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Quigley AL, Kunasekaran M, Stone H, Honeyman D, Notaras A, Lim S, MacIntyre CR. The impact of the cruise ship coral princess on COVID-19 transmission in regional Western Australia in 2022. J Travel Med 2024:taae044. [PMID: 38470290 DOI: 10.1093/jtm/taae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/19/2024] [Indexed: 03/13/2024]
Abstract
Increased COVID-19 community transmission in regional areas with high Aboriginal populations, limited health infrastructure and low vaccination rates, could result in clusters of transmission with increased deaths rates. Pilbara, a regional community with a high Aboriginal population, showed a 34.8% increase in COVID-19 cases in the four-weeks post cruise-ship docking.
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Affiliation(s)
- Ashley L Quigley
- Biosecurity Research Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Mohana Kunasekaran
- Biosecurity Research Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Haley Stone
- Biosecurity Research Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Damian Honeyman
- Biosecurity Research Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Adriana Notaras
- Biosecurity Research Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Samsung Lim
- School of Civil and Environmental Engineering, Faculty of Engineering, University of New South Wales, Sydney, Australia
| | - C Raina MacIntyre
- Biosecurity Research Program, The Kirby Institute, University of New South Wales, Sydney, Australia
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Moa A, Kunasekaran M, Akhtar Z, Costantino V, MacIntyre CR. Systematic review of influenza vaccine effectiveness against laboratory-confirmed influenza among older adults living in aged care facilities. Hum Vaccin Immunother 2023; 19:2271304. [PMID: 37929779 PMCID: PMC10629430 DOI: 10.1080/21645515.2023.2271304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023] Open
Abstract
We estimated the effectiveness of influenza vaccines in preventing laboratory-confirmed influenza among older adults in aged care. Electronic database searches were conducted using search terms, and studies were selected as per the selection criteria. Fourteen studies were included for final review. The studies exhibited considerable variation in reported vaccine effectiveness (VE) across different seasons. Among the observational studies, VE ranged from 7.2% to 89.8% against laboratory-confirmed influenza across different vaccines. Randomized clinical trials demonstrated a 17% reduction in infection rates with the adjuvanted trivalent vaccine. The limitations include the small number of included studies conducted in different countries or regions, varied seasons, variations in diagnostic testing methods, a focus on the A/H3N2 strain, and few studies available on the effectiveness of enhanced influenza vaccines in aged care settings. Despite challenges associated with achieving optimal protection, the studies showed the benefits of influenza vaccination in the elderly residents.
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Affiliation(s)
- Aye Moa
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Mohana Kunasekaran
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Zubair Akhtar
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Valentina Costantino
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - C. Raina MacIntyre
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
- College of Public Service and Community Solutions, Arizona State University, Phoenix, AZ, USA
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Hutchinson D, Kunasekaran M, Stone H, Chen X, Quigley A, Moa A, MacIntyre CR. Healthcare Workers' SARS-CoV-2 Infections in Four Hospital Outbreaks during Delta Variant Prevalence in Sydney, Australia. Nurs Res Pract 2023; 2023:1806909. [PMID: 37745813 PMCID: PMC10513866 DOI: 10.1155/2023/1806909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/07/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023] Open
Abstract
Background Healthcare workers (HCWs) are at risk of SARS-CoV-2 infections due to occupational exposure. The use of airborne personal protective equipment (PPE) significantly reduces this risk. In June 2021, an epidemic of the Delta variant began in New South Wales (NSW), Australia. Concurrent PPE guidelines, set by the Clinical Excellence Commission (CEC), restricted the use of respirators. Objective To understand the relationship of PPE guidelines with workplace-acquired HCW SARS-CoV-2 infections in different clinical settings and to examine the relationship between rates of community transmission and workplace-acquired HCW infections during the Delta outbreak in NSW. Methods Total SARS-CoV-2 HCW infections between 13 June and 30 October 2021 (first four months of the Delta wave) were estimated from the government COVID-19 surveillance reports and compared with the surveillance reports of community transmission. In the absence of a detailed reporting of HCW infections, open-source data including news articles, media releases, and epidemiological surveillance reports were also collected. Data were extracted on HCW cases of SARS-CoV-2 from four hospitals, including the number of HCW cases (per NSW Health definition), clinical setting, PPE guidelines, and evidence of increasing local transmission. Results SARS-CoV-2 infections in HCW identified as workplace-acquired infections (n = 177) and those without a known transmission source (n = 532) increased during the period of increasing community transmission (n = 75,014) in NSW. Four hospital COVID-19 clusters affecting 20 HCWs were identified between June and October 2021. HCW clusters occurred in general wards where staff were recommended to wear surgical masks. No workplace-acquired HCW infections were reported in these hospitals from critical care wards, where respirators were recommended during the same outbreak weeks. Conclusions Differences in PPE policy across different wards may leave healthcare staff at risk of SARS-CoV-2 infection. During periods of high community transmission, respirators should be provided to protect hospital staff. Formal reporting of HCW infections should occur.
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Affiliation(s)
- Danielle Hutchinson
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Mohana Kunasekaran
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Haley Stone
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Xin Chen
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Ashley Quigley
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Aye Moa
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - C. Raina MacIntyre
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- College of Public Service & Community Solutions, Arizona State University, Tempe, AZ 85004, USA
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Stone H, Heslop D, Lim S, Sarmiento I, Kunasekaran M, MacIntyre CR. Open-Source Intelligence for Detection of Radiological Events and Syndromes Following the Invasion of Ukraine in 2022: Observational Study. JMIR Infodemiology 2023; 3:e39895. [PMID: 37379069 PMCID: PMC10365590 DOI: 10.2196/39895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 01/26/2023] [Accepted: 04/11/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND On February 25, 2022, Russian forces took control of the Chernobyl power plant after continuous fighting within the Chernobyl exclusion zone. Continual events occurred in the month of March, which raised the risk of potential contamination of previously uncontaminated areas and the potential for impacts on human and environmental health. The disruption of war has caused interruptions to normal preventive activities, and radiation monitoring sensors have been nonfunctional. Open-source intelligence can be informative when formal reporting and data are unavailable. OBJECTIVE This paper aimed to demonstrate the value of open-source intelligence in Ukraine to identify signals of potential radiological events of health significance during the Ukrainian conflict. METHODS Data were collected from search terminology for radiobiological events and acute radiation syndrome detection between February 1 and March 20, 2022, using 2 open-source intelligence (OSINT) systems, EPIWATCH and Epitweetr. RESULTS Both EPIWATCH and Epitweetr identified signals of potential radiobiological events throughout Ukraine, particularly on March 4 in Kyiv, Bucha, and Chernobyl. CONCLUSIONS Open-source data can provide valuable intelligence and early warning about potential radiation hazards in conditions of war, where formal reporting and mitigation may be lacking, to enable timely emergency and public health responses.
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Affiliation(s)
- Haley Stone
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Kensington, Australia
| | - David Heslop
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Samsung Lim
- School of Civil & Environmental Engineering, University of New South Wales, Sydney, Australia
| | - Ines Sarmiento
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Kensington, Australia
| | - Mohana Kunasekaran
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Kensington, Australia
| | - C Raina MacIntyre
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Kensington, Australia
- College of Public Service & Community Solutions, Arizona State University, Tempe, AZ, United States
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Hutchinson D, Kunasekaran M, Quigley A, Moa A, MacIntyre CR. Could it be monkeypox? Use of an AI-based epidemic early warning system to monitor rash and fever illness. Public Health 2023; 220:142-147. [PMID: 37327561 DOI: 10.1016/j.puhe.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/03/2023] [Accepted: 05/10/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES The EPIWATCH artificial intelligence (AI) system scans open-source data using automated technology and can be used to detect early warnings of infectious disease outbreaks. In May 2022, a multicountry outbreak of Mpox in non-endemic countries was confirmed by the World Health Organization. This study aimed to identify signals of fever and rash-like illness using EPIWATCH and, if detected, determine if they represented potential Mpox outbreaks. STUDY DESIGN The EPIWATCH AI system was used to detect global signals for syndromes of rash and fever that may have represented a missed diagnosis of Mpox from 1 month prior to the initial case confirmation in the United Kingdom (7 May 2022) to 2 months following. METHODS Articles were extracted from EPIWATCH and underwent review. A descriptive epidemiologic analysis was conducted to identify reports pertaining to each rash-like illness, locations of each outbreak and report publication dates for the entries from 2022, with 2021 as a control surveillance period. RESULTS Reports of rash-like illnesses in 2022 between 1 April and 11 July (n = 656 reports) were higher than in the same period in 2021 (n = 75 reports). The data showed an increase in reports from July 2021 to July 2022, and the Mann-Kendall trend test showed a significant upward trend (P = 0.015). The most frequently reported illness was hand-foot-and-mouth disease, and the country with the most reports was India. CONCLUSIONS Vast open-source data can be parsed using AI in systems such as EPIWATCH to assist in the early detection of disease outbreaks and monitor global trends.
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Affiliation(s)
- D Hutchinson
- Kirby Institute, University of New South Wales, New South Wales, Australia.
| | - M Kunasekaran
- Kirby Institute, University of New South Wales, New South Wales, Australia
| | - A Quigley
- Kirby Institute, University of New South Wales, New South Wales, Australia
| | - A Moa
- Kirby Institute, University of New South Wales, New South Wales, Australia
| | - C R MacIntyre
- Kirby Institute, University of New South Wales, New South Wales, Australia
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MacIntyre CR, Chen X, Kunasekaran M, Quigley A, Lim S, Stone H, Paik HY, Yao L, Heslop D, Wei W, Sarmiento I, Gurdasani D. Artificial intelligence in public health: the potential of epidemic early warning systems. J Int Med Res 2023; 51:3000605231159335. [PMID: 36967669 PMCID: PMC10052500 DOI: 10.1177/03000605231159335] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
The use of artificial intelligence (AI) to generate automated early warnings in epidemic surveillance by harnessing vast open-source data with minimal human intervention has the potential to be both revolutionary and highly sustainable. AI can overcome the challenges faced by weak health systems by detecting epidemic signals much earlier than traditional surveillance. AI-based digital surveillance is an adjunct to-not a replacement of-traditional surveillance and can trigger early investigation, diagnostics and responses at the regional level. This narrative review focuses on the role of AI in epidemic surveillance and summarises several current epidemic intelligence systems including ProMED-mail, HealthMap, Epidemic Intelligence from Open Sources, BlueDot, Metabiota, the Global Biosurveillance Portal, Epitweetr and EPIWATCH. Not all of these systems are AI-based, and some are only accessible to paid users. Most systems have large volumes of unfiltered data; only a few can sort and filter data to provide users with curated intelligence. However, uptake of these systems by public health authorities, who have been slower to embrace AI than their clinical counterparts, is low. The widespread adoption of digital open-source surveillance and AI technology is needed for the prevention of serious epidemics.
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Affiliation(s)
- Chandini Raina MacIntyre
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, Australia
- College of Public Service & Community Solutions, Arizona State University, Tempe, United States
| | - Xin Chen
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Mohana Kunasekaran
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ashley Quigley
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Samsung Lim
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, Australia
- School of Civil and Environmental Engineering, University of New South Wales, Sydney, Australia
| | - Haley Stone
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Hye-Young Paik
- School of Computer Science and Engineering, Faulty of Engineering, University of New South Wales, Sydney, Australia
| | - Lina Yao
- School of Computer Science and Engineering, Faulty of Engineering, University of New South Wales, Sydney, Australia
| | - David Heslop
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Wenzhao Wei
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ines Sarmiento
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Deepti Gurdasani
- William Harvey Research Institute, Queen Mary University of London, United Kingdom
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Raphael M, Kelly-Hanku A, Heslop D, Hutchinson D, Kunasekaran M, Quigley A, MacIntyre R. Early pandemic use of face masks in Papua New Guinea under a mask mandate. Western Pac Surveill Response J 2023; 14:1-6. [PMID: 37138672 PMCID: PMC10150155 DOI: 10.5365/wpsar.2023.14.1.998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Objective During the coronavirus disease (COVID-19) pandemic, face mask wearing was mandated in Port Moresby, Papua New Guinea in July 2020, but compliance was observed to be low. We aimed to determine the frequency of face mask wearing by the general public in Papua New Guinea under the mask mandate. Methods To estimate compliance with the mandate, we analysed photographs of people gathering in Port Moresby published between 29 September and 29 October 2020. Photo-epidemiology was performed on the 40 photographs that met pre-defined selection criteria for inclusion in our study. Results Among the total of 445 fully visible photographed faces, 53 (11.9%) were observed wearing a face mask over mouth and nose. Complete non-compliance (no faces wearing masks) was observed in 19 (4.3%) photographs. Physical distancing was observed in 10% of the 40 photographs. Mask compliance in indoor settings (16.4%) was higher than that observed in outdoor settings (9.8%), and this difference was statistically significant (P < 0.05). Mask compliance was observed in 8.9% of large-sized gatherings (> 30 people), 12.7% of medium-sized gatherings (11-30 people) and 25.0% of small-sized gatherings (4-10 people; photographs with < 4 people were excluded from analysis). Discussion We found very low population compliance with face mask mandates in Papua New Guinea during the pre-vaccine pandemic period. Individuals without face coverings and non-compliant with physical distancing guidelines are considered to be in a high-risk category for COVID-19 transmission particularly in medium- and large-sized gatherings. A new strategy to enforce public health mandates is required and should be clearly promoted to the public.
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Affiliation(s)
- Mark Raphael
- Papua New Guinea Institute of Medical Research, Goroka, Eastern Highland Province, Papua New Guinea
| | - Angela Kelly-Hanku
- Papua New Guinea Institute of Medical Research, Goroka, Eastern Highland Province, Papua New Guinea
- Public Health Intervention Research Program, Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - David Heslop
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Danielle Hutchinson
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Mohana Kunasekaran
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Ashley Quigley
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Raina MacIntyre
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- School of Public Affairs, College of Public Service and Community Solutions, Arizona State University, AZ, United States of America
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Kunasekaran M, Moa A, Hooshmand E, Trent M, Poulos CJ, Chughtai AA, Heslop DJ, Raina MacIntyre C. Effectiveness estimates for enhanced trivalent influenza vaccines in an aged care summer outbreak. Vaccine 2022; 40:7170-7175. [PMID: 36328885 DOI: 10.1016/j.vaccine.2022.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 05/26/2022] [Accepted: 06/05/2022] [Indexed: 11/11/2022]
Abstract
An influenza outbreak occurred during summer (February 2019) in an aged-care facility in Sydney, Australia. Residents had not received the annual 2019 influenza vaccine while 76.7% had received 2018 influenza vaccines about 9 months prior. Overall, 2018 influenza vaccine effectiveness during this outbreak was high (93.6%). The effectiveness of the high-dose trivalent vaccine (HD-TIV) and adjuvanted trivalent (a-TIV) vaccine were 89.8% (95% confidence interval: 18.8%-98.7%) and 72.5% (95% confidence interval: -106.7%-96.3%) respectively. The differences in effectiveness between HD-TIV, a-TIV and SD-QIV, during the summer outbreak were not significant.
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Affiliation(s)
- Mohana Kunasekaran
- The University of New South Wales, Kirby Institute, Biosecurity Program, Sydney, New South Wales, Australia.
| | - Aye Moa
- The University of New South Wales, Kirby Institute, Biosecurity Program, Sydney, New South Wales, Australia
| | - Elmira Hooshmand
- The University of New South Wales, Kirby Institute, Biosecurity Program, Sydney, New South Wales, Australia
| | - Mallory Trent
- The University of New South Wales, Kirby Institute, Biosecurity Program, Sydney, New South Wales, Australia
| | - Christopher J Poulos
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia; HammondCare, Sydney, New South Wales, Australia
| | - Abrar A Chughtai
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia
| | - David J Heslop
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia
| | - C Raina MacIntyre
- The University of New South Wales, Kirby Institute, Biosecurity Program, Sydney, New South Wales, Australia
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Kunasekaran M, Poulos CJ, Chughtai AA, Heslop DJ, MacIntyre CR. Factors associated with repeated influenza vaccine uptake among aged care staff in an Australian sample from 2017 to 2019. Vaccine 2022; 40:7238-7246. [PMID: 36328882 DOI: 10.1016/j.vaccine.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/13/2022] [Accepted: 08/08/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND/AIM Influenza vaccination is strongly recommended every year for aged care staff to protect themselves and minimise risk of transmission to residents. This study aimed to determine the factors associated with repeated annual influenza vaccine uptake among Australian aged care staff from 2017 to 2019. METHODS Demographic, medical and vaccination data collected from the staff, who participated in an observational study from nine aged care facilities under a single provider in Sydney Australia, were analysed retrospectively. Based on the pattern of repeated influenza vaccination from 2017 to 2019, three groups were identified: (1) unvaccinated all three years; (2) vaccinated occasionally(once or twice) over three years; and (3)vaccinated all threeyears. Multinomial logistic regression analysis was performed to better understand the factors associated with the pattern of repeated influenza vaccination. RESULTS From a total of 138 staff, between 2017 and 2019, 28.9 % (n = 40) never had a vaccination, while 44.2 % (n = 61) had vaccination occasionally and 26.8 % (n = 37) had vaccination all three years. In the multinomial logistic regression model, those who were<40 years old (OR = 0.57, 95 % CI: 0.19-0.90, p < 0.05) and those who were current smokers (OR = 0.20; 95 % CI: 0.03-0.76, p < 0.05) were less likely to have repeated vaccination for all three years compared to the unvaccinated group. Those who were<40 years old (OR = 0.61; 95 % CI: 0.22-0.68, p < 0.05) and those who were born overseas (OR = 0.50; 95 % CI:0.27-0.69, p < 0.05) were more likely to be vaccinated occasionally compared to the unvaccinated group. CONCLUSION The significant predictors of repeated vaccine uptake across the three-year study period among aged care staff were age, smoking status and country of birth (Other vs Australia). Targeted interventions towards the younger age group (<40 years old), smokers and those who were born overseas could improve repeated influenza vaccination uptake in the aged care workforce.
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Affiliation(s)
- Mohana Kunasekaran
- The University of New South Wales, Kirby Institute, Biosecurity Program, Sydney, New South Wales, Australia.
| | - Christopher J Poulos
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia; HammondCare, Sydney, New South Wales, Australia
| | - Abrar A Chughtai
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia
| | - David J Heslop
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia
| | - C Raina MacIntyre
- The University of New South Wales, Kirby Institute, Biosecurity Program, Sydney, New South Wales, Australia; College of Public Service and Community Solutions and College ofHealth Solutions, Arizona StateUniversity, Tempe, AZ, USA
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Lai YA, Chen X, Kunasekaran M, Rahman B, MacIntyre CR. Global epidemiology of vaccine-derived poliovirus 2016-2021: A descriptive analysis and retrospective case-control study. EClinicalMedicine 2022; 50:101508. [PMID: 35784443 PMCID: PMC9240990 DOI: 10.1016/j.eclinm.2022.101508] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Vaccine derived poliovirus (VDPV) remains a major barrier to polio eradication, and recent growing emergences are concerning. This paper presents the global epidemiology of circulating VDPV (cVDPV) by exploring associations between demographic and socioeconomic factors with its recent rise. METHODS Data on reported cVDPV cases and isolates between January 1 2016 and June 30 2021 were compiled from EPIWATCH, an open-source observatory for outbreak scanning and analysis, the World Health Organisation (WHO) and ProMed, and analysed descriptively. Reports containing cVDPV case information were included while duplicates and defective links were excluded. Data collection occurred from April 5 2021 to July 16 2021. To identify factors associated with cVDPV, a retrospective case-control study comparing socioeconomic profiles of countries which reported cVDPV with those that did not was undertaken with weighted logistic regression analysis. FINDINGS cVDPV caused by serotype 2 poliovirus was the predominant strain (95%) of 1818 total human cVDPV cases reported. Of 40 countries reporting cVDPV cases or isolates, 22 (55%) had polio vaccination coverages below 80%. Low vaccination coverage (Adjusted OR = 83·41, 95% CI: [5·01, 1387·71], p = 0·0020) was found to be associated with increased odds of reporting cVDPV after adjusting for confounding effects of GDP per capita, female adult literacy rates, maternal mortality rate, and Global Peace Index. INTERPRETATION Our findings reinforce the importance of maintaining high levels of vaccination, as risk of re-emergence rises when immunity wanes. Interventions to increase vaccination and standards of living in developing countries, coupled with robust surveillance are required if humanity hopes to eradicate polio in the near future. FUNDING This research was supported by the MRFF 2021 Frontier Health and Medical Research Grant (ID RFRHPI000280), Department of Health, the Australian Government.
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Affiliation(s)
- Yi An Lai
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Corresponding author at: Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - Xin Chen
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Mohana Kunasekaran
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Bayzidur Rahman
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Chandini Raina MacIntyre
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
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Kunasekaran M, Quigley A, Rahman B, Chughtai AA, Heslop DJ, Poulos CJ, MacIntyre CR. Factors associated with SARS-COV-2 attack rates in aged care– a meta-analysis. Open Forum Infect Dis 2022; 9:ofac033. [PMID: 35194554 PMCID: PMC8807324 DOI: 10.1093/ofid/ofac033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has resulted in significant morbidity and mortality in aged-care facilities worldwide. The attention of infection control in aged care needs to shift towards the built environment, especially in relation to using the existing space to allow social distancing and isolation. Physical infrastructure of aged care facilities has been shown to present challenges to the implementation of isolation procedures. To explore the relationship of the physical layout of aged care facilities with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) attack rates among residents, a meta-analysis was conducted. Methods Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P), studies were identified from 5 databases using a registered search strategy with PROSPERO. Meta-analysis for pooled attack rates of SARS-CoV-2 in residents and staff was conducted, with subgroup analysis for physical layout variables such as total number of beds, single rooms, number of floors, number of buildings in the facility, and staff per 100 beds. Results We included 41 articles across 11 countries, reporting on 90 657 residents and 6521 staff in 757 facilities. The overall pooled attack rate was 42.0% among residents (95% CI, 38.0%–47.0%) and 21.7% in staff (95% CI, 15.0%–28.4%). Attack rates in residents were significantly higher in single-site facilities with standalone buildings than facilities with smaller, detached buildings. Staff-to-bed ratio significantly explains some of the heterogeneity of the attack rate between studies. Conclusions The design of aged care facilities should be smaller in size, with adequate space for social distancing.
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Affiliation(s)
- Mohana Kunasekaran
- Biosecurity Program, Kirby Institute, The University of New South Wales Sydney, New South Wales, Australia
| | - Ashley Quigley
- Biosecurity Program, Kirby Institute, The University of New South Wales Sydney, New South Wales, Australia
| | - Bayzidur Rahman
- Biosecurity Program, Kirby Institute, The University of New South Wales Sydney, New South Wales, Australia
- School of Medicine, The University of Notre Dame, Australia
| | - Abrar A Chughtai
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia
| | - David J Heslop
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia
| | - Christopher J Poulos
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia
- HammondCare, Sydney, New South Wales, Australia
| | - C Raina MacIntyre
- Biosecurity Program, Kirby Institute, The University of New South Wales Sydney, New South Wales, Australia
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12
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Costantino V, Kunasekaran M, MacIntyre CR. Modelling of optimal vaccination strategies in response to a bioterrorism associated smallpox outbreak. Hum Vaccin Immunother 2021; 17:738-746. [PMID: 33734944 PMCID: PMC7993194 DOI: 10.1080/21645515.2020.1800324] [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: 11/19/2022] Open
Abstract
The reemergence of smallpox as a bioterrorism attack is now an increasing and legitimate concern. Advances in synthetic biology have now made it possible for the virus to be synthesized in a laboratory, with methods publicly available. Smallpox introduction into a susceptible population, with increased immunosuppression and an aging population, raises questions of how vaccination should be used in an epidemic situation when supply may be limited. We constructed three modified susceptible-latent-infectious-recovered (SEIR) models to simulate targeted, ring and mass vaccination in response to a smallpox outbreak in Sydney, Australia. We used age-specific distributions of susceptibility, infectivity, contact rates, and tested outputs under different assumptions. The number of doses needed of second- and third-generation vaccines are estimated, along with the total number of deaths at the end of the epidemic. We found a faster response is the key and ring vaccination of traced contacts is the most effective strategy and requires a smaller number of doses. However if public health authorities are unable to trace a high proportion of contacts, mass vaccination with at least 125,000 doses delivered per day is required. This study informs a better preparedness and response planning for vaccination in a case of a smallpox outbreak in a setting such as Sydney.
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Affiliation(s)
- Valentina Costantino
- Biosecurity Program, Kirby Institute, Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Mohana Kunasekaran
- Biosecurity Program, Kirby Institute, Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Chandini Raina MacIntyre
- Biosecurity Program, Kirby Institute, Faculty of Medicine, The University of New South Wales, Sydney, Australia.,College of Public Service and Community Solutions, Arizona State University, Arizona, USA
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13
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Chughtai AA, Tan TC, Hitchen EM, Kunasekaran M, MacIntyre CR. Association of influenza infection and vaccination with cardiac biomarkers and left ventricular ejection fraction in patients with acute myocardial infarction. Int J Cardiol Heart Vasc 2020; 31:100648. [PMID: 33088900 PMCID: PMC7567940 DOI: 10.1016/j.ijcha.2020.100648] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/05/2020] [Revised: 09/10/2020] [Accepted: 09/20/2020] [Indexed: 11/24/2022]
Abstract
We examined the association of influenza infection and vaccination with cardiac biomarkers and LVEF . Mean and median CK-MB levels were significantly higher among unvaccinated cases . Large size infarcts were more frequent in influenza positive cases and less frequent in vaccinated cases. Influenza vaccine may have a protective effect against large infarcts .
Aims The aim of this study was to examine the association of influenza infection and vaccination with extent of cardiac damage during acute myocardial infarctions (AMIs) as measured by serum biomarkers and left ventricular ejection function (LVEF) in patients. Methods Post-hoc analysis was performed on data from a prospective case-control study of influenza and AMI, conducted in a tertiary care hospital in Sydney, Australia. We included 275 cases of AMI, aged ≥ 40 years admitted to the cardiology during the study period. Results Mean and median CK-MB levels were significantly higher among unvaccinated group compared to vaccinated group (p value < 0.05). Troponin levels were also higher among unvaccinated group compared to vaccinated group; although not statistically significant. Troponin and CKMB values were not statistically different among influenza positive cases and influenza negative cases. Large size infarcts were less frequent among vaccinated cases compared to unvaccinated cases (25% vs 35.5%) and were more frequent among influenza positive cases compared to influenza negative cases (35.3% vs 31.5%), however differences were not statistically significant. LVEF was lower among vaccinated cases compared to unvaccinated cases (62.5% vs. 52.8%) and influenza positive cases compared to influenza negative cases (58.8% vs 55.4), however differences were not significant. Conclusion Lower CKMB levels among vaccinated groups showed that influenza vaccine may have a protective effect against large infarcts, therefore influenza vaccination should be recommended for high risk groups. The study suggests an association of larger infarcts with influenza infection, but larger studies are required to confirm this.
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Affiliation(s)
- Abrar Ahmad Chughtai
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Timothy C Tan
- School of Medical Sciences, UNSW Medicine, The University of New South Wales, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Department of Medicine, Westmead Hospital, Australia
| | - Eleanor M Hitchen
- Sydney Medical School, The University of Sydney, Department of Medicine, Westmead Hospital, Australia
| | - Mohana Kunasekaran
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Chandini Raina MacIntyre
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, NSW, 2052, Australia.,College of Public Service & Community Solutions, Arizona State University, Phoenix, AZ, USA
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14
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Hooshmand E, Moa A, Trent M, Kunasekaran M, Poulos CJ, Chughtai AA, MacIntyre CR. Epidemiology of 2017 influenza outbreaks in nine Australian Aged care facilities. Influenza Other Respir Viruses 2020; 15:278-283. [PMID: 33026149 PMCID: PMC7902252 DOI: 10.1111/irv.12811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/24/2020] [Accepted: 08/30/2020] [Indexed: 01/07/2023] Open
Abstract
Background The 2017 A/H3N2 influenza season was the most severe season since the 2009 influenza pandemic. There were over 591 influenza outbreaks in institutions across the state of New South Wales (NSW) in Australia. Aim To describe the epidemiology of influenza outbreaks in nine Sydney aged care facilities in 2017. Methods Study data were collected from nine Sydney aged care facilities for 2017 influenza season. Descriptive epidemiological analysis was conducted. Results From the nine sites included, with a total of 716 residents, four sites reported laboratory‐confirmed influenza outbreaks during the study period, with an attack rate in residents ranging from 6% to 29%. The outbreaks resulted in lockdowns in two facilities and hospitalisation of seven residents. No deaths were reported as a result of influenza infection. Influenza A was the most common influenza type reported across the facilities. The duration of outbreak lasted for 1‐4 weeks varied by site. Conclusion The 2017 season was a severe influenza season recorded in Australia. About half of the facilities studied experienced outbreaks of influenza, with a high attack rate among residents. Infection prevention and control measures and outbreak management plans are crucial for aged care facilities, including vaccination of staff and visitors to prevent outbreaks among the vulnerable residents.
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Affiliation(s)
- Elmira Hooshmand
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Aye Moa
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mallory Trent
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mohana Kunasekaran
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Abrar Ahmad Chughtai
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - C Raina MacIntyre
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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15
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Chughtai AA, Seale H, Rawlinson WD, Kunasekaran M, Macintyre CR. Selection and Use of Respiratory Protection by Healthcare Workers to Protect from Infectious Diseases in Hospital Settings. Ann Work Expo Health 2020; 64:368-377. [DOI: 10.1093/annweh/wxaa020] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 02/03/2020] [Accepted: 02/13/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Infection control policies and guidelines recommend using facemasks and respirators to protect healthcare workers (HCWs) from respiratory infections. Common types of respirators used in healthcare settings are filtering facepiece respirators (FFRs) and powered air-purifying respirators (PAPRs). Aims of this study were to examine the current attitudes and practices of HCWs regarding the selection and use of respiratory protection and determine the acceptability of a novel PAPR.
Methods
In-depth interviews were undertaken with 20 HCWs from a large tertiary hospital in Sydney, Australia. Participants were fit tested with a lightweight tight-fitting half-facepiece PAPR (CleanSpace2™ Power Unit, PAF-0034, by CleanSpace Technology®) using the TSI™ Portacount quantitative fit test method.
Results
Interview results showed that HCWs had a limited role in the selection and use of facemasks and respirators and had been using the devices provided by the hospital. The majority of subjects had no knowledge of hospital policy for the use of facemasks and respirators, had not been trained on the use of respirators, and had not been fit tested previously. Compliance with the use of facemasks and respirators was perceived as being low and facemasks and respirators were typically used only for short periods of time.
All 20 participants were successfully fit tested to the CleanSpace2™ PAPR (overall geometric mean fit factor—6768). According to the exit surveys, CleanSpace2™ PAPRs were easy to don (14/20) and doff (15/20) and comfortable to wear (14/20). Most participants believed that PAPRs provide higher protection, comfort and reusability over N95 FFR and can be used during pandemics and other high-risk situations.
Conclusions
HCWs should be aware of infection control policies and training should be provided on the correct use of respiratory protective devices. PAPRs can be used in hospital settings to protect HCWs from certain highly infectious and emerging pathogens, however, HCWs require adequate training on storage, use, and cleaning of PAPRs.
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Affiliation(s)
- Abrar Ahmad Chughtai
- School of Public Health and Community Medicine, The University of New South Wales, , Sydney, NSW, Australia
| | - Holly Seale
- School of Public Health and Community Medicine, The University of New South Wales, , Sydney, NSW, Australia
| | - William D Rawlinson
- Virology Research Laboratory, Serology and Virology Division (SAViD), NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Mohana Kunasekaran
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - C Raina Macintyre
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
- College of Public Service & Community Solutions, Arizona State University, Phoenix, AZ, USA
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16
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Lai E, Tan HY, Kunasekaran M, Chughtai AA, Trent M, Poulos C, MacIntyre CR. Influenza vaccine coverage and predictors of vaccination among aged care workers in Sydney Australia. Vaccine 2020; 38:1968-1974. [PMID: 31983582 DOI: 10.1016/j.vaccine.2020.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 12/13/2019] [Accepted: 01/05/2020] [Indexed: 01/07/2023]
Abstract
Aged care facilities (ACFs) are residential communities with a concentration of vulnerable individuals with increased risk of severe influenza infection and complications such as outbreaks, hospitalisations and deaths. Aged care workers (ACW) are potential sources of influenza introduction and transmission in ACFs. Little is known about vaccine uptake among ACW. This study aimed to measure the vaccine uptake rate among Australian ACW and evaluate the demographic determinants of uptake during the influenza season of 2018. 146 ACWs were recruited from 7 facilities of a multisite aged care provider in Sydney. ACWs completed a questionnaire regarding their demographic, occupational and vaccination status. Vaccine coverage was calculated and variables were examined against their 2018 influenza vaccination status in statistical analysis. ACWs in our study were predominantly from a non-health occupational background with a large proportion of migrant workers (56%, 75/134). Vaccine coverage in 2018 was 48% (65/135). The strongest determinants of vaccine uptake were previous year vaccination history (Odds Ratio [OR] 10.49, 95% CI 3.33-33.10), workplace immunisation programs for employees (OR 7.87, 95% CI 2.47-25.10), casual work as employment status (OR 0.14, 95% CI 0.02-0.77), and presence of comorbidities (OR 4.04, 95% CI 1.23-13.32). ACW are a unique and understudied group who are critical to infection control in ACFs. Few ACWs have formal health training, and many are migrants who may lack access to subsidised health care and face out of pocket costs for vaccination. Vaccine coverage among ACW were below recommended levels. Provision of influenza vaccine for staff in workplaces is highly effective in raising vaccine coverage amongst ACWs. More research on the aged care sector workforce is needed in order to evaluate the determinants of vaccine uptake among Australian ACWs.
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Affiliation(s)
- Elisa Lai
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, Australia.
| | - Hao Yi Tan
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Mohana Kunasekaran
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Abrar Ahmad Chughtai
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Mallory Trent
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Christopher Poulos
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia; Research and Aged Care Clinical Services, HammondCare, Australia
| | - C Raina MacIntyre
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, Australia; College of Public Service and Community Solutions, Arizona State University, AZ, USA
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17
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Tan HY, Lai E, Kunasekaran M, Chughtai AA, Trent M, Poulos CJ, MacIntyre CR. Prevalence and predictors of influenza vaccination among residents of long-term care facilities. Vaccine 2019; 37:6329-6335. [PMID: 31526622 DOI: 10.1016/j.vaccine.2019.09.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/29/2019] [Accepted: 09/06/2019] [Indexed: 12/14/2022]
Abstract
Influenza is a respiratory illness which results in significant morbidity and mortality, especially in the older population. Older people living in Long-Term Care Facilities (LTCFs) have a significantly higher risk of infection and complications from influenza. Influenza vaccine is considered the best strategy to prevent infection in high-risk populations. In Australia, the Communicable Diseases Network Australia (CNDA) suggests a vaccination coverage rate of 95% in both staff and residents1. This study aims to measure the vaccination coverage rates for residents in LTCFs and identify predictors of vaccination uptake for these individuals. This study was conducted in nine LTCFs in four sites from March to September 2018. This was done via medical record reviews for residents over 65 years old in these LTCFs, collecting information such as vaccination status, age, gender, ethnicity and occupation. Simple and multivariable logistic regression was used to calculate the Odds Ratio (OR) to determine significant predictors of influenza vaccination uptake. The overall vaccination rate among LTCF residents was 83.6%. Significant predictors of vaccination were LTCF location, ethnicity and previous year vaccination status. Residents in LTCF Site D were less likely to be vaccinated compared to Site A (OR 0.11, 95% CI 0.02-0.61), non-Caucasians were less likely to get vaccinated (OR 0.09, 95% CI 0.01-0.67), and residents who refused the 2017 vaccine were less likely to be vaccinated (OR 0.04, 95% CI 0.01-0.15). Compared with previous Australian studies on LTCF vaccination rates, the overall vaccination rate was high in these LTCFs (83.6% versus 66-84%), but it varied across different sites. Reasons for varying vaccination rates should be explored further - for example, lower rates in non-Caucasians with diverse cultural backgrounds. Better understanding the causes of under-vaccination can help improve vaccination programs in LTCFs.
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Affiliation(s)
- Hao Yi Tan
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Elisa Lai
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Mohana Kunasekaran
- The Biosecurity Program, Kirby Institute, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Abrar A Chughtai
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Mallory Trent
- The Biosecurity Program, Kirby Institute, UNSW Medicine, University of New South Wales, Sydney, Australia.
| | - Christopher J Poulos
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, Australia; HammondCare, Sydney, Australia
| | - Chandini R MacIntyre
- The Biosecurity Program, Kirby Institute, UNSW Medicine, University of New South Wales, Sydney, Australia
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18
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MacIntyre CR, Costantino V, Chen X, Segelov E, Chughtai AA, Kelleher A, Kunasekaran M, Lane JM. Influence of Population Immunosuppression and Past Vaccination on Smallpox Reemergence. Emerg Infect Dis 2019; 24:646-653. [PMID: 29553311 PMCID: PMC5875263 DOI: 10.3201/eid2404.171233] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We built a SEIR (susceptible, exposed, infected, recovered) model of smallpox transmission for New York, New York, USA, and Sydney, New South Wales, Australia, that accounted for age-specific population immunosuppression and residual vaccine immunity and conducted sensitivity analyses to estimate the effect these parameters might have on smallpox reemergence. At least 19% of New York’s and 17% of Sydney’s population are immunosuppressed. The highest smallpox infection rates were in persons 0–19 years of age, but the highest death rates were in those >45 years of age. Because of the low level of residual vaccine immunity, immunosuppression was more influential than vaccination on death and infection rates in our model. Despite widespread smallpox vaccination until 1980 in New York, smallpox outbreak severity appeared worse in New York than in Sydney. Immunosuppression is highly prevalent and should be considered in future smallpox outbreak models because excluding this factor probably underestimates death and infection rates.
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19
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Adam DC, Bui CM, Heywood AE, Kunasekaran M, Sheikh M, Narasimhan P, MacIntyre CR. Adherence to anti-vectorial prevention measures among travellers with chikungunya and malaria returning to Australia: comparative epidemiology. BMC Res Notes 2018; 11:590. [PMID: 30107816 PMCID: PMC6092863 DOI: 10.1186/s13104-018-3695-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 02/13/2018] [Accepted: 08/09/2018] [Indexed: 12/03/2022] Open
Abstract
Objective Compare the adoption and adherence to health protection behaviours prior to and during travel among international Australian travellers who return to Australia with notified chikungunya or malaria infection. This information could inform targeted health promotion and intervention strategies to limit the establishment of these diseases within Australia. Results Seeking travel advice prior to departure was moderate (46%, N = 21/46) yet compliance with a range of recommended anti-vectorial prevention measures was low among both chikungunya and malaria infected groups (16%, N = 7/45). Reasons for not seeking advice between groups was similar and included ‘previous overseas travel with no problems’ (45%, N = 9/20) and ‘no perceived risk of disease’ (20%, N = 4/20). Most chikungunya cases (65%, N = 13/20) travelled to Indonesia and a further 25% (N = 5/20) visited India, however most malaria cases (62%, N = 16/26) travelled to continental Africa with only 12% (N = 3/26) travelling to India. The majority (50%, N = 10/20) of chikungunya cases reported ‘holiday’ as their primary purpose of travel, compared to malaria cases who most frequently reported travel to visit friends and family (VFR; 42%, N = 11/26). These results provide import data that may be used to support distinct public health promotion and intervention strategies of two important vector-borne infectious diseases of concern for Australia. Electronic supplementary material The online version of this article (10.1186/s13104-018-3695-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dillon Charles Adam
- Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, Australia.
| | - Chau Minh Bui
- School of Public Health & Community Medicine, University of New South Wales (UNSW) Sydney, Sydney, Australia
| | - Anita Elizabeth Heywood
- School of Public Health & Community Medicine, University of New South Wales (UNSW) Sydney, Sydney, Australia
| | - Mohana Kunasekaran
- Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, Australia
| | - Mohamud Sheikh
- School of Public Health & Community Medicine, University of New South Wales (UNSW) Sydney, Sydney, Australia
| | - Padmanesan Narasimhan
- School of Public Health & Community Medicine, University of New South Wales (UNSW) Sydney, Sydney, Australia
| | - Chandini Raina MacIntyre
- Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, Australia.,College of Public Service & Community Solutions, Arizona State University (ASU), Tempe, AZ, USA
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20
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MacIntyre CR, Kpozehouen E, Kunasekaran M, Harriman K, Conaty S, Rosewell A, Druce J, Martin N, Heywood AE, Gidding HF, Wood J, Nicholl S. Measles control in Australia - threats, opportunities and future needs. Vaccine 2018; 36:4393-4398. [PMID: 29934234 DOI: 10.1016/j.vaccine.2018.06.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 06/07/2018] [Accepted: 06/08/2018] [Indexed: 11/18/2022]
Abstract
Control of measles was the focus of a national workshop held in 2015 in Sydney, Australia, bringing together stakeholders in disease control and immunisation to discuss maintaining Australia's measles elimination status in the context of regional and global measles control. The global epidemiology of measles was reviewed, including outbreaks in countries that have achieved elimination, such as the Disneyland outbreak in the United States and large outbreaks in Sydney, Australia. Transmission of measles between Australia and New Zealand occurs, but has not been a focus of control measures. Risk groups, the genetic and seroepidemiology of measles as well as surveillance, modelling and waning vaccine-induced immunity were reviewed. Gaps in policy, research and practice for maintaining measles elimination status in Australia were identified and recommendations were developed. Elimination of measles globally is challenging because of the infectiousness of measles and the need for 2-dose vaccine coverage rates in excess of 95% in all countries to achieve it. Until this occurs, international travel will continue to permit measles importation from endemic countries to countries that have achieved elimination. When measles cases are imported, failure to diagnose and isolate cases places the health system at risk of measles outbreaks. Vaccine funding models can result in gaps in vaccine coverage for adults and migrants. Australia introduced a whole-of-life immunisation register in 2016 and catch-up vaccination for at-risk communities, which will improve measles control. Research on diagnosis, immunology, case management and modelling of vaccination strategies are important to ensure continued control of measles.
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Affiliation(s)
- C Raina MacIntyre
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia; Kirby Institute, Biosecurity Program, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Elizabeth Kpozehouen
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia.
| | - Mohana Kunasekaran
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | | | - Stephen Conaty
- Public Health Unit, South Western Sydney Local Health District, Australia
| | - Alexander Rosewell
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Julian Druce
- Victorian Infectious Diseases Reference Laboratory, Australia; VIDRL, Doherty Institute, Australia
| | - Nicolee Martin
- Victorian Infectious Diseases Reference Laboratory, Australia
| | - Anita E Heywood
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia; National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| | - Heather F Gidding
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia; National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| | - James Wood
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
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