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Giles ML, Flanagan KL. COVID-19 vaccination: are more jabs needed or are we now immune? Intern Med J 2024; 54:368-373. [PMID: 38414215 DOI: 10.1111/imj.16341] [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: 08/14/2023] [Accepted: 01/12/2024] [Indexed: 02/29/2024]
Abstract
As the COVID-19 pandemic has progressed, it has become apparent that COVID-19 vaccination has limited impact on SAR-CoV-2 transmission and provides only short-term protection against acquiring infection, but more robust protection against severe disease and death. As a result, vaccinated people remain susceptible to SARS-CoV-2 infection but are less likely to experience severe outcomes. Studies show that immunity derived from the combination of vaccination and natural infection, so-called hybrid immunity, is superior to that provided by vaccination or natural infection alone. Since most Australian adults have received three or more doses of COVID-19 vaccines and >70% have also been infected with SARS-CoV-2, we now have a population with high levels of hybrid immunity. This was mostly achieved by receiving original Wuhan strain vaccines and then experiencing Omicron strain infections. The original Wuhan strain of SARS-CoV-2 has now disappeared and been replaced with Omicron-lineage variants globally. The predominance of the Omicron strain initially led to the development of bivalent vaccines containing both the Wuhan strain and Omicron variants. Currently, vaccines containing the original Wuhan strain of spike protein are being phased out, and new COVID-19 vaccines based exclusively on the Omicron strain XBB have become available in Australia. This article explores the question of whether further doses will be required from 2024 onwards and, if so, who should receive them?
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Affiliation(s)
- Michelle L Giles
- Department of Infectious Diseases, University of Melbourne, Melbourne, Victoria, Australia
- Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Katie L Flanagan
- Department of Medicine, Launceston General Hospital, Launceston, Tasmania, Australia
- Tasmanian Vaccine Trial Centre, Clifford Craig Foundation, Launceston General Hospital, Launceston, Tasmania, Australia
- School of Medicine, University of Tasmania, Launceston, Tasmania, Australia
- School of Health and Biomedical Science, RMIT University, Melbourne, Victoria, Australia
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Giles ML, Cole S, O’Bryan J, Krishnaswamy S, Ben-Othman R, Amenyogbe N, Davey MA, Kollmann T. The PRotective Effect of Maternal Immunisation on preTerm birth: characterising the Underlying mechanisms and Role in newborn immune function: the PREMITUR study protocol. Front Immunol 2023; 14:1212320. [PMID: 38187392 PMCID: PMC10771328 DOI: 10.3389/fimmu.2023.1212320] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 12/04/2023] [Indexed: 01/09/2024] Open
Abstract
Maternal immunisation, a low cost and high efficacy intervention is recommended for its pathogen specific protection. Evidence suggests that maternal immunisation has another significant impact: reduction of preterm birth (PTB), the single greatest cause of childhood morbidity and mortality globally. Our overarching question is: how does maternal immunisation modify the immune system in pregnant women and/or their newborn to reduce adverse pregnancy outcomes and enhance the newborn infant's capacity to protect itself from infectious diseases during early childhood? To answer this question we are conducting a multi-site, prospective observational cohort study collecting maternal and infant biological samples at defined time points during pregnancy and post-partum from nulliparous women. We aim to enrol 400 women and determine the immune trajectory in pregnancy and the impact of maternal immunisation (including influenza, pertussis and/or COVID-19 vaccines) on this trajectory. The results are expected to identify areas that can be targeted for future intervention studies.
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Affiliation(s)
- Michelle L. Giles
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
- Department of Infectious Diseases, University of Melbourne, Melbourne, VIC, Australia
- Department of Obstetric Medicine and Maternal Fetal Medicine, Royal Women’s Hospital, Melbourne, VIC, Australia
| | - Stephen Cole
- Department of Obstetrics and Gynaecology, Epworth Healthcare, Melbourne, VIC, Australia
| | - Jessica O’Bryan
- Department of Infectious Diseases, Monash Health, Melbourne, VIC, Australia
| | - Sushena Krishnaswamy
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
- Department of Infectious Diseases, Monash Health, Melbourne, VIC, Australia
| | - Rym Ben-Othman
- Department of Paediatrics, Telethon Kids, Perth, WA, Australia
| | - Nelly Amenyogbe
- Department of Paediatrics, Telethon Kids, Perth, WA, Australia
| | - Mary-Ann Davey
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Tobias Kollmann
- Department of Paediatrics, Telethon Kids, Perth, WA, Australia
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Nolan TM, Deliyannis G, Griffith M, Braat S, Allen LF, Audsley J, Chung AW, Ciula M, Gherardin NA, Giles ML, Gordon TP, Grimley SL, Horng L, Jackson DC, Juno JA, Kedzierska K, Kent SJ, Lewin SR, Littlejohn M, McQuilten HA, Mordant FL, Nguyen THO, Soo VP, Price B, Purcell DFJ, Ramanathan P, Redmond SJ, Rockman S, Ruan Z, Sasadeusz J, Simpson JA, Subbarao K, Fabb SA, Payne TJ, Takanashi A, Tan CW, Torresi J, Wang JJ, Wang LF, Al-Wassiti H, Wong CY, Zaloumis S, Pouton CW, Godfrey DI. Interim results from a phase I randomized, placebo-controlled trial of novel SARS-CoV-2 beta variant receptor-binding domain recombinant protein and mRNA vaccines as a 4th dose booster. EBioMedicine 2023; 98:104878. [PMID: 38016322 PMCID: PMC10696466 DOI: 10.1016/j.ebiom.2023.104878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/18/2023] [Accepted: 11/02/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND SARS-CoV-2 booster vaccination should ideally enhance protection against variants and minimise immune imprinting. This Phase I trial evaluated two vaccines targeting SARS-CoV-2 beta-variant receptor-binding domain (RBD): a recombinant dimeric RBD-human IgG1 Fc-fusion protein, and an mRNA encoding a membrane-anchored RBD. METHODS 76 healthy adults aged 18-64 y, previously triple vaccinated with licensed SARS-CoV-2 vaccines, were randomised to receive a 4th dose of either an adjuvanted (MF59®, CSL Seqirus) protein vaccine (5, 15 or 45 μg, N = 32), mRNA vaccine (10, 20, or 50 μg, N = 32), or placebo (saline, N = 12) at least 90 days after a 3rd boost vaccination or SARS-CoV-2 infection. Bleeds occurred on days 1 (prior to vaccination), 8, and 29. CLINICALTRIALS govNCT05272605. FINDINGS No vaccine-related serious or medically-attended adverse events occurred. The protein vaccine reactogenicity was mild, whereas the mRNA vaccine was moderately reactogenic at higher dose levels. Best anti-RBD antibody responses resulted from the higher doses of each vaccine. A similar pattern was seen with live virus neutralisation and surrogate, and pseudovirus neutralisation assays. Breadth of immune response was demonstrated against BA.5 and more recent omicron subvariants (XBB, XBB.1.5 and BQ.1.1). Binding antibody titres for both vaccines were comparable to those of a licensed bivalent mRNA vaccine. Both vaccines enhanced CD4+ and CD8+ T cell activation. INTERPRETATION There were no safety concerns and the reactogenicity profile was mild and similar to licensed SARS-CoV-2 vaccines. Both vaccines showed strong immune boosting against beta, ancestral and omicron strains. FUNDING Australian Government Medical Research Future Fund, and philanthropies Jack Ma Foundation and IFM investors.
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Affiliation(s)
- Terry M Nolan
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
| | - Georgia Deliyannis
- Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Maryanne Griffith
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne, Australia
| | - Sabine Braat
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Lilith F Allen
- Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Jennifer Audsley
- Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Amy W Chung
- Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Marcin Ciula
- Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Nicholas A Gherardin
- Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Michelle L Giles
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne, Australia
| | - Tom P Gordon
- Department of Immunology, Flinders University and SA Pathology, Flinders Medical Centre, Bedford Park, Adelaide, Australia
| | - Samantha L Grimley
- Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Lana Horng
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - David C Jackson
- Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Jennifer A Juno
- Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Katherine Kedzierska
- Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan
| | - Stephen J Kent
- Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Sharon R Lewin
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Australia
| | - Mason Littlejohn
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne, Australia
| | - Hayley A McQuilten
- Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Francesca L Mordant
- Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Thi H O Nguyen
- Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Vanessa Pac Soo
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Briony Price
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Damian F J Purcell
- Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Pradhipa Ramanathan
- Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Samuel J Redmond
- Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Steven Rockman
- Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; CSL Seqirus, Vaccine Innovation Unit, Parkville, Melbourne, Australia
| | - Zheng Ruan
- Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Joseph Sasadeusz
- Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Australia
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Kanta Subbarao
- Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; WHO Collaborating Centre for Reference and Research on Influenza at the Peter Doherty Institute for Infection and Immunity, Australia
| | - Stewart A Fabb
- Monash Institute of Pharmaceutical Sciences, Parkville, Australia
| | - Thomas J Payne
- Monash Institute of Pharmaceutical Sciences, Parkville, Australia
| | - Asuka Takanashi
- Monash Institute of Pharmaceutical Sciences, Parkville, Australia
| | - Chee Wah Tan
- Duke NUS Medical School, Programme for Emerging Infectious Diseases, Singapore
| | - Joseph Torresi
- Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Jing Jing Wang
- Department of Immunology, Flinders University and SA Pathology, Flinders Medical Centre, Bedford Park, Adelaide, Australia
| | - Lin-Fa Wang
- Duke NUS Medical School, Programme for Emerging Infectious Diseases, Singapore
| | | | - Chinn Yi Wong
- Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Sophie Zaloumis
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Colin W Pouton
- Monash Institute of Pharmaceutical Sciences, Parkville, Australia
| | - Dale I Godfrey
- Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
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Giles ML, Krishnaswamy S, Coote W, Davey MA. Factors Associated with Early Versus Late Uptake of the COVID-19 Vaccine during Pregnancy over Time in Australia: A Population-Based Cohort Study. Vaccines (Basel) 2023; 11:1713. [PMID: 38006045 PMCID: PMC10674957 DOI: 10.3390/vaccines11111713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 10/30/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Pregnant women are at an increased risk of hospitalisation, admission to the intensive care unit, mechanical ventilation, and death from SARS-CoV-2 infection. The aim of this study is to determine the predictive factors associated with COVID-19 vaccine uptake during pregnancy over time in a population with a high background uptake of maternal influenza and pertussis vaccination. METHODS This is a population-based, cohort study of all pregnant women who gave birth in Victoria, Australia between 1 July 2021 and 30 June 2022. Data from the Victorian Perinatal Data Collection were analysed using univariable and multivariable logistic regression. RESULTS This study reports on 77,719 women who gave birth over a 12 month period, of whom 49,281 (63.4%) received a COVID-19 vaccine, 54,887 (70.6%) received an influenza vaccination and 63,594 (81.8%) received a pertussis vaccine by the time of delivery. Pregnant women aged >30 years (aOR 1.31 CI 1.27, 1.36), who had >=8 antenatal visits (aOR 1.08 CI 1.04, 1.12), and those who received influenza vaccine (aOR 1.23 CI 1.19, 1.28) were more likely to have received a COVID-19 vaccine. Those who smoked (aOR 0.7 CI 0.66, 0.74), were First Nations (aOR 0.83 CI 0.74, 0.93) and those who gave birth in public hospitals (aOR 0.65 CI 0.63, 0.68) were less likely to receive COVID-19 vaccine in the first 12 months of the rollout. CONCLUSION Maternal age, smoking, parity and Indigenous status were factors associated with delayed and sustained lower coverage, even in a population with background maternal influenza and pertussis coverage of 70.6% and 81.8%, respectively.
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Affiliation(s)
- Michelle L. Giles
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC 3168, Australia; (S.K.); (W.C.); (M.-A.D.)
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Alexander A, Krishnaswamy S, Cole S, Giles ML. Vaccination recommendations for pregnant people travelling overseas. Aust N Z J Obstet Gynaecol 2023; 63:643-650. [PMID: 37872718 DOI: 10.1111/ajo.13704] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/07/2023] [Indexed: 10/25/2023]
Abstract
With international travel on the rise following pandemic restrictions, the number of pregnant travellers is likely to proportionally increase. Recent published data suggest most pregnant travellers seek pre-travel advice from their maternity and primary care providers. With these data, it is important to provide maternity and primary care providers with guidelines and resources to help aid safe, informed, and timely delivery of vaccinations prior to travel. Vaccination for travel during pregnancy is fundamental in mitigating maternal and fetal communicable disease morbidity and mortality. This clinical perspective provides an overview of the indications, safety, and recommendations for pre-travel vaccines in pregnancy.
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Affiliation(s)
- Adrian Alexander
- Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
| | - Sushena Krishnaswamy
- Department of Infectious Diseases, Monash Health, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
- Department of Obstetric Medicine and Maternal-Fetal Medicine, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Stephen Cole
- Department of Obstetric Medicine and Maternal-Fetal Medicine, Royal Women's Hospital, Melbourne, Victoria, Australia
- Institute of Obstetrics & Gynaecology, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Michelle L Giles
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
- Department of Obstetric Medicine and Maternal-Fetal Medicine, Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne, Victoria, Australia
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Fernando M, L Giles M, Krishnaswamy S, Cole S. The pregnant traveller: An overview of general travel advice. Aust N Z J Obstet Gynaecol 2023; 63:638-642. [PMID: 37872721 DOI: 10.1111/ajo.13686] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/30/2023] [Indexed: 10/25/2023]
Abstract
Travel during pregnancy is common, but is associated with a number of risks and potential problems. There are many pregnancy-specific and destination-specific issues to be considered along with issues related to method of transport. Travel experiences should be made as safe as possible through evidence-based counselling via pregnancy healthcare providers prior to travel. This travelling in pregnancy article has been created to facilitate pregnancy healthcare providers in having these pre-travel discussions to optimise maternal and fetal wellbeing.
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Affiliation(s)
| | - Michelle L Giles
- Department of Obstetric Medicine and Maternal-Fetal Medicine, The Royal Women's Hospital, Victoria, Melbourne, Australia
- Department of Obstetrics and Gynaecology, Monash University, Victoria, Melbourne, Australia
- Department of Infectious Diseases, University of Melbourne, Victoria, Melbourne, Australia
| | - Sushena Krishnaswamy
- Department of Obstetric Medicine and Maternal-Fetal Medicine, The Royal Women's Hospital, Victoria, Melbourne, Australia
- Department of Obstetrics and Gynaecology, Monash University, Victoria, Melbourne, Australia
- Department of Infectious Diseases, Monash Health, Melbourne, Victoria, Australia
| | - Stephen Cole
- Department of Obstetric Medicine and Maternal-Fetal Medicine, The Royal Women's Hospital, Victoria, Melbourne, Australia
- Institute of Obstetrics & Gynaecology, Epworth Healthcare, Victoria, Melbourne, Australia
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Lee WJI, Giles ML, Cole S, Krishnaswamy S. The pregnant traveller: An overview of common preventable infections. Aust N Z J Obstet Gynaecol 2023; 63:651-655. [PMID: 37872716 DOI: 10.1111/ajo.13729] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/26/2023] [Indexed: 10/25/2023]
Abstract
Pregnant travellers are often unaware of the various infections that can be acquired during travel and that pregnant people may be at increased risk of severe disease compared to their non-pregnant counterparts. Pregnant people often seek pre-travel counselling from their obstetrician or primary care physicians, who may not be well versed in travel medicine. This paper aims to provide information for maternity care providers regarding important travel-related food, water and mosquito-borne illnesses, including their prevention and treatment methods, equipping maternity care providers to confidently counsel prospective travellers during pregnancy.
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Affiliation(s)
- Wen Jie Isaac Lee
- Department of Medicine, Monash Health, Melbourne, Victoria, Australia
| | - Michelle L Giles
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne, Melbourne, Victoria, Australia
- Department of Obstetric Medicine and Maternal-Fetal Medicine, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Stephen Cole
- Department of Obstetric Medicine and Maternal-Fetal Medicine, Royal Women's Hospital, Melbourne, Victoria, Australia
- Institute of Obstetrics & Gynaecology, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Sushena Krishnaswamy
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
- Department of Obstetric Medicine and Maternal-Fetal Medicine, Royal Women's Hospital, Melbourne, Victoria, Australia
- Monash Infectious Diseases, Monash Health, Melbourne, Victoria, Australia
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Fields NJ, Palmer KR, Rolnik DL, Yo J, Nold MF, Giles ML, Krishnaswamy S, Serpa Neto A, Hodges RJ, Marshall SA. CO-Sprout-A Pilot Double-Blinded Placebo-Controlled Randomised Trial of Broccoli Sprout Powder Supplementation for Pregnant Women with COVID-19 on the Duration of COVID-19-Associated Symptoms: Study Protocol. Nutrients 2023; 15:3980. [PMID: 37764764 PMCID: PMC10537772 DOI: 10.3390/nu15183980] [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: 08/13/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Since its discovery in late 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been estimated to be responsible for at least 769.3 million infections and over 6.95 million deaths. Despite significant global vaccination efforts, there are limited therapies that are considered safe and effective for use in the management of COVID-19 during pregnancy despite the common knowledge that pregnant patients have a much higher risk of adverse outcomes. A bioactive compound found in broccoli sprout-sulforaphane-is a potent inducer of phase-II detoxification enzymes promoting a series of potentially beneficial effects notably as an antioxidant, anti-inflammatory, and anti-viral. A pilot, double-blinded, placebo-controlled randomised trial is to be conducted in Melbourne, Australia, across both public and private hospital sectors. We will assess a commercially available broccoli sprout extract in pregnant women between 20+0 and 36+0 weeks gestation with SARS-CoV-2 infection to investigate (i) the duration of COVID-19 associated symptoms, (ii) maternal and neonatal outcomes, and (iii) biomarkers of infection and inflammation. We plan to enrol 60 outpatient women with COVID-19 irrespective of vaccination status diagnosed by PCR swab or RAT (rapid antigen test) within five days and randomised to 14 days of oral broccoli sprout extract (42 mg of sulforaphane daily) or identical microcrystalline cellulose placebo. The primary outcome of this pilot trial will be to assess the feasibility of conducting a larger trial investigating the duration (days) of COVID-19-associated symptoms using a broccoli sprout supplement for COVID-19-affected pregnancies. Pregnant patients remain an at-risk group for severe disease following infection with SARS-CoV-2 and currently unclear consequences for the offspring. Therefore, this study will assess feasibility of using a broccoli sprout supplement, whilst providing important safety data for the use of sulforaphane in pregnancy.
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Affiliation(s)
- Neville J. Fields
- The Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Melbourne 3168, Australia (D.L.R.); (M.F.N.); (M.L.G.); (R.J.H.); (S.A.M.)
- Monash Health, Monash Medical Centre, Melbourne 3168, Australia
| | - Kirsten R. Palmer
- The Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Melbourne 3168, Australia (D.L.R.); (M.F.N.); (M.L.G.); (R.J.H.); (S.A.M.)
- Monash Health, Monash Medical Centre, Melbourne 3168, Australia
| | - Daniel L. Rolnik
- The Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Melbourne 3168, Australia (D.L.R.); (M.F.N.); (M.L.G.); (R.J.H.); (S.A.M.)
- Monash Health, Monash Medical Centre, Melbourne 3168, Australia
| | - Jennifer Yo
- The Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Melbourne 3168, Australia (D.L.R.); (M.F.N.); (M.L.G.); (R.J.H.); (S.A.M.)
- Monash Health, Monash Medical Centre, Melbourne 3168, Australia
| | - Marcel F. Nold
- The Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Melbourne 3168, Australia (D.L.R.); (M.F.N.); (M.L.G.); (R.J.H.); (S.A.M.)
- Department of Paediatrics, Monash University, Melbourne 3168, Australia
- Monash Newborn, Monash Children’s Hospital, Melbourne 3168, Australia
| | - Michelle L. Giles
- The Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Melbourne 3168, Australia (D.L.R.); (M.F.N.); (M.L.G.); (R.J.H.); (S.A.M.)
- Monash Health, Monash Medical Centre, Melbourne 3168, Australia
| | | | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Melbourne 3004, Australia;
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne 3084, Australia
- Department of Intensive Care, Austin Hospital, Melbourne 3084, Australia
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo 05652-900, Brazil
| | - Ryan J. Hodges
- The Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Melbourne 3168, Australia (D.L.R.); (M.F.N.); (M.L.G.); (R.J.H.); (S.A.M.)
- Monash Health, Monash Medical Centre, Melbourne 3168, Australia
| | - Sarah A. Marshall
- The Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Melbourne 3168, Australia (D.L.R.); (M.F.N.); (M.L.G.); (R.J.H.); (S.A.M.)
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Valeri M, Durrani S, Tran C, Chiu C, Macartney KK, Giles ML, Crawford NW, Australian Technical Advisory Group On Immunisation Atagi Secretariat Immunisation Branch Australian Government. ATAGI 2023 Annual Statement on Immunisation. Commun Dis Intell (2018) 2023; 47. [PMID: 37817301 DOI: 10.33321/cdi.2023.47.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Indexed: 10/12/2023]
Affiliation(s)
- Madeline Valeri
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Shireen Durrani
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Catherine Tran
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Clayton Chiu
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Sydney, New South Wales, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney
| | - Kristine K Macartney
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Sydney, New South Wales, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney; Australian Technical Advisory Group on Immunisation, Department of Health, Australian Government, Canberra, Australian Capital Territory, Australia
| | - Michelle L Giles
- Australian Technical Advisory Group on Immunisation, Department of Health, Australian Government, Canberra, Australian Capital Territory, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia; Department of Infectious Diseases, University of Melbourne, Melbourne, Victoria, Australia
| | - Nigel W Crawford
- Australian Technical Advisory Group on Immunisation, Department of Health, Australian Government, Canberra, Australian Capital Territory, Australia; Department of General Paediatrics, Royal Children's Hospital, Melbourne, Victoria, Australia; Infection and Immunity, Murdoch Children's Research Institute and University of Melbourne, Victoria, Australia
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10
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Paramasivam S, Krishnaswamy S, Giles ML. Unravelling the mechanisms by which chronic hepatitis B infection is associated with an increased risk of gestational diabetes. Front Glob Womens Health 2023; 4:1184090. [PMID: 37325792 PMCID: PMC10266902 DOI: 10.3389/fgwh.2023.1184090] [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: 03/24/2023] [Accepted: 05/11/2023] [Indexed: 06/17/2023] Open
Abstract
An independent association between chronic hepatitis B virus (HBV) and the development of gestational diabetes (GDM) has been reported in the literature. Ethnic background and regional influences have been demonstrated to play a role in the reporting of incidence rates of GDM among women with chronic HBV. The mechanisms behind this association are poorly understood, but evidence suggests an inflammatory basis. Viral factors such as chronic HBV replication, quantifiable by HBV viral load, have been proposed to contribute to the increasing risk of insulin resistance in pregnancy. More research is needed to better characterise the association and determine if any interventions early in pregnancy for women infected with chronic HBV would mitigate the development of GDM.
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Affiliation(s)
| | - Sushena Krishnaswamy
- Department of Obstetrics and Gynaecology (Monash University), Melbourne, VIC, Australia
| | - Michelle L Giles
- Department of Obstetrics and Gynaecology (Monash University), Melbourne, VIC, Australia
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11
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McRae JE, McHugh L, King C, Beard FH, Blyth CC, Danchin MH, Giles ML, Mohammed H, Wood N, Macartney K. Influenza and pertussis vaccine coverage in pregnancy in Australia, 2016-2021. Med J Aust 2023. [PMID: 37248802 DOI: 10.5694/mja2.51989] [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: 11/10/2022] [Revised: 04/14/2023] [Accepted: 05/02/2023] [Indexed: 05/31/2023]
Abstract
Vaccination in pregnancy is the best strategy to reduce complications from influenza or pertussis infection in infants who are too young to be protected directly from vaccination. Pregnant women are also at risk of influenza complications preventable through antenatal vaccination. Both vaccines are funded under the National Immunisation Program for pregnant women in Australia, but coverage is not routinely reported nationally. We reviewed all reported Australian maternal influenza and pertussis vaccine coverage data for the period 2016-2021, to identify gaps and information needs. Maternal influenza vaccine coverage was suboptimal at < 58% for 2016-2018, with higher coverage of 62-75% reported in two states (Victoria and Western Australia) for 2019-2021. Maternal pertussis vaccine coverage from 2016 was generally higher than for influenza at > 70%, with the highest jurisdictional coverage of 89% reported in Western Australia in 2020. Vaccination rates were often suboptimal among First Nations pregnant women and up to 20% lower than among non-First Nations Australian women; while data were limited, coverage was low among culturally and linguistically diverse women and among women of lower socio-economic status. Jurisdictional perinatal data collections were the best source of information on antenatal vaccine coverage but were only available for a minority of the population; a nationally consistent systematic approach is lacking. Timely and comprehensive data are needed to provide feedback to improve maternal vaccination coverage, particularly among groups with higher risk and/or low uptake, and as new vaccines are recommended, including COVID-19 vaccination.
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Affiliation(s)
- Jocelynne E McRae
- National Centre for Immunisation Research and Surveillance, Sydney, NSW
- University of Sydney, Sydney, NSW
| | | | - Catherine King
- National Centre for Immunisation Research and Surveillance, Sydney, NSW
- University of Sydney, Sydney, NSW
| | - Frank H Beard
- National Centre for Immunisation Research and Surveillance, Sydney, NSW
- University of Sydney, Sydney, NSW
| | - Christopher C Blyth
- University of Western Australia, Perth, WA
- Perth Children's Hospital, Perth, WA
| | - Margie H Danchin
- Royal Children's Hospital, Melbourne, VIC
- Murdoch Children's Research Institute, Melbourne, VIC
| | - Michelle L Giles
- Monash University, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
| | - Hassen Mohammed
- Women's and Children's Health Network, Adelaide, SA
- Robinson Research Institute, University of Adelaide, Adelaide, SA
| | - Nicholas Wood
- University of Sydney, Sydney, NSW
- The Children's Hospital at Westmead, Sydney, NSW
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance, Sydney, NSW
- University of Sydney, Sydney, NSW
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12
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Borg S, Tenneti N, Lee A, Drewett G, Ivan M, Giles ML. The Re-emergence of Syphilis Among Females of Reproductive Age and Congenital Syphilis in Victoria, Australia, 2010-2020: A Public Health Priority. Sex Transm Dis 2023:00007435-990000000-00201. [PMID: 37155648 DOI: 10.1097/olq.0000000000001825] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Syphilis notifications in Victoria, Australia have been increasing over the past decade, with an increase in infectious syphilis (syphilis of less than two years duration) cases in females of reproductive age, and an associated re-emergence of congenital syphilis (CS). Prior to 2017 there had been two CS cases in the preceding 26 years. This study describes the epidemiology of infectious syphilis among females of reproductive age and CS in Victoria. METHODS Routine surveillance data provided by mandatory Victorian syphilis case notifications were extracted and grouped into a descriptive analysis of infectious syphilis and CS incidence data from 2010-20. RESULTS In 2020, infectious syphilis notifications in Victoria were approximately five times more than 2010 (n = 289 in 2010 to n = 1440 in 2020), with a more than seven-fold rise among females (n = 25 in 2010 to n = 186 in 2020). Females made up 29% (n = 60/209) of Aboriginal and Torres Strait Islander notifications occurring between 2010-2020. Between 2017-2020, 67% of notifications in females (n = 456/678) were diagnosed in low-caseload clinics, at least 13% (n = 87/678) of all female notifications were known to be pregnant at diagnosis, and there were nine CS notifications. CONCLUSIONS Cases of infectious syphilis in females of reproductive age and CS are on the rise in Victoria, necessitating sustained public health action. Increasing awareness among individuals and clinicians, and health system strengthening, particularly targeting primary care where most females are diagnosed prior to pregnancy, is required. Treating infections before or promptly during pregnancy and undertaking partner notification and treatment to reduce risk of reinfection is critical to reducing CS cases.
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Affiliation(s)
- Sarah Borg
- Victorian Department of Health, Melbourne, VIC, Australia
| | - Naveen Tenneti
- Victorian Department of Health, Melbourne, VIC, Australia
| | - Alvin Lee
- Victorian Department of Health, Melbourne, VIC, Australia
| | - George Drewett
- Victorian Department of Health, Melbourne, VIC, Australia
| | - Mihaela Ivan
- Victorian Department of Health, Melbourne, VIC, Australia
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13
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Giles ML, Gunatilaka A, Cole S, Kollmann T. The non-specific effects of maternal immunization on birth outcomes: The evidence, mechanisms, and the implications. Int J Gynaecol Obstet 2023. [PMID: 37092178 DOI: 10.1002/ijgo.14795] [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: 08/11/2022] [Revised: 02/12/2023] [Accepted: 04/03/2023] [Indexed: 04/25/2023]
Abstract
Preterm birth (PTB) and stillbirth remain two of the most important causes of death, morbidity, and disability in childhood. Despite efforts to reduce PTB and stillbirth worldwide, rates of these adverse outcomes remain persistently elevated, independent of income setting. There is an urgent need for more effective interventions to reduce associated neonatal and early childhood morbidity and mortality. Maternal vaccines are a well-established strategy used for prevention of pathogen-specific disease in mothers and infants through transplacental antibody transfer. Beyond these pathogen-specific benefits, some studies have also identified non-specific effects (NSEs) of maternal vaccination protecting against several adverse birth outcomes, including PTB and stillbirth. This paper will review the evidence supporting the NSEs of maternal vaccination on birth outcomes, describe the possible underlying mechanisms, outline the research gaps, and summarize the significance from a global health perspective.
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Affiliation(s)
- Michelle L Giles
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne, Melbourne, Victoria, Australia
| | - Ahinsa Gunatilaka
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Stephen Cole
- Department of Obstetrics, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Tobias Kollmann
- Department of Paediatrics, Telethon Kids Institute, Perth, Western Australia, Australia
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14
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Giles ML, Sing Way S, Marchant A, Aghaepour N, James T, Schaltz-Buchholzer F, Zazara D, Arck P, Kollmann TR. Maternal vaccination to prevent adverse pregnancy outcomes: An underutilized molecular immunological intervention? J Mol Biol 2023; 435:168097. [PMID: 37080422 DOI: 10.1016/j.jmb.2023.168097] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/27/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
Adverse pregnancy outcomes including maternal mortality, stillbirth, preterm birth, intrauterine growth restriction cause millions of deaths each year. More effective interventions are urgently needed. Maternal immunization could be one such intervention protecting the mother and newborn from infection through its pathogen-specific effects. However, many adverse pregnancy outcomes are not directly linked to the infectious pathogens targeted by existing maternal vaccines but rather are linked to pathological inflammation unfolding during pregnancy. The underlying pathogenesis driving such unfavourable outcomes have only partially been elucidated but appear to relate to altered immune regulation by innate as well as adaptive immune responses, ultimately leading to aberrant maternal immune activation. Maternal immunization, like all immunization, impacts the immune system beyond pathogen-specific immunity. This raises the possibility that maternal vaccination could potentially be utilised as a pathogen-agnostic immune modulatory intervention to redirect abnormal immune trajectories towards a more favourable phenotype providing pregnancy protection. In this review we describe the epidemiological evidence surrounding this hypothesis, along with the mechanistic plausibility and present a possible path forward to accelerate addressing the urgent need of adverse pregnancy outcomes.
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Affiliation(s)
| | - Sing Sing Way
- Center for Inflammation and Tolerance; Cincinnati Children's Hospital, Cincinnati USA
| | | | - Nima Aghaepour
- Stanford University School of Medicine, Stanford, CA, USA
| | - Tomin James
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - Dimitra Zazara
- Division of Experimental Feto-Maternal Medicine, Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg, Hamburg, Germany
| | - Petra Arck
- Division of Experimental Feto-Maternal Medicine, Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg, Hamburg, Germany
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15
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Gunatilaka A, Rolnik DL, Giles ML. Protective effect of maternal immunization on birth outcomes: A data linkage study. Int J Gynaecol Obstet 2023. [PMID: 37036448 DOI: 10.1002/ijgo.14774] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/11/2023] [Accepted: 03/20/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVE To explore the impact of maternal immunization on adverse pregnancy outcomes including preterm birth (PTB) and stillbirth. METHODS The authors performed a data linkage study for women who delivered a singleton baby between January 2017 and May 2021. They used Poisson models to estimate incidence rates of adverse pregnancy outcomes and Cox proportional hazards models to estimate hazard ratios (HRs) with 95% confidence intervals (CIs), accounting for the time-dependent nature of the exposure and adjusting for confounders. RESULTS This study included 10 938 women who received at least one vaccine, and 4029 unvaccinated women. Influenza vaccine was associated with a significant reduction in stillbirth (adjusted HR [aHR], 0.55 [95% CI, 0.33-0.94]), but not in PTB (aHR, 0.92 [95% CI, 0.77-1.10]). Pertussis vaccine was associated with a significant reduction in PTB (aHR, 0.78 [95% CI, 0.64-0.94]) and a similar point estimate for reduction in stillbirth (aHR, 0.59 [95% CI, 0.31-1.10]), although not significant. CONCLUSION Reductions in PTB and stillbirth associated with maternal immunization suggest possible protective effects beyond pathogen-specific protection. These findings may strengthen justification for scaling up maternal immunization in low-income settings where there remains a high burden of these adverse pregnancy outcomes.
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Affiliation(s)
- Ahinsa Gunatilaka
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Daniel L Rolnik
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Michelle L Giles
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne, Melbourne, Victoria, Australia
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16
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Mol BW, Giles ML. Editorial for FandS36134: Effect of female COVID-19 vaccination on assisted reproductive outcomes: a systematic review and meta-analysis by Huang J. Fertil Steril 2023; 119:784. [PMID: 36965597 PMCID: PMC10033253 DOI: 10.1016/j.fertnstert.2023.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 03/25/2023]
Affiliation(s)
- Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University. 246 Clayton Rd, Clayton Victoria 3168 Australia; Aberdeen Centre for Women's Health Research, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
| | - Michelle L Giles
- Department of Obstetrics and Gynaecology, Monash University. 246 Clayton Rd, Clayton Victoria 3168 Australia; Department of Infectious Diseases, University of Melbourne
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Giles ML, Krishnaswamy S, Metlapalli M, Roman A, Jin W, Li W, Mol BW, Sheehan P, Said J. Azithromycin treatment for short cervix with or without amniotic fluid sludge: A matched cohort study. Aust N Z J Obstet Gynaecol 2023. [PMID: 36752049 DOI: 10.1111/ajo.13648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/17/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Preterm birth (PTB) is one of the leading causes of neonatal mortality and morbidity worldwide. A shortened cervix is a recognised risk factor for PTB, and amniotic fluid sludge (AFS) diagnosed on ultrasound may be suggestive of underlying inflammation or infection. AIMS The aim is to determine if azithromycin, administered in cases of a shortened cervix, results in prolongation of gestation with improvements in neonatal outcomes. MATERIALS AND METHODS We performed a retrospective cohort study at three tertiary maternity services in Melbourne, Australia, between 2015 and 2020. Women with a singleton pregnancy were included if they had a cervical length of 15 mm or less at 13-24 weeks' gestation, with or without AFS. Exclusion criteria comprised multiple pregnancy, major fetal congenital anomaly, placenta praevia, prelabour premature rupture of membranes, vaginal bleeding and/or clinical signs suggestive of chorioamnionitis at the time of diagnosis of the short cervix. The results of antibiotic treatment with azithromycin were compared to those of no antibiotic treatment. The outcomes of interest were PTB, prelabour premature rupture of membranes (PPROM), chorioamnionitis and neonatal morbidity. RESULTS A total of 374 women were included in the study, of whom 129 received azithromycin and 245 received no antibiotics. When adjusting for potential confounders, the adjusted risk of PTB overall was higher in the treatment group (adjusted hazard ratio 1.36 (95% confidence interval 1.04-1.77) P = 0.023) with no differences found for PPROM, chorioamnionitis or neonatal morbidity. CONCLUSION These data do not support the routine use of azithromycin in women with a short cervix, including those with AFS detected on ultrasound.
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Affiliation(s)
- Michelle L Giles
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Joan Kirner Women's and Children's Hospital, Melbourne, Victoria, Australia
| | - Sushena Krishnaswamy
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Manogna Metlapalli
- Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Victoria, Australia
| | - Alina Roman
- Department of Obstetrics and Gynaecology, Joan Kirner Women's and Children's Hospital, Melbourne, Victoria, Australia
| | - Wallace Jin
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics & Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Wentao Li
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Penelope Sheehan
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Joanne Said
- Department of Obstetrics and Gynaecology, Joan Kirner Women's and Children's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics & Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
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18
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Yan D, McMahon J, Lee S, Giles ML. Quality of life in people living with HIV (the fourth 90) - are we there yet in Australia? AIDS Care 2023; 35:306-315. [PMID: 36200405 DOI: 10.1080/09540121.2022.2129562] [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] [Indexed: 10/10/2022]
Abstract
In 2014, UNAIDS outlined the 90-90-90 treatment targets. The "fourth 90" reflects the need to focus on optimising quality of life (HRQoL) in people living with HIV. Using a sample of non-heterosexual males in Melbourne, Australia, we aimed to assess HRQoL differences between HIV-positive and HIV-negative individuals, and identify factors that predict HRQoL both at baseline and after three years of follow up. Clinical information and patient-reported outcomes incorporating the Assessing Quality of Life-6D scale were collected at baseline and at three years. Sixty-two HIV-positive cases (antiretroviral therapy naïve at baseline) and 48 controls were enrolled. Results were compared between cases and controls at baseline, three-year follow-up, and between timepoints. HRQoL was significantly lower in cases compared to controls (83.5 (IQR 77.2-88.6) vs 87.3 (IQR 82.1-91.8), p = 0.022) at baseline, with increased depression and anxiety associated with reduced HRQoL in multivariate analysis. Mental health in cases improved between timepoints (75.0 (IQR 56.3-81.3) to 81.3 (IQR 62.5-81.3), p = 0.0428). No differences between the HRQoL of cases and controls were observed at three years. Increased mental health support may be required at commencement of antiretroviral therapy to enable similar levels of HRQoL between HIV-positive and HIV-negative individuals to be achieved.
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Affiliation(s)
- Daniel Yan
- Central Clinical School, Monash University, Melbourne, Australia
| | - James McMahon
- Central Clinical School, Monash University, Melbourne, Australia
- Department of Infectious Diseases, Alfred Health, Melbourne, Australia
| | - Sue Lee
- Central Clinical School, Monash University, Melbourne, Australia
| | - Michelle L Giles
- Department of Infectious Diseases, Alfred Health, Melbourne, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
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19
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McQuilten ZK, Venkatesh B, Jha V, Roberts J, Morpeth SC, Totterdell JA, McPhee GM, Abraham J, Bam N, Bandara M, Bangi AK, Barina LA, Basnet BK, Bhally H, Bhusal KR, Bogati U, Bowen AC, Burke AJ, Christopher DJ, Chunilal SD, Cochrane B, Curnow JL, Das SK, Dhungana A, Di Tanna GL, Dotel R, DSouza H, Dummer J, Dutta S, Foo H, Gilbey TL, Giles ML, Goli K, Gordon A, Gyanwali P, Haksar D, Hudson BJ, Jani MK, Jevaji PR, Jhawar S, Jindal A, John MJ, John M, John FB, John O, Jones M, Joshi RD, Kamath P, Kang G, Karki AR, Karmalkar AM, Kaur B, Koganti KC, Koshy JM, Krishnamurthy MS, Lau JS, Lewin SR, Lim LL, Marschner IC, Marsh JA, Maze MJ, McGree JM, McMahon JH, Medcalf RL, Merriman EG, Misal AP, Mora JM, Mudaliar VK, Nguyen V, O'Sullivan MV, Pant S, Pant P, Paterson DL, Price DJ, Rees MA, Robinson JO, Rogers BA, Samuel S, Sasadeusz J, Sharma D, Sharma PK, Shrestha R, Shrestha SK, Shrestha P, Shukla U, Shum O, Sommerville C, Spelman T, Sullivan RP, Thatavarthi U, Tran HA, Trask N, Whitehead CL, Mahar RK, Hammond NE, McFadyen JD, Snelling TL, Davis JS, Denholm JT, Tong SYC. Anticoagulation Strategies in Non-Critically Ill Patients with Covid-19. NEJM Evid 2023; 2:EVIDoa2200293. [PMID: 38320033 DOI: 10.1056/evidoa2200293] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Anticoagulation in Non-Critically Ill Covid-19 PatientsMcQuilten et al. conducted a randomized clinical trial comparing low-dose, intermediate-dose, low-dose plus aspirin, and therapeutic-dose anticoagulation in patients with Covid-19 of diverse ethnicities in high-, low-, and middle-income countries.
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Affiliation(s)
- Zoe K McQuilten
- Monash University, Melbourne, Australia
- Monash Health, Melbourne, Australia
| | - Balasubramanian Venkatesh
- University of Queensland, Brisbane, Australia
- The George Institute for Global Health, Sydney, Australia
- The George Institute for Global Health, Delhi, Delhi, India
- The Wesley Hospital, Brisbane, Queensland, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Vivekanand Jha
- The George Institute for Global Health, Delhi, Delhi, India
- Imperial College, London, England, United Kingdom
| | - Jason Roberts
- University of Queensland, Brisbane, Australia
- Metro North Health, Brisbane, Queensland, Australia
| | | | - James A Totterdell
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Grace M McPhee
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - John Abraham
- Christian Medical College, Ludhiana, Punjab, India
| | - Niraj Bam
- Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Bagmati, Nepal
| | - Methma Bandara
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Ashpak K Bangi
- Jivanrekha Multispeciality Hospital, Pune, Maharashtra, India
| | - Lauren A Barina
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Bhupendra K Basnet
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Bagmati, Nepal
| | - Hasan Bhally
- North Shore Hospital, Auckland, North Island, New Zealand
| | - Khema R Bhusal
- Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Bagmati, Nepal
| | - Umesh Bogati
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Bagmati, Nepal
| | - 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
| | - Andrew J Burke
- University of Queensland, Brisbane, Australia
- The Prince Charles Hospital, Brisbane, Queensland, Australia
| | | | - Sanjeev D Chunilal
- Monash University, Melbourne, Australia
- Monash Medical Centre, Melbourne, Victoria, Australia
| | - Belinda Cochrane
- Campbelltown Hospital, Campbelltown, New South Wales, Australia
- Western Sydney University, Sydney, New South Wales, Australia
| | - Jennifer L Curnow
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Westmead Hospital, Sydney, New South Wales, Australia
| | - Santa Kumar Das
- Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Bagmati, Nepal
| | - Ashesh Dhungana
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Bagmati, Nepal
| | | | | | - Hyjel DSouza
- The George Institute for Global Health, Delhi, Delhi, India
| | - Jack Dummer
- University of Otago, Dunedin, Otago, New Zealand
- Dunedin Hospital, Dunedin, Otago, New Zealand
| | - Sourabh Dutta
- Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Hong Foo
- NSW Health Pathology, Sydney, New South Wales, Australia
| | - Timothy L Gilbey
- Wagga Wagga Base Hospital, Wagga Wagga, New South Wales, Australia
| | - Michelle L Giles
- Monash University, Melbourne, Australia
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Kasiram Goli
- Aditya Multi-speciality Hospital, Guntur, Andhra Pradesh, India
| | - Adrienne Gordon
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Newborn Care, Melbourne, Victoria, Australia
| | - Pradip Gyanwali
- Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Bagmati, Nepal
- Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Bagmati, Nepal
| | | | | | | | | | | | - Aikaj Jindal
- Satguru Partap Singh Hospitals, Ludhiana, Punjab, India
| | | | - Mary John
- Christian Medical College, Ludhiana, Punjab, India
| | | | - Oommen John
- The George Institute for Global Health, Delhi, Delhi, India
- Manipal Academy of Higher Education, Udupi, Karnataka, India
| | - Mark Jones
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Rajesh D Joshi
- The George Institute for Global Health, Delhi, Delhi, India
| | | | | | - Achyut R Karki
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Bagmati, Nepal
| | | | - Baldeep Kaur
- The George Institute for Global Health, Sydney, Australia
| | | | - Jency M Koshy
- Believers Church Medical College Hospital, Thiruvalla, Kerala, India
| | | | - Jillian S Lau
- Eastern Health, Melbourne, Victoria, Australia
- The Alfred Hospital, Melbourne, Victoria, Australia
| | - Sharon R Lewin
- Monash Health, Melbourne, Australia
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | | | - Ian C Marschner
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Julie A Marsh
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | | | - James M McGree
- Queensland University of Technology, Brisbane, Queensland, Australia
| | | | | | | | | | - Jocelyn M Mora
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | | | - Vi Nguyen
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Matthew V O'Sullivan
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Westmead Hospital, Sydney, New South Wales, Australia
- NSW Health Pathology, Sydney, New South Wales, Australia
| | - Suman Pant
- Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Bagmati, Nepal
| | - Pankaj Pant
- Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Bagmati, Nepal
| | - David L Paterson
- National Institute of Singapore, Singapore, Singapore, Singapore
| | - David J Price
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Melbourne School of Population & Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Megan A Rees
- Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - James O Robinson
- College of Science, Health, Engineering and Education, Discipline of Health, Murdoch University, Perth, Western Australia, Australia
- PathWest Laboratory Medicine, Perth, Western Australia, Australia
| | - Benjamin A Rogers
- Monash University, Melbourne, Australia
- Monash Health, Melbourne, Australia
| | | | - Joe Sasadeusz
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Deepak Sharma
- Maharaja Agrasen Superspeciality Hospital, Delhi, Delhi, India
| | | | - Roshan Shrestha
- Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Bagmati, Nepal
| | - Sailesh K Shrestha
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Bagmati, Nepal
| | - Prajowl Shrestha
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Bagmati, Nepal
| | - Urvi Shukla
- Symbiosis University Hospital & Research Centre, Pune, Maharashtra, India
| | - Omar Shum
- The Wollongong Hospital, Wollongong, New South Wales, Australia
- University of Wollongong, Wollongong, New South Wales, Australia
| | - Christine Sommerville
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Tim Spelman
- Karolinska Institute, Solna, Stockholm, Sweden
- Burnet Institute, Melbourne, Victoria, Australia
| | - Richard P Sullivan
- St. George Hospital, School of Clinical Medicine, UNSW Medicine & Health, Sydney, New South Wales, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | | | - Huyen A Tran
- Monash University, Melbourne, Australia
- The Alfred Hospital, Melbourne, Victoria, Australia
| | - Nanette Trask
- Chartered Accountants Australia and New Zealand, Perth, Western Australia, Australia
| | - Clare L Whitehead
- The Royal Women's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Robert K Mahar
- Melbourne School of Population & Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Perth, Western Australia, Australia
| | - Naomi E Hammond
- The George Institute for Global Health, Sydney, Australia
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - James D McFadyen
- The Alfred Hospital, Melbourne, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Thomas L Snelling
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Joshua S Davis
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- University of Newcastle, Newcastle, New South Wales, Australia
| | - Justin T Denholm
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Steven Y C Tong
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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20
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Gordon SF, Virah Sawmy E, Duckworth E, Wolthuizen M, Clothier HJ, Chea M, Tenneti N, Blow N, Buttery JP, de Luca J, Korman TM, Barnes S, Slade C, Maggs C, Giles ML, Teh BW, Aboltins C, Langan KM, Van Diemen A, Crawford NW. Victorian Specialist Immunisation Services (VicSIS) - bolstering adult clinics for COVID-19 vaccines. Hum Vaccin Immunother 2022; 18:2052701. [PMID: 35471988 PMCID: PMC9225531 DOI: 10.1080/21645515.2022.2052701] [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] [Indexed: 11/30/2022] Open
Abstract
The Victorian Specialist Immunization Services (VicSIS) was established in Victoria, Australia, in February 2021, aiming to enhance vaccine safety services for Coronavirus disease (COVID-19) vaccines. VicSIS supports practitioners and patients with complex vaccine safety questions, including those who experience adverse events following immunization (AEFI) after COVID-19 vaccines. VicSIS provides individual vaccination recommendations, allergy testing, vaccine challenges, and vaccination under supervision. VicSIS initially comprised of eight adult COVID-19 specialist vaccination clinics, subsequently, expanding to better support pediatric patients as the Australian vaccine roll-out extended to adolescents and children. Since their establishment to September 2021, the inaugural VicSIS clinics received a total of 26,401 referrals and reviewed 6,079 patients. Consults were initially predominantly for pre-vaccination reviews, later predominantly becoming post-vaccination AEFI reviews as the program progressed. Regardless of the type of consult, the most common consult outcome was a recommendation for routine vaccination (73% and 55% of consult outcomes respectively). VicSIS is an integral component of the COVID-19 vaccination program and supports confidence in COVID-19 vaccine safety by providing consistent advice across the state. VicSIS aims to strengthen the health system through the pandemic, bolstering specialist immunization services beyond COVID-19 vaccines, including training the next generation of vaccinology experts.
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Affiliation(s)
- Sally F Gordon
- Vaccine Safety and Evaluation, COVID-19 Vaccination Program, Victorian Department of Health, Melbourne, Australia
| | - Elise Virah Sawmy
- Vaccine Safety and Evaluation, COVID-19 Vaccination Program, Victorian Department of Health, Melbourne, Australia
| | - Eleanor Duckworth
- Vaccine Safety and Evaluation, COVID-19 Vaccination Program, Victorian Department of Health, Melbourne, Australia
| | - Michelle Wolthuizen
- Vaccine Safety and Evaluation, COVID-19 Vaccination Program, Victorian Department of Health, Melbourne, Australia
| | - Hazel J Clothier
- Vaccine Safety and Evaluation, COVID-19 Vaccination Program, Victorian Department of Health, Melbourne, Australia.,SAEFVIC, Murdoch Childrens Research Institute (MCRI), Melbourne, Australia.,Centre for Health Analytics, Melbourne Children's Campus, Melbourne, Australia
| | - Malinda Chea
- Vaccine Safety and Evaluation, COVID-19 Vaccination Program, Victorian Department of Health, Melbourne, Australia
| | - Naveen Tenneti
- Vaccine Safety and Evaluation, COVID-19 Vaccination Program, Victorian Department of Health, Melbourne, Australia
| | - Ngaree Blow
- Vaccine Safety and Evaluation, COVID-19 Vaccination Program, Victorian Department of Health, Melbourne, Australia
| | - Jim P Buttery
- Vaccine Safety and Evaluation, COVID-19 Vaccination Program, Victorian Department of Health, Melbourne, Australia.,SAEFVIC, Murdoch Childrens Research Institute (MCRI), Melbourne, Australia.,Centre for Health Analytics, Melbourne Children's Campus, Melbourne, Australia
| | - Joseph de Luca
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Melbourne, Australia
| | - Tony M Korman
- Department of Medicine, Monash University, Melbourne, Australia.,Monash Infectious Diseases, Monash Health, Melbourne, Australia
| | - Sara Barnes
- Department of Monash Lung, Sleep, Allergy and Immunology, Monash Health, Melbourne, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Charlotte Slade
- Department of Allergy and Clinical Immunology, Melbourne Health, Melbourne, Australia
| | - Callum Maggs
- Department of Infectious Diseases, Barwon Health, Geelong, Australia
| | | | - Benjamin W Teh
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Craig Aboltins
- Department of Infectious Diseases, Northern Health, Epping, Victoria, Australia.,Northern Health Clinical School, the University of Melbourne, Victoria, Australia
| | - Katherine M Langan
- Department of Infectious Diseases, Sunshine Hospital, Western Health, Melbourne, Australia
| | - Annaliese Van Diemen
- Vaccine Safety and Evaluation, COVID-19 Vaccination Program, Victorian Department of Health, Melbourne, Australia
| | - Nigel W Crawford
- Vaccine Safety and Evaluation, COVID-19 Vaccination Program, Victorian Department of Health, Melbourne, Australia.,SAEFVIC, Murdoch Childrens Research Institute (MCRI), Melbourne, Australia
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21
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Tran CT, Valeri M, Chiu C, Giles ML, Cheng AC, Macartney KK, Blyth CC, Crawford NW. ATAGI 2022 Annual Statement on Immunisation. Commun Dis Intell (2018) 2022; 46. [PMID: 36303396 DOI: 10.33321/cdi.2022.46.67] [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] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Catherine T Tran
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Madeline Valeri
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Clayton Chiu
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Michelle L Giles
- Australian Technical Advisory Group on Immunisation, Department of Health, Australian Government, Canberra, Australian Capital Territory, Australia.,Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Allen C Cheng
- Australian Technical Advisory Group on Immunisation, Department of Health, Australian Government, Canberra, Australian Capital Territory, Australia.,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, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Australian Technical Advisory Group on Immunisation, Department of Health, Australian Government, Canberra, Australian Capital Territory, Australia
| | - Christopher C Blyth
- Australian Technical Advisory Group on Immunisation, Department of Health, Australian Government, Canberra, Australian Capital Territory, Australia.,Wesfarmers Centre of Vaccines and Infecetious Diseases, Telethon Kids Institute and School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Department of Infectious Diseases, Perth Children's Hospital and PathWest Laboratory Medicine, QEII Medical Centre, Perth, Western Australia, Australia
| | - Nigel W Crawford
- Australian Technical Advisory Group on Immunisation, Department of Health, Australian Government, Canberra, Australian Capital Territory, Australia.,Department of General Paediatrics, Royal Children's Hospital, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Children's Research Institute and University of Melbourne, Victoria, Australia
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22
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Homer CSE, Roach V, Cusack L, Giles ML, Whitehead C, Burton W, Downton T, Gleeson G, Gordon A, Hose K, Hunt J, Kitschke J, McDonnell N, Middleton P, Oats JJN, Shand AW, Wilton K, Vogel J, Elliott J, McGloughlin S, McDonald SJ, White H, Cheyne S, Turner T. The National COVID-19 Clinical Evidence Taskforce: pregnancy and perinatal guidelines. Med J Aust 2022; 217 Suppl 9:S14-S19. [PMID: 36183307 PMCID: PMC9538383 DOI: 10.5694/mja2.51729] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/23/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Pregnant women are at higher risk of severe illness from coronavirus disease 2019 (COVID-19) than non-pregnant women of a similar age. Early in the COVID-19 pandemic, it was clear that evidenced-based guidance was needed, and that it would need to be updated rapidly. The National COVID-19 Clinical Evidence Taskforce provided a resource to guide care for people with COVID-19, including during pregnancy. Care for pregnant and breastfeeding women and their babies was included as a priority when the Taskforce was set up, with a Pregnancy and Perinatal Care Panel convened to guide clinical practice. MAIN RECOMMENDATIONS As of May 2022, the Taskforce has made seven specific recommendations on care for pregnant women and those who have recently given birth. This includes supporting usual practices for the mode of birth, umbilical cord clamping, skin-to-skin contact, breastfeeding, rooming-in, and using antenatal corticosteroids and magnesium sulfate as clinically indicated. There are 11 recommendations for COVID-19-specific treatments, including conditional recommendations for using remdesivir, tocilizumab and sotrovimab. Finally, there are recommendations not to use several disease-modifying treatments for the treatment of COVID-19, including hydroxychloroquine and ivermectin. The recommendations are continually updated to reflect new evidence, and the most up-to-date guidance is available online (https://covid19evidence.net.au). CHANGES IN MANAGEMENT RESULTING FROM THE GUIDELINES The National COVID-19 Clinical Evidence Taskforce has been a critical component of the infrastructure to support Australian maternity care providers during the COVID-19 pandemic. The Taskforce has shown that a rapid living guidelines approach is feasible and acceptable.
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Affiliation(s)
- Caroline SE Homer
- Maternal, Child and Adolescent Health ProgramBurnet InstituteMelbourneVIC
| | - Vijay Roach
- Royal North Shore HospitalSydneyNSW,Mater HospitalSydneyNSW
| | | | | | - Clare Whitehead
- Royal Women’s HospitalMelbourneVIC,University of MelbourneMelbourneVIC
| | | | - Teena Downton
- Australian College of Rural and Remote MedicineBrisbaneQLD
| | - Glenda Gleeson
- CentralAustraliaHealth ServiceAlice SpringsNT,CRANAplusAdelaideSA
| | - Adrienne Gordon
- Sydney Local Health DistrictSydneyNSW,Sydney Institute for WomenChildren and their FamiliesSydneyNSW
| | | | - Jenny Hunt
- Victorian Aboriginal Health ServiceMelbourneVIC
| | | | - Nolan McDonnell
- King Edward Memorial HospitalPerthWA,University of Western AustraliaPerthWA
| | - Philippa Middleton
- SAHMRI, Women and Children's HospitalAdelaideSA,University of AdelaideAdelaideSA
| | | | - Antonia W Shand
- Royal Hospital for WomenSydneyNSW,University of NSWSydneyNSW
| | | | - Joshua Vogel
- Maternal, Child and Adolescent Health ProgramBurnet InstituteMelbourneVIC,CochraneAustraliaMonash UniversityMelbourneVIC
| | - Julian Elliott
- CochraneAustraliaMonash UniversityMelbourneVIC,Monash UniversityMelbourneVIC
| | | | | | - Heath White
- CochraneAustraliaMonash UniversityMelbourneVIC
| | - Saskia Cheyne
- CochraneAustraliaMonash UniversityMelbourneVIC,Australian College of MidwivesCanberraACT,NHMRC Clinical Trials CentreUniversity of SydneySydneyNSW
| | - Tari Turner
- CochraneAustraliaMonash UniversityMelbourneVIC
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23
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Giles ML, O'Bryan J, Angliss M, Lee S, Krishnaswamy S. How COVID-19 has impacted immunisation service delivery in Australia: a national study. Aust N Z J Public Health 2022; 46:495-501. [PMID: 35616400 PMCID: PMC9348466 DOI: 10.1111/1753-6405.13260] [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: 10/01/2021] [Revised: 11/01/2021] [Accepted: 04/01/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The objective of this study was to determine the impact the COVID-19 pandemic had on the delivery of adult, maternal and childhood immunisation services in Australia in 2020 prior to the rollout of COVID-19 vaccines, and to understand the adaptations made at a service delivery level that may have contributed to the successful delivery of immunisation services during the first year of the pandemic. METHODS An electronic survey was sent to immunisation providers and pharmacists in all states and territories in Australia between November 2020 and December 2020. It explored interruption to the delivery of immunisation services, strategies implemented to maintain services, prioritisation of populations, and self-reported challenges and solutions initiated by providers. RESULTS A total of 850 people responded to the survey. Of these, the most common professional groups identified were pharmacists followed by nurse immunisers, nurses/midwives and general practitioners. Several changes were implemented including relocation of vaccination clinics, change to bookings rather than walk-in appointments, infection prevention measures, clients waiting in cars pre- and post-vaccination and reduced observation period post-vaccination. CONCLUSION The pandemic has provided opportunities for services to trial new and innovative strategies such as electronic pre-assessment, electronic consent and drive-through vaccination services. IMPLICATIONS FOR PUBLIC HEALTH Immunisation providers mostly viewed these changes positively and intend to continue many post-pandemic. The experience gained from the trialling of these strategies may be adapted for vaccine delivery and National Immunisation Program vaccines beyond the pandemic.
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Affiliation(s)
- Michelle L. Giles
- Department of Obstetrics and Gynaecology, Monash University, Victoria,Correspondence to: Professor Michelle Giles, Department of Obstetrics and Gynaecology, Monash University, 246 Clayton Road, Clayton VIC 3168
| | | | | | - Sue Lee
- Central Clinical School, Monash University, Victoria
| | - Sushena Krishnaswamy
- Department of Obstetrics and Gynaecology, Monash University, Victoria,Department of Infectious Diseases, Monash Health, Victoria
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24
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Brichko L, Van Breugel L, Underhill A, Tran H, Mitra B, Cameron P, Smit D, Giles ML, McCreary D, Paton A, O'Reilly G. The Impact of COVID-19 Vaccinations on Emergency Department Presentations. Emerg Med Australas 2022; 34:913-919. [PMID: 35475322 PMCID: PMC9111314 DOI: 10.1111/1742-6723.14012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/07/2022] [Accepted: 04/21/2022] [Indexed: 11/29/2022]
Abstract
Objective The aim of the present study was to describe the burden of patients presenting to the ED with symptoms occurring after receiving a COVID‐19 vaccination. Methods This was a retrospective cohort study performed over a 4‐month period across two EDs. Participants were eligible for inclusion if it was documented in the ED triage record that their ED attendance was associated with the receipt of a COVID‐19 vaccination. Data regarding the type of vaccine (Comirnaty or ChAdOx1) were subsequently extracted from their electronic medical record. Primary outcome was ED length of stay (LOS) and secondary outcomes included requests for imaging and ED disposition destination. Results During the study period of 22 February 2021 to 21 June 2021, 632 patients were identified for inclusion in the present study, of which 543 (85.9%) had received the ChAdOx1 vaccination. The highest proportion of COVID‐19 vaccine‐related attendances occurred in June 2021 and accounted for 21 (8%) of 262 total daily ED attendances. Patients who had an ED presentation related to ChAdOx1 had a longer median ED LOS (253 vs 180 min, P < 0.001) compared to Comirnaty and a higher proportion had haematology tests and imaging requested in the ED. Most patients (n = 588, 88.8%) were discharged home from the ED. Conclusion There was a notable proportion of ED attendances related to recent COVID‐19 vaccination administration, many of which were associated with lengthy ED stays and had multiple investigations. In the majority of cases, the patients were able to be discharged home from the ED.
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Affiliation(s)
- L Brichko
- The Alfred Emergency & Trauma Centre, Alfred Hospital, Melbourne, Australia.,Emergency Department, Cabrini Hospital, Melbourne, Australia.,School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - L Van Breugel
- The Alfred Emergency & Trauma Centre, Alfred Hospital, Melbourne, Australia
| | - A Underhill
- The Alfred Emergency & Trauma Centre, Alfred Hospital, Melbourne, Australia
| | - H Tran
- Haematology Department, Alfred Hospital, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - B Mitra
- The Alfred Emergency & Trauma Centre, Alfred Hospital, Melbourne, Australia.,School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia.,National Trauma Research Institute, Melbourne, Australia
| | - P Cameron
- The Alfred Emergency & Trauma Centre, Alfred Hospital, Melbourne, Australia.,School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - D Smit
- The Alfred Emergency & Trauma Centre, Alfred Hospital, Melbourne, Australia.,School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia.,National Trauma Research Institute, Melbourne, Australia
| | - M L Giles
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia.,Department of Infectious Diseases, Alfred Hospital, Melbourne, Australia
| | - D McCreary
- The Alfred Emergency & Trauma Centre, Alfred Hospital, Melbourne, Australia.,School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - A Paton
- The Alfred Emergency & Trauma Centre, Alfred Hospital, Melbourne, Australia.,Adult Retrieval Victoria, Melbourne, Australia
| | - G O'Reilly
- The Alfred Emergency & Trauma Centre, Alfred Hospital, Melbourne, Australia.,School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia.,National Trauma Research Institute, Melbourne, Australia
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25
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Chu SHS, Krishnaswamy S, Cole S, Giles ML. Travel patterns and advice-seeking behaviour of pregnant women in the Australian context: A multicentre cross-sectional analysis. Aust N Z J Obstet Gynaecol 2022; 62:688-694. [PMID: 35383883 DOI: 10.1111/ajo.13526] [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: 09/19/2021] [Accepted: 03/18/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Travel poses risks to pregnant women, but little data exist describing the travel habits of women during pregnancy or pre-travel recommendations given. AIMS To examine travel patterns of pregnant women including frequency of pre-travel consultation, and advice recalled. MATERIALS AND METHODS Cross-sectional analysis of post-partum women admitted to five Victorian maternity hospitals between 21 May 2019 and 22 April 2020 in Australia. RESULTS Forty-four percent (182/410) of women travelled during pregnancy, 32.9% (135/410) interstate and 19.5% (80/410) internationally. Fifty-five percent travelled for leisure (118/215) and 27% to visit friends/relatives (58/215). Overall, 68.1% (124/182) sought pre-travel advice, primarily from an obstetrician (60.5%, 75/124) or general practitioner (29.8%, 37/124). Only one woman attended a travel clinic. The most common reason for not seeking pre-travel advice was the belief that travel posed no risk (63.4%, 45/71). Pre-travel advice was sought least by those visiting friends/relatives (61.4%, 35/57). Women recalled recommendations regarding travel restrictions by gestational age and venous thromboembolism precautions, but not infectious disease prevention for those to whom it was relevant. Of international travellers, 48.8% (39/80) sought advice from the internet, one-third (13/39) as an alternative to seeing a healthcare provider. CONCLUSIONS Travel is common during pregnancy and women seek pre-travel advice from the healthcare provider they see most often during pregnancy. All pregnant women should be provided with consistent, evidence-based pre-travel advice regardless of whom they consult. Further work is needed to educate and provide resources to maternity care providers to optimise pre-travel counselling.
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Affiliation(s)
- Sandy H S Chu
- Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Victoria, Australia
| | - Sushena Krishnaswamy
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Monash Infectious Diseases, Monash Health, Melbourne, Victoria, Australia
| | - Stephen Cole
- Institute of Obstetrics and Gynaecology, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Michelle L Giles
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
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26
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Palmer KR, Tanner M, Davies-Tuck M, Rindt A, Papacostas K, Giles ML, Brown K, Diamandis H, Fradkin R, Stewart AE, Rolnik DL, Stripp A, Wallace EM, Mol BW, Hodges RJ. Widespread Implementation of a Low-Cost Telehealth Service in the Delivery of Antenatal Care During the COVID-19 Pandemic: An Interrupted Time-Series Analysis. Obstet Gynecol Surv 2022. [DOI: 10.1097/01.ogx.0000805176.26681.ba] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Abu-Raya B, Madhi SA, Omer SB, Amirthalingam G, Giles ML, Flanagan KL, Zimmermann P, O’Ryan M, Safadi MA, Papaevangelou V, Maertens K, Wanlapakorn N, Diaz-Brito V, Tommelein E, Esposito S. Global Perspectives on Immunization Against SARS-CoV-2 During Pregnancy and Priorities for Future Research: An International Consensus Paper From the World Association of Infectious Diseases and Immunological Disorders. Front Immunol 2021; 12:808064. [PMID: 35003137 PMCID: PMC8733958 DOI: 10.3389/fimmu.2021.808064] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/03/2021] [Indexed: 12/18/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy is associated with a higher risk for severe morbidity and mortality when compared with infection in non-pregnant women of childbearing age. An increasing number of countries recommend immunization against SARS-CoV-2 in pregnant women. Recent studies provide preliminary and supportive evidence on safety, immunogenicity and effectiveness of coronavirus disease 2019 (COVID-19) vaccines in pregnant women; however, important knowledge gaps remain which warrant further studies. This collaborative consensus paper provides a review of the current literature on COVID-19 vaccines in pregnant women, identifies knowledge gaps and outlines priorities for future research to optimize protection against SARS-CoV-2 in the pregnant women and their infants.
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Affiliation(s)
- Bahaa Abu-Raya
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Shabir A. Madhi
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Saad B. Omer
- Department of Internal Medicine (Infectious Diseases), Yale School of Medicine, New Haven, CT, United States
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
| | - Gayatri Amirthalingam
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, United Kingdom
| | - Michelle L. Giles
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Katie L. Flanagan
- School of Medicine, Faculty of Health Sciences, University of Tasmania, Launceston, TAS, Australia
- School of Health and Biomedical Science, Royal Melbourne Institute of Technology (RMIT) University, Melbourne, VIC, Australia
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia
- Tasmanian Vaccine Trial Centre, Clifford Craig Foundation, Launceston General Hospital, Launceston, TAS, Australia
| | - Petra Zimmermann
- Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Department of Paediatrics, Fribourg Hospital HFR, Fribourg, Switzerland
| | - Miguel O’Ryan
- Microbiology and Mycology Program, Institute of Biomedical Sciences and Millennium Institute of Immunology and Immunotherapy, Faculty of Medicine, University of Chile, Santiago de Chile, Chile
| | - Marco A. Safadi
- Department of Pediatrics, Santa Casa de Sao Paulo School of Medical Sciences, Sao Paulo, Brazil
| | - Vassiliki Papaevangelou
- National and Kapodistrian University of Athens, Third Department of Pediatrics, University Hospital Attikon, Athens, Greece
| | - Kirsten Maertens
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Diseases Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Nasamon Wanlapakorn
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Vicens Diaz-Brito
- Department of Infectious Diseases, Parc Sanitari Sant Joan de Déu,, Barcelona, Spain
| | - Eline Tommelein
- Department of Pharmacy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
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Tran C, Chiu C, Cheng AC, Crawford NW, Giles ML, Macartney KK, Blyth CC. ATAGI 2021 annual statement on immunisation Last updated: 19 September 2021. Commun Dis Intell (2018) 2021; 45. [PMID: 34711147 DOI: 10.33321/cdi.2021.45.60] [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] [Indexed: 11/20/2022]
Abstract
The Australian Technical Advisory Group on Immunisation (ATAGI) 2021 Annual Statement on Immunisation is the first publication in this series. It highlights the key successes, trends and challenges in the use of vaccines and control of vaccine preventable diseases (VPDs) in Australia in 2020. It also signals ATAGI’s priority actions for addressing key issues for 2021 and beyond.
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Affiliation(s)
- Catherine Tran
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, University of Sydney, Sydney, New South Wales, Australia
| | - Clayton Chiu
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, University of Sydney, Sydney, New South Wales, Australia
| | - Allen C Cheng
- Australian Technical Advisory Group on Immunisation, Department of Health, Australian Government, Canberra, Australian Capital Territory, Australia
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nigel W Crawford
- Australian Technical Advisory Group on Immunisation, Department of Health, Australian Government, Canberra, Australian Capital Territory, Australia
- Department of General Paediatrics, Royal Children's Hospital, Melbourne, Victoria, Australia
- Infection and Immunity, Murdoch Children's Research Institute and University of Melbourne, Victoria, Australia
| | - Michelle L Giles
- Australian Technical Advisory Group on Immunisation, Department of Health, Australian Government, Canberra, Australian Capital Territory, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Kristine K Macartney
- Australian Technical Advisory Group on Immunisation, Department of Health, Australian Government, Canberra, Australian Capital Territory, Australia
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, University of Sydney, Sydney, New South Wales, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Christopher C Blyth
- Australian Technical Advisory Group on Immunisation, Department of Health, Australian Government, Canberra, Australian Capital Territory, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital and PathWest Laboratory Medicine, QEII Medical Centre, Perth, Western Australia, Australia
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Giles ML, Gunatilaka A, Palmer K, Sharma K, Roach V. Alignment of national COVID-19 vaccine recommendations for pregnant and lactating women. Bull World Health Organ 2021; 99:739-746. [PMID: 34621092 PMCID: PMC8477428 DOI: 10.2471/blt.21.286644] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 07/01/2021] [Revised: 08/15/2021] [Accepted: 08/15/2021] [Indexed: 01/16/2023] Open
Abstract
The rapid development and roll-out of coronavirus disease 2019 (COVID-19) vaccines is providing hope for a way to control the pandemic. As pregnant and lactating women are generally excluded from clinical trials, the vaccination programme was launched without adequate safety and efficacy data for pregnant women. Yet many professional organizations have recognized the need for administration of COVID-19 vaccines in pregnancy and have issued their own set of recommendations. The lack of evidence, however, has often led to confused messaging, inconsistent language and differing recommendations across organizations, potentially contributing to delay or refusal to accept vaccination by pregnant women. We summarize those differences and recommend that leaders collaborate at a country level to produce joint recommendations. We use the example of Australia, where two professional authorities along with the government and partners in New Zealand worked towards one message, consistent language and a unified recommendation. The aim was to help health professionals and women who are planning pregnancy or who are currently pregnant or breastfeeding to make an informed decision about COVID-19 vaccination. National advisory groups for immunization, professional obstetric organizations and government bodies should be encouraged to coordinate their statements on COVID-19 vaccination for pregnant and lactating women and to use similar language and phrasing for greater clarity.
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Affiliation(s)
- Michelle L Giles
- Department of Obstetrics and Gynaecology, Monash University, 246 Clayton Road, Clayton, Victoria 3168, Melbourne, Australia
| | - Ahinsa Gunatilaka
- Department of Obstetrics and Gynaecology, Monash University, 246 Clayton Road, Clayton, Victoria 3168, Melbourne, Australia
| | - Kirsten Palmer
- Department of Obstetrics and Gynaecology, Monash University, 246 Clayton Road, Clayton, Victoria 3168, Melbourne, Australia
| | - Ketaki Sharma
- National Centre for Immunisation Research and Surveillance, Sydney, Australia
| | - Vijay Roach
- Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Melbourne, Australia
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Abstract
Respiratory syncytial virus (RSV) is a common cause of acute lower respiratory tract infection and is responsible for a large proportion of infant morbidity and mortality worldwide. Most RSV-related deaths occur in children under six months, and the majority of these occur in low-income settings. To date, there is no known efficacious treatment for RSV infection; hence, prevention remains an important strategy to reduce the global burden of disease. Monoclonal antibodies and vaccinations are currently the two main approaches for prevention of RSV disease. Maternal RSV vaccination is of particular interest as a strategy to protect infants during their most vulnerable period as this approach has proven highly efficacious in other vaccine-preventable conditions such as pertussis and influenza. As results from ongoing phase III clinical trials become available, important decisions will need to be made about the priority and potential implementation of RSV vaccines alongside other public health measures.
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Affiliation(s)
- Ahinsa Gunatilaka
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Michelle L Giles
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
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Giles ML, Davey MA, Wallace EM. Associations Between Maternal Immunisation and Reduced Rates of Preterm Birth and Stillbirth: A Population Based Retrospective Cohort Study. Front Immunol 2021; 12:704254. [PMID: 34557193 PMCID: PMC8454544 DOI: 10.3389/fimmu.2021.704254] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Stillbirth and preterm birth (PTB) remain two of the most important, unresolved challenges in modern pregnancy care. Approximately 10% of all births are preterm with nearly one million children dying each year due to PTB. It remains the most common cause of death among children under five years of age. The numbers for stillbirth are no less shocking with 2.6 million babies stillborn each year. With minimal impact on the rate of these adverse birth outcomes over the past decade there is an urgent need to identify more effective interventions to tackle these problems. In this retrospective cohort study, we used whole-of-population data, to determine if maternal immunization during pregnancy against influenza and/or pertussis, is associated with a lower risk of PTB, delivering a small-for-gestational age (SGA) infant, developing preeclampsia or stillbirth. Women with a singleton pregnancy at 28 or more weeks' gestation delivering in Victoria, Australia from July 2015 to December 2018 were included in the analysis. Log-binomial regression was used to measure the relationship between vaccination during pregnancy against influenza and against pertussis, with preterm birth, SGA, preeclampsia and stillbirth. Variables included in the adjusted model were maternal age, body mass index, first or subsequent birth, maternal Indigenous status, socio-economic quintile, smoking, public or private maternity care and metropolitan or rural location of the hospital. Women who received influenza vaccine were 75% less likely to have a stillbirth (aRR 025; 95% CI 0.20, 0.31), and 31% less likely to birth <37 weeks (aRR 0.69; 95% CI 0.66, 0.72). Women who received pertussis vaccine were 77% less likely to have a stillbirth (aOR 0.23; 95% CI 0.18, 0.28) and 32% less likely to birth <37 weeks gestation (aRR 0.68; 95% CI 0.66, 0.71). Vaccination also reduced the odds of small for gestational age by 13% and reduced the odds of pre-eclampsia when restricted to primiparous women. This association was seen over four different influenza seasons and independent of the time of year suggesting that any protective effect on obstetric outcomes afforded by maternal vaccination may not be due to a pathogen-specific response but rather due to pathogen-agnostic immune-modulatory effects.
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Affiliation(s)
- Michelle L. Giles
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
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Giles ML, Wallace EM, Alpren C, Brady N, Crouch S, Romanes F, Sutton B, Cheng A. Suppression of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) After a Second Wave in Victoria, Australia. Clin Infect Dis 2021; 73:e808-e810. [PMID: 33354719 PMCID: PMC7799206 DOI: 10.1093/cid/ciaa1882] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/21/2020] [Indexed: 11/14/2022] Open
Abstract
Countries around the world are experiencing a second wave of COVID-19 which is proving to be difficult to control. This report describes the combination of physical distancing, mandatory mask wearing, movement restrictions and enhanced test, trace and isolation efforts that can be used to successfully suppress community transmission to zero.
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Affiliation(s)
- Michelle L Giles
- Department of Health and Human Services, Victorian Government , Melbourne, Australia.,Department of Obstetrics and Gynecology, Monash University, Melbourne,Australia
| | - Euan M Wallace
- Department of Health and Human Services, Victorian Government , Melbourne, Australia.,Department of Obstetrics and Gynecology, Monash University, Melbourne,Australia
| | - Charles Alpren
- Department of Health and Human Services, Victorian Government , Melbourne, Australia
| | - Nicole Brady
- Department of Health and Human Services, Victorian Government , Melbourne, Australia
| | - Simon Crouch
- Department of Health and Human Services, Victorian Government , Melbourne, Australia
| | - Finn Romanes
- Department of Health and Human Services, Victorian Government , Melbourne, Australia
| | - Brett Sutton
- Department of Health and Human Services, Victorian Government , Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Allen Cheng
- Department of Health and Human Services, Victorian Government , Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Palmer KR, Tanner M, Davies-Tuck M, Rindt A, Papacostas K, Giles ML, Brown K, Diamandis H, Fradkin R, Stewart AE, Rolnik DL, Stripp A, Wallace EM, Mol BW, Hodges RJ. Widespread implementation of a low-cost telehealth service in the delivery of antenatal care during the COVID-19 pandemic: an interrupted time-series analysis. Lancet 2021; 398:41-52. [PMID: 34217399 PMCID: PMC8248925 DOI: 10.1016/s0140-6736(21)00668-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/03/2021] [Accepted: 03/11/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Little evidence is available on the use of telehealth for antenatal care. In response to the COVID-19 pandemic, we developed and implemented a new antenatal care schedule integrating telehealth across all models of pregnancy care. To inform this clinical initiative, we aimed to assess the effectiveness and safety of telehealth in antenatal care. METHODS We analysed routinely collected health data on all women giving birth at Monash Health, a large health service in Victoria (Australia), using an interrupted time-series design. We assessed the impact of telehealth integration into antenatal care from March 23, 2020, across low-risk and high-risk care models. Allowing a 1-month implementation period from March 23, 2020, we compared the first 3 months of telehealth integrated care delivered between April 20 and July 26, 2020, with conventional care delivered between Jan 1, 2018, and March 22, 2020. The primary outcomes were detection and outcomes of fetal growth restriction, pre-eclampsia, and gestational diabetes. Secondary outcomes were stillbirth, neonatal intensive care unit admission, and preterm birth (birth before 37 weeks' gestation). FINDINGS Between Jan 1, 2018, and March 22, 2020, 20 031 women gave birth at Monash Health during the conventional care period and 2292 women gave birth during the telehealth integrated care period. Of 20 154 antenatal consultations provided in the integrated care period, 10 731 (53%) were delivered via telehealth. Overall, compared with the conventional care period, no significant differences were identified in the integrated care period with regard to the number of babies with fetal growth restriction (birthweight below the 3rd percentile; 2% in the integrated care period vs 2% in the conventional care period, p=0·72, for low-risk care models; 5% in the integrated care period vs 5% in the conventional care period, p=0·50 for high-risk care models), number of stillbirths (1% vs 1%, p=0·79; 2% vs 2%, p=0·70), or pregnancies complicated by pre-eclampsia (3% vs 3%, p=0·70; 9% vs 7%, p=0·15), or gestational diabetes (22% vs 22%, p=0·89; 30% vs 26%, p=0·06). Interrupted time-series analysis showed a significant reduction in preterm birth among women in high-risk models (-0·68% change in incidence per week [95% CI -1·37 to -0·002]; p=0·049), but no significant differences were identified in other outcome measures for low-risk or high-risk care models after telehealth integration compared with conventional care. INTERPRETATION Telehealth integrated antenatal care enabled the reduction of in-person consultations by 50% without compromising pregnancy outcomes. This care model can help to minimise in-person interactions during the COVID-19 pandemic, but should also be considered in post-pandemic health-care models. FUNDING None.
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Affiliation(s)
- Kirsten R Palmer
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia.
| | - Michael Tanner
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | | | - Andrea Rindt
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia
| | - Kerrie Papacostas
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia
| | - Michelle L Giles
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Kate Brown
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia
| | - Helen Diamandis
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia
| | - Rebecca Fradkin
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia
| | - Alice E Stewart
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia
| | - Daniel L Rolnik
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Andrew Stripp
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia; Monash Health, Clayton, VIC, Australia
| | - Euan M Wallace
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia; Safer Care Victoria, Melbourne, VIC, Australia
| | - Ben W Mol
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Ryan J Hodges
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
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Abstract
BACKGROUND Maternal immunisation, which refers to vaccinations administered during pregnancy, is an integral part of preventive healthcare for pregnant women and infants. With new maternal vaccines in development, the scope of maternal immunisation is expanding. OBJECTIVE This review focuses on the principles underpinning maternal immunisation, the existing recommendations and maternal vaccines in development, a review of vaccines that may be indicated for pregnant women who wish to travel, and safety data on inadvertent administration of live vaccines to pregnant women. DISCUSSION Maternal immunisation has the potential to protect women from severe disease (as in the case of influenza) and infants from severe morbidity and mortality (as in the case of pertussis). With other maternal vaccines currently in development, such as vaccines against respiratory syncytial virus and Group B streptococcus, maternal immunisation is playing an increasingly important role in improving maternal and neonatal health.
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Affiliation(s)
- Khai Lin Kong
- MBBS, FRACP, Infectious Diseases Physician, Department of Obstetrics and Gynaecology, Monash University, Vic
| | - Sushena Krishnaswamy
- MBBS, FRACP, PhD,@Infectious Diseases Physician, Department of Infectious Diseases, Monash Health, Vic; Adjunct Lecturer, Department of Obstetrics and Gynaecology, Monash University, Vic
| | - Michelle L Giles
- MBBS, FRACP, PhD, Infectious Diseases Physician, Department of Infectious Diseases, Alfred Health and Royal Women@s Hospital, Vic; Associate Professor, Department of Obstetrics and Gynaecology, Monash University, Vic
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Giles ML, Mason EM, Lambach P, Mantel C. Maternal immunization country readiness: a checklist approach. Hum Vaccin Immunother 2020; 16:3177-3183. [PMID: 32460664 PMCID: PMC8641584 DOI: 10.1080/21645515.2020.1750248] [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: 11/02/2022] Open
Abstract
Prior to the addition of a maternal vaccine onto the National Immunization Programme, it is important for a country to evaluate their capacity and readiness. This checklist has been developed that is deliberately not restricted to any particular vaccine so it can be applied by national-level stakeholders during the decision-making stage for the introduction of any additional or new maternal vaccine. It is suggested that a team consisting of representatives from the Ministry of Health, including the National Immunization Programme (NIP) and Maternal, Newborn and Child Health (MNCH) programs complete and review the checklist together. This checklist enables countries to assess their capacity, strengths and weaknesses and identify a list of priorities to allow for smooth implementation of maternal vaccines.
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Affiliation(s)
- Michelle L. Giles
- Department of Obstetrics and Gynecology, Monash University, Melbourne, Australia
| | - Elizabeth M. Mason
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Philipp Lambach
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
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Affiliation(s)
- Bahaa Abu Raya
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michelle L Giles
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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Meher-Homji Z, Giles ML. Vaccination in the person with newly diagnosed HIV. Aust J Gen Pract 2020; 49:93-98. [PMID: 32113207 DOI: 10.31128/ajgp-10-19-5125] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND People living with human immunodeficiency virus (HIV) are at increased risk of acquiring multiple infections, many of which are preventable by vaccination. When an individual is newly diagnosed with HIV, it is important to take a vaccination history, test for immunity against a range of infectious diseases and administer vaccines as indicated, keeping in mind the person's immune status, as this may affect response to the vaccine, number of recommended doses and timing. OBJECTIVE This aim of this article is to guide the general practitioner (GP) through each vaccine-preventable disease, highlight the risk in someone newly diagnosed with HIV and discuss the recommended number of doses and optimal timing of administration in relation to the individual's level of immunosuppression. DISCUSSION The GP plays an important role in testing and diagnosing individuals with HIV. Prevention of disease is always preferable to treatment, and this article outlines an approach to vaccination that takes into account the variation in the level of immunosuppression that may be present at diagnosis and therefore affect an individual's responsiveness to a standard vaccine schedule.
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Affiliation(s)
- Zaal Meher-Homji
- MBBS, BMedSci, DTM@H, Department of Infectious Diseases, Alfred Health, Vic
| | - Michelle L Giles
- MBBS (Hons), FRACP, PhD Department of Infectious Diseases, Alfred Health, Vic; Department of Obstetrics and Gynaecology, Monash University, Vic
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Giles ML, MacPhail A, Bell C, Bradshaw CS, Furner V, Gunathilake M, John M, Krishnaswamy S, Martin SJ, Ooi C, Owen L, Russell D, Street A, Post JJ. A national study of the clinical management of HIV-positive women in Australia: what are the successes and where are the gaps? Sex Health 2020; 16:282-288. [PMID: 31167698 DOI: 10.1071/sh18070] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 02/23/2019] [Indexed: 11/23/2022]
Abstract
Background Women comprise ~10% of people living with HIV in Australia, so are often underrepresented in research. METHODS This study invited clinicians providing care to women living with HIV to complete an anonymous survey containing questions related to four key areas: HIV (including diagnosis, treatment and virological outcomes), reproductive health (including sexual activity, contraception, pregnancy and outcomes) and linkage and retention in care. RESULTS In total, 484 surveys were received, with responses from all states and territories. Most women living with HIV in Australia are on treatment (>90%) and virologically suppressed (>90% have a viral load <50 copies mL-1). Almost 75% of women have had at least one switch in treatment (with toxicity almost as common as simplification as the indication). Treatment interruption is also relatively common, but is more likely the longer a woman has been diagnosed, if she is on benefits (P = 0.007) and is the primary carer of children without a partner (P = 0.001). In Australia, women living with HIV are a diverse heterogeneous group, with over 70 different countries of birth and almost half speaking a language other than English at home. Mental health diagnosis was the most common co-morbid condition identified. A total of 21% of women were post-menopausal, with 42% reporting symptoms to their healthcare provider, but only 17% were receiving treatment for symptoms attributed to menopause. CONCLUSIONS As well as strategies to support women vulnerable to treatment interruption, important areas for future investment in research and clinical care include co-morbid mental health and menopause symptoms and treatment.
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Affiliation(s)
- Michelle L Giles
- Department of Infectious Diseases, Alfred Health, 55 Commercial Road, Melbourne, Vic. 3004, Australia; and Department of Obstetrics and Gynecology, Monash University, 246 Clayton Road, Clayton, Vic. 3168, Australia; and Corresponding author.
| | - Aleece MacPhail
- Department of Infectious Diseases, Alfred Health, 55 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Charlotte Bell
- Royal Adelaide Hospital, Port Road, Adelaide, SA 5000, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Central Clinical School, Alfred Centre, 99 Commercial Road, Melbourne, Vic. 3004 , Australia
| | - Virginia Furner
- The Albion Centre, 150-154 Albion Street, Surry Hills, NSW 2010, Australia
| | - Manoji Gunathilake
- Sexual Health and Blood Borne Virus Unit, Centre for Disease Control, Northern Territory Department of Health, PO Box 40596, Casuarina, NT 0811, Australia; and Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, High Street, Kensington, NSW 2052, Australia
| | - Mina John
- Department of Clinical Immunology, Royal Perth Hospital, Wellington Street, Perth, WA 6000, Australia
| | - Sushena Krishnaswamy
- Department of Medicine, Alice Springs Hospital, 6 Gap Road, The Gap, NT 0870, Australia; and Monash Infectious Diseases, Monash Health, 246 Clayton Road, Clayton, Vic. 3168, Australia
| | - Sarah J Martin
- Canberra Sexual Health Centre, Building 5, Canberra Hospital, Hospital Road, Garran, ACT 2605, Australia; and Australian National University Medical School, Building 4, Canberra Hospital, Hospital Road, Garran, ACT 2605, Australia
| | - Catriona Ooi
- Western Sydney Sexual Health Centre, 162 Marsden Street, Parramatta, NSW 2150, Australia
| | - Louise Owen
- Statewide Sexual Health Service, Clinic 60, 60 Collins Street, Hobart, Tas. 7000 , Australia
| | - Darren Russell
- Cairns Sexual Health Service, 381 Sheridan Street, Cairns North, Qld 4870, Australia; and School of Medicine and Dentistry, James Cook University, 1/14-88 McGregor Road, Smithfield, Qld 4878, Australia
| | - Alan Street
- Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Parkville, Vic. 3000, Australia
| | - Jeffrey J Post
- The Albion Centre, 150-154 Albion Street, Surry Hills, NSW 2010, Australia; and Department of Infectious Diseases, Prince of Wales Hospital, Barker Street, Randwick, NSW 2031, Australia; and Prince of Wales Clinical School, University of New South Wales, Sydney, NSW 2052, Australia
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Bryan ER, McLachlan RI, Rombauts L, Katz DJ, Yazdani A, Bogoevski K, Chang C, Giles ML, Carey AJ, Armitage CW, Trim LK, McLaughlin EA, Beagley KW. Detection of chlamydia infection within human testicular biopsies. Hum Reprod 2020; 34:1891-1898. [PMID: 31586185 PMCID: PMC6810529 DOI: 10.1093/humrep/dez169] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 01/20/2019] [Revised: 07/12/2019] [Indexed: 12/17/2022] Open
Abstract
STUDY QUESTION Can Chlamydia be found in the testes of infertile men? SUMMARY ANSWER Chlamydia can be found in 16.7% of fresh testicular biopsies and 45.3% of fixed testicular biopsies taken from a selection of infertile men. WHAT IS KNOWN ALREADY Male chlamydial infection has been understudied despite male and female infections occurring at similar rates. This is particularly true of asymptomatic infections, which occur in 50% of cases. Chlamydial infection has also been associated with increased sperm DNA damage and reduced male fertility. STUDY DESIGN, SIZE, DURATION We collected diagnostic (fixed, n = 100) and therapeutic (fresh, n = 18) human testicular biopsies during sperm recovery procedures from moderately to severely infertile men in a cross-sectional approach to sampling. PARTICIPANTS/MATERIALS, SETTING, METHODS The diagnostic and therapeutic biopsies were tested for Chlamydia-specific DNA and protein, using real-time PCR and immunohistochemical approaches, respectively. Serum samples matched to the fresh biopsies were also assayed for the presence of Chlamydia-specific antibodies using immunoblotting techniques. MAIN RESULTS AND THE ROLE OF CHANCE Chlamydial major outer membrane protein was detected in fixed biopsies at a rate of 45.3%. This was confirmed by detection of chlamydial DNA and TC0500 protein (replication marker). C. trachomatis DNA was detected in fresh biopsies at a rate of 16.7%, and the sera from each of these three positive patients contained C. trachomatis-specific antibodies. Overall, C. trachomatis-specific antibodies were detected in 72.2% of the serum samples from the patients providing fresh biopsies, although none of the patients were symptomatic nor had they reported a previous sexually transmitted infection diagnosis including Chlamydia. LIMITATIONS, REASONS FOR CAUTION No reproductively healthy male testicular biopsies were tested for the presence of Chlamydia DNA or proteins or Chlamydia-specific antibodies due to the unavailability of these samples. WIDER IMPLICATIONS FOR THE FINDINGS Application of Chlamydia-specific PCR and immunohistochemistry in this human male infertility context of testicular biopsies reveals evidence of a high prevalence of previously unrecognised infection, which may potentially have a pathogenic role in spermatogenic failure. STUDY FUNDING/COMPETING INTEREST(S) Funding for this project was provided by the Australian NHMRC under project grant number APP1062198. We also acknowledge assistance from the Monash IVF Group and Queensland Fertility Group in the collection of fresh biopsies, and the Monash Health and co-author McLachlan (declared equity interest) in retrieval and sectioning of fixed biopsies. E.M. declares an equity interest in the study due to financing of fixed biopsy sectioning. All other authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Emily R Bryan
- School of Biomedical Sciences and Institute of Health & Biomedical Innovation, Queensland University of Technology, 300 Herston Rd, Herston, QLD 4006, Australia
| | - Robert I McLachlan
- Monash IVF Group, 89 Bridge Road, Richmond, VIC 3121, Australia.,Department of Obstetrics and Gynecology, Monash Medical Centre, Monash University, 246 Clayton Road, Clayton, VIC 3168, Australia.,Hudson Institute of Medical Research, Monash Medical Centre, Monash University, 246 Clayton Road, Clayton, VIC 3168, Australia
| | - Luk Rombauts
- Monash IVF Group, 89 Bridge Road, Richmond, VIC 3121, Australia.,Department of Obstetrics and Gynecology, Monash Medical Centre, Monash University, 246 Clayton Road, Clayton, VIC 3168, Australia
| | - Darren J Katz
- Men's Health Melbourne, 233 Collins Street, Melbourne, VIC 3000, Australia.,Department of Surgery, Western Health, Melbourne, VIC 3000, Australia
| | - Anusch Yazdani
- Queensland Fertility Group, 55 Little Edward Street, Spring Hill, QLD 4000, Australia
| | - Kristofor Bogoevski
- Histology Services, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD 4006, Australia
| | - Crystal Chang
- Histology Services, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD 4006, Australia
| | - Michelle L Giles
- Ritchie Centre, Department of Obstetrics and Gynecology, Monash University, Melbourne, VIC 3000, Australia
| | - Alison J Carey
- School of Biomedical Sciences and Institute of Health & Biomedical Innovation, Queensland University of Technology, 300 Herston Rd, Herston, QLD 4006, Australia
| | - Charles W Armitage
- School of Biomedical Sciences and Institute of Health & Biomedical Innovation, Queensland University of Technology, 300 Herston Rd, Herston, QLD 4006, Australia
| | - Logan K Trim
- School of Biomedical Sciences and Institute of Health & Biomedical Innovation, Queensland University of Technology, 300 Herston Rd, Herston, QLD 4006, Australia
| | - Eileen A McLaughlin
- School of Environmental and Life Sciences, Faculty of Science, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.,School of Science Faculty of Science and Technology, University of Canberra, Kirinari Street, Bruce, ACT 2617, Australia.,School of Biological Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Kenneth W Beagley
- School of Biomedical Sciences and Institute of Health & Biomedical Innovation, Queensland University of Technology, 300 Herston Rd, Herston, QLD 4006, Australia
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Abu-Raya B, Giles ML, Kollmann TR, Sadarangani M. Profiling avidity of antibodies elicited by vaccination using enzyme-linked immunosorbent assay-based elution - Insights into a novel experimental and analytical approach. Vaccine 2020; 38:5389-5392. [PMID: 32620372 DOI: 10.1016/j.vaccine.2020.06.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/14/2020] [Accepted: 06/19/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Bahaa Abu-Raya
- Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia, Vancouver, Canada; Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
| | - Michelle L Giles
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Tobias R Kollmann
- Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Telethon Kids Institute, Perth, Australia
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia, Vancouver, Canada; Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Abu-Raya B, Maertens K, Edwards KM, Omer SB, Englund JA, Flanagan KL, Snape MD, Amirthalingam G, Leuridan E, Damme PV, Papaevangelou V, Launay O, Dagan R, Campins M, Cavaliere AF, Frusca T, Guidi S, O'Ryan M, Heininger U, Tan T, Alsuwaidi AR, Safadi MA, Vilca LM, Wanlapakorn N, Madhi SA, Giles ML, Prymula R, Ladhani S, Martinón-Torres F, Tan L, Michelin L, Scambia G, Principi N, Esposito S. Global Perspectives on Immunization During Pregnancy and Priorities for Future Research and Development: An International Consensus Statement. Front Immunol 2020; 11:1282. [PMID: 32670282 PMCID: PMC7326941 DOI: 10.3389/fimmu.2020.01282] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/20/2020] [Indexed: 12/17/2022] Open
Abstract
Immunization during pregnancy has been recommended in an increasing number of countries. The aim of this strategy is to protect pregnant women and infants from severe infectious disease, morbidity and mortality and is currently limited to tetanus, inactivated influenza, and pertussis-containing vaccines. There have been recent advancements in the development of vaccines designed primarily for use in pregnant women (respiratory syncytial virus and group B Streptococcus vaccines). Although there is increasing evidence to support vaccination in pregnancy, important gaps in knowledge still exist and need to be addressed by future studies. This collaborative consensus paper provides a review of the current literature on immunization during pregnancy and highlights the gaps in knowledge and a consensus of priorities for future research initiatives, in order to optimize protection for both the mother and the infant.
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Affiliation(s)
- Bahaa Abu-Raya
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Kirsten Maertens
- Faculty of Medicine and Health Sciences, Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Kathryn M. Edwards
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Saad B. Omer
- Department of Internal Medicine (Infectious Diseases), Department of Epidemiology of Microbial Diseases, Yale School of Medicine, Yale School of Public Health, New Haven, CT, United States
| | - Janet A. Englund
- Department of Pediatrics, Seattle Children's Research Institute, University of Washington, Seattle, WA, United States
| | - Katie L. Flanagan
- Faculty of Health Sciences, School of Medicine, University of Tasmania, Launceston, TAS, Australia
- School of Health and Biomedical Science, RMIT University, Melbourne, VIC, Australia
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia
| | - Matthew D. Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Gayatri Amirthalingam
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, United Kingdom
| | - Elke Leuridan
- Faculty of Medicine and Health Sciences, Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Pierre Van Damme
- Faculty of Medicine and Health Sciences, Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Vana Papaevangelou
- Third Department of Pediatrics, University Hospital ATTIKON, National and Kapodistrian University of Athens, Athens, Greece
| | - Odile Launay
- Université de Paris, Inserm, CIC 1417, F-CRIN I REIVAC, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ron Dagan
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Magda Campins
- Preventive Medicine and Epidemiology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Anna Franca Cavaliere
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tiziana Frusca
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Sofia Guidi
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Miguel O'Ryan
- Microbiology and Mycology Program, Faculty of Medicine, Institute of Biomedical Sciences and Associate Researcher, Millennium Institute of Immunology and Immunotherapy, University of Chile, Santiago, Chile
| | - Ulrich Heininger
- Pediatric Infectious Diseases, University of Basel Children's Hospital, Basel, Switzerland
| | - Tina Tan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Ahmed R. Alsuwaidi
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Marco. A. Safadi
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Luz M. Vilca
- Unit of Obstetrics and Gynecology, Buzzi Hospital - ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Nasamon Wanlapakorn
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Shabir A. Madhi
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michelle L. Giles
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Roman Prymula
- School of Medicine Hradec Kralove, Institute of Social Medicine, Charles University Prague, Prague, Czechia
| | - Shamez Ladhani
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, United Kingdom
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, University of Santiago, Santiago de Compostela, Spain
| | - Litjen Tan
- Immunization Action Coalition, St. Paul, MN, United States
| | - Lessandra Michelin
- Infectious Diseases and Vaccinology Division, Health Sciences Post Graduation Program, University of Caxias Do Sul, Caxias Do Sul, Brazil
| | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Susanna Esposito
- Department of Medicine and Surgery, Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
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Giles ML, Mason E, Muñoz FM, Moran AC, Lambach P, Merten S, Diaz T, Baye M, Mathai M, Pathirana J, Rendell S, Tunçalp Ö, Hombach J, Roos N. Antenatal care service delivery and factors affecting effective tetanus vaccine coverage in low- and middle-income countries: Results of the Maternal Immunisation and Antenatal Care Situational analysis (MIACSA) project. Vaccine 2020; 38:5278-5285. [PMID: 32527598 PMCID: PMC7342001 DOI: 10.1016/j.vaccine.2020.05.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 05/04/2020] [Accepted: 05/07/2020] [Indexed: 01/31/2023]
Abstract
Objectives To map the integration of existing maternal tetanus immunization programmes within antenatal care (ANC) services for pregnant women in low- and middle-income countries (LMICs) and to identify and understand the challenges, barriers and facilitators associated with high performance maternal vaccine service delivery. Design A mixed methods, cross sectional study with four data collection phases including a desk review, online survey, telephone and face-to-face interviews and in country visits was undertaken between 2016 and 2018. Associations of different service delivery process components with protection at birth (PAB) and with country groups were established. PAB was defined as the proportion of neonates protected at birth against neonatal tetanus. Regression analysis and structural equation modelling was used to assess associations of different variables with maternal tetanus immunization coverage. Latent class analysis (LCA), was used to group country performance for maternal immunization, and to address the problem of multicollinearity. Setting LMICs. Results The majority of LMICs had a policy on recommended number of ANC visits, however most were yet to implement the WHO guidelines recommending eight ANC contacts. Countries that recommended > 4 ANC contacts were more likely to have high PAB > 90%. Passive disease surveillance was the most common form of disease surveillance performed but the maternal and neonatal morbidity and mortality indicators recorded differed between countries. The presence of user fees for antenatal care and maternal immunization was significantly associated with lower PAB (<90%). Conclusions Recommendations include implementing the current WHO ANC guideline to facilitate increased opportunities for vaccination during each pregnancy. Improved utilisation of ANC services by increasing the demand side by increasing the quality of services, reducing any associated costs and supporting user fee exemptions, or the supply side can also enhance utilisation of ANC services which are positioned as an ideal platform for delivery of maternal vaccines.
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Affiliation(s)
- M L Giles
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia.
| | - E Mason
- London School of Hygiene and Tropical Medicine, London, UK
| | - F M Muñoz
- Section Infectious Diseases, Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - A C Moran
- Epidemiology, Monitoring and Evaluation (EME), Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - P Lambach
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - S Merten
- Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland
| | - T Diaz
- Epidemiology, Monitoring and Evaluation (EME), Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - M Baye
- Coordinator of the National Program to Combat Maternal, Newborn and Child Mortality, Ministry of Public Health, Cameroon
| | - M Mathai
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - J Pathirana
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - S Rendell
- Department of Anthropology, University of Pennsylvania, Philadelphia, USA
| | - Ö Tunçalp
- Department of Sexual and Reproductive Health and Research Including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Geneva, Switzerland
| | - J Hombach
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - N Roos
- Karolinska Institutet, Department of Medicine, Clinical Epidemiology Division, Stockholm, Sweden
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Kaufman J, Attwell K, Tuckerman J, O'Sullivan J, Omer SB, Leask J, Regan A, Marshall H, Lee KJ, Snelling T, Perrett K, Wiley K, Giles ML, Danchin M. Feasibility and acceptability of the multi-component P3-MumBubVax antenatal intervention to promote maternal and childhood vaccination: A pilot study. Vaccine 2020; 38:4024-4031. [PMID: 32321684 DOI: 10.1016/j.vaccine.2020.04.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Pregnancy is a critical time for vaccine decision-making, but coverage remains suboptimal for maternal influenza (45-60%) and pertussis vaccination (65-80%) in Australia. The multi-component P3-MumBubVax intervention has been designed for Australian midwives to optimise antenatal vaccine discussions and improve maternal and childhood vaccine uptake. A pilot study was conducted to assess intervention feasibility and acceptability. METHODS P3-MumBubVax includes components at three levels: 1. Practice ('vaccine champions'; stickers to prompt and record vaccine discussions/delivery); 2. Provider (website with vaccine communication training; learning exercise; fact sheets; links to child vaccination resources); 3. Parent (SMS reminders; website; fact sheets). Midwives and pregnant women 18-22 weeks gestation were recruited at the Royal Women's Hospital, Melbourne. Post-intervention online surveys assessed intervention feasibility, implementation, acceptability and impact on vaccine uptake. RESULTS Twenty-five midwives and 62 pregnant women were recruited and 19/25 midwives completed training. Surveys were returned by 18/25 midwives and 56/62 women. 14/18 midwives reported using the sticker prompts, 10/18 reported using or referring to the website, and 11/18 reported using the fact sheets. 48/56 pregnant women (86%) reported discussing influenza and 46/56 (82%) discussed pertussis vaccines with their midwives. These conversations were reported to be short (1-3 min) for 48/56 women (87%). All midwives were satisfied with the intervention and 17/18 reported feeling more confident discussing vaccines following the intervention. Women were very satisfied with SMS content (50/56; 94%) and timing (49/55; 89%), and with their vaccine discussions in general (34/56; 63%). However, 16/54 (30%) wanted more discussion about childhood vaccines. Self-reported maternal vaccine uptake was 82% (45/55) and 93% (51/55) for influenza and pertussis (baseline 2017-2018: 43% influenza, 60% pertussis) and 96% (50/52) of infants were fully vaccinated at 12 weeks. DISCUSSION The P3-MumBubVax intervention is feasible and acceptable in the Australian public antenatal setting. Further evaluation is required to determine effectiveness.
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Affiliation(s)
- Jessica Kaufman
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC 3052, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 50 Flemington Road, Parkville, VIC 3052, Australia.
| | - Katie Attwell
- Faculty of Arts, Business, Law and Education, School of Social Sciences, University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia; Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia.
| | - Jane Tuckerman
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC 3052, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 50 Flemington Road, Parkville, VIC 3052, Australia.
| | - Jacinta O'Sullivan
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC 3052, Australia.
| | - Saad B Omer
- Yale Institute for Global Health, Yale University, PO Box 208034, New Haven, CT 06520, United States.
| | - Julie Leask
- University of Sydney Susan Wakil School of Nursing and Midwifery, 88 Mallett St, Camperdown, NSW 2050, Australia.
| | - Annette Regan
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia; School of Public Health, Texas A&M University, College Station, TX 77845, United States.
| | - Helen Marshall
- Robinson Research Institute and Adelaide Medical School, University of Adelaide, 55 King William St, North Adelaide, SA 5006, Australia; Women's and Children's Health Network, 72 King William Rd, North Adelaide, SA 5006, Australia.
| | - Katherine J Lee
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC 3052, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 50 Flemington Road, Parkville, VIC 3052, Australia.
| | - Tom Snelling
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia; Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia; School of Public Health, Curtin University, Kent Street, Bentley, WA 6102, Australia; Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, NT 0811, Australia.
| | - Kirsten Perrett
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC 3052, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 50 Flemington Road, Parkville, VIC 3052, Australia; Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia.
| | - Kerrie Wiley
- University of Sydney School of Public Health, A27 Fisher Rd, Camperdown, NSW 2006, Australia.
| | - Michelle L Giles
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC 3168, Australia.
| | - Margie Danchin
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC 3052, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 50 Flemington Road, Parkville, VIC 3052, Australia; Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia.
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Giles ML, Davey MA, Wallace EM. Chronic hepatitis B infection and the risk of gestational diabetes: a cross-sectional study. BJOG 2020; 127:1147-1152. [PMID: 32176400 DOI: 10.1111/1471-0528.16217] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE An estimated two billion people worldwide live with hepatitis B virus (HBV) infection. Many of these are women of reproductive age. Studies that have examined pregnancy outcomes in women living with HBV have reported conflicting results in relation to the incidence of gestational diabetes (GDM). The aim of this study is to examine if gestational diabetes is more common in women with chronic HBV residing in a non-Asian country. DESIGN Cross-sectional study. SETTING Victoria, Australia. POPULATION All singleton births between 2009 and 2017. METHODS Poisson regression was performed to determine whether gestational diabetes is more common in women with HBV than in women without HBV taking into account other risk factors such as maternal age, body mass index (BMI), parity and country of birth. MAIN OUTCOME MEASURE Gestational diabetes diagnosis in women with chronic HBV infection. RESULTS For women with HBV, the unadjusted incidence risk ratio for GDM was 1.75 (95% CI 1.6-1.9). After adjusting for region of birth, BMI, parity, age and smoking, the adjusted incidence risk ratio was 1.2 (95% CI 1.1-1.3). The highest incidence (37.1%) of GDM was in women with HBV and a BMI of >40. CONCLUSIONS The findings from this study confirm an association between HBV and GDM. TWEETABLE ABSTRACT HBV is associated with GDM with an incidence risk ratio for GDM of 1.75 (95% CI 1.6-1.9).
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Affiliation(s)
- M L Giles
- Department of Obstetrics and Gynaecology, The Ritchie Centre, Monash University, Melbourne, Vic., Australia.,Women's and Children's Health, Monash Health, Melbourne, Vic., Australia
| | - M-A Davey
- Department of Obstetrics and Gynaecology, The Ritchie Centre, Monash University, Melbourne, Vic., Australia
| | - E M Wallace
- Department of Obstetrics and Gynaecology, The Ritchie Centre, Monash University, Melbourne, Vic., Australia
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45
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Kong KL, Chu S, Giles ML. Factors influencing the uptake of influenza vaccine vary among different groups in the hard‐to‐reach population. Aust N Z J Public Health 2020; 44:163-168. [DOI: 10.1111/1753-6405.12964] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/01/2019] [Accepted: 11/01/2019] [Indexed: 11/26/2022] Open
Affiliation(s)
- Khai Lin Kong
- Department of Obstetrics and GynaecologyMonash University Melbourne Victoria
| | - Sandy Chu
- Faculty of Medicine, Nursing and Health SciencesMonash University Melbourne Victoria
| | - Michelle L. Giles
- Department of Obstetrics and GynaecologyMonash University Melbourne Victoria
- Monash Immunisation, Monash Health Melbourne Victoria
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46
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Griffin DW, Martin GE, McLean C, Cheng AC, Giles ML. A case of drug reaction with eosinophilia and systemic symptoms (DRESS) without a typical precipitant. Med J Aust 2020; 212:300-301.e1. [PMID: 32092152 DOI: 10.5694/mja2.50519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | | | | | - Allen C Cheng
- Alfred Health, Melbourne, VIC.,Monash University, Melbourne, VIC
| | - Michelle L Giles
- Alfred Health, Melbourne, VIC.,Monash University, Melbourne, VIC
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Giles ML, Cheng AC. Regulatory agencies have a role to play in maintaining consumer confidence in vaccine safety for pregnant women. Hum Vaccin Immunother 2020; 16:2573-2576. [PMID: 32078437 PMCID: PMC7644227 DOI: 10.1080/21645515.2020.1718976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Michelle L Giles
- Department of Obstetrics and Gynaecology, Monash University , Melbourne, Australia.,Infectious Diseases Unit, Alfred Health , Melbourne, Australia
| | - Allen C Cheng
- Central Clinical School, Monash University , Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University , Melbourne, Australia
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Kong KL, Giles ML, Wallace EM. Influenza and pertussis vaccination of women during pregnancy in Victoria, 2015-2017. Med J Aust 2019; 211:474-474.e1. [PMID: 31680257 DOI: 10.5694/mja2.50387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abu-Raya B, Giles ML, Kollmann TR, Sadarangani M. The Effect of Timing of Tetanus-Diphtheria-Acellular Pertussis Vaccine Administration in Pregnancy on the Avidity of Pertussis Antibodies. Front Immunol 2019; 10:2423. [PMID: 31681310 PMCID: PMC6798090 DOI: 10.3389/fimmu.2019.02423] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 09/27/2019] [Indexed: 11/15/2022] Open
Abstract
Background: Optimal timing of gestational tetanus-diphtheria-acellular pertussis (Tdap) vaccination is not well-defined. No well-established specific anti-pertussis antibody level correlates with protection, suggesting the importance of antibody quality such as avidity. We aimed to determine the effect of timing of vaccination with Tdap in pregnancy on the avidity of cord anti-pertussis toxin (PT) immunoglobulin G (IgG). Methods: Prospective study of newborns in a tertiary hospital (Melbourne, Australia) born to women vaccinated with Tdap in pregnancy. Ammonium thiocyanate was used as a bond-breaking agent to measure the avidity of anti-PT IgG using concentrations between 0.25 M (to measure low avidity antibodies) and 3 M (to measure very high avidity antibodies). Anti-PT IgG levels achieved at each ammonium thiocyanate concentration in cord samples of women vaccinated during 28–32 weeks gestation (WG) vs. 33–36 WG, and women vaccinated 5–12 vs. 1–4 weeks prior to delivery were compared using t-tests. Results: Newborns of women vaccinated with Tdap during 28–32 WG (n = 43) had statistically significant higher concentrations of medium and high avidity anti-PT IgG compared with newborns of women vaccinated during 33–36 WG (n = 47), 11.6 IU/ml (95% CI, 8.8–15.2) IU/ml vs. 6.7 IU/ml (95% CI, 5.2–8.6) and 10.1 IU/ml (95% CI, 7.4–13.8) vs. 5.7 (95% CI, 3.6–8.9) IU/ml (p = 0.007 and p = 0.035), respectively. Newborns of women vaccinated 5–12 weeks before delivery (n = 64) had statistically significant higher concentrations of high and very high avidity anti-PT IgG compared with newborns of women vaccinated within 4 weeks before delivery (n = 25), 10.3 IU/mL (95% CI, 7.9–13.4) vs. 3.3 IU/mL (95% CI, 1.7–6.4), 12.6 IU/mL (95% CI, 9.4–16.9) vs. 4.3 IU/mL (95% CI, 2.2–8.5) (all p < 0.03), respectively. Conclusions: Quantification of levels of anti-PT IgG with different avidities demonstrated that pertussis vaccination 5–12 weeks before delivery was associated with higher anti-PT IgG avidity compared with vaccination within 4 weeks before delivery. Pertussis vaccination during 28–32 WG was associated with higher anti-PT IgG avidity compared with vaccination during 33–36 WG, supporting vaccination at 28–32 over 33–36 WG for optimal protection against pertussis in infancy.
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Affiliation(s)
- Bahaa Abu-Raya
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Michelle L Giles
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Tobias R Kollmann
- Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Giles ML, Buttery J, Davey MA, Wallace E. Pregnant women's knowledge and attitude to maternal vaccination including group B streptococcus and respiratory syncytial virus vaccines. Vaccine 2019; 37:6743-6749. [PMID: 31540809 DOI: 10.1016/j.vaccine.2019.08.084] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/11/2019] [Accepted: 08/30/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Maternal immunisation is an important strategy to reduce neonatal mortality and morbidity. New maternal vaccines such as Respiratory Syncytial Virus (RSV) and Group B streptococcus (GBS) are in development and/or clinical trials. However, little is known about pregnant women's knowledge about these diseases. METHODS Women attending antenatal clinics in Melbourne, Australia were invited to complete a questionnaire collecting demographic information, past vaccination history, understanding of risk of GBS and RSV disease in pregnancy and likelihood to accept these theoretical vaccines in the future. FINDINGS 495 women (48% born outside of Australia, from 48 different countries) completed the questionnaire. A large number of women had never heard of GBS (63%) or RSV (83%). Women over 35 years, born in Australia and women who had more than one child were more likely to have heard of GBS or RSV (p < 0.001). Women who had received influenza or pertussis vaccine in pregnancy were more likely to accept a RSV or GBS vaccine (p < 0.001). CONCLUSIONS This study has shown that knowledge of GBS and RSV is poor. However, when provided with information about the two diseases, acceptance of a hypothetical vaccine for both diseases was high. This study highlights the enormous amount of work that needs to be done in educating pregnant women about the seriousness of these two diseases if a future vaccine is ever to be accepted and high coverage achieved among the target population.
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Affiliation(s)
- Michelle L Giles
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia; Women's and Children's Health, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia; Monash Immunisation, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia.
| | - Jim Buttery
- School of Public Health and Preventive Medicine and Department of Pediatrics, Monash University, 246 Clayton Road, Clayton, Victoria 3168, Australia; Monash Immunisation, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - Mary-Ann Davey
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - Euan Wallace
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia
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