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Leach AJ, Wilson N, Arrowsmith B, Beissbarth J, Mulholland EK, Santosham M, Torzillo PJ, McIntyre P, Smith-Vaughan H, Skull SA, Oguoma VM, Chatfield M, Lehmann D, Binks MJ, Licciardi PV, Andrews R, Snelling T, Krause V, Carapetis J, Chang AB, Morris PS. Otitis media at 6-monthly assessments of Australian First Nations children between ages 12-36 months: Findings from two randomised controlled trials of combined pneumococcal conjugate vaccines. Int J Pediatr Otorhinolaryngol 2023; 175:111776. [PMID: 37951020 DOI: 10.1016/j.ijporl.2023.111776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/26/2023] [Accepted: 11/03/2023] [Indexed: 11/13/2023]
Abstract
OBJECTIVES In remote communities of northern Australia, First Nations children with hearing loss are disproportionately at risk of poor school readiness and performance compared to their peers with no hearing loss. The aim of this trial is to prevent early childhood persisting otitis media (OM), associated hearing loss and developmental delay. To achieve this, we designed a mixed pneumococcal conjugate vaccine (PCV) schedule that could maximise immunogenicity and thereby prevent bacterial otitis media (OM) and a trajectory of educational and social disadvantage. METHODS In two sequential parallel, open-label, randomised controlled trials, eligible infants were first allocated 1:1:1 to standard or mixed PCV primary schedules at age 28-38 days, then at age 12 months to a booster dose (1:1) of 13-valent PCV, PCV13 (Prevenar13®, +P), or 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugated vaccine, PHiD-CV10 (Synflorix®, +S). Here we report findings of standardised ear assessments conducted six-monthly from age 12-36 months, by booster dose. RESULTS From March 2013 to September 2018, 261 children were allocated to booster + P (n = 131) or + S (n = 130). There were no significant differences in prevalence of any OM diagnosis by booster dose or when stratified by primary schedule. We found high, almost identical prevalence of OM in both boost groups at each age (for example 88% of 129 and 91% of 128 children seen, respectively, at primary endpoint age 18 months, difference -3% [95% Confidence Interval -11, 5]). At each age prevalence of bilateral OM was 52%-78%, and tympanic membrane perforation was 10%-18%. CONCLUSION Despite optimal pneumococcal immunisation, the high prevalence of OM persists throughout early childhood. Novel approaches to OM prevention are needed, along with improved early identification strategies and evaluation of expanded valency PCVs.
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Affiliation(s)
- A J Leach
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
| | - N Wilson
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - B Arrowsmith
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia; Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - J Beissbarth
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - E K Mulholland
- London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - M Santosham
- Departments of International Health and Pediatrics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Center for Indigenous Health, Johns Hopkins University, Baltimore, USA
| | - P J Torzillo
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; Department of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - P McIntyre
- Discipline of Child and Adolescent Health, University of Sydney, New South Wales, Australia; Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - H Smith-Vaughan
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - S A Skull
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
| | - V M Oguoma
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia; Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Queensland, Australia
| | - M Chatfield
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - D Lehmann
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - M J Binks
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - P V Licciardi
- London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - R Andrews
- Office of the Chief Health Officer, Queensland Health, Brisbane, Queensland, Australia
| | - T Snelling
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - V Krause
- Centre for Disease Control (CDC)-Environmental Health, Northern Territory Health, Darwin, Northern Territory, Australia
| | - J Carapetis
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia; Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
| | - A B Chang
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia; Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - P S Morris
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia; Royal Darwin Hospital, Paediatrics Department, Darwin, Northern Territory, Australia
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McGree JM, Hockham C, Kotwal S, Wilcox A, Bassi A, Pollock C, Burrell LM, Snelling T, Jha V, Jardine M, Jones M. Controlled evaLuation of Angiotensin Receptor Blockers for COVID-19 respIraTorY disease (CLARITY): statistical analysis plan for a randomised controlled Bayesian adaptive sample size trial. Trials 2022; 23:361. [PMID: 35477480 PMCID: PMC9044378 DOI: 10.1186/s13063-022-06167-2] [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: 10/19/2021] [Accepted: 03/10/2022] [Indexed: 11/10/2022] Open
Abstract
The CLARITY trial (Controlled evaLuation of Angiotensin Receptor Blockers for COVID-19 respIraTorY disease) is a two-arm, multi-centre, randomised controlled trial being run in India and Australia that investigates the effectiveness of angiotensin receptor blockers in addition to standard care compared to placebo (in Indian sites) with standard care in reducing the duration and severity of lung failure in patients with COVID-19. The trial was designed as a Bayesian adaptive sample size trial with regular planned analyses where pre-specified decision rules will be assessed to determine whether the trial should be stopped due to sufficient evidence of treatment effectiveness or futility. Here, we describe the statistical analysis plan for the trial and define the pre-specified decision rules, including those that could lead to the trial being halted. The primary outcome is clinical status on a 7-point ordinal scale adapted from the WHO Clinical Progression scale assessed at day 14. The primary analysis will follow the intention-to-treat principle. A Bayesian adaptive trial design was selected because there is considerable uncertainty about the extent of potential benefit of this treatment. Trial registration ClinicalTrials.gov NCT04394117. Registered on 19 May 2020Clinical Trial Registry of India CTRI/2020/07/026831 Version and revisions Version 1.0. No revisions.
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Affiliation(s)
- J M McGree
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Australia.
| | - C Hockham
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,The George Institute for Global Health, Imperial College London, London, UK
| | - S Kotwal
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Prince of Wales Hospital, Sydney, Australia
| | - A Wilcox
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - A Bassi
- The George Institute for Global Health, New Delhi, India
| | - C Pollock
- Royal North Shore Hospital, Sydney, Australia.,Kolling Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - L M Burrell
- Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
| | - T Snelling
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,The Sydney Children's Hospitals Network, Westmead, Australia
| | - V Jha
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,The George Institute for Global Health, New Delhi, India
| | - M Jardine
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia.,Concord Repatriation General Hospital, Sydney, Australia
| | - M Jones
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
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Straiton N, McKenzie A, Bowden J, Nichol A, Murphy R, Snelling T, Zalcberg J, Clements J, Stubbs J, Economides A, Kent D, Ansell J, Symons T. Facing the Ethical Challenges: Consumer Involvement in COVID-19 Pandemic Research. J Bioeth Inq 2020; 17:743-748. [PMID: 33169265 PMCID: PMC7651817 DOI: 10.1007/s11673-020-10060-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/23/2020] [Indexed: 06/11/2023]
Abstract
Consumer involvement in clinical research is an essential component of a comprehensive response during emergent health challenges. During the COVID-19 pandemic, the moderation of research policies and regulation to facilitate research may raise ethical issues. Meaningful, diverse consumer involvement can help to identify practical approaches to prioritize, design, and conduct rapidly developed clinical research amid current events. Consumer involvement might also elucidate the acceptability of flexible ethics review approaches that aim to protect participants whilst being sensitive to the challenging context in which research is taking place. This article describes the main ethical challenges arising from pandemic research and how involving consumers and the community could enable resolution of such issues.
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Affiliation(s)
- N Straiton
- Australian Clinical Trials Alliance, Suite 1, Level 2, 24 Albert Road, Melbourne, VIC, 3205, Australia.
| | - A McKenzie
- Telethon Kids Institute, Consumer Engagement, Perth, Australia
| | | | - A Nichol
- Monash University, Melbourne, Australia
- St. Vincent's University Hospital, Dublin, Ireland
| | - R Murphy
- University of Auckland, Auckland, New Zealand
| | - T Snelling
- University of Sydney, Faculty of Medicine and Health, Sydney, Australia
| | - J Zalcberg
- Monash University, Cancer Research, Melbourne, Australia
| | - J Clements
- Australian Clinical Trials Alliance, Consumer Engagement, Melbourne, Australia
| | - J Stubbs
- Australian Clinical Trials Alliance, Consumer Engagement, Melbourne, Australia
| | - A Economides
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - D Kent
- Australian Clinical Trials Alliance, Consumer Engagement, Melbourne, Australia
| | - J Ansell
- Consumers Health Forum, Canberra, Australia
| | - T Symons
- Australian Clinical Trials Alliance, Consumer Engagement, Melbourne, Australia
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Attwell K, Wiley KE, Waddington C, Leask J, Snelling T. Midwives' attitudes, beliefs and concerns about childhood vaccination: A review of the global literature. Vaccine 2018; 36:6531-6539. [PMID: 29483029 DOI: 10.1016/j.vaccine.2018.02.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 12/15/2016] [Revised: 12/20/2017] [Accepted: 02/02/2018] [Indexed: 11/24/2022]
Abstract
Vaccine hesitancy in industrialised countries is an area of concern. Health professionals play a significant role in parental vaccination decisions, however, to date the role of midwives has not been widely explored. This review sought to describe the attitudes and communication practices of midwives in developed countries towards childhood vaccines. Medline, Cinahl, PsychInfo, Embase and the grey literature were searched. Inclusion criteria were qualitative and quantitative studies reporting midwives' beliefs, attitudes and communication practices toward childhood vaccination. The search returned 366 articles, of which 359 were excluded by abstract. Two additional articles were identified from the grey literature and references, resulting in nine studies from five countries included in the review. Across the studies, the majority of midwives supported vaccination, although a spectrum of beliefs and concerns emerged. A minority expressed reservations about the scientific justification for vaccination, which focussed on what is not yet known rather than mistrust of current evidence. Most midwives felt that vaccines were safe; a minority were unsure, or believed they were unsafe. The majority of midwives agreed that childhood vaccines are necessary. Among those who expressed doubt, a commonly held opinion was that vaccine preventable diseases such as measles are relatively benign and didn't warrant vaccination against them. Finally, the midwifery model of care was shown to focus on providing individualised care, with parental choice being placed at a premium. The midwifery model care appears to differ in approach from others, possibly due to a difference in the underpinning philosophies. Research is needed to understand how midwives see vaccination, and why there appears to be a spectrum of views on the subject. This information will inform the development of resources tailored to the midwifery model of care, supporting midwives in advocating for childhood vaccination.
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Affiliation(s)
- K Attwell
- School of Social Science, University of Western Australia, 35 Stirling Hwy, Crawley, Australia; Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Western Australia, Australia.
| | - K E Wiley
- School of Public Health, Edward Ford Building A27, University of Sydney, Australia; National Centre for Immunisation Research & Surveillance, cnr Hawkesbury Rd & Hainsworth St, Westmead 2415, Australia
| | - C Waddington
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Western Australia, Australia
| | - J Leask
- School of Public Health, Edward Ford Building A27, University of Sydney, Australia
| | - T Snelling
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Western Australia, Australia; Menzies School of Health Research and Charles Darwin University, Darwin, Australia
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