundation, Centers for Disease Control and Prevention , Atlanta, Georgia , USA
| | - Jeffrey W Cannon
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health , Boston, Massachusetts , USA
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
| | - Asha C Bowen
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
- Perth Children’s Hospital , Nedlands, Western Australia , Australia
| | - Jonathan R Carapetis
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
- Perth Children’s Hospital , Nedlands, Western Australia , Australia
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31
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Miller KM, Lamagni T, Cherian T, Cannon JW, Parks T, Adegbola RA, Pickering J, Barnett T, Engel ME, Manning L, Bowen AC, Carapetis JR, Moore HC, Barth DD, Kaslow DC, Van Beneden CA. Standardization of Epidemiological Surveillance of Invasive Group A Streptococcal Infections. Open Forum Infect Dis 2022; 9:S31-S40. [PMID: 36128405 PMCID: PMC9474937 DOI: 10.1093/ofid/ofac281] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/13/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Invasive group A streptococcal (Strep A) infections occur when Streptococcus pyogenes, also known as beta-hemolytic group A Streptococcus, invades a normally sterile site in the body. This article provides guidelines for establishing surveillance for invasive Strep A infections. The primary objective of invasive Strep A surveillance is to monitor trends in rates of infection and determine the demographic and clinical characteristics of patients with laboratory-confirmed invasive Strep A infection, the age- and sex-specific incidence in the population of a defined geographic area, trends in risk factors, and the mortality rates and rates of nonfatal sequelae caused by invasive Strep A infections.
This article includes clinical descriptions followed by case definitions, based on clinical and laboratory evidence, and case classifications (confirmed or probable, if applicable) for invasive Strep A infections and for 3 Strep A syndromes: streptococcal toxic shock syndrome, necrotizing fasciitis, and pregnancy-associated Strep A infection.
Considerations of the type of surveillance are also presented, noting that most people who have invasive Strep A infections will present to hospital and that invasive Strep A is a notifiable disease in some countries. Minimal surveillance necessary for invasive Strep A infection is facility-based, passive surveillance. A resource-intensive but more informative approach is active case finding of laboratory-confirmed Strep A invasive infections among a large (eg, state-wide) and well defined population.
Participant eligibility, surveillance population, and additional surveillance components such as the use of International Classification of Disease diagnosis codes, follow-up, period of surveillance, seasonality, and sample size are discussed. Finally, the core data elements to be collected on case report forms are presented.
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Affiliation(s)
- Kate M Miller
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
| | | | | | - Jeffrey W Cannon
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health , Boston, Massachusetts , USA
| | - Tom Parks
- Department of Infectious Disease, Imperial College London, Hammersmith Hospital , London , United Kingdom
| | | | - Janessa Pickering
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
| | - Tim Barnett
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
| | - Mark E Engel
- AFROStrep Research Initiative, Department of Medicine, University of Cape Town , Cape Town , South Africa
| | - Laurens Manning
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
- Infectious Diseases Department, Fiona Stanley Hospital , Perth, Western Australia , Australia
- Medical School, University of Western Australia , Perth, Western Australia , Australia
| | - Asha C Bowen
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
- Perth Children’s Hospital , Nedlands, Western Australia
- Faculty of Health and Medicine, University of Western Australia , Nedlands, Western Australia
| | - Jonathan R Carapetis
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
- Faculty of Health and Medicine, University of Western Australia , Nedlands, Western Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
| | - Dylan D Barth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
- Faculty of Health and Medicine, University of Western Australia , Nedlands, Western Australia
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32
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Jayasundara D, Randall D, Sheridan S, Sheppeard V, Liu B, Richmond PC, Blyth CC, Wood JG, Moore HC, McIntyre PB, Gidding HF. Estimating the excess burden of pertussis disease in Australia within the first year of life, that might have been prevented through timely vaccination. Int J Epidemiol 2022; 52:250-259. [PMID: 36099159 PMCID: PMC9908038 DOI: 10.1093/ije/dyac175] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/29/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Previous Australian studies have shown that delayed vaccination with each of the three primary doses of diphtheria-tetanus-pertussis-containing vaccines (DTP) is up to 50 % in certain subpopulations. We estimated the excess burden of pertussis that might have been prevented if (i) all primary doses and (ii) each dose was given on time. METHODS Perinatal, immunization, pertussis notification and death data were probabilistically linked for 1 412 984 infants born in two Australian states in 2000-12. A DTP dose administered >15 days after the recommended age was considered delayed. We used Poisson regression models to compare pertussis notification rates to 1-year of age in infants with ≥1 dose delayed (Aim 1) or any individual dose delayed (Aim 2) versus a propensity weighted counterfactual on-time cohort. RESULTS Of all infants, 42% had ≥1 delayed DTP dose. We estimated that between 39 to 365 days of age, 85 (95% CI: 61-109) cases per 100 000 infants, could have been prevented if all infants with ≥1 delayed dose had received their three doses within the on-time window. Risk of pertussis was higher in the delayed versus the on-time cohort, so crude rates overestimated the excess burden (110 cases per 100 000 infants (95% CI: 95-125)). The estimated dose-specific excess burden per 100 000 infants was 132 for DTP1, 50 for DTP2 and 19 for DTP3. CONCLUSIONS We provide robust evidence that improved DTP vaccine timeliness, especially for the first dose, substantially reduces the burden of infant pertussis. Our methodology, using a potential outcomes framework, is applicable to other settings.
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Affiliation(s)
- Duleepa Jayasundara
- NSW Biostatistics Training Program, NSW Ministry of Health, St Leonards, NSW, Australia,Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia,University of Sydney, Northern Clinical School, St Leonards, NSW, Australia
| | - Deborah Randall
- Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia,University of Sydney, Northern Clinical School, St Leonards, NSW, Australia
| | - Sarah Sheridan
- Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia,University of Sydney, Northern Clinical School, St Leonards, NSW, Australia,National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, NSW, Australia
| | - Vicky Sheppeard
- Public Health Unit, South Eastern Sydney Local Health District, Sydney, NSW, Australia,School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Bette Liu
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, NSW, Australia,School of Population Health, UNSW Medicine, UNSW, Sydney, NSW, Australia
| | - Peter C Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia,Department of General Paediatrics, Perth Children's Hospital, Perth, WA, Australia,School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia,School of Medicine, University of Western Australia, Perth, WA, Australia,Department of Infectious Diseases, Perth Children's Hospital, Perth, WA, Australia,Department of Microbiology, PathWest Laboratory Medicine WA, Perth Children's Hospital, Perth, WA, Australia
| | - James G Wood
- School of Population Health, UNSW Medicine, UNSW, Sydney, NSW, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Peter B McIntyre
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, NSW, Australia,Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Heather F Gidding
- Corresponding author. Women and Babies Research, Level 5, Douglas Building, Royal North, Shore Hospital, St Leonards, NSW 2065, Australia. E-mail:
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Pratt MTG, Abdalla T, Richmond PC, Moore HC, Snelling TL, Blyth CC, Bhuiyan MU. Prevalence of respiratory viruses in community-acquired pneumonia in children: a systematic review and meta-analysis. The Lancet Child & Adolescent Health 2022; 6:555-570. [DOI: 10.1016/s2352-4642(22)00092-x] [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] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 12/17/2022]
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Nazareno AL, Muscatello DJ, Turner RM, Wood JG, Moore HC, Newall AT. Modelled estimates of hospitalisations attributable to respiratory syncytial virus and influenza in Australia, 2009-2017. Influenza Other Respir Viruses 2022; 16:1082-1090. [PMID: 35775106 PMCID: PMC9530581 DOI: 10.1111/irv.13003] [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: 11/28/2021] [Revised: 03/30/2022] [Accepted: 04/17/2022] [Indexed: 11/30/2022] Open
Abstract
Background Respiratory syncytial virus (RSV) and influenza are important causes of disease in children and adults. In Australia, information on the burden of RSV in adults is particularly limited. Methods We used time series analysis to estimate respiratory, acute respiratory infection, pneumonia and influenza, and bronchiolitis hospitalisations attributable to RSV and influenza in Australia during 2009 through 2017. RSV and influenza‐coded hospitalisations in <5‐year‐olds were used as proxies for relative weekly viral activity. Results From 2009 to 2017, the estimated all‐age average annual rates of respiratory hospitalisations attributable to RSV and seasonal influenza (excluding 2009) were 54.8 (95% confidence interval [CI]: 20.1, 88.8) and 87.8 (95% CI: 74.5, 97.7) per 100,000, respectively. The highest estimated average annual RSV‐attributable respiratory hospitalisation rate per 100,000 was 464.2 (95% CI: 285.9, 641.2) in <5‐year‐olds. For seasonal influenza, it was 521.6 (95% CI: 420.9, 600.0) in persons aged ≥75 years. In ≥75‐year‐olds, modelled estimates were approximately eight and two times the coded estimates for RSV and seasonal influenza, respectively. Conclusions RSV and influenza are major causes of hospitalisation in young children and older adults in Australia, with morbidity underestimated by hospital diagnosis codes.
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Affiliation(s)
- Allen L Nazareno
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Institute of Mathematical Sciences and Physics, College of Arts and Sciences, University of the Philippines Los Baños, Laguna, Philippines
| | - David J Muscatello
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Robin M Turner
- Biostatistics Centre, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - James G Wood
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Anthony T Newall
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Foo D, Sarna M, Pereira G, Moore HC, Regan AK. Maternal influenza vaccination and child mortality: Longitudinal, population-based linked cohort study. Vaccine 2022; 40:3732-3736. [PMID: 35606236 DOI: 10.1016/j.vaccine.2022.05.030] [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: 04/05/2022] [Revised: 05/02/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
Abstract
Influenza vaccination is recommended to protect mothers and their infants from influenza. Few studies have evaluated the association between maternal influenza vaccination and child mortality. We aimed to evaluate the association between in utero exposure to seasonal inactivated influenza vaccine (IIV) and mortality among young children. This longitudinal, population-based cohort study included 191,247 maternal-child pairs in Western Australia between April 2012 and December 2017. Maternal vaccine information was obtained from a state-wide antenatal vaccination database. Mortality was defined as a record of a death registration. We used Cox proportional hazard models, weighted by the inverse-probability of treatment (vaccination), to estimate the hazard ratio of child mortality associated with in utero exposure to seasonal IIV. This study found no association between in utero exposure to seasonal IIV and mortality through age five years.
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Affiliation(s)
- Damien Foo
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.
| | - Mohinder Sarna
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia; Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway; enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Hannah C Moore
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Annette K Regan
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia; School of Nursing and Health Professions, University of San Francisco, San Francisco, California, United States; Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States
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Miller KM, Carapetis JR, Van Beneden CA, Cadarette D, Daw JN, Moore HC, Bloom DE, Cannon JW. The global burden of sore throat and group A Streptococcus pharyngitis: A systematic review and meta-analysis. EClinicalMedicine 2022; 48:101458. [PMID: 35706486 PMCID: PMC9124702 DOI: 10.1016/j.eclinm.2022.101458] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Contemporary data for the global burden of sore throat and group A Streptococcus (Strep A) pharyngitis are required to understand the frequency of disease and develop value propositions for Strep A vaccines. METHODS We used Clarivate Analytics' Web of Science platform to search WoS core collection, PubMed, Medline, data citation index, KCI-Korean Journal Database, Russian Science Citation Index, and the SciELO Citation Index for articles published between Jan 1, 2000, and Feb 15, 2021, from any country and in any language. The risk of bias was assessed using the JBI critical appraisal checklist. We used random-effects meta-analyses to pool sore throat and Strep A sore throat incidence rates from community-based studies. Our study was registered with PROSPERO (CRD42020181103). FINDINGS Of 5,529 articles identified by the search strategy, 26 studies met the inclusion criteria, but only two included data to determine incidence among adults. The pooled incidence rate, calculated for children only, was 82.2 episodes per 100 child-years (95% CI 25.2-286.3, I2 = 100%) for sore throat (7 studies; 7,964 person years) and 22.1 episodes per 100 child-years (95% CI 14.7-33.1, I2 = 98%) for Strep A sore throat (9 studies; 15,696 person years). The pooled cumulative incidence rate of sore throat from five studies was 31.9 per 100 children. There was significant methodological and statistical heterogeneity among studies, and five of 26 studies had a risk of bias score less than five (range: nine [maximum score] to one). INTERPRETATION Strep A sore throat has a considerable global burden. However, methodologically standardised studies are required to quantify that burden, analyse differences in rates between populations, and evaluate the likely impact of future Strep A vaccines. FUNDING This study was funded by Wellcome Trust 215,490/Z/19/Z.
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Affiliation(s)
- Kate M. Miller
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia, PO Box 855, West Perth, Nedlands, WA 6872, Australia
- Corresponding author.
| | - Jonathan R. Carapetis
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia, PO Box 855, West Perth, Nedlands, WA 6872, Australia
- Perth Children's Hospital, Nedlands, WA, Australia
| | | | - Daniel Cadarette
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jessica N. Daw
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia, PO Box 855, West Perth, Nedlands, WA 6872, Australia
| | - Hannah C. Moore
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia, PO Box 855, West Perth, Nedlands, WA 6872, Australia
| | - David E. Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jeffrey W. Cannon
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia, PO Box 855, West Perth, Nedlands, WA 6872, Australia
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Kabir A, Newall AT, Randall D, Moore HC, Jayasinghe S, Fathima P, Liu B, McIntyre P, Gidding HF. Effectiveness of 7-Valent Pneumococcal Conjugate Vaccine Against Invasive Pneumococcal Disease in Medically At-Risk Children in Australia: A Record Linkage Study. J Pediatric Infect Dis Soc 2022; 11:391-399. [PMID: 35640283 PMCID: PMC9520284 DOI: 10.1093/jpids/piac038] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 05/01/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Children with chronic medical conditions are at higher risk of invasive pneumococcal disease (IPD), but little is known about the effectiveness of the primary course of pneumococcal conjugate vaccine (PCV) in these children. METHODS A cohort born in 2001-2004 from two Australian states and identified as medically at-risk (MAR) of IPD either using ICD-coded hospitalizations (with conditions of interest identified by 6 months of age) or linked perinatal data (for prematurity) were followed to age 5 years for notified IPD by serotype. We categorized fully vaccinated children as either receiving PCV dose 3 by <12 months of age or ≥1 PCV dose at ≥12 months of age. Cox proportional hazard modeling was used to estimate hazard ratios (HRs), adjusted for confounders, and vaccine effectiveness (VE) was estimated as (1-HR) × 100. RESULTS A total of 9220 children with MAR conditions had 53 episodes of IPD (43 vaccine-type); 4457 (48.3%) were unvaccinated and 4246 (46.1%) were fully vaccinated, with 1371 (32.3%) receiving dose 3 by 12 months and 2875 (67.7%) having ≥1 dose at ≥12 months. Estimated VE in fully vaccinated children was 85.9% (95% CI: 33.9-97.0) against vaccine-type IPD and 71.5% (95% CI: 26.6-88.9) against all-cause IPD. CONCLUSION This is the first population-based study evaluating the effectiveness of PCV in children with MAR conditions using record linkage. Our study provides evidence that the VE for vaccine-type and all-cause IPD in MAR children in Australia is high and not statistically different from previously reported estimates for the general population. This method can be replicated in other countries to evaluate VE in MAR children.
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Affiliation(s)
- Alamgir Kabir
- Corresponding Author: Alamgir Kabir, School of Population Health, University of New South Wales, Sydney New South Wales 2052, Australia. E-mail:
| | - Anthony T Newall
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Deborah Randall
- The University of Sydney Northern Clinical School, Sydney, New South Wales, Australia,Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Sanjay Jayasinghe
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia,Discipline of Child and Adolescent Health, Children’s Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
| | - Parveen Fathima
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia,Communicable Disease Control Directorate, Department of Health Western Australia, 189 Royal Street, Perth, Western Australia 6004, Australia
| | - Bette Liu
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Peter McIntyre
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - Heather F Gidding
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia,The University of Sydney Northern Clinical School, Sydney, New South Wales, Australia,Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, New South Wales, Australia,National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
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Li Y, Wang X, Blau DM, Caballero MT, Feikin DR, Gill CJ, Madhi SA, Omer SB, Simões EAF, Campbell H, Pariente AB, Bardach D, Bassat Q, Casalegno JS, Chakhunashvili G, Crawford N, Danilenko D, Do LAH, Echavarria M, Gentile A, Gordon A, Heikkinen T, Huang QS, Jullien S, Krishnan A, Lopez EL, Markić J, Mira-Iglesias A, Moore HC, Moyes J, Mwananyanda L, Nokes DJ, Noordeen F, Obodai E, Palani N, Romero C, Salimi V, Satav A, Seo E, Shchomak Z, Singleton R, Stolyarov K, Stoszek SK, von Gottberg A, Wurzel D, Yoshida LM, Yung CF, Zar HJ, Nair H. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis. Lancet 2022; 399:2047-2064. [PMID: 35598608 PMCID: PMC7613574 DOI: 10.1016/s0140-6736(22)00478-0] [Citation(s) in RCA: 377] [Impact Index Per Article: 188.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/21/2022] [Accepted: 03/08/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the most common cause of acute lower respiratory infection in young children. We previously estimated that in 2015, 33·1 million episodes of RSV-associated acute lower respiratory infection occurred in children aged 0-60 months, resulting in a total of 118 200 deaths worldwide. Since then, several community surveillance studies have been done to obtain a more precise estimation of RSV associated community deaths. We aimed to update RSV-associated acute lower respiratory infection morbidity and mortality at global, regional, and national levels in children aged 0-60 months for 2019, with focus on overall mortality and narrower infant age groups that are targeted by RSV prophylactics in development. METHODS In this systematic analysis, we expanded our global RSV disease burden dataset by obtaining new data from an updated search for papers published between Jan 1, 2017, and Dec 31, 2020, from MEDLINE, Embase, Global Health, CINAHL, Web of Science, LILACS, OpenGrey, CNKI, Wanfang, and ChongqingVIP. We also included unpublished data from RSV GEN collaborators. Eligible studies reported data for children aged 0-60 months with RSV as primary infection with acute lower respiratory infection in community settings, or acute lower respiratory infection necessitating hospital admission; reported data for at least 12 consecutive months, except for in-hospital case fatality ratio (CFR) or for where RSV seasonality is well-defined; and reported incidence rate, hospital admission rate, RSV positive proportion in acute lower respiratory infection hospital admission, or in-hospital CFR. Studies were excluded if case definition was not clearly defined or not consistently applied, RSV infection was not laboratory confirmed or based on serology alone, or if the report included fewer than 50 cases of acute lower respiratory infection. We applied a generalised linear mixed-effects model (GLMM) to estimate RSV-associated acute lower respiratory infection incidence, hospital admission, and in-hospital mortality both globally and regionally (by country development status and by World Bank Income Classification) in 2019. We estimated country-level RSV-associated acute lower respiratory infection incidence through a risk-factor based model. We developed new models (through GLMM) that incorporated the latest RSV community mortality data for estimating overall RSV mortality. This review was registered in PROSPERO (CRD42021252400). FINDINGS In addition to 317 studies included in our previous review, we identified and included 113 new eligible studies and unpublished data from 51 studies, for a total of 481 studies. We estimated that globally in 2019, there were 33·0 million RSV-associated acute lower respiratory infection episodes (uncertainty range [UR] 25·4-44·6 million), 3·6 million RSV-associated acute lower respiratory infection hospital admissions (2·9-4·6 million), 26 300 RSV-associated acute lower respiratory infection in-hospital deaths (15 100-49 100), and 101 400 RSV-attributable overall deaths (84 500-125 200) in children aged 0-60 months. In infants aged 0-6 months, we estimated that there were 6·6 million RSV-associated acute lower respiratory infection episodes (4·6-9·7 million), 1·4 million RSV-associated acute lower respiratory infection hospital admissions (1·0-2·0 million), 13 300 RSV-associated acute lower respiratory infection in-hospital deaths (6800-28 100), and 45 700 RSV-attributable overall deaths (38 400-55 900). 2·0% of deaths in children aged 0-60 months (UR 1·6-2·4) and 3·6% of deaths in children aged 28 days to 6 months (3·0-4·4) were attributable to RSV. More than 95% of RSV-associated acute lower respiratory infection episodes and more than 97% of RSV-attributable deaths across all age bands were in low-income and middle-income countries (LMICs). INTERPRETATION RSV contributes substantially to morbidity and mortality burden globally in children aged 0-60 months, especially during the first 6 months of life and in LMICs. We highlight the striking overall mortality burden of RSV disease worldwide, with one in every 50 deaths in children aged 0-60 months and one in every 28 deaths in children aged 28 days to 6 months attributable to RSV. For every RSV-associated acute lower respiratory infection in-hospital death, we estimate approximately three more deaths attributable to RSV in the community. RSV passive immunisation programmes targeting protection during the first 6 months of life could have a substantial effect on reducing RSV disease burden, although more data are needed to understand the implications of the potential age-shifts in peak RSV burden to older age when these are implemented. FUNDING EU Innovative Medicines Initiative Respiratory Syncytial Virus Consortium in Europe (RESCEU).
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Affiliation(s)
- You Li
- School of Public Health, Nanjing Medical University, Nanjing, China; Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Xin Wang
- School of Public Health, Nanjing Medical University, Nanjing, China; Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Dianna M Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mauricio T Caballero
- Fundacion INFANT, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Daniel R Feikin
- Department of Immunizations, Vaccines, and Biologicals, WHO, Geneva, Switzerland
| | - Christopher J Gill
- Boston University School of Public Health, Department of Global Health, Boston, Massachusetts, USA
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa; African Leadership Initiative in Vaccinology Expertise, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Saad B Omer
- Yale Institute for Global Health, New Haven, CT, USA
| | - Eric A F Simões
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado, School of Medicine, Aurora, CO, USA; Department of Epidemiology and Center for Global Health, Colorado School of Public Health, Aurora, CO, USA
| | - Harry Campbell
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ana Bermejo Pariente
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Darmaa Bardach
- National Center for Communicable Diseases (Mongolia), Ulaanbaatar, Mongolia
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Catalan Institution for Research and Advanced Studies, Barcelona, Spain
| | - Jean-Sebastien Casalegno
- Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Centre de Biologie Nord, Institut des Agents Infectieux, Laboratoire de Virologie, Lyon, France
| | | | - Nigel Crawford
- The Royal Children's Hospital, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Daria Danilenko
- Smorodintsev Research Institute of Influenza, Saint Petersburg, Russia
| | - Lien Anh Ha Do
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Marcela Echavarria
- Clinical Virology Unit, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina
| | - Angela Gentile
- Ricardo Gutierrez Children Hospital, Buenos Aires, Argentina
| | - Aubree Gordon
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Terho Heikkinen
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Q Sue Huang
- WHO National Influenza Centre, Institute of Environmental Science and Research, Wellington, New Zealand
| | - Sophie Jullien
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Jigme Dorji Wangchuck National Referral Hospital, Gongphel Lam, Thimphu, Bhutan
| | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Eduardo Luis Lopez
- Hospital de Niños Dr. Ricardo Gutiérrez, Department of Medicine, Pediatric Infectious Diseases Program, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Joško Markić
- Department of Pediatrics, University Hospital Split, Split, Croatia; University of Split, School of Medicine, Split, Croatia
| | - Ainara Mira-Iglesias
- Área de Investigación en Vacunas, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, Salud Pública, Valencia, Spain
| | - Hannah C Moore
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Jocelyn Moyes
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Lawrence Mwananyanda
- Boston University School of Public Health, Department of Global Health, Boston, Massachusetts, USA
| | - D James Nokes
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; School of Life Sciences, University of Warwick, Coventry, UK
| | - Faseeha Noordeen
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Evangeline Obodai
- Virology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Nandhini Palani
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | | | - Vahid Salimi
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ashish Satav
- MAHAN Trust Mahatma Gandhi Tribal Hospital, Karmgram, Utavali, Tahsil, Dharni, India
| | - Euri Seo
- Department of Pediatrics, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, South Korea
| | - Zakhar Shchomak
- Department of Pediatrics, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | | | - Kirill Stolyarov
- Smorodintsev Research Institute of Influenza, Saint Petersburg, Russia
| | | | - Anne von Gottberg
- School of Pathology, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa; National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Danielle Wurzel
- Murdoch Children's Research Institute, Melbourne, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Lay-Myint Yoshida
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Chee Fu Yung
- Infectious Diseases Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore; Lee Kong Chian School of Medicine, Imperial College, Nanyang Technological University, Singapore
| | - Heather J Zar
- Department of Paediatrics and Child Health, and South African Medical Research Council Unit on Child & Adolescent Health, University of Cape Town and Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Harish Nair
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK; Respiratory Syncytial Virus Network Foundation, Zeist, Netherlands, on behalf of the Respiratory Virus Global Epidemiology Network, and the RESCEU investigators.
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Foley DA, Phuong LK, Peplinski J, Lim SMJ, Lee WH, Keane A, Wong JWS, Minney-Smith CA, Martin AC, Mace AO, Sikazwe CT, Le H, Levy A, Borland M, Hazelton B, Moore HC, Blyth C, Yeoh D, Bowen AC. Examining the entire delayed respiratory syncytial virus season in Western Australia. Arch Dis Child 2022; 107:517-519. [PMID: 34930725 DOI: 10.1136/archdischild-2021-323375] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 11/03/2022]
Affiliation(s)
- David Anthony Foley
- Microbiology, PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia .,Wesfarmers Centre of Vaccines and Infecitous Diseases, University of Western Australia, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Linny Kimly Phuong
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Joseph Peplinski
- Department of General Paediatrics, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Selina Mei Jy Lim
- Infectious Diseases Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Wei Hao Lee
- Department of General Paediatrics, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Aoife Keane
- Department of General Paediatrics, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Jessica Win See Wong
- Department of General Paediatrics, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Cara A Minney-Smith
- Microbiology, PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia
| | - Andrew C Martin
- Department of General Paediatrics, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Ariel O Mace
- Department of General Paediatrics, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Chisha T Sikazwe
- Microbiology, PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia.,Infection and Immunity, Biomedical Science, University of Western Australia, Perth, Western Australia, Australia
| | - Huong Le
- Wesfarmers Centre of Vaccines and Infecitous Diseases, University of Western Australia, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Avram Levy
- Microbiology, PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia.,Infection and Immunity, Biomedical Science, University of Western Australia, Perth, Western Australia, Australia
| | - Meredith Borland
- Emergency Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Divisions of Paediatrics and Emergency Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Briony Hazelton
- Microbiology, PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia.,Infectious Diseases Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infecitous Diseases, University of Western Australia, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Christopher Blyth
- Microbiology, PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia.,Wesfarmers Centre of Vaccines and Infecitous Diseases, University of Western Australia, Telethon Kids Institute, Perth, Western Australia, Australia.,Infectious Diseases Department, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Paediatrics and Child Health, University of Western Australia, Subiaco, Western Australia, Australia
| | - Daniel Yeoh
- Infectious Diseases Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Asha C Bowen
- Wesfarmers Centre of Vaccines and Infecitous Diseases, University of Western Australia, Telethon Kids Institute, Perth, Western Australia, Australia.,Infectious Diseases Department, Perth Children's Hospital, Perth, Western Australia, Australia
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40
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Moore HC, Cannon JW, Kaslow DC, Lamagni T, Bowen AC, Miller KM, Cherian T, Carapetis J, Van Beneden C. A systematic framework for prioritising burden of disease data required for vaccine development and implementation: the case for group A streptococcal diseases. Clin Infect Dis 2022; 75:1245-1254. [PMID: 35438130 PMCID: PMC9525082 DOI: 10.1093/cid/ciac291] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/04/2022] [Indexed: 12/30/2022] Open
Abstract
Vaccine development and implementation decisions need to be guided by accurate and robust burden of disease data. We developed an innovative systematic framework outlining the properties of such data that are needed to advance vaccine development and evaluation, and prioritize research and surveillance activities. We focus on 4 objectives—advocacy, regulatory oversight and licensure, policy and post-licensure evaluation, and post-licensure financing—and identify key stakeholders and specific requirements for burden of disease data aligned with each objective. We apply this framework to group A Streptococcus, a pathogen with an underrecognized global burden, and give specific examples pertinent to 8 clinical endpoints. This dynamic framework can be adapted for any disease with a vaccine in development and can be updated as vaccine candidates progress through clinical trials. This framework will also help with research and innovation priority setting of the Immunization Agenda 2030 (IA2030) and accelerate development of future vaccines.
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Affiliation(s)
- Hannah C Moore
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Jeffrey W Cannon
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | | | - Asha C Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Perth Children's Hospital, Perth, Western Australia, Australia
| | - Kate M Miller
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | | | - Jonathan Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Perth Children's Hospital, Perth, Western Australia, Australia
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Foo D, Sarna M, Pereira G, Moore HC, Regan AK. Prenatal influenza vaccination and allergic and autoimmune diseases in childhood: A longitudinal, population-based linked cohort study. PLoS Med 2022; 19:e1003963. [PMID: 35381006 PMCID: PMC9017895 DOI: 10.1371/journal.pmed.1003963] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 04/19/2022] [Accepted: 03/16/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Few studies have evaluated the effect of maternal influenza vaccination on the development of allergic and autoimmune diseases in children beyond 6 months of age. We aimed to investigate the association between in utero exposure to seasonal inactivated influenza vaccine (IIV) and subsequent diagnosis of allergic and autoimmune diseases. METHODS AND FINDINGS This longitudinal, population-based linked cohort study included 124,760 singleton, live-born children from 106,206 mothers in Western Australia (WA) born between April 2012 and July 2016, with up to 5 years of follow-up from birth. In our study cohort, 64,169 (51.4%) were male, 6,566 (5.3%) were Aboriginal and/or Torres Strait Islander children, and the mean age at the end of follow-up was 3.0 (standard deviation, 1.3) years. The exposure was receipt of seasonal IIV during pregnancy. The outcomes were diagnosis of an allergic or autoimmune disease, including asthma and anaphylaxis, identified from hospital and/or emergency department (ED) records. Inverse probability of treatment weights (IPTWs) accounted for baseline probability of vaccination by maternal age, Aboriginal and/or Torres Strait Islander status, socioeconomic status, body mass index, parity, medical conditions, pregnancy complications, prenatal smoking, and prenatal care. The models additionally adjusted for the Aboriginal and/or Torres Strait Islander status of the child. There were 14,396 (11.5%) maternally vaccinated children; 913 (6.3%) maternally vaccinated and 7,655 (6.9%) maternally unvaccinated children had a diagnosis of allergic or autoimmune disease, respectively. Overall, maternal influenza vaccination was not associated with diagnosis of an allergic or autoimmune disease (adjusted hazard ratio [aHR], 1.02; 95% confidence interval [CI], 0.95 to 1.09). In trimester-specific analyses, we identified a negative association between third trimester influenza vaccination and the diagnosis of asthma (n = 40; aHR, 0.70; 95% CI, 0.50 to 0.97) and anaphylaxis (n = 36; aHR, 0.67; 95% CI, 0.47 to 0.95).We did not capture outcomes diagnosed in a primary care setting; therefore, our findings are only generalizable to more severe events requiring hospitalization or presentation to the ED. Due to small cell sizes (i.e., <5), estimates could not be determined for all outcomes after stratification. CONCLUSIONS In this study, we observed no association between in utero exposure to influenza vaccine and diagnosis of allergic or autoimmune diseases. Although we identified a negative association of asthma and anaphylaxis diagnosis when seasonal IIV was administered later in pregnancy, additional studies are needed to confirm this. Overall, our findings support the safety of seasonal inactivated influenza vaccine during pregnancy in relation to allergic and autoimmune diseases in early childhood and support the continuation of current global maternal vaccine programs and policies.
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Affiliation(s)
- Damien Foo
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- * E-mail:
| | - Mohinder Sarna
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Hannah C. Moore
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Annette K. Regan
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- School of Nursing and Health Professions, University of San Francisco, San Francisco, California, United States of America
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
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Foley DA, Phuong LK, Peplinski J, Lim SM, Lee WH, Farhat A, Minney-Smith CA, Martin AC, Mace AO, Sikazwe CT, Le H, Levy A, Hoeppner T, Borland ML, Hazelton B, Moore HC, Blyth C, Yeoh DK, Bowen AC. Examining the interseasonal resurgence of respiratory syncytial virus in Western Australia. Arch Dis Child 2022; 107:e7. [PMID: 34433552 PMCID: PMC8390145 DOI: 10.1136/archdischild-2021-322507] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/12/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Following a relative absence in winter 2020, a large resurgence of respiratory syncytial virus (RSV) detections occurred during the 2020/2021 summer in Western Australia. This seasonal shift was linked to SARS-CoV-2 public health measures. We examine the epidemiology and RSV testing of respiratory-coded admissions, and compare clinical phenotype of RSV-positive admissions between 2019 and 2020. METHOD At a single tertiary paediatric centre, International Classification of Diseases, 10th edition Australian Modification-coded respiratory admissions longer than 12 hours were combined with laboratory data from 1 January 2019 to 31 December 2020. Data were grouped into bronchiolitis, other acute lower respiratory infection (OALRI) and wheeze, to assess RSV testing practices. For RSV-positive admissions, demographics and clinical features were compared between 2019 and 2020. RESULTS RSV-positive admissions peaked in early summer 2020, following an absent winter season. Testing was higher in 2020: bronchiolitis, 94.8% vs 89.2% (p=0.01); OALRI, 88.6% vs 82.6% (p=0.02); and wheeze, 62.8% vs 25.5% (p<0.001). The 2020 peak month, December, contributed almost 75% of RSV-positive admissions, 2.5 times the 2019 peak. The median age in 2020 was twice that observed in 2019 (16.4 vs 8.1 months, p<0.001). The proportion of RSV-positive OALRI admissions was greater in 2020 (32.6% vs 24.9%, p=0.01). There were no clinically meaningful differences in length of stay or disease severity. INTERPRETATION The 2020 RSV season was in summer, with a larger than expected peak. There was an increase in RSV-positive non-bronchiolitis admissions, consistent with infection in older RSV-naïve children. This resurgence raises concern for regions experiencing longer and more stringent SARS-CoV-2 public health measures.
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Affiliation(s)
- David Anthony Foley
- Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, University of Western Australia, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Linny Kimly Phuong
- Murdoch Children's Research Institute, Infection and Immunity, Parkville, Victoria, Australia
| | - Joseph Peplinski
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Selina Mei Lim
- Infectious Diseases Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Wei Hao Lee
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Asifa Farhat
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Cara A Minney-Smith
- Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
| | - Andrew C Martin
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Ariel O Mace
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Chisha T Sikazwe
- Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
- Infection and Immunity, Biomedical Science, University of Western Australia, Perth, Western Australia, Australia
| | - Huong Le
- Wesfarmers Centre for Vaccines and Infectious Diseases, University of Western Australia, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Avram Levy
- Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
- Infection and Immunity, Biomedical Science, University of Western Australia, Perth, Western Australia, Australia
| | - Tobias Hoeppner
- Emergency Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Meredith L Borland
- Emergency Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Divisions of Paediatrics and Emergency Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Briony Hazelton
- Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
- Infectious Diseases Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Hannah C Moore
- Wesfarmers Centre for Vaccines and Infectious Diseases, University of Western Australia, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Christopher Blyth
- Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, University of Western Australia, Telethon Kids Institute, Nedlands, Western Australia, Australia
- School of Paediatrics and Child Health, University of Western Australia, Subiaco, Western Australia, Australia
| | - Daniel K Yeoh
- Infectious Diseases Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Asha C Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, University of Western Australia, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Infectious Diseases Department, Perth Children's Hospital, Perth, Western Australia, Australia
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Foo D, Sarna M, Pereira G, Moore HC, Regan AK. Longitudinal, population-based cohort study of prenatal influenza vaccination and influenza infection in childhood. Vaccine 2022; 40:656-665. [PMID: 35000794 DOI: 10.1016/j.vaccine.2021.11.084] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/21/2021] [Accepted: 11/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Influenza vaccination is recommended to protect mothers and their infants from influenza infection. Few studies have evaluated the health impacts of in utero exposure to influenza vaccine among children more than six months of age. METHODS We used probabilistically linked administrative health records to establish a mother-child cohort to evaluate the risk of influenza and acute respiratory infections associated with maternal influenza vaccination. Outcomes were laboratory-confirmed influenza (LCI) and hospitalization for influenza or acute respiratory infection (ARI). Adjusted hazard ratios (aHRs) accounted for child's Aboriginal status and were weighted by the inverse-probability of treatment. RESULTS 14,396 (11.5%) children were born to vaccinated mothers. Maternally vaccinated infants aged < 6 months had lower risk of LCI (aHR: 0.33; 95% CI: 0.13, 0.85), influenza-associated hospitalization (aHR: 0.39; 95% CI: 0.16, 0.94) and ARI-associated hospitalization (aHR: 0.85; 95% CI: 0.77, 0.94) compared to maternally unvaccinated infants. With the exception of an increased risk of LCI among children aged 6 months to < 2 years old following first trimester vaccination (aHR: 2.28; 95% CI: 1.41, 3.69), there were no other differences in the risk of LCI, influenza-associated hospitalization or ARI-associated hospitalization among children aged > 6 months. CONCLUSION Study results show that maternal influenza vaccination is effective in preventing influenza in the first six months and had no impact on respiratory infections after two years of age.
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Affiliation(s)
- Damien Foo
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia; Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.
| | - Mohinder Sarna
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia; Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia; Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway; enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Hannah C Moore
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia; Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Annette K Regan
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia; Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia; School of Nursing and Health Professions, University of San Francisco, San Francisco, California, United States; Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States
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Gebremedhin AT, Hogan AB, Blyth CC, Glass K, Moore HC. Developing a prediction model to estimate the true burden of respiratory syncytial virus (RSV) in hospitalised children in Western Australia. Sci Rep 2022; 12:332. [PMID: 35013434 PMCID: PMC8748465 DOI: 10.1038/s41598-021-04080-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [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: 04/03/2021] [Accepted: 12/14/2021] [Indexed: 12/23/2022] Open
Abstract
Respiratory syncytial virus (RSV) is a leading cause of childhood morbidity, however there is no systematic testing in children hospitalised with respiratory symptoms. Therefore, current RSV incidence likely underestimates the true burden. We used probabilistically linked perinatal, hospital, and laboratory records of 321,825 children born in Western Australia (WA), 2000-2012. We generated a predictive model for RSV positivity in hospitalised children aged < 5 years. We applied the model to all hospitalisations in our population-based cohort to determine the true RSV incidence, and under-ascertainment fraction. The model's predictive performance was determined using cross-validated area under the receiver operating characteristic (AUROC) curve. From 321,825 hospitalisations, 37,784 were tested for RSV (22.8% positive). Predictors of RSV positivity included younger admission age, male sex, non-Aboriginal ethnicity, a diagnosis of bronchiolitis and longer hospital stay. Our model showed good predictive accuracy (AUROC: 0.87). The respective sensitivity, specificity, positive predictive value and negative predictive values were 58.4%, 92.2%, 68.6% and 88.3%. The predicted incidence rates of hospitalised RSV for children aged < 3 months was 43.7/1000 child-years (95% CI 42.1-45.4) compared with 31.7/1000 child-years (95% CI 30.3-33.1) from laboratory-confirmed RSV admissions. Findings from our study suggest that the true burden of RSV may be 30-57% higher than current estimates.
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Affiliation(s)
- Amanuel Tesfay Gebremedhin
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, 6872, Australia.
| | - Alexandra B Hogan
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, 6872, Australia
- School of Medicine, The University of Western Australia, Perth, WA, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, WA, Australia
- PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, Perth, WA, Australia
| | - Kathryn Glass
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, 6872, Australia
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Pérez Chacón G, Fathima P, Jones M, Barnes R, Richmond PC, Gidding HF, Moore HC, Snelling TL. Pertussis immunisation in infancy and atopic outcomes: A protocol for a population-based cohort study using linked administrative data. PLoS One 2021; 16:e0260388. [PMID: 34874968 PMCID: PMC8651097 DOI: 10.1371/journal.pone.0260388] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/06/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The burden of IgE-mediated food allergy in Australian born children is reported to be among the highest globally. This illness shares risk factors and frequently coexists with asthma, one of the most common noncommunicable diseases of childhood. Findings from a case-control study suggest that compared to immunisation with acellular pertussis vaccine, early priming of infants with whole-cell pertussis vaccine may be associated with a lower risk of subsequent IgE-mediated food allergy. If whole-cell vaccination is protective of food allergy and other atopic diseases, especially if protective against childhood asthma, the population-level effects could justify its preferential recommendation. However, the potential beneficial effects of whole-cell pertussis vaccination for the prevention of atopic diseases at a population-scale are yet to be investigated. METHODS AND ANALYSIS Analyses of population-based record linkage data will be undertaken to compare the rates of admissions to hospital for asthma in children aged between 5 and 15 years old, who were born in Western Australia (WA) or New South Wales (NSW) between 1997 and 1999 (329,831) when pertussis immunisation in Australia transitioned from whole-cell to acellular only schedules. In the primary analysis we will estimate hazard ratios and 95% confidence intervals for the time-to-first-event (hospital admissions as above) using Cox proportional hazard models in recipients of a first dose of whole-cell versus acellular pertussis-containing vaccine before 112 days old (~4 months of age). Similarly, we will also fit time-to-recurrent events analyses using Andersen-Gill models, and robust variance estimates to account for potential within-child dependence. Hospitalisations for all-cause anaphylaxis, food anaphylaxis, venom, all-cause urticaria and atopic dermatitis will also be examined in children who received at least one dose of pertussis-containing vaccine by the time of the cohort entry, using analogous statistical methods. Presentations to the emergency departments will be assessed separately using the same statistical approach.
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Affiliation(s)
- Gladymar Pérez Chacón
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- Faculty of Health Science, Curtin School of Population Health, Curtin University, Bentley, WA, Australia
| | - Parveen Fathima
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Mark Jones
- Faculty of Medicine and Health, Health and Clinical Analytics Lab, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Rosanne Barnes
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Peter C. Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- Division of Paediatrics, University of Western Australia, Perth, WA, Australia
| | - Heather F. Gidding
- Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
- Women and Babies Health Research, Kolling Institute, Northern Sydney Local Health District, Sydney, NSW, Australia
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Hannah C. Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- Faculty of Health Science, Curtin School of Population Health, Curtin University, Bentley, WA, Australia
| | - Thomas L. Snelling
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- Faculty of Health Science, Curtin School of Population Health, Curtin University, Bentley, WA, Australia
- Faculty of Medicine and Health, Health and Clinical Analytics Lab, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
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Moore HC, Le H, Mace A, Blyth CC, Yeoh D, Foley D, Martin A. Interrupted time-series analysis showed unintended consequences of non-pharmaceutical interventions on pediatric hospital admissions. J Clin Epidemiol 2021; 143:1-10. [PMID: 34801694 PMCID: PMC8600916 DOI: 10.1016/j.jclinepi.2021.11.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 08/19/2021] [Revised: 10/27/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE COVID-19-associated non-pharmaceutical interventions (NPI) have disrupted respiratory viral transmission. We quantified the changes in pediatric hospital admissions in 2020 from five different NPI phases in Western Australia for acute lower respiratory infections (ALRI) in children in the context of all-cause admissions. STUDY DESIGN AND SETTING We assessed anonymised hospitalization data from Perth Children's Hospital (Jan 2015-Dec 2020) for all-cause admissions, ALRI, febrile illnesses and trauma (negative control) in those <17 years. We evaluated absolute changes in admissions and the weekly change estimated from interrupted time-series models. RESULTS The absolute number of admissions was comparable in 2020 (15,678) vs. 2015 to 2019 average (15,310). Following the introduction of strict NPIs, all-cause admissions declined by 35%, recovered to pre-pandemic levels, then increased by 24% following NPI cessation. ALRI admissions in children <5 years initially declined by 89%, which was sustained throughout the gradual easing of NPI until an increase of 579% (997% in <3 months) following the final easing of NPI. Admissions for trauma showed minimal changes in 2020 compared to preceding years. CONCLUSION COVID-19-associated NPI had significant unintended consequences in health service utilization, especially for ALRI and infants <3 months, prompting the need to understand viral transmission dynamics in young children.
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Affiliation(s)
- Hannah C Moore
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia.
| | - Huong Le
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Ariel Mace
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of General Paediatrics, Perth Children's Hospital, Perth, Australia; Department of Paediatrics, Fiona Stanley Hospital, Murdoch, Australia
| | - Christopher C Blyth
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Infectious Diseases, Perth Children's Hospital, Perth, Australia; PathWest Laboratory Medicine, Perth, Australia; School of Medicine, University of Western Australia, Perth, Australia
| | - Daniel Yeoh
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria
| | - David Foley
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia; PathWest Laboratory Medicine, Perth, Australia
| | - Andrew Martin
- Department of General Paediatrics, Perth Children's Hospital, Perth, Australia
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Norman DA, Cheng AC, Macartney KK, Moore HC, Danchin M, Seale H, McRae J, Clark JE, Marshall HS, Buttery J, Francis JR, Crawford NW, Blyth CC. Influenza hospitalizations in Australian children 2010-2019: The impact of medical comorbidities on outcomes, vaccine coverage, and effectiveness. Influenza Other Respir Viruses 2021; 16:316-327. [PMID: 34787369 PMCID: PMC8818821 DOI: 10.1111/irv.12939] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 08/17/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Children with comorbidities are at greater risk of severe influenza outcomes compared with healthy children. In Australia, influenza vaccination was funded for those with comorbidities from 2010 and all children aged <5 years from 2018. Influenza vaccine coverage remains inadequate in children with and without comorbidities. METHODS Children ≤16 years admitted with acute respiratory illness and tested for influenza at sentinel hospitals were evaluated (2010-2019). Multivariable regression was used to identify predictors of severe outcomes. Vaccine effectiveness was estimated using the modified incidence density test-negative design. RESULTS Overall, 6057 influenza-confirmed hospitalized cases and 3974 test-negative controls were included. Influenza A was the predominant type (68.7%). Comorbidities were present in 40.8% of cases. Children with comorbidities were at increased odds of ICU admission, respiratory support, longer hospitalizations, and mortality. Specific comorbidities including neurological and cardiac conditions increasingly predisposed children to severe outcomes. Influenza vaccine coverage in influenza negative children with and without comorbidities was low (33.5% and 17.9%, respectively). Coverage improved following introduction of universal influenza vaccine programs for children <5 years. Similar vaccine effectiveness was demonstrated in children with (55% [95% confidence interval (CI): 45; 63%]) and without comorbidities (57% [(95%CI: 44; 67%]). CONCLUSIONS Comorbidities were present in 40.8% of influenza-confirmed admissions and were associated with more severe outcomes. Children with comorbidities were more likely experience severe influenza with ICU admission, mechanical ventilation, and in-hospital morality. Despite demonstrated vaccine effectiveness in those with and without comorbidities, vaccine coverage was suboptimal. Interventions to increase vaccination are expected to reduce severe influenza outcomes.
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Affiliation(s)
- Daniel A Norman
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Allen C Cheng
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kristine K Macartney
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Discipline of Child and Adolescent Health, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Margie Danchin
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Vaccine Hesitancy, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of General Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Holly Seale
- School of Population Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Jocelynne McRae
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Discipline of Child and Adolescent Health, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Julia E Clark
- Infection Management and Prevention Service, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Helen S Marshall
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.,Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.,The Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Jim Buttery
- Department of Infection and Immunity, Monash Children's Hospital, Monash Health, Clayton, Victoria, Australia.,Monash Centre of Health Care Research and Implementation, Departments of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Joshua R Francis
- Royal Darwin Hospital, Top End Health Service, Darwin, Northern Territory, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Nigel W Crawford
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of General Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia.,SAFEVIC, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,School of Medicine, University of Western Australia, Crawley, Western Australia, Australia.,Department of Infectious Disease, Perth Children's Hospital, Nedlands, Western Australia, Australia.,PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, Western Australia, Australia
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48
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Britton KJ, Pickering JL, Pomat WS, de Gier C, Nation ML, Pell CL, Granland CM, Solomon V, Ford RL, Greenhill A, Hinds J, Moore HC, Richmond PC, Blyth CC, Lehmann D, Satzke C, Kirkham LAS. Lack of effectiveness of 13-valent pneumococcal conjugate vaccination against pneumococcal carriage density in Papua New Guinean infants. Vaccine 2021; 39:5401-5409. [PMID: 34384633 DOI: 10.1016/j.vaccine.2021.07.085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 06/10/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Papua New Guinea (PNG) introduced the 13-valent pneumococcal conjugate vaccine (PCV13) in 2014, with administration at 1, 2, and 3 months of age. PCV13 has reduced or eliminated carriage of vaccine types in populations with low pneumococcal carriage prevalence, carriage density and serotype diversity. This study investigated PCV13 impact on serotype-specific pneumococcal carriage prevalence, density, and serotype diversity in PNG infants, who have some of the highest reported rates of pneumococcal carriage and disease in the world. METHODS Nasopharyngeal swabs were collected at 1, 4 and 9 months of age from PCV13-vaccinated infants (n = 57) and age-/season-matched, unvaccinated infants (at approximately 1 month, n = 53; 4 months, n = 57; 9 months, n = 52). Serotype-specific pneumococcal carriage density and antimicrobial resistance genes were identified by qPCR and microarray. RESULTS Pneumococci were present in 89% of swabs, with 60 different serotypes and four non-encapsulated variants detected. Multiple serotype carriage was common (47% of swabs). Vaccine type carriage prevalence was similar between PCV13-vaccinated and unvaccinated infants at 4 and 9 months of age. The prevalence of non-vaccine type carriage was also similar between cohorts, with non-vaccine types present in three-quarters of samples (from both vaccinated and unvaccinated infants) by 4 months of age. The median pneumococcal carriage density was high and similar at each age group (~7.0 log10genome equivalents/mL). PCV13 had no effect on overall pneumococcal carriage density, vaccine type density, non-vaccine type density, or the prevalence of antimicrobial resistance genes. CONCLUSION PNG infants experience dense and diverse pneumococcal colonisation with concurrent serotypes from 1 month of age. PCV13 had no impact on pneumococcal carriage density, even for vaccine serotypes. The low prevalence of vaccine serotypes, high pneumococcal carriage density and abundance of non-vaccine serotypes likely contribute to the lack of PCV13 impact on carriage in PNG infants. Indirect effects of the infant PCV programs are likely to be limited in PNG. Alternative vaccines with broader coverage should be considered.
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Affiliation(s)
- Kathryn J Britton
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia; Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Australia.
| | - Janessa L Pickering
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia.
| | - William S Pomat
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia; Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - Camilla de Gier
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia; Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Australia.
| | - Monica L Nation
- Translational Microbiology Group, Murdoch Children's Research Institute, Melbourne, Australia.
| | - Casey L Pell
- Translational Microbiology Group, Murdoch Children's Research Institute, Melbourne, Australia.
| | - Caitlyn M Granland
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia.
| | - Vela Solomon
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - Rebecca L Ford
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - Andrew Greenhill
- School of Health and Life Sciences, Federation University, Victoria, Australia.
| | - Jason Hinds
- Institute for Infection and Immunity, St. George's University of London, London, United Kingdom.
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia.
| | - Peter C Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia; Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Australia.
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia; Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Australia; Department of Paediatric Infectious Diseases, Perth Children's Hospital, Perth, Australia; Department of Microbiology, PathWest Laboratory Medicine WA, QEII Medical Centre, Perth, Australia.
| | - Deborah Lehmann
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia.
| | - Catherine Satzke
- Translational Microbiology Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.
| | - Lea-Ann S Kirkham
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia; Centre for Child Health Research, The University of Western Australia, Perth, Australia.
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49
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Chan J, Gidding HF, Blyth CC, Fathima P, Jayasinghe S, McIntyre PB, Moore HC, Mulholland K, Nguyen CD, Andrews R, Russell FM. Levels of pneumococcal conjugate vaccine coverage and indirect protection against invasive pneumococcal disease and pneumonia hospitalisations in Australia: An observational study. PLoS Med 2021; 18:e1003733. [PMID: 34343186 PMCID: PMC8376256 DOI: 10.1371/journal.pmed.1003733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 08/19/2021] [Accepted: 07/13/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is limited empiric evidence on the coverage of pneumococcal conjugate vaccines (PCVs) required to generate substantial indirect protection. We investigate the association between population PCV coverage and indirect protection against invasive pneumococcal disease (IPD) and pneumonia hospitalisations among undervaccinated Australian children. METHODS AND FINDINGS Birth and vaccination records, IPD notifications, and hospitalisations were individually linked for children aged <5 years, born between 2001 and 2012 in 2 Australian states (New South Wales and Western Australia; 1.37 million children). Using Poisson regression models, we examined the association between PCV coverage, in small geographical units, and the incidence of (1) 7-valent PCV (PCV7)-type IPD; (2) all-cause pneumonia; and (3) pneumococcal and lobar pneumonia hospitalisation in undervaccinated children. Undervaccinated children received <2 doses of PCV at <12 months of age and no doses at ≥12 months of age. Potential confounding variables were selected for adjustment a priori with the assistance of a directed acyclic graph. There were strong inverse associations between PCV coverage and the incidence of PCV7-type IPD (adjusted incidence rate ratio [aIRR] 0.967, 95% confidence interval [CI] 0.958 to 0.975, p-value < 0.001), and pneumonia hospitalisations (all-cause pneumonia: aIRR 0.991 95% CI 0.990 to 0.994, p-value < 0.001) among undervaccinated children. Subgroup analyses for children <4 months old, urban, rural, and Indigenous populations showed similar trends, although effects were smaller for rural and Indigenous populations. Approximately 50% coverage of PCV7 among children <5 years of age was estimated to prevent up to 72.5% (95% CI 51.6 to 84.4) of PCV7-type IPD among undervaccinated children, while 90% coverage was estimated to prevent 95.2% (95% CI 89.4 to 97.8). The main limitations of this study include the potential for differential loss to follow-up, geographical misclassification of children (based on residential address at birth only), and unmeasured confounders. CONCLUSIONS In this study, we observed substantial indirect protection at lower levels of PCV coverage than previously described-challenging assumptions that high levels of PCV coverage (i.e., greater than 90%) are required. Understanding the association between PCV coverage and indirect protection is a priority since the control of vaccine-type pneumococcal disease is a prerequisite for reducing the number of PCV doses (from 3 to 2). Reduced dose schedules have the potential to substantially reduce program costs while maintaining vaccine impact.
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Affiliation(s)
- Jocelyn Chan
- Asia-Pacific Health Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- * E-mail:
| | - Heather F. Gidding
- Northern Clinical School, The University of Sydney, Sydney Australia
- Women and Babies Health Research, Kolling Institute, Northern Sydney Local Health District, Sydney Australia
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children’s Hospital at Westmead, Sydney, Australia
| | | | - Parveen Fathima
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Sanjay Jayasinghe
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children’s Hospital at Westmead, Sydney, Australia
- Children’s Hospital at Westmead Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Peter B. McIntyre
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children’s Hospital at Westmead, Sydney, Australia
| | - Hannah C. Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Kim Mulholland
- Asia-Pacific Health Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Cattram D. Nguyen
- Asia-Pacific Health Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Ross Andrews
- Global & Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- National Centre for Epidemiology & Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Fiona M. Russell
- Asia-Pacific Health Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
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50
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Leung VKY, Wong JY, Barnes R, Kelso J, Milne GJ, Blyth CC, Cowling BJ, Moore HC, Sullivan SG. Excess respiratory mortality and hospitalizations associated with influenza in Australia, 2007-2015. Int J Epidemiol 2021; 51:458-467. [PMID: 34333637 DOI: 10.1093/ije/dyab138] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Influenza is the most common vaccine-preventable disease in Australia, causing significant morbidity and mortality. We assessed the burden of influenza across all ages in terms of influenza-associated mortality and hospitalizations using national mortality, hospital-discharge and influenza surveillance data. METHODS Influenza-associated excess respiratory mortality and hospitalization rates from 2007 to 2015 were estimated using generalized additive models with a proxy of influenza activity based on syndromic and laboratory surveillance data. Estimates were made for each age group and year. RESULTS The estimated mean annual influenza-associated excess respiratory mortality was 2.6 per 100 000 population [95% confidence interval (CI): 1.8, 3.4 per 100 000 population]. The excess annual respiratory hospitalization rate was 57.4 per 100 000 population (95% CI: 32.5, 82.2 per 100 000 population). The highest mortality rates were observed among those aged ≥75 years (35.11 per 100 000 population; 95% CI: 19.93, 50.29 per 100 000 population) and hospitalization rates were also highest among older adults aged ≥75 years (302.95 per 100 000 population; 95% CI: 144.71, 461.19 per 100 000 population), as well as children aged <6 months (164.02 per 100 000 population; 95% CI: -34.84, 362.88 per 100 000 population). Annual variation was apparent, ranging from 1.0 to 3.9 per 100 000 population for mortality and 24.2 to 94.28 per 100 000 population for hospitalizations. Influenza A contributed to almost 80% of the average excess respiratory hospitalizations and 60% of the average excess respiratory deaths. CONCLUSIONS Influenza causes considerable burden to all Australians. Expected variation was observed among age groups, years and influenza type, with the greatest burden falling to older adults and young children. Understanding the current burden is useful for understanding the potential impact of mitigation strategies, such as vaccination.
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Affiliation(s)
- Vivian K Y Leung
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Victoria, Australia
| | - Jessica Y Wong
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, PR China
| | - Roseanne Barnes
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Joel Kelso
- Department of Computer Science, University of Western Australia, Perth, Australia
| | - George J Milne
- Department of Computer Science, University of Western Australia, Perth, Australia
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,PathWest Laboratory Medicine WA, QE11 Medical Centre, Perth, Western Australia, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, PR China
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Sheena G Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Victoria, Australia.,Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.,Department of Epidemiology, University of California, Los Angeles, USA
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