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Andraweera PH, Wang B, Danchin M, Blyth C, Vlaev I, Ong J, Dodd J, Couper J, Sullivan TR, Karnon J, Spurrier N, Cusack M, Mordaunt D, Simatos D, Dekker G, Carlson S, Tuckerman J, Wood N, Whop L, Marshall HS. Randomised controlled trials of behavioural nudges delivered through text messages to increase influenza and COVID-19 vaccines among pregnant women (the EPIC study): study protocol. Trials 2023; 24:454. [PMID: 37438776 DOI: 10.1186/s13063-023-07485-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/28/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Influenza and COVID-19 infections during pregnancy may have serious adverse consequences for women as well as their infants. However, uptake of influenza and COVID-19 vaccines during pregnancy remains suboptimal. This study aims to assess the effectiveness of a multi-component nudge intervention to improve influenza and COVID-19 vaccine uptake among pregnant women. METHODS Pregnant women who receive antenatal care at five tertiary hospitals in South Australia, Western Australia and Victoria will be recruited to two separate randomised controlled trials (RCTs). Women will be eligible for the COVID-19 RCT is they have received two or less doses of a COVID-19 vaccine. Women will be eligible for the influenza RCT if they have not received the 2023 seasonal influenza vaccine. Vaccination status at all stages of the trial will be confirmed by the Australian Immunisation Register (AIR). Participants will be randomised (1:1) to standard care or intervention group (n = 1038 for each RCT). The nudge intervention in each RCT will comprise three SMS text message reminders with links to short educational videos from obstetricians, pregnant women and midwives and vaccine safety information. The primary outcome is at least one dose of a COVID-19 or influenza vaccine during pregnancy, as applicable. Logistic regression will compare the proportion vaccinated between groups. The effect of treatment will be described using odds ratio with a 95% CI. DISCUSSION Behavioural nudges that facilitate individual choices within a complex context have been successfully used in other disciplines to stir preferred behaviour towards better health choices. If our text-based nudges prove to be successful in improving influenza and COVID-19 vaccine uptake among pregnant women, they can easily be implemented at a national level. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT05613751. Registered on November 14, 2022.
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Affiliation(s)
- Prabha H Andraweera
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, SA Health, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Bing Wang
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, SA Health, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Margie Danchin
- The Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher Blyth
- Perth Children's Hospital, Perth, Western Australia, Australia
- Department of Paediatrics, The University of Western Australia, Perth, Western Australia, Australia
| | - Ivo Vlaev
- School of Business, Warwick University, Warwick, UK
| | - Jason Ong
- School of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jodie Dodd
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Women's and Babies Division, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Jennifer Couper
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Division of Paediatrics, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Thomas R Sullivan
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jonathan Karnon
- Discipline of Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Nicola Spurrier
- Discipline of Paediatrics, Flinders University, Adelaide, South Australia, Australia
- SA Health, South Australian Government, Adelaide, South Australia, Australia
| | - Michael Cusack
- SA Health, South Australian Government, Adelaide, South Australia, Australia
| | - Dylan Mordaunt
- Discipline of Paediatrics, Flinders University, Adelaide, South Australia, Australia
| | - Dimi Simatos
- Discipline of Paediatrics, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Gus Dekker
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Discipline of Women's Health, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Samantha Carlson
- Department of Paediatrics, The University of Western Australia, Perth, Western Australia, Australia
| | - Jane Tuckerman
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Nicholas Wood
- Discipline of Paediatrics, University of Sydney, Sydney, New South Wales, Australia
- Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Lisa Whop
- Discipline of Public Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Helen S Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, SA Health, Adelaide, South Australia, Australia.
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.
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2
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Roberts G, Cahill A, Lawthom C, Price M, Blyth C, Jones C, Mc Laughlin L, Noyes J. Protocol for a realist and social return on investment evaluation of the use of patient-reported outcomes in four value-based healthcare programmes. BMJ Open 2023; 13:e072234. [PMID: 37105686 PMCID: PMC10151973 DOI: 10.1136/bmjopen-2023-072234] [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] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION There is growing recognition that in order to remain sustainable, the UK's National Health Service must deliver the best patient outcomes within available resources. This focus on outcomes relative to cost is the basis of value-based healthcare (VBHC) and has led to interest in the recording of patient-reported outcome measures (PROMs) to measure patient perspectives on the impact of a health condition on their lives. Every health board in Wales is now required to collect PROMS as part of routine care. We will evaluate the VBHC programme implemented in a lead health board. The study aim is to understand what works about PROMs collection, for whom, in what contexts and why in a VBHC context. In addition, we will assess the social value of integrating PROMs collection into routine care. METHODS AND ANALYSIS A three-stage mixed-methods study comprising a realist evaluation integrated with social return on investment (SROI) analysis across four conditions; Parkinson's disease, epilepsy, heart failure and cataract surgery. Workstream 1: Development of logic models, informed by a scoping review, documentary analysis, patient and public involvement (PPI), staff and key stakeholder engagement. Workstream 2: Realist evaluation building on multiple data sources from stages 1 to 3 to test and refine the programme theories that arise from the logic model development. Workstream 3: SROI analysis using interview data with patients, staff and carers, stakeholder and PPI engagement, anonymised routinely collected data, and questionnaires to populate a model that will explore the social value generated by the implementation of PROMs. Findings across stages will be validated with key stakeholders. ETHICS AND DISSEMINATION The study is approved by Wales Research Ethics Committee #5 (22/WA/0044). Outcomes will be shared with key stakeholders, published in peer-reviewed journals and presented at national and international conferences.This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) licence, which permits others to distribute, remix, adapt, build on this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial.
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Affiliation(s)
- Gareth Roberts
- Aneurin Bevan University Health Board, Newport, Gwent, UK
| | - Adele Cahill
- Aneurin Bevan University Health Board, Newport, Gwent, UK
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3
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McLeod C, Ramsay J, Flanagan KL, Plebanski M, Marshall H, Dymock M, Marsh J, Estcourt MJ, Wadia U, Williams PCM, Tjiam MC, Blyth C, Subbarao K, Nicholson S, Faust S, Thornton RB, Mckenzie A, Snelling TL, Richmond P. Core protocol for the adaptive Platform Trial In COVID-19 Vaccine priming and BOOsting (PICOBOO). Trials 2023; 24:202. [PMID: 36934272 PMCID: PMC10024280 DOI: 10.1186/s13063-023-07225-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/06/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND The need for coronavirus 2019 (COVID-19) vaccination in different age groups and populations is a subject of great uncertainty and an ongoing global debate. Critical knowledge gaps regarding COVID-19 vaccination include the duration of protection offered by different priming and booster vaccination regimens in different populations, including homologous or heterologous schedules; how vaccination impacts key elements of the immune system; how this is modified by prior or subsequent exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and future variants; and how immune responses correlate with protection against infection and disease, including antibodies and effector and T cell central memory. METHODS The Platform Trial In COVID-19 priming and BOOsting (PICOBOO) is a multi-site, multi-arm, Bayesian, adaptive, randomised controlled platform trial. PICOBOO will expeditiously generate and translate high-quality evidence of the immunogenicity, reactogenicity and cross-protection of different COVID-19 priming and booster vaccination strategies against SARS-CoV-2 and its variants/subvariants, specific to the Australian context. While the platform is designed to be vaccine agnostic, participants will be randomised to one of three vaccines at trial commencement, including Pfizer's Comirnaty, Moderna's Spikevax or Novavax's Nuvaxovid COVID-19 vaccine. The protocol structure specifying PICOBOO is modular and hierarchical. Here, we describe the Core Protocol, which outlines the trial processes applicable to all study participants included in the platform trial. DISCUSSION PICOBOO is the first adaptive platform trial evaluating different COVID-19 priming and booster vaccination strategies in Australia, and one of the few established internationally, that is designed to generate high-quality evidence to inform immunisation practice and policy. The modular, hierarchical protocol structure is intended to standardise outcomes, endpoints, data collection and other study processes for nested substudies included in the trial platform and to minimise duplication. It is anticipated that this flexible trial structure will enable investigators to respond with agility to new research questions as they arise, such as the utility of new vaccines (such as bivalent, or SARS-CoV-2 variant-specific vaccines) as they become available for use. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12622000238774. Registered on 10 February 2022.
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Affiliation(s)
- C McLeod
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia.
- Centre for Child Health Research, The University of Western Australia, Crawley, Australia.
- Infectious Diseases Department, Perth Children's Hospital, Nedlands, Australia.
| | - J Ramsay
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
| | - K L Flanagan
- Tasmanian Vaccine Trial Centre, Clifford Craig Foundation, Launceston General Hospital, Launceston, TAS, Australia
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology University (RMIT), Melbourne, VIC, Australia
| | - M Plebanski
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology University (RMIT), Melbourne, VIC, Australia
| | - H Marshall
- Women's and Children's Health Network, North Adelaide, Australia
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - M Dymock
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
| | - J Marsh
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
| | - M J Estcourt
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - U Wadia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Centre for Child Health Research, The University of Western Australia, Crawley, Australia
- Infectious Diseases Department, Perth Children's Hospital, Nedlands, Australia
| | - P C M Williams
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital Network, Westmead, Australia
- School of Women and Children's Health, UNSW, Kensington, Australia
| | - M C Tjiam
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Centre for Child Health Research, The University of Western Australia, Crawley, Australia
| | - C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Centre for Child Health Research, The University of Western Australia, Crawley, Australia
- Infectious Diseases Department, Perth Children's Hospital, Nedlands, Australia
- Division of Paediatrics, School of Medicine, University of Western Australia, Crawley, Australia
| | - K Subbarao
- WHO Collaborating Centre for Reference and Research On Influenza, University of Melbourne, Parkville, VIC, Australia
| | - S Nicholson
- Serology Laboratory, Victorian Infectious Diseases Research Laboratory, Melbourne, Australia
| | - S Faust
- Southampton Clinical Research Facility and Biomedical Research Centre, National Institute of Health Research, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - R B Thornton
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Centre for Child Health Research, The University of Western Australia, Crawley, Australia
| | - A Mckenzie
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
| | - T L Snelling
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - P Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Centre for Child Health Research, The University of Western Australia, Crawley, Australia
- Division of Paediatrics, School of Medicine, University of Western Australia, Crawley, Australia
- General Paediatrics and Immunology Departments, Perth Children's Hospital, Nedlands, Australia
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4
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Foley DA, Phuong LK, Peplinski J, Lim SMJ, Lee WH, Keane A, Wong JWS, Minney-Smith CA, Martin AC, Mace AO, Sikazwe CT, Le H, Levy A, Borland M, Hazelton B, Moore HC, Blyth C, Yeoh D, Bowen AC. Examining the entire delayed respiratory syncytial virus season in Western Australia. Arch Dis Child 2022; 107:517-519. [PMID: 34930725 DOI: 10.1136/archdischild-2021-323375] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 11/03/2022]
Affiliation(s)
- David Anthony Foley
- Microbiology, PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia .,Wesfarmers Centre of Vaccines and Infecitous Diseases, University of Western Australia, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Linny Kimly Phuong
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Joseph Peplinski
- Department of General Paediatrics, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Selina Mei Jy Lim
- Infectious Diseases Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Wei Hao Lee
- Department of General Paediatrics, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Aoife Keane
- Department of General Paediatrics, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Jessica Win See Wong
- Department of General Paediatrics, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Cara A Minney-Smith
- Microbiology, PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia
| | - Andrew C Martin
- Department of General Paediatrics, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Ariel O Mace
- Department of General Paediatrics, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Chisha T Sikazwe
- Microbiology, PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia.,Infection and Immunity, Biomedical Science, University of Western Australia, Perth, Western Australia, Australia
| | - Huong Le
- Wesfarmers Centre of Vaccines and Infecitous Diseases, University of Western Australia, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Avram Levy
- Microbiology, PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia.,Infection and Immunity, Biomedical Science, University of Western Australia, Perth, Western Australia, Australia
| | - Meredith Borland
- Emergency Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Divisions of Paediatrics and Emergency Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Briony Hazelton
- Microbiology, PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia.,Infectious Diseases Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infecitous Diseases, University of Western Australia, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Christopher Blyth
- Microbiology, PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia.,Wesfarmers Centre of Vaccines and Infecitous Diseases, University of Western Australia, Telethon Kids Institute, Perth, Western Australia, Australia.,Infectious Diseases Department, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Paediatrics and Child Health, University of Western Australia, Subiaco, Western Australia, Australia
| | - Daniel Yeoh
- Infectious Diseases Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Asha C Bowen
- Wesfarmers Centre of Vaccines and Infecitous Diseases, University of Western Australia, Telethon Kids Institute, Perth, Western Australia, Australia.,Infectious Diseases Department, Perth Children's Hospital, Perth, Western Australia, Australia
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5
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Foley DA, Phuong LK, Peplinski J, Lim SM, Lee WH, Farhat A, Minney-Smith CA, Martin AC, Mace AO, Sikazwe CT, Le H, Levy A, Hoeppner T, Borland ML, Hazelton B, Moore HC, Blyth C, Yeoh DK, Bowen AC. Examining the interseasonal resurgence of respiratory syncytial virus in Western Australia. Arch Dis Child 2022; 107:e7. [PMID: 34433552 PMCID: PMC8390145 DOI: 10.1136/archdischild-2021-322507] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/12/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Following a relative absence in winter 2020, a large resurgence of respiratory syncytial virus (RSV) detections occurred during the 2020/2021 summer in Western Australia. This seasonal shift was linked to SARS-CoV-2 public health measures. We examine the epidemiology and RSV testing of respiratory-coded admissions, and compare clinical phenotype of RSV-positive admissions between 2019 and 2020. METHOD At a single tertiary paediatric centre, International Classification of Diseases, 10th edition Australian Modification-coded respiratory admissions longer than 12 hours were combined with laboratory data from 1 January 2019 to 31 December 2020. Data were grouped into bronchiolitis, other acute lower respiratory infection (OALRI) and wheeze, to assess RSV testing practices. For RSV-positive admissions, demographics and clinical features were compared between 2019 and 2020. RESULTS RSV-positive admissions peaked in early summer 2020, following an absent winter season. Testing was higher in 2020: bronchiolitis, 94.8% vs 89.2% (p=0.01); OALRI, 88.6% vs 82.6% (p=0.02); and wheeze, 62.8% vs 25.5% (p<0.001). The 2020 peak month, December, contributed almost 75% of RSV-positive admissions, 2.5 times the 2019 peak. The median age in 2020 was twice that observed in 2019 (16.4 vs 8.1 months, p<0.001). The proportion of RSV-positive OALRI admissions was greater in 2020 (32.6% vs 24.9%, p=0.01). There were no clinically meaningful differences in length of stay or disease severity. INTERPRETATION The 2020 RSV season was in summer, with a larger than expected peak. There was an increase in RSV-positive non-bronchiolitis admissions, consistent with infection in older RSV-naïve children. This resurgence raises concern for regions experiencing longer and more stringent SARS-CoV-2 public health measures.
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Affiliation(s)
- David Anthony Foley
- Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, University of Western Australia, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Linny Kimly Phuong
- Murdoch Children's Research Institute, Infection and Immunity, Parkville, Victoria, Australia
| | - Joseph Peplinski
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Selina Mei Lim
- Infectious Diseases Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Wei Hao Lee
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Asifa Farhat
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Cara A Minney-Smith
- Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
| | - Andrew C Martin
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Ariel O Mace
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Chisha T Sikazwe
- Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
- Infection and Immunity, Biomedical Science, University of Western Australia, Perth, Western Australia, Australia
| | - Huong Le
- Wesfarmers Centre for Vaccines and Infectious Diseases, University of Western Australia, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Avram Levy
- Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
- Infection and Immunity, Biomedical Science, University of Western Australia, Perth, Western Australia, Australia
| | - Tobias Hoeppner
- Emergency Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Meredith L Borland
- Emergency Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Divisions of Paediatrics and Emergency Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Briony Hazelton
- Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
- Infectious Diseases Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Hannah C Moore
- Wesfarmers Centre for Vaccines and Infectious Diseases, University of Western Australia, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Christopher Blyth
- Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, University of Western Australia, Telethon Kids Institute, Nedlands, Western Australia, Australia
- School of Paediatrics and Child Health, University of Western Australia, Subiaco, Western Australia, Australia
| | - Daniel K Yeoh
- Infectious Diseases Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Asha C Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, University of Western Australia, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Infectious Diseases Department, Perth Children's Hospital, Perth, Western Australia, Australia
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6
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McLeod C, Norman R, Wood J, Mulrennan S, Morey S, Schultz A, Messer M, Spaapen K, Stoneham M, Wu Y, Smyth A, Blyth C, Webb S, Mascaro S, Woodberry O, Snelling T. Novel method to select meaningful outcomes for evaluation in clinical trials. BMJ Open Respir Res 2021; 8:8/1/e000877. [PMID: 34620699 PMCID: PMC8499339 DOI: 10.1136/bmjresp-2021-000877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/15/2021] [Indexed: 12/25/2022] Open
Abstract
Background A standardised framework for selecting outcomes for evaluation in trials has been proposed by the Core Outcome Measures in Effectiveness Trials working group. However, this method does not specify how to ensure that the outcomes that are selected are causally related to the disease and the health intervention being studied. Causal network diagrams may help researchers identify outcomes that are both clinically meaningful and likely to be causally dependent on the intervention, and endpoints that are, in turn, causally dependent on those outcomes. We aimed to (1) develop a generalisable method for selecting outcomes and endpoints in trials and (2) apply this method to select outcomes for evaluation in a trial investigating treatment strategies for pulmonary exacerbations of cystic fibrosis (CF). Methods We conducted a series of online surveys and workshops among people affected by CF. We used a modified Delphi approach to develop a consensus list of important outcomes. A workshop involving domain experts elicited how these outcomes were causally related to the underlying pathophysiological processes. Meaningful outcomes were prioritised based on the extent to which each outcome captured separate rather than common aspects of the underlying pathophysiological process. Results The 10 prioritised outcomes were: breathing difficulty/pain, sputum production/clearance, fatigue, appetite, pain (not related to breathing), motivation/demoralisation, fevers/night sweats, treatment burden, inability to meet personal goals and avoidance of gastrointestinal symptoms. Conclusions This proposed method for selecting meaningful outcomes for evaluation in clinical trials may improve the value of research as a basis for clinical decisions.
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Affiliation(s)
- Charlie McLeod
- Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia .,Infectious Diseases Implementation Research, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Richard Norman
- School of Population Health, Curtin University Bentley Campus, Bentley, Western Australia, Australia
| | - Jamie Wood
- Abilities Research Center, Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Physiotherapy, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Siobhain Mulrennan
- Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,The Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Sue Morey
- Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - André Schultz
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, Western Australia, Australia.,Department of Respiratory Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Mitch Messer
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Kate Spaapen
- Consumer advocate, Perth, Western Australia, Australia
| | | | - Yue Wu
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Alan Smyth
- Evidence Based Child Health Group, School of Medicine, University of Nottingham, Nottingham, UK
| | - Christopher Blyth
- Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Steve Webb
- School of Population Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Department of Intensive Care Medicine, St John of God Health Care, West Perth, Western Australia, Australia
| | | | | | - Tom Snelling
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Menzies School of Health Research, Casuarina, Northern Territory, Australia
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7
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Le H, Blyth C, Gidding H, Snelling T, Fathima P, Moore H. 1238Estimating the non-specific effects of seasonal influenza vaccine on RSV-hospitalisations in children. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.369] [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: 11/14/2022] Open
Abstract
Abstract
Background
Seasonal influenza vaccine is effective against influenza hospitalisations, but little is known about non-specific effects on other respiratory pathogens with similar seasonal patterns. We aimed to assess the causal impact of seasonal influenza vaccine on laboratory-confirmed hospitalisations for respiratory syncytial virus (RSV) in children using an instrumental variable (IV) strategy.
Methods
We used population-based probabilistically linked data on births, childhood immunisations, deaths, hospitalisations, perinatal and statewide microbiology data (2000-2013) in Western Australia (WA). Our analysis cohort included children up to age 7 years. We exploited WA’s unique preschool influenza vaccination policy commencing in 2008 and used this as an instrument for vaccination status. We estimated a system of two simultaneous probit equations: determinants of influenza vaccine uptake, and determinants of RSV-confirmed hospitalisation.
Results
Influenza vaccine coverage was low prior to 2008 but increased to 33.7% in children aged 6-23 months in 2009. RSV-hospitalisations ranged from 3.5/1000 children (12-23 months) to 6.4/1000 (6-12 months). Receipt of seasonal influenza vaccine reduced RSV-hospitalisations in the population cohort of children aged <2 years by an average of 0.21% in the same year (p < 0.001).
Conclusions
To our knowledge, this is the first analysis utilising an IV estimation strategy to assess the impact of influenza vaccine on RSV-hospitalisations. We estimated a small, but highly statistically significant impact that warrants further investigation using contemporary data.
Key messages
RSV is a leading cause of childhood morbidity. The role of influenza vaccine offering cross protection to RSV could be further explored prior to RSV vaccines being commercially available.
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Affiliation(s)
- Huong Le
- Telethon Kids Institute, Perth, Nedlands, Australia
- The University of Western Australia, Perth, Crawley, Australia
| | - Christopher Blyth
- Telethon Kids Institute, Perth, Nedlands, Australia
- The University of Western Australia, Perth, Crawley, Australia
- Perth Children's Hospital, Perth, Nedlands, Australia
- PathWest Laboratory Medicine, Perth, Nedlands, Australia
| | | | - Tom Snelling
- The University of Sydney, Sydney, Camperdown, Australia
| | | | - Hannah Moore
- Telethon Kids Institute, Perth, Nedlands, Australia
- The University of Western Australia, Perth, Crawley, Australia
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8
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Bhuiyan M, Pavlos R, O'Brien S, Borland M, Doyle S, Blyth C. 1324Clinical Registry for Acute Respiratory Infections in Children in Western Australia. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.079] [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: 11/13/2022] Open
Abstract
Abstract
Background
Acute respiratory infections (ARIs) are the leading cause for emergency presentation and a major driver for antibiotic use in children. In 2020, we established an ARI clinical registry to: evaluate clinical care for ARI to inform clinical guidelines; and as a platform for clinical trials assessing antimicrobial interventions.
Methods
Any child <16 years presenting to Perth Children’s Hospital Emergency Department (ED) with cough, fever, sore throat and/or difficulty breathing was eligible for enrolment. Using an automated survey sent to parents’ mobile phones, each enrolled child was followed weekly until 28 days or disease recovery (whichever occurred first). Data collected included clinical symptoms, antibiotic prescription, adherence, and duration to return to regular activity (recovery).
Results
From Feb 2020-April 2021, 448 participants were enrolled (84% <5 years). Fever and cough were the most frequently reported symptoms. Of 448, 274 (61%) ARI cases completed all surveys until recovered. The median recovery length was 9 days (IQR:6-12). The recovery days were longer, although not statistically significant (p > 0.05), in: children who received antibiotics versus those who did not (9.5 days vs. 8); children <5 years versus those over (9 days vs. 7); and children with chronic illnesses versus those without (9 days vs. 8).
Conclusions
Most children presenting to ED with ARI recover within 10 days. The length of recovery does not vary significantly by age, chronic illnesses, or antibiotic usage.
Key messages
Registry data provides baseline data to inform clinical trials assessing the role and duration of antibiotics for ARI.
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Affiliation(s)
| | | | | | | | - Sarah Doyle
- What the Doctor Said, North Perth, Australia
| | - Christopher Blyth
- Telethon Kids Institute, Nedlands, Australia
- Perth Children's Hospital, Nedlands, Australia
- University of Western Australia, Crawley, Australia
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9
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Jayasundara D, Randall D, Sheridan S, Sheppeard V, Liu B, Richmond P, Blyth C, Wood JG, Moore HC, McIntyre PB, Gidding HF. 473Preventable pertussis burden in Australia within the first year of life by improving vaccination timeliness. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.322] [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: 11/14/2022] Open
Abstract
Abstract
Background
Previous Australian studies have shown that on-time Diphtheria-Tetanus-Pertussis (DTP) vaccination coverage is 50-60% in certain subpopulations. We estimated the potentially preventable burden of pertussis if, 1) the full primary course and, 2) each dose was given on-time.
Methods
Perinatal, immunisation, pertussis notification, and death data were linked for 1,412,984 infants born in two Australian states in 2000-2012. A DTP dose administered >15 days after the recommended age was categorised as delayed. For aim 1, pertussis rates up to 1-year of age were compared in infants with ≥1 dose delayed versus all doses on-time, using Poisson regression methods. For aim 2, the expected number of cases preventable by each dose was calculated as the product of the number of cases observed during the period of delay and (1 – dose-specific vaccine effectiveness).
Results
58% of infants had all primary DTP doses on time. We estimated that 85 (95% CI: 61-109) cases per 100,000 infants, aged 39-days to 1-year, could have been prevented if all infants had been vaccinated on time; 77% of these infants had received ≥1 DTP dose within the first year of life. Estimated preventable burden attributable to delayed DTP1 (58/100,000) was higher than for DTP2 (26/100,000) and DTP3 (15/100,000).
Conclusions and Key messages
Poor vaccine timeliness, especially delayed DTP1, is a key contributor to the residual burden of pertussis. These findings can inform cost-benefit analyses of targeted programs and public health messaging to reduce delays.
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Affiliation(s)
- Duleepa Jayasundara
- Centre for Epidemiology and Evidence, NSW Ministry of Health, St Leonards, Australia
- Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, Australia
- The University of Sydney Northern Clinical School, St Leonards, Australia
| | - Deborah Randall
- Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, Australia
- The University of Sydney Northern Clinical School, St Leonards, Australia
| | - Sarah Sheridan
- Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, Australia
- The University of Sydney Northern Clinical School, St Leonards, Australia
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, Australia
- School of Public Health and Community Medicine, UNSW Medicine, University of NSW,, Sydney, Australia
| | - Vicky Sheppeard
- Communicable Diseases Branch, Health Protection NSW, Sydney, Australia
| | - Bette Liu
- School of Public Health and Community Medicine, UNSW Medicine, University of NSW,, Sydney, Australia
| | - Peter Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Perth Children's Hospital, Perth, Australia
- School of Medicine, University of Western Australia, Perth, Australia
| | - Christopher Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Perth Children's Hospital, Perth, Australia
- School of Medicine, University of Western Australia, Perth, Australia
- Department of Microbiology, PathWest Laboratory Medicine WA, Perth Children's Hospital, Perth, Australia
| | - James G Wood
- School of Public Health and Community Medicine, UNSW Medicine, University of NSW,, Sydney, Australia
| | - Hanna C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Peter B McIntyre
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, Australia
| | - Heather F Gidding
- Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, Australia
- The University of Sydney Northern Clinical School, St Leonards, Australia
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, Australia
- School of Public Health and Community Medicine, UNSW Medicine, University of NSW,, Sydney, Australia
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10
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Nguyen C, Weaver R, Blyth C, Mollendorf CV, Britton K, Chan J, Dance DAB, Ford R, Lai JYR, Mungun T, Newton P, Mulholland EK, Pomat W, Vilivong K, Xeuatvongsa A, Russell FM. 383Pneumococcal conjugate vaccine is effective against hypoxic pneumonia in Laos, Mongolia and Papua New Guinea. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.481] [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: 11/13/2022] Open
Abstract
Abstract
Background
We describe a novel approach to determine PCV13 effectiveness (VE) against hypoxic pneumonia in children admitted with pneumonia in Lao People’s Democratic Republic (Laos), Mongolia and Papua New Guinea (PNG).
Methods
A 3-5 year prospective hospital-based observational study of children < =59 months admitted with pneumonia was undertaken. Pneumonia was defined using the 2013 WHO definition. Hypoxia was defined as an oxygen saturation <90% in room air or requiring oxygen supplementation during hospitalisation. PCV13 status was determined by written record. VE was calculated using logistic regression comparing the odds of hypoxia between vaccinated and under-vaccinated pneumonia cases. To handle potential confounding, a propensity score (PS) analysis using inverse probability of treatment weighting (IPW) was used. In Laos, multiple imputation (MI) analysis was undertaken for missing data.
Results
The VE against hypoxic pneumonia were: in Laos, unadjusted 23% (95% CI: -9, 46%; p = 0·14), IPW adjusted 37% (6, 57%; p = 0.02), MI and IPW adjusted 35% (7, 55%; p = 0.02); in Mongolia, unadjusted 33% (26, 40%; p < 0.001), IPW adjusted 33% (16, 47%; p < 0.001); and in PNG, unadjusted 6% (-15, 24%; p = 0.53), IPW adjusted 36% (17, 51%; p = 0.001).
Conclusions
Our novel approach shows that PCV13 is effective against hypoxic pneumonia. PCV13 will contribute to reducing child mortality.
Key messages
We describe a novel, single hospital-based approach for determining VE that can be applied to other similar settings. This is one of the first studies showing PCV13 to be effective against hypoxic pneumonia in children in Asia.
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Affiliation(s)
- Cattram Nguyen
- Infection and Immunity, Murdoch Children's Research Institure, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Rupert Weaver
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Christopher Blyth
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- University of Western Australia, School of Paediatric and Child Health, Perth, Australia
| | - Claire von Mollendorf
- Infection and Immunity, Murdoch Children's Research Institure, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Kate Britton
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- University of Western Australia, School of Paediatric and Child Health, Perth, Australia
| | - Jocelyn Chan
- Infection and Immunity, Murdoch Children's Research Institure, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - David A B Dance
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR and Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rebecca Ford
- Papua New Guinea Institute of Medical Research, Infection and Immunity Unit, Goroka, Papua New Guinea
| | - Jana Y R Lai
- World Health Organization, Lao People's Democratic Republic
| | | | - Paul Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR and Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Edward Kim Mulholland
- Infection and Immunity, Murdoch Children's Research Institure, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - William Pomat
- University of Western Australia, School of Paediatric and Child Health, Perth, Australia
- Papua New Guinea Institute of Medical Research, Infection and Immunity Unit, Goroka, Papua New Guinea
| | - Keoudomphone Vilivong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR and Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Anonh Xeuatvongsa
- National Immunization Programme, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Fiona M Russell
- Infection and Immunity, Murdoch Children's Research Institure, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
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11
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Olijve L, Amarasena L, Best E, Blyth C, van den Boom M, Bowen A, Bryant PA, Buttery J, Dobinson HC, Davis J, Francis J, Goldsmith H, Griffiths E, Hung TY, Huynh J, Kesson A, Meehan A, McMullan B, Nourse C, Palasanthiran P, Penumarthy R, Pilkington K, Searle J, Stephenson A, Webb R, Williman J, Walls T. The role of Kingella kingae in pre-school aged children with bone and joint infections. J Infect 2021; 83:321-331. [PMID: 34265316 DOI: 10.1016/j.jinf.2021.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/20/2021] [Accepted: 06/28/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The Pre-school Osteoarticular Infection (POI) study aimed to describe the burden of disease, epidemiology, microbiology and treatment of acute osteoarticular infections (OAI) and the role of Kingella kingae in these infections. METHODS Information about children 3-60 months of age who were hospitalized with an OAI to 11 different hospitals across Australia and New Zealand between January 2012 and December 2016 was collected retrospectively. RESULTS A total of 907 cases (73%) were included. Blood cultures grew a likely pathogen in only 18% (140/781). The peak age of presentation was 12 to 24 months (466/907, 51%) and Kingella kingae was the most frequently detected microorganism in this age group (60/466, 13%). In the majority of cases, no microorganism was detected (517/907, 57%). Addition of PCR to culture increased detection rates of K. kingae. However, PCR was performed infrequently (63/907, 7%). CONCLUSIONS This large multi-national study highlights the need for more widespread use of molecular diagnostic techniques for accurate microbiological diagnosis of OAI in pre-school aged children. The data from this study supports the hypothesis that a substantial proportion of pre-school aged children with OAI and no organism identified may in fact have undiagnosed K. kingae infection. Improved detection of Kingella cases is likely to reduce the average length of antimicrobial treatment.
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Affiliation(s)
- Laudi Olijve
- Department of Paediatrics, University of Otago, Christchurch School of Medicine, New Zealand; Sheffield Teaching Hospitals, UK; Sydney Children's Hospital Randwick, 61 High Street, Randwick, NSW 2031, Australia
| | - Lahiru Amarasena
- Department of Paediatrics; Child and Youth Health, National Immunisation Advisory Centre, The University of Auckland, New Zealand
| | - Emma Best
- Paediatric Infectious Diseases, Starship Children's Health, Auckland, New Zealand; Paediatric Infectious Diseases, Starship Children's Health, Auckland, New Zealand; Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Grafton, Auckland, New Zealand; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Australia
| | - Christopher Blyth
- School of Medicine, University of Western Australia, Australia; School of Medicine, University of Western Australia, Australia; Perth Children's Hospital, Hospital Avenue, Nedlands, WA 6009, Australia; Department of Microbiology, Pathwest Laboratory Medicine, QEII Medical Centre, Australia; Department of Paediatrics, Christchurch Hospital, Canterbury District Health Board, University of Otago, PO Box 4345, Christchurch Mail Centre, Christchurch 8140, New Zealand
| | - Mirjam van den Boom
- Starship Children's Hospital, Auckland, New Zealand; Starship Children's Hospital, Auckland, New Zealand; Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Avenue, Nedlands WA 6009, Locked Bag 2010, Nedlands WA 6909, Australia
| | - Asha Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Australia; National Health and Medical Research Council, Australia; Division of Paediatrics, School of Medicine, University of Western Australia, Australia; Menzies School of Health Research, Charles Darwin University, Australia; Institute for Health Research, The University of Notre Dame Australia, Australia; Dept of General Medicine, The Royal Children's Hospital Melbourne, Victoria, Australia
| | - Penelope A Bryant
- Infectious Diseases and Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Australia; Infectious Diseases and Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Australia; Infection, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia; Department of Infection and Immunity, Monash Children's Hospital, Australia
| | - Jim Buttery
- Monash Centre for Health Care Research and Implementation, Department of Paediatrics, Monash University, Melbourne, 246 Clayton Rd, Clayton 3168, Victoria, Australia; Monash Centre for Health Care Research and Implementation, Department of Paediatrics, Monash University, Melbourne, 246 Clayton Rd, Clayton 3168, Victoria, Australia; Wellington Regional Hospital, Capital and Coast District Health Board, Department of Paediatrics and Child Health, Wellington Regional Hospital, Capital and Coast District Health Board, Wellington, New Zealand
| | - Hazel C Dobinson
- Global Health Division, Menzies School of Health Research, Darwin, Australia
| | - Joshua Davis
- Infectious Diseases, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle, NSW 2300, Australia; Infectious Diseases, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle, NSW 2300, Australia; Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Joshua Francis
- Department of Paediatrics, Royal Darwin Hospital, 105 Rocklands Dr Tiwi NT 0810, Darwin, Australia; Department of Paediatrics, Royal Darwin Hospital, 105 Rocklands Dr Tiwi NT 0810, Darwin, Australia; John Hunter Children's Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia
| | - Heidi Goldsmith
- Queensland Children's Hospital, 501 Stanley Street, South Brisbane 4101, Australia
| | - Elle Griffiths
- Department of Paediatrics, Royal Darwin Hospital, 105 Rocklands Drive, Tiwi 0810, Northern Territory, Australia
| | - Te-Yu Hung
- Departments of Infectious Disease and Microbiology, The Children's Hospital at Westmead, Westmead New South Wales, Australia
| | - Julie Huynh
- Discipline of Child and Adolescent health, University of Sydney, Australia; Discipline of Child and Adolescent health, University of Sydney, Australia; Centre for tropical medicine, 764 Vo Van Kiet, District 5 Ho Chi Minh City, Viet Nam; Departments of Infectious Disease and Microbiology, The Children's Hospital at Westmead, Westmead New South Wales, Locked Bag 4001, Westmead 2145, Australia
| | - Alison Kesson
- Discipline of Child and Adolescent health, University of Sydney, Australia; Discipline of Child and Adolescent health, University of Sydney, Australia; The Marie Bashir Institute of Infectious Diseases and Biosecurrity, University of Sydney, Australia; Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Locked Bag 2010, Nedlands WA 6909, Australia
| | - Andrea Meehan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, Randwick, NSW 2031, Australia
| | - Brendan McMullan
- National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia; National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, Australia; Queensland Children's Hospital, Children's Health Queensland, Level 12, South Brisbane, QLD 4101, Australia
| | - Clare Nourse
- Faculty of Medicine, University of Queensland, Australia; Faculty of Medicine, University of Queensland, Australia; Department of Immunology and Infectious Diseases, Sydney Children's Hospital Network, Randwick, High Street, Randwick, NSW 2031, Australia
| | - Pamela Palasanthiran
- University of New South Wales, UNSW, Kensington, NSW, Australia; University of New South Wales, UNSW, Kensington, NSW, Australia; Counties manukau district health board, Middlemore Hospital, 100 hospital road, Otahuhu 2025, Auckland, New Zealand
| | - Rushi Penumarthy
- Monash Children's Hospital, Monash Health, 101/71 Abinger Street, Richmond, VIC 3121, Australia
| | - Katie Pilkington
- Department of Paediatrics, the University of Melbourne, Australia; Department of Paediatrics, the University of Melbourne, Australia; Department of General Medicine, The Royal Children's Hospital Melbourne, 50 Flemington Road, Melbourne 3052, Australia
| | - Janine Searle
- Starship Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand
| | - Anya Stephenson
- University of Auckland, Middlemore Hospital, 100 hospital road, Otahuhu, 2025 Auckland, New Zealand
| | - Rachel Webb
- Starship Children's Hospital and KidzFirst Children's Hospital, Counties Manukau District Health Board, New Zealand; Starship Children's Hospital and KidzFirst Children's Hospital, Counties Manukau District Health Board, New Zealand; Biostatistics and Computation Biology Unit, University of Otago, 2 Riccarton Avenue, Christchurch, 8140, New Zealand
| | - Jonathan Williman
- Department of Paediatrics, University of Otago, Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - Tony Walls
- Department of Paediatrics, University of Otago, Christchurch School of Medicine, New Zealand.
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12
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Bhuiyan MU, Snelling T, Sikazwe C, Lang J, Borland M, Martin A, Richmond P, Jaffe A, Smith D, Blyth C. Nasopharyngeal density of respiratory viruses in childhood pneumonia in a highly vaccinated setting: findings from a case-control study. BMJ Open Respir Res 2021; 7:7/1/e000593. [PMID: 32727742 PMCID: PMC7394014 DOI: 10.1136/bmjresp-2020-000593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/18/2020] [Accepted: 06/18/2020] [Indexed: 11/06/2022] Open
Abstract
Background Detection of pneumonia-causing respiratory viruses in the nasopharynx of asymptomatic children has made their actual contribution to pneumonia unclear. We compared nasopharyngeal viral density between children with and without pneumonia to understand if viral density could be used to diagnose pneumonia. Methods Nasopharyngeal swabs (NPS) were collected from hospitalised pneumonia cases at Princess Margaret Hospital (PMH) and contemporaneous age-matched controls at PMH outpatient clinics and a local immunisation clinic in Perth, Australia. The density (copies/mL) of respiratory syncytial virus (RSV), influenza A virus (InfA), human metapneumovirus (HMPV) and rhinovirus in NPS was determined using quantitative PCR. Linear regression analysis was done to assess the trend between viral density and age in months. The association between viral density and disease status was examined using logistic regression. Area under receiver operating characteristic (AUROC) curves were assessed to determine optimal discriminatory viral density cut-offs. Results Through May 2015 to October 2017, 230 pneumonia cases and 230 controls were enrolled. Median nasopharyngeal density for any respiratory virus was not substantially higher in cases than controls (p>0.05 for each). A decreasing density trend with increasing age was observed—the trend was statistically significant for RSV (regression coefficient −0.04, p=0.004) but not for other viruses. After adjusting for demographics and other viral densities, for every log10 copies/mL density increase, the odds of being a case increased by six times for RSV, three times for HMPV and two times for InfA. The AUROC curves were <0.70 for each virus, suggesting poor case–control discrimination based on viral density. Conclusion The nasopharyngeal density of respiratory viruses was not significantly higher in children with pneumonia than those without; however, the odds of being a case increased with increased density for some viruses. The utility of viral density, alone, in defining pneumonia was limited.
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Affiliation(s)
- Mejbah Uddin Bhuiyan
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia .,School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Tom Snelling
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Chisha Sikazwe
- PathWest Laboratory Medical WA, Nedlands, Western Australia, Australia
| | - Jurissa Lang
- PathWest Laboratory Medical WA, Nedlands, Western Australia, Australia
| | - Meredith Borland
- School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Emergency Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Andrew Martin
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Peter Richmond
- School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Adam Jaffe
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - David Smith
- PathWest Laboratory Medical WA, Nedlands, Western Australia, Australia.,School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Christopher Blyth
- School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia
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13
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McMullan B, Cooper C, Spotswood N, James R, Jones C, Konecny P, Blyth C, Karen T. Antibiotic prescribing in neonatal sepsis: an Australian nationwide survey. BMJ Paediatr Open 2020; 4:e000643. [PMID: 32232180 PMCID: PMC7101048 DOI: 10.1136/bmjpo-2020-000643] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/24/2020] [Accepted: 02/27/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To evaluate quality and variation in antibiotic prescribing for neonatal sepsis. DESIGN We analysed prescribing in hospitalised neonates using the National Antimicrobial Prescribing Survey in Australian neonates from 1 January 2014 to 31 December 2018. SETTING Data from antibiotic point prevalence surveys performed in hospitals, ranging from rural hospitals to tertiary paediatric and maternity hospitals within Australia. PATIENTS Admitted neonates <28 days of age from participating hospitals. MAIN OUTCOME MEASURES Variation and appropriateness in prescribing for neonatal sepsis and variation in dosing for gentamicin and benzylpenicillin across hospitals. RESULTS A total of 415 prescriptions among 214 neonates from 39 different hospitals were included. The majority of prescriptions (342, 82.4%) were for neonates <7 days of age. The most commonly prescribed antibiotics were gentamicin and benzylpenicillin, with 323 (77.8%) prescriptions. Dosing variability was substantial, with doses ranging from 2 to 8 mg/kg for gentamicin (median 5 mg/kg, IQR 4-5) and from 45 to 72 mg/kg for benzylpenicillin (median 60 mg/kg, IQR 50-60), although only 13 (3.2%) and 19 (4.6%) prescriptions were locally assessed as inappropriate or non-compliant with guidelines, respectively. At time of audit, 22% of antibiotics had been given for more than 48 hours and 9% more than 72 hours, although microbiologically confirmed infection was documented in only nine (4.2%) neonates. CONCLUSIONS Prescribing for neonatal sepsis was dominated by use of benzylpenicillin and gentamicin with substantial variation in dosing. A small minority had culture-confirmed infection. Efforts to standardise antibiotic dosing and duration for suspected neonatal sepsis are recommended.
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Affiliation(s)
- Brendan McMullan
- Immunology and Infectious Diseases, Sydney Children's Hospital Randwick, Sydney, New South Wales, Australia.,National Centre for Infections in Cancer, University of Melbourne, Melbourne, Victoria, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Celia Cooper
- Department of Infectious Diseases, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Naomi Spotswood
- Burnet Institute, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Rodney James
- National Centre for Antimicrobial Stewardship, Melbourne, Victoria, Australia
| | - Cheryl Jones
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Pamela Konecny
- Infectious Diseases, Immunology and Sexual Health, St George Hospital, Kogarah, Sydney, New South Wales, Australia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher Blyth
- School of Paediatrics and Child Health, University of Western Australia, Subiaco, Western Australia, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia.,Department of Paediatric Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia.,Department of Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
| | - Thursky Karen
- National Centre for Infections in Cancer, University of Melbourne, Melbourne, Victoria, Australia.,Infectious Diseases Service and Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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14
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Gidding HF, Flack LK, Sheridan S, Liu B, Fathima P, Sheppeard V, Richmond P, Hull B, Blyth C, Andrews RM, Snelling TL, de Klerk N, McIntyre PB, Moore HC. Infant, maternal and demographic predictors of delayed vaccination: A population-based cohort study. Vaccine 2019; 38:6057-6064. [PMID: 31628032 DOI: 10.1016/j.vaccine.2019.09.091] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 07/22/2019] [Revised: 09/27/2019] [Accepted: 09/27/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Receiving vaccines at or close to their due date (vaccination timeliness) is a now key measure of program performance. However, studies comprehensively examining predictors of delayed infant vaccination are lacking. We aimed to identify predictors of short and longer-term delays in diphtheria-tetanus-pertussis (DTP) vaccination by dose number and ethnicity. METHODS Perinatal, notification, death and immunisation databases were linked for 1.3 million births in 2000-11 from two Australian states (Western Australia and New South Wales), with follow-up data until 2013. Ordinal logistic regression was used to estimate adjusted relative risks (RR) by degree of delay. Separate models were constructed for each vaccine dose and for Aboriginal and non-Aboriginal children. RESULTS Each dose-specific cohort included at least 49,000 Aboriginal and 1.1 million non-Aboriginal children. Delayed receipt was more common among Aboriginal than non-Aboriginal children (eg for the first dose of DTP [DTP1] 19.4 v 8.1%). Risk factors for delayed vaccination were strongest for DTP1, and delayed receipt of DTP1 was a key driver of subsequent delays; every week DTP1 was delayed was associated with a 1.6 to 2-fold increased risk of delayed DTP2 receipt. For DTP1, ≥3 previous pregnancies (the only factor more strongly associated with longer than shorter delays; RR ≥5 compared to no previous pregnancies), and children born to mothers <20 years of age (RR ≥2 compared to ≥35 years) were at highest risk of delay. Other independent predictors were prematurity, maternal smoking during pregnancy, and being born in Western Australia (if Aboriginal) or another country in the Oceania region. CONCLUSION The sub-populations at risk for delayed vaccination we have identified are likely generalisable to other high-income settings. Measures to improve their dose 1 timeliness, particularly for children with older siblings, are likely to have significant flow-on benefits for timeliness of later doses.
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Affiliation(s)
- Heather F Gidding
- Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia; The University of Sydney Northern Clinical School, NSW, Australia; National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, NSW, Australia; School of Public Health and Community Medicine, UNSW Medicine, University of NSW, Sydney, NSW, Australia.
| | - Lloyd K Flack
- School of Public Health and Community Medicine, UNSW Medicine, University of NSW, Sydney, NSW, Australia
| | - Sarah Sheridan
- Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia; The University of Sydney Northern Clinical School, NSW, Australia; National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, NSW, Australia; School of Public Health and Community Medicine, UNSW Medicine, University of NSW, Sydney, NSW, Australia
| | - Bette Liu
- School of Public Health and Community Medicine, UNSW Medicine, University of NSW, Sydney, NSW, Australia
| | - Parveen Fathima
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Vicky Sheppeard
- Communicable Diseases Branch, Health Protection NSW, Sydney, NSW, Australia
| | - Peter Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia; Perth Children's Hospital, WA, Australia; School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Brynley Hull
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, NSW, Australia
| | - Christopher Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia; Perth Children's Hospital, WA, Australia; School of Medicine, University of Western Australia, Perth, WA, Australia; Department of Microbiology, PathWest Laboratory Medicine WA, Perth Children's Hospital, Perth, WA, Australia
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia; National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Thomas L Snelling
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia; Perth Children's Hospital, WA, Australia; Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia; School of Public Health, Curtin University, Perth, WA, Australia
| | - Nicholas de Klerk
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Peter B McIntyre
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, NSW, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
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15
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Chan J, Lai JY, von Mollendorf C, Blyth C, Dance DAB, Datta S, Dunne EM, Ford R, Fox K, Hinds J, Vilivong K, La Vincente S, Lehmann D, Moore KA, Mungun T, Nation ML, Newton PN, Nguyen CD, Pomat W, Xeuatvongsa A, Satzke C, Mulholland EK, Russell FM. Determining the pneumococcal conjugate vaccine coverage required for indirect protection within Asia and the Pacific: a prospective observational study. The Lancet Global Health 2019. [DOI: 10.1016/s2214-109x(19)30100-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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16
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Lucas M, Arnold A, Sommerfield A, Trevenen M, Braconnier L, Schilling A, Abass F, Slevin L, Knezevic B, Blyth C, Murray K, von Ungern-Sternberg B, Rueter K. Antibiotic Allergy Labels in Children Are Associated with Adverse Clinical Outcomes. The Journal of Allergy and Clinical Immunology: In Practice 2019; 7:975-982. [DOI: 10.1016/j.jaip.2018.09.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 08/21/2018] [Accepted: 09/02/2018] [Indexed: 11/17/2022]
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17
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Cheng AC, Holmes M, Dwyer DE, Irving L, Korman T, Senenayake S, Macartney K, Blyth C, Brown S, Waterer G, Cooley L, Friedman ND, Wark P, Simpson G, Upham J, Bowler S, Brady S, Kotsimbos T, Kelly P. Influenza epidemiology in patients admitted to sentinel Australian hospitals in 2016: the Influenza Complications Alert Network (FluCAN). Commun Dis Intell (2018) 2017; 41:E337-E347. [PMID: 29864387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
During the period 1 April to 30 October 2016 (the 2016 influenza season), 1,952 patients were admitted with confirmed influenza to one of 17 FluCAN sentinel hospitals. Of these, 46% were elderly (e65 years), 18% were children (<16 years), 5% were Aboriginal and Torres Strait Islander peoples, 3% were pregnant and 76% had chronic co-morbidities.
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Affiliation(s)
| | - Mark Holmes
- University of Adelaide, Royal Adelaide Hospital
| | | | - Louis Irving
- Royal Melbourne Hospital, University of Melbourne
| | | | | | | | - Christopher Blyth
- Princess Margaret Hospital, University of Western Australia, Telethon Kids Institute
| | - Simon Brown
- University of Western Australia, Royal Perth Hospital
| | - Grant Waterer
- University of Western Australia, Royal Perth Hospital
| | | | | | - Peter Wark
- University of Newcastle, John Hunter Hospital
| | | | - John Upham
- Princess Alexandra Hospital, University of Queensland
| | | | | | | | - Paul Kelly
- ACT Government Health Directorate; Australian National University Medical School
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18
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Chapman B, Slavin M, Marriott D, Halliday C, Kidd S, Arthur I, Bak N, Heath CH, Kennedy K, Morrissey CO, Sorrell TC, van Hal S, Keighley C, Goeman E, Underwood N, Hajkowicz K, Hofmeyr A, Leung M, Macesic N, Botes J, Blyth C, Cooley L, George CR, Kalukottege P, Kesson A, McMullan B, Baird R, Robson J, Korman TM, Pendle S, Weeks K, Liu E, Cheong E, Chen S. Changing epidemiology of candidaemia in Australia. J Antimicrob Chemother 2017; 72:1103-1108. [PMID: 28364558 DOI: 10.1093/jac/dkw422] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/07/2016] [Indexed: 01/07/2023] Open
Abstract
Objectives Knowledge of contemporary epidemiology of candidaemia is essential. We aimed to identify changes since 2004 in incidence, species epidemiology and antifungal susceptibilities of Candida spp. causing candidaemia in Australia. Methods These data were collected from nationwide active laboratory-based surveillance for candidaemia over 1 year (within 2014-2015). Isolate identification was by MALDI-TOF MS supplemented by DNA sequencing. Antifungal susceptibility testing was performed using Sensititre YeastOne™. Results A total of 527 candidaemia episodes (yielding 548 isolates) were evaluable. The mean annual incidence was 2.41/105 population. The median patient age was 63 years (56% of cases occurred in males). Of 498 isolates with confirmed species identity, Candida albicans was the most common (44.4%) followed by Candida glabrata complex (26.7%) and Candida parapsilosis complex (16.5%). Uncommon Candida species comprised 25 (5%) isolates. Overall, C. albicans (>99%) and C. parapsilosis (98.8%) were fluconazole susceptible. However, 16.7% (4 of 24) of Candida tropicalis were fluconazole- and voriconazole-resistant and were non-WT to posaconazole. Of C. glabrata isolates, 6.8% were resistant/non-WT to azoles; only one isolate was classed as resistant to caspofungin (MIC of 0.5 mg/L) by CLSI criteria, but was micafungin and anidulafungin susceptible. There was no azole/echinocandin co-resistance. Conclusions We report an almost 1.7-fold proportional increase in C. glabrata candidaemia (26.7% versus 16% in 2004) in Australia. Antifungal resistance was generally uncommon, but azole resistance (16.7% of isolates) amongst C. tropicalis may be emerging.
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Affiliation(s)
- Belinda Chapman
- Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Monica Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Victorian Infectious Diseases Service at the Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Debbie Marriott
- Department of Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, NSW, Australia
| | - Catriona Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Westmead, Sydney, NSW, Australia
| | - Sarah Kidd
- National Mycology Reference Centre, SA Pathology, Adelaide, SA, Australia
| | - Ian Arthur
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, WA, Australia
| | - Narin Bak
- Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Christopher H Heath
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Department of Microbiology, PathWest Laboratory Medicine Fiona Stanley Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | - Karina Kennedy
- Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, ACT, Australia
| | - C Orla Morrissey
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, VIC, Australia
| | - Tania C Sorrell
- Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia.,Centre for Infectious Diseases and Microbiology Westmead Institute for Medical Research, Westmead Hospital and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia
| | - Sebastian van Hal
- Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Caitlin Keighley
- Centre for Infectious Diseases and Microbiology Westmead Institute for Medical Research, Westmead Hospital and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia
| | - Emma Goeman
- Department of Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, NSW, Australia
| | - Neil Underwood
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Krispin Hajkowicz
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Ann Hofmeyr
- Department of Microbiology and Infectious Diseases, Liverpool Hospital, Sydney, NSW, Australia
| | - Michael Leung
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, WA, Australia
| | - Nenad Macesic
- Department of Infectious Diseases, Austin Hospital, Heidelberg, VIC, Australia and Division of Infectious Diseases, Columbia University Medical Center, New York City, NY, USA
| | - Jeannie Botes
- Department of Microbiology, SEALS South Pathology, Wollongong Hospital, Wollongong, NSW, Australia
| | - Christopher Blyth
- School of Paediatrics and Child Health, University of Western Australia, Subiaco, WA, Australia and Department of Infectious Diseases, Princess Margaret Hospital, Subiaco, WA, Australia
| | - Louise Cooley
- Department of Microbiology and Infectious Diseases, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - C Robert George
- Department of Microbiology, South Eastern Area Laboratory Services, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Pankaja Kalukottege
- Department of Microbiology, Pathology -North, Hunter, Newcastle, NSW, Australia
| | - Alison Kesson
- Department of Infectious Diseases and Microbiology, The Children's Hospital, Westmead and Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Robert Baird
- Department of Microbiology, Royal Darwin Hospital, Darwin, NT, Australia
| | - Jennifer Robson
- Sullivan and Nicolaides Pathology, Brisbane, Queensland, Australia
| | - Tony M Korman
- Monash Infectious Diseases, Monash University and Monash Health, Melbourne, VIC, Australia
| | - Stella Pendle
- Department of Microbiology, Australian Clinical Laboratories, Sydney, NSW, Australia
| | - Kerry Weeks
- Department of Microbiology, Pathology North, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Eunice Liu
- Department of Microbiology and Infectious Diseases, Concord Hospital, Sydney, NSW, Australia
| | - Elaine Cheong
- Department of Microbiology and Infectious Diseases, Concord Hospital, Sydney, NSW, Australia
| | - Sharon Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Westmead, Sydney, NSW, Australia.,Centre for Infectious Diseases and Microbiology Westmead Institute for Medical Research, Westmead Hospital and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia
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19
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Hoyles K, Blyth C. 87STOP! LOOK! LISTEN! THINK! DOES YOUR PATIENT DRIVE? Age Ageing 2017. [DOI: 10.1093/ageing/afx055.87] [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: 11/15/2022] Open
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20
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Moore H, McCallum L, Fathima P, De Klerk N, Liu B, Snelling T, Blyth C, McIntyre P, Gidding H. Linking the Australian Childhood Immunisation Register to population-based perinatal datasets to assess coverage in at-risk groups. Int J Popul Data Sci 2017. [DOI: 10.23889/ijpds.v1i1.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
ABSTRACT
ObjectiveImmunisation remains one of the most important public health interventions. However, linkage of population-based immunisation registers to perinatal and health outcome datasets to evaluate immunisation programs is limited. We have conducted the first-ever linkages of immunisation records from Australia’s Childhood Immunisation Register (ACIR) for the purposes of evaluating Australia’s unique national immunisation program. As an initial outcome of our linkage study we present estimates of pneumococcal conjugate vaccine (PCV) coverage for the 3rd dose assessed at 12 months of age in extremely preterm children (gestational age <28 weeks), in whom a funded vaccination program was established in 2001 prior to a universal funded program for all children in 2005.
ApproachIndividual immunisation records from ACIR, hospital admissions, deaths and infectious diseases notifications were linked to perinatal records for a cohort of births from 1996 to 2012 in two Australian states. Three separate data linkage units were involved in the process with varying procedures for linkage. The perinatal datasets were used to identify extremely preterm children.
ResultsThe birth cohort for the study included 1,958,537 live births in New South Wales (1,492,399) and Western Australia (461,620). Linkage weights based on sensitivity and positive predictive value of >99% were used to identify immunisation records from ACIR to link to the birth cohort. A unique scrambled pin on ACIR was used to link immunisation records to birth cohort datasets. The final cohort consisted of 1,954,019 children with 95.5% linking to at least 1 ACIR record from a total of >26.6 million ACIR records. In 2001, coverage of the 3rd dose of PCV in extremely preterm children was 0.9% and increased to 69.1% in 2004 (overall coverage 2001-2004: 25.3%). From 2005 to 2012, coverage increased to an average of 89.7%.
ConclusionThese are the first results of cross-jurisdictional linkages of immunisation records to state-based administrative datasets in Australia. This process has identified some improvements that are needed to streamline future linkage projects of this scale. Linkage of perinatal datasets to ACIR has enabled us to assess the first-ever coverage estimates in specific medically at-risk population subgroups. Future analyses will focus on the predictors and timeliness of vaccination coverage and population based estimates of vaccine effectiveness.
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21
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Moore H, Abdalla T, Blyth C, Gilbert R, Hardelid P. Trends in admissions for acute respiratory infections in children: an inter-country comparison between Western Australia and England. Int J Popul Data Sci 2017. [PMCID: PMC8362468 DOI: 10.23889/ijpds.v1i1.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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22
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Chapman B, Slavin M, Marriott D, Halliday C, Kidd S, Arthur I, Bak N, Heath CH, Kennedy K, Morrissey CO, Sorrell TC, van Hal S, Keighley C, Goeman E, Underwood N, Hajkowicz K, Hofmeyr A, Leung M, Macesic N, Botes J, Blyth C, Cooley L, George CR, Kalukottege P, Kesson A, McMullan B, Baird R, Robson J, Korman TM, Pendle S, Weeks K, Liu E, Cheong E, Chen S. Changing epidemiology of candidaemia in Australia. J Antimicrob Chemother 2017; 72:1270. [PMID: 28204502 DOI: 10.1093/jac/dkx047] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Belinda Chapman
- Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Monica Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Victorian Infectious Diseases Service at the Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Debbie Marriott
- Department of Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, NSW, Australia
| | - Catriona Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Westmead, Sydney, NSW, Australia
| | - Sarah Kidd
- National Mycology Reference Centre, SA Pathology, Adelaide, SA, Australia
| | - Ian Arthur
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, WA, Australia
| | - Narin Bak
- Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Christopher H Heath
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Department of Microbiology, PathWest Laboratory Medicine Fiona Stanley Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | - Karina Kennedy
- Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, ACT, Australia
| | - C Orla Morrissey
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, VIC, Australia
| | - Tania C Sorrell
- Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia.,Centre for Infectious Diseases and Microbiology Westmead Institute for Medical Research, Westmead Hospital and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia
| | - Sebastian van Hal
- Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Caitlin Keighley
- Centre for Infectious Diseases and Microbiology Westmead Institute for Medical Research, Westmead Hospital and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia
| | - Emma Goeman
- Department of Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, NSW, Australia
| | - Neil Underwood
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Krispin Hajkowicz
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Ann Hofmeyr
- Department of Microbiology and Infectious Diseases, Liverpool Hospital, Sydney, NSW, Australia
| | - Michael Leung
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, WA, Australia
| | - Nenad Macesic
- Department of Infectious Diseases, Austin Hospital, Heidelberg, Victoria and Division of Infectious Diseases, Columbia University Medical Center, New York City, NY, USA
| | - Jeannie Botes
- Department of Microbiology, SEALS South Pathology, Wollongong Hospital, Wollongong, NSW, Australia
| | - Christopher Blyth
- School of Paediatrics and Child Health, University of Western Australia, Subiaco and Department of Infectious Diseases, Princess Margaret Hospital, Subiaco, WA, Australia
| | - Louise Cooley
- Department of Microbiology and Infectious Diseases, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - C Robert George
- Department of Microbiology, South Eastern Area Laboratory Services, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Pankaja Kalukottege
- Department of Microbiology, Pathology-North, Hunter, Newcastle, NSW, Australia
| | - Alison Kesson
- Department of Infectious Diseases and Microbiology, The Children's Hospital, Westmead and Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Robert Baird
- Department of Microbiology, Royal Darwin Hospital, Darwin, NT, Australia
| | - Jennifer Robson
- Sullivan and Nicolaides Pathology, Brisbane, Queensland, Australia
| | - Tony M Korman
- Monash Infectious Diseases, Monash University and Monash Health, Melbourne, VIC, Australia
| | - Stella Pendle
- Department of Microbiology, Australian Clinical Laboratories, Sydney, NSW, Australia
| | - Kerry Weeks
- Department of Microbiology, Pathology North, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Eunice Liu
- Department of Microbiology and Infectious Diseases, Concord Hospital, Sydney, NSW, Australia
| | - Elaine Cheong
- Department of Microbiology and Infectious Diseases, Concord Hospital, Sydney, NSW, Australia
| | - Sharon Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Westmead, Sydney, NSW, Australia.,Centre for Infectious Diseases and Microbiology Westmead Institute for Medical Research, Westmead Hospital and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia
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23
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Balasubramanian H, Thompson K, Blyth C, Rao S. Failure of Oral Valganciclovir Treatment in Congenital Cytomegalovirus Hepatitis in a Neonate. Clin Pediatr (Phila) 2017; 56:83-84. [PMID: 27099388 DOI: 10.1177/0009922816642741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Haribalakrishna Balasubramanian
- 1 Department of Neonatology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,2 Department of Neonatology, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
| | - Kirsten Thompson
- 1 Department of Neonatology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,2 Department of Neonatology, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
| | - Christopher Blyth
- 4 Department of Paediatric and Adolescent Medicine, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,5 School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,6 PathWest Laboratory Medicine WA, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Shripada Rao
- 1 Department of Neonatology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,2 Department of Neonatology, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia.,3 Centre of Neonatal research and Education, University of Western Australia, Perth, Western Australia, Australia
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24
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Britton P, Dale R, Blyth C, Clark J, Crawford N, Marshall HS, Elliott E, Macartney K, Booy R, Jones C. The Causes and Clinical Features of Childhood Encephalitis in Australia: A Multicentre, Prospective, Cohort Study. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Philip Britton
- Discipline of Child and Adolescent Health, University of Sydney, Westmead, Australia
- Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Westmead, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Westmead, Australia
| | - Russell Dale
- Discipline of Child and Adolescent Health, University of Sydney, Westmead, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Westmead, Australia
| | - Christopher Blyth
- Telethon Institute for Child Health Research, Subiaco Western Australia, Australia
- Department of Paediatric and Adolescent Medicine, Princess Margaret Hospital for Children, Perth, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Westmead, Australia
| | - Julia Clark
- Infectious Diseases, Immunology/Allergy and Rheumatology, Lady Cilento Children's Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Westmead, Australia
| | - Nigel Crawford
- General Paediatrics, Royal Children's Hospital, Melbourne, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Westmead, Australia
| | - Helen S. Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, North Adelaide, Australia
- University of Adelaide, Adelaide, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Westmead, Australia
| | - Elizabeth Elliott
- Discipline of Child and Adolescent Health, University of Sydney, Westmead, Australia
- Australian Paediatric Surveillance Unit, Westmead, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Westmead, Australia
| | - Kristine Macartney
- Discipline of Child and Adolescent Health, University of Sydney, Westmead, Australia
- National Centre for Immunisation Research and Surveillance, Westmead, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Westmead, Australia
| | - Robert Booy
- Discipline of Child and Adolescent Health, University of Sydney, Westmead, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Westmead, Australia
| | - Cheryl Jones
- Discipline of Child and Adolescent Health, University of Sydney, Westmead, Australia
- Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Westmead, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Westmead, Australia
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Pillsbury A, Cashman P, Leeb A, Regan A, Westphal D, Snelling T, Blyth C, Crawford N, Wood N, Macartney K. Real-time safety surveillance of seasonal influenza vaccines in children, Australia, 2015. ACTA ACUST UNITED AC 2016; 20:30050. [PMID: 26536867 DOI: 10.2807/1560-7917.es.2015.20.43.30050] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 10/29/2015] [Indexed: 11/20/2022]
Abstract
Increased febrile reactions in Australian children from one influenza vaccine brand in 2010 diminished confidence in influenza immunisation, highlighting the need for improved vaccine safety surveillance. AusVaxSafety, a national vaccine safety surveillance system collected adverse events in young children for 2015 influenza vaccine brands in real time through parent/carer reports via SMS/email. Weekly cumulative data on 3,340 children demonstrated low rates of fever (4.4%) and medical attendance (1.1%). Fever was more frequent with concomitant vaccination.
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Affiliation(s)
- Alexis Pillsbury
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, NSW, Australia
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Kennedy KJ, Daveson K, Slavin MA, van Hal SJ, Sorrell TC, Lee A, Marriott DJ, Chapman B, Halliday CL, Hajkowicz K, Athan E, Bak N, Cheong E, Heath CH, Morrissey CO, Kidd S, Beresford R, Blyth C, Korman TM, Robinson JO, Meyer W, Chen SCA. Mucormycosis in Australia: contemporary epidemiology and outcomes. Clin Microbiol Infect 2016; 22:775-781. [PMID: 26806139 DOI: 10.1016/j.cmi.2016.01.005] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [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: 10/25/2015] [Revised: 12/30/2015] [Accepted: 01/09/2016] [Indexed: 11/27/2022]
Abstract
Mucormycosis is the second most common cause of invasive mould infection and causes disease in diverse hosts, including those who are immuno-competent. We conducted a multicentre retrospective study of proven and probable cases of mucormycosis diagnosed between 2004-2012 to determine the epidemiology and outcome determinants in Australia. Seventy-four cases were identified (63 proven, 11 probable). The majority (54.1%) were caused by Rhizopus spp. Patients who sustained trauma were more likely to have non-Rhizopus infections relative to patients without trauma (OR 9.0, p 0.001, 95% CI 2.1-42.8). Haematological malignancy (48.6%), chemotherapy (42.9%), corticosteroids (52.7%), diabetes mellitus (27%) and trauma (22.9%) were the most common co-morbidities or risk factors. Rheumatological/autoimmune disorders occurred in nine (12.1%) instances. Eight (10.8%) cases had no underlying co-morbidity and were more likely to have associated trauma (7/8; 87.5% versus 10/66; 15.2%; p <0.001). Disseminated infection was common (39.2%). Apophysomyces spp. and Saksenaea spp. caused infection in immuno-competent hosts, most frequently associated with trauma and affected sites other than lung and sinuses. The 180-day mortality was 56.7%. The strongest predictors of mortality were rheumatological/autoimmune disorder (OR = 24.0, p 0.038 95% CI 1.2-481.4), haematological malignancy (OR = 7.7, p 0.001, 95% CI 2.3-25.2) and admission to intensive care unit (OR = 4.2, p 0.02, 95% CI 1.3-13.8). Most deaths occurred within one month. Thereafter we observed divergence in survival between the haematological and non-haematological populations (p 0.006). The mortality of mucormycosis remains particularly high in the immuno-compromised host. Underlying rheumatological/autoimmune disorders are a previously under-appreciated risk for infection and poor outcome.
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Affiliation(s)
- K J Kennedy
- Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, Australia.
| | - K Daveson
- Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, Australia
| | - M A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Victorian Infectious Diseases Service at the Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - S J van Hal
- Departments of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - T C Sorrell
- Centre for Infectious Diseases and Microbiology, Westmead Hospital and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
| | - A Lee
- Departments of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - D J Marriott
- Department of Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, Australia
| | - B Chapman
- The Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, Australia; Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Sydney, Australia
| | - C L Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Sydney, Australia
| | - K Hajkowicz
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - E Athan
- Department of Infectious Diseases, Barwon Health, Deakin University, Geelong, Australia
| | - N Bak
- Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, Australia
| | - E Cheong
- Department of Infectious Diseases and Microbiology, Concord Hospital, Sydney, Australia
| | - C H Heath
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - C O Morrissey
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia
| | - S Kidd
- National Mycology Reference Centre, SA Pathology, Adelaide, Australia
| | - R Beresford
- Department of Infectious Diseases and Microbiology, Liverpool Hospital, Sydney, Australia
| | - C Blyth
- School of Paediatrics and Child Health, University of Western Australia, Princess Margaret Hospital, Perth, Australia
| | - T M Korman
- Monash Infectious Diseases and Monash University, Melbourne, Australia
| | - J O Robinson
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Australian Collaborating Centre for Enterococcus and Staphylococcus Species Typing and Research, School of Biomedical Sciences, Curtin University, School of Veterinary and Life Sciences, Murdoch University, Perth, Australia
| | - W Meyer
- The Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, Australia; Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Sydney, Australia
| | - S C-A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Sydney, Australia; Centre for Infectious Diseases and Microbiology, The University of Sydney, Sydney, Australia
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Britton P, Dale R, Booy R, Blyth C, Crawford N, Marshall H, Elliott E, Jones C. Influenza-Associated Neurological Disease: Cases Identified by the Australian Childhood Encephalitis (ACE) Study. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.692] [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: 11/14/2022] Open
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Greenhill AR, Phuanukoonnon S, Michael A, Yoannes M, Orami T, Smith H, Murphy D, Blyth C, Reeder J, Siba P, Pomat W, Lehmann D. Streptococcus pneumoniae and Haemophilus influenzae in paediatric meningitis patients at Goroka General Hospital, Papua New Guinea: serotype distribution and antimicrobial susceptibility in the pre-vaccine era. BMC Infect Dis 2015; 15:485. [PMID: 26521138 PMCID: PMC4628371 DOI: 10.1186/s12879-015-1197-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 06/18/2015] [Accepted: 10/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bacterial meningitis remains an important infection globally, with the greatest burden in children in low-income settings, including Papua New Guinea (PNG). We present serotype, antimicrobial susceptibility and outcome data from paediatric meningitis patients prior to introduction of Haemophilus influenzae type b (Hib) and pneumococcal conjugate vaccines (PCVs) in PNG, providing a baseline for evaluation of immunisation programs. METHODS Cerebrospinal fluid (CSF) was collected from children admitted to Goroka General Hospital with suspected meningitis between 1996 and 2005. Culture and sensitivity was conducted, and pneumococci and H. influenzae were serotyped. Laboratory findings were linked to clinical outcomes. RESULTS We enrolled 1884 children. A recognised pathogen was identified in 375 children (19.9%). Streptococcus pneumoniae (n = 180) and Hib (n = 153) accounted for 88.8% of pathogens isolated. 24 different pneumococcal serogroups were identified; non-PCV types 2, 24 and 46 accounted for 31.6% of pneumococcal meningitis. 10- and 13-valent PCVs would cover 44.1% and 45.4% of pneumococcal meningitis respectively. Pneumococcal isolates were commonly resistant to penicillin (21.5%) and 23% of Hib isolates were simultaneously resistant to ampicillin, co-trimoxazole and chloramphenicol. The case fatality rate in patients with a recognised bacterial pathogen was 13.4% compared to 8.5% in culture-negative patients. CONCLUSIONS If implemented in routine expanded programme of immunisation (EPI) with high coverage, current PCVs could prevent almost half of pneumococcal meningitis cases. Given the diversity of circulating serotypes in PNG serotype replacement is of concern. Ongoing surveillance is imperative to monitor the impact of vaccines. In the longer term vaccines providing broader protection against pneumococcal meningitis will be needed.
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Affiliation(s)
- Andrew R Greenhill
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. .,Telethon Kids Institute, The University of Western Australia, Perth, Australia. .,School of Applied and Biomedical Sciences, Federation University, Churchill, Australia.
| | - Suparat Phuanukoonnon
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. .,The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.
| | | | - Mition Yoannes
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - Tilda Orami
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - Helen Smith
- Queensland Department of Health, Forensic and Scientific Services, Coopers Plains, Australia.
| | - Denise Murphy
- Queensland Department of Health, Forensic and Scientific Services, Coopers Plains, Australia
| | - Christopher Blyth
- Telethon Kids Institute, The University of Western Australia, Perth, Australia. .,School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia. .,Princess Margaret Hospital for Children, Perth, Australia. .,PathWest Laboratory Medicine, Perth, Western Australia, Australia.
| | - John Reeder
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. .,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia.
| | - Peter Siba
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - William Pomat
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - Deborah Lehmann
- Telethon Kids Institute, The University of Western Australia, Perth, Australia.
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Cheng AC, Holmes M, Senenayake S, Dwyer DE, Hewagama S, Korman T, Irving L, Brown S, Waterer G, Hunter C, Friedman ND, Wark P, Simpson G, Upman J, Bowler S, Macartney K, Blyth C, Kotsimbos T, Kelly P. Influenza epidemiology in adults admitted to sentinel Australian hospitals in 2014: the Influenza Complications Alert Network (FluCAN). Commun Dis Intell (2018) 2015; 39:E355-E360. [PMID: 26620349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The Influenza Complications Alert Network (FluCAN) is a sentinel hospital-based surveillance program that operates at sites in all states and territories in Australia. This report summarises the epidemiology of hospitalisations with laboratory-confirmed influenza during the 2014 influenza season. In this observational study, cases were defined as patients admitted to one of the sentinel hospitals with an acute respiratory illness with influenza confirmed by nucleic acid detection. During the period 3 April to 31 October 2014 (the 2014 influenza season), 1,692 adult patients (>16 years) were admitted with confirmed influenza to one of 15 of 17 FluCAN sentinel hospitals (excluding 2 paediatric hospitals). Of these, 47% were over 65 years of age, 10% were Indigenous Australians, 3.3% were pregnant and 85% had chronic co-morbidities. The majority of cases were due to influenza A. Influenza B was detected in 7% of patients. There were a large number of hospital admissions detected with confirmed influenza in this national observational surveillance system in 2014. These are estimated to represent a national annual burden of around 15,000 admissions and almost 100,000 bed-days nationally.
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Affiliation(s)
| | - Mark Holmes
- University of Adelaide, Royal Adelaide Hospital
| | | | | | | | | | - Louis Irving
- Royal Melbourne Hospital, University of Melbourne
| | - Simon Brown
- University of Western Australia, Royal Perth Hospital
| | - Grant Waterer
- University of Western Australia, Royal Perth Hospital
| | | | | | - Peter Wark
- University of Newcastle, John Hunter Hospital
| | | | - John Upman
- Princess Alexandra Hospital, University of Queensland
| | | | | | - Christopher Blyth
- Princess Margaret Hospital, University of Western Australia, Telethon Kids Institute
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30
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Francis J, Blyth C. Antivirals for children with influenza: Current evidence. J PEDIAT INF DIS-GER 2015. [DOI: 10.3233/jpi-120345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Joshua Francis
- Department of Paediatric and Adolescent Medicine, Princess Margaret Hospital, Subiaco, WA, Australia
| | - Christopher Blyth
- Department of Paediatric and Adolescent Medicine, Princess Margaret Hospital, Subiaco, WA, Australia
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31
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Williams GS, Seow E, Evans H, Owoniyi M, Evans S, Blyth C. Factors affecting visual acuity after one year of follow up after repeated intravitreal ranibizumab for macular degeneration. Saudi J Ophthalmol 2015; 29:187-91. [PMID: 26155076 PMCID: PMC4487938 DOI: 10.1016/j.sjopt.2015.02.004] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 01/26/2015] [Accepted: 02/25/2015] [Indexed: 11/05/2022] Open
Abstract
Aim Providing intravitreal ranibizumab therapy for neovascular age related macular degeneration (nARMD) is a source of increasing strain for many UK eye departments. Whilst most units attempt to adhere to the product licence of following up patients at four weekly intervals; delays in follow up appointments can and do occur. We aim to see if mean follow up intervals during the maintenance phase are correlated with visual outcomes at one year and perform a multivariate analysis of patient factors in a bit to understand the factors affecting visual acuity outcomes. Method A continuously updated prospective audit of patients receiving ranibizumab therapy at the Royal Gwent Hospital was accessed and a coefficient of determination and Spearman’s rank test undertaken to see whether mean follow up delays resulted in visual acuity penalties after nine months of maintenance. Multivariate analysis using ANOVA was then undertaken to examine in more detail the various factors affecting visual acuity outcomes. Results 805 eyes of 708 patients were included in the study. Mean follow up intervals varied between 28.0 and 96.3 days over the first six treatments of the maintenance phase (mean 49.2 – SD 10.7) with a mean change in visual acuity from baseline of +7.1 letters at 12 weeks and +4.6 letters at 52 weeks. There was a negative correlation seen between visual acuity gains after nine months of the maintenance phase and increasing clinic follow up times although Spearman’s rank analysis demonstrated a correlation coefficient of only −0.078, which was not statistically significant. Variability in follow up appointments resulting in worse outcomes was however significant (p < 0.01), as was increasing age at presentation (p = 0.04). Smoking was found to decrease age of presentation by six years (74.2 years vs 80.0 years). The adjusted R2 for the whole analysis was 0.44. Conclusion Wide variation in follow up intervals was associated with a worse visual acuity outcome although longer mean follow up interval was not. Smokers presented at a significantly younger age than non-smokers or ex-smokers. This was a large study with an adjusted R2 of 0.44. The results are relevant to other macular degeneration service providers around the world.
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Affiliation(s)
- Gwyn Samuel Williams
- Department of Ophthalmology, Royal Gwent Hospital, Cardiff Road, Newport, Wales NP20 2UB, United Kingdom
| | - Eulee Seow
- Department of Ophthalmology, Royal Gwent Hospital, Cardiff Road, Newport, Wales NP20 2UB, United Kingdom
| | - Huw Evans
- Department of Ophthalmology, Royal Gwent Hospital, Cardiff Road, Newport, Wales NP20 2UB, United Kingdom
| | - Muyiwa Owoniyi
- Department of Ophthalmology, Royal Gwent Hospital, Cardiff Road, Newport, Wales NP20 2UB, United Kingdom
| | - Sam Evans
- Department of Ophthalmology, Royal Gwent Hospital, Cardiff Road, Newport, Wales NP20 2UB, United Kingdom
| | - Christopher Blyth
- Department of Ophthalmology, Royal Gwent Hospital, Cardiff Road, Newport, Wales NP20 2UB, United Kingdom
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32
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Williams GS, Blyth C, Laws D. A MULTIVARIATE ANALYSIS OF FACTORS AFFECTING DID NOT ATTEND (DNA) RATES IN A PAEDIATRIC EYE CLINIC: DO WEATHER AND SCHOOL HOLIDAYS AFFECT ATTENDANCE AT PAEDIATRIC EYE CLINIC? Ulster Med J 2015; 84:132. [PMID: 26376494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Slavin M, van Hal S, Sorrell T, Lee A, Marriott D, Daveson K, Kennedy K, Hajkowicz K, Halliday C, Athan E, Bak N, Cheong E, Heath C, Orla Morrissey C, Kidd S, Beresford R, Blyth C, Korman T, Owen Robinson J, Meyer W, Chen SA. Invasive infections due to filamentous fungi other than Aspergillus: epidemiology and determinants of mortality. Clin Microbiol Infect 2015; 21:490.e1-10. [DOI: 10.1016/j.cmi.2014.12.021] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 12/18/2014] [Accepted: 12/30/2014] [Indexed: 11/30/2022]
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Macartney KK, Gidding HF, Trinh L, Wang H, McRae J, Crawford N, Gold M, Kynaston A, Blyth C, Yvonne Z, Elliott E, Booy R, Buttery J, Marshall H, Nissen M, Richmond P, McInytre PB, Wood N. Febrile seizures following measles and varicella vaccines in young children in Australia. Vaccine 2014; 33:1412-7. [PMID: 25444797 DOI: 10.1016/j.vaccine.2014.10.071] [Citation(s) in RCA: 23] [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] [Received: 08/11/2014] [Revised: 10/12/2014] [Accepted: 10/27/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Febrile seizures (FS) are common in childhood with incidence peaking in the second year of life when measles and varicella-containing vaccines are administered. This study aimed to examine the vaccine-attributable risk of FS following separate administration of MMR and monovalent varicella vaccines (VV) prior to a planned change to MMRV as the second dose of measles-containing vaccine at 18 months of age. METHODS All FS cases in children aged <5 years from 1st January 2012 to 30th April 2013 were identified from emergency department (ED) and inpatient databases at five Australian tertiary paediatric hospitals participating in PAEDS (Paediatric Active Enhanced Disease Surveillance). Immunization records were obtained from the Australian Childhood Immunization Register (ACIR). The relative incidence (RI) of FS following MMR dose 1 (MMR1) and VV in children aged 11-23 months was determined using the self-controlled case series (SCCS) method and used to calculate attributable risk. RESULTS There were 2013 FS episodes in 1761 children. The peak age at FS was 18 months. The risk of FS was significantly increased 5-12 days post receipt of MMR1 at 12 months (RI=1.9 [95% CI: 1.3-2.9]), but not after VV at 18 months (RI=0.6 [95% CI: 0.3-1.2]. The estimated excess annual number of FS post MMR1 was 24 per 100,000 vaccinated children aged 11-23 months (95% CI=7-49 cases per 100,000) or 1 per 4167 doses. CONCLUSIONS Our study detected the expected increased FS risk post MMR1 vaccine at 12 months, but monovalent varicella vaccine at age 18 months was not associated with increased risk of FS. This provides baseline data to assess the risk of FS post MMRV, introduced in Australia as the second dose of measles-containing vaccine at 18 months of age in July 2013.
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Affiliation(s)
- Kristine K Macartney
- National Centre for Immunization Research & Surveillance, Westmead, NSW, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia; Children's Hospital Westmead, Sydney, Australia.
| | - Heather F Gidding
- National Centre for Immunization Research & Surveillance, Westmead, NSW, Australia; School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Lieu Trinh
- National Centre for Immunization Research & Surveillance, Westmead, NSW, Australia
| | - Han Wang
- National Centre for Immunization Research & Surveillance, Westmead, NSW, Australia
| | - Jocelynne McRae
- National Centre for Immunization Research & Surveillance, Westmead, NSW, Australia
| | - Nigel Crawford
- Murdoch Children's Research Institute, Parkville, Australia; Royal Children's Hospital, Melbourne, Australia
| | - Michael Gold
- Women and Children's Hospital, Adelaide, Australia; Robinson Research Institute and School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia
| | | | - Christopher Blyth
- Wesfarmer's Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia; University of Western Australia School of Paediatrics and Child health, Princess Margaret Hospital, Perth, Australia
| | - Zurynski Yvonne
- Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia; Children's Hospital Westmead, Sydney, Australia; Australian Paediatric Surveillance Unit, Westmead, Australia
| | - Elizabeth Elliott
- Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia; Children's Hospital Westmead, Sydney, Australia; Australian Paediatric Surveillance Unit, Westmead, Australia
| | - Robert Booy
- National Centre for Immunization Research & Surveillance, Westmead, NSW, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia; Children's Hospital Westmead, Sydney, Australia
| | - Jim Buttery
- Murdoch Children's Research Institute, Parkville, Australia; Paediatrics Department, The University of Melbourne, Melbourne, Australia
| | - Helen Marshall
- Women and Children's Hospital, Adelaide, Australia; Robinson Research Institute and School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia
| | | | - Peter Richmond
- Wesfarmer's Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia; University of Western Australia School of Paediatrics and Child health, Princess Margaret Hospital, Perth, Australia
| | - Peter B McInytre
- National Centre for Immunization Research & Surveillance, Westmead, NSW, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia; Children's Hospital Westmead, Sydney, Australia
| | - Nicholas Wood
- National Centre for Immunization Research & Surveillance, Westmead, NSW, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia; Children's Hospital Westmead, Sydney, Australia
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Wang B, Dwyer DE, Soedjono M, Shi H, Matlho K, Ratnamohan M, Blyth C, McPhie K, Cunningham AL, Saksena NK. Evidence of the circulation of pandemic influenza (H1N1) 2009 with D222D/G/N/S hemagglutinin polymorphisms during the first wave of the 2009 influenza pandemic. J Clin Virol 2011; 52:304-6. [PMID: 21925936 DOI: 10.1016/j.jcv.2011.08.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 08/22/2011] [Accepted: 08/25/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND The hemagglutinin HA1 D222G substitution may be associated with adverse outcomes in pandemic influenza A (H1N1) 2009 infections by enhancing the binding capacity of α2-3 sialyl receptors to pandemic influenza (H1N1) 2009 viruses. OBJECTIVES To investigate the emergence of the D222G mutation and other polymorphisms at this position during the first southern hemisphere pandemic wave in 2009. STUDY DESIGN A total of 127 samples that were nucleic acid test positive for pandemic influenza (H1N1) 2009 virus were subjected to a sequence-based genotypic assessment of viral populations. Specimens showing polymorphisms at position 222 were further cloned to characterise the viral quasispecies. RESULTS A high proportion of intensive care unit (ICU) admissions (20%) and outpatients with mild symptoms (11.3%) carried polymorphisms of D/G/N/S at position 222 in hemagglutinin. Viral quasispecies derived from the upper and lower respiratory tract (URT and LRT) in ICU patients showed comparable levels of 222G populations. CONCLUSION The detection of 222G quasispecies present in the URT in both ICU and outpatient groups suggest ready transmission of these variants, and its frequent detection (and clusters) in outpatients imply local community transmission.
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Affiliation(s)
- Bin Wang
- Center for Virus Research, Westmead Millennium Institute, University of Sydney, Australia.
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36
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Affiliation(s)
- C Blyth
- Princess Margaret Hospital for Children, Western Australian TB Control Program, Perth, Western Australia, Australia
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Ahluwalia HS, Lukaris A, Lane CM, Blyth C. Angioid streaks with congenital hypertrophy of the retinal pigment epithelium: an association or a mere coincidence? Eye (Lond) 2002; 16:645-6. [PMID: 12194085 DOI: 10.1038/sj.eye.6700108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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39
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Scott DA, Silbert BS, Blyth C, O'Brien J, Santamaria J. Blood loss in elective coronary artery surgery: a comparison of centrifugal versus roller pump heads during cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2001; 15:322-5. [PMID: 11426362 DOI: 10.1053/jcan.2001.23279] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To compare the effects of centrifugal pumps versus roller pumps for cardiopulmonary bypass (CPB) in routine cardiac surgery on hematologic parameters in the context of modern practice. DESIGN Prospective, randomized, partially blinded. SETTING University teaching hospital. PARTICIPANTS Elective coronary artery surgery patients (n = 113) INTERVENTION Patients were randomized to be perfused with either a roller head (group R, n = 56) or a centrifugal head (group C, n = 57) pump. Patients received epsilon-aminocaproic acid before and during CPB. Core body temperatures were allowed to drift down to approximately 32 degrees C. MEASUREMENTS AND MAIN RESULTS Postoperative chest tube blood loss, blood product requirements, hemoglobin, and platelet counts were assessed. There were no significant differences in preoperative or intraoperative parameters, including CPB time, complexity of procedure, and minimum core temperature. There were the expected reductions in hemoglobin and platelet levels post-CPB in both groups to a similar extent. Chest tubes remained in situ for similar durations, and the final volume of drainage was not significantly different (group C, 1300 +/- 92 mL; group R 1117 +/- 83 mL; p = 0.14). Allogeneic blood was given to 23% of patients in group C and 18% in group R (p = 0.63). Aspirin was associated with an increase in early chest tube drainage. CONCLUSIONS In this surgical and perfusion environment, the authors were unable to show an advantage, from the hematologic point of view, in the routine use of a centrifugal pump head in elective coronary artery surgical patients. The use of antifibrinolytic agents and mild hypothermia may have effects on hemostasis that overshadow the influence of pump head design in this type of surgery.
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Affiliation(s)
- D A Scott
- Departments of Anaesthesia and Intensive Care, St.Vincent's Hospital, Melbourne, Victoria, Australia
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Abstract
OBJECTIVE To undertake neuropsychologic testing within 18 hours of cardiac surgery after fast-track anesthesia. DESIGN Prospective study. SETTING University hospital, single center. PARTICIPANTS Fifty patients undergoing first-time elective coronary artery surgery. INTERVENTIONS A neuropsychologic test battery was administered preoperatively and 18 hours and 5 days after surgery. MAIN RESULTS Seven patients were withdrawn, and 9 patients did not attempt the postoperative tests (on both occasions) because of medical complications. Thirty patients completed > or =4 tests at both postoperative occasions. Of these, 9 patients (30%) showed a deficit in > or =2 tests at 18 hours postoperatively, and 3 (10%) showed a deficit at 5 days postoperatively. CONCLUSION In the absence of medical complications and despite the difficulties, early postoperative neuropsychologic testing is possible after fast-track anesthesia. Such testing has the potential to more clearly define the course of cognitive decline after cardiac surgery.
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Affiliation(s)
- B S Silbert
- Department of Anaesthesia, St. Vincent's Hospital, Melbourne, Australia
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Davies MJ, Silbert BS, Scott DA, Cook RJ, Mooney PH, Blyth C. Superficial and deep cervical plexus block for carotid artery surgery: a prospective study of 1000 blocks. Reg Anesth 1997; 22:442-6. [PMID: 9338906 DOI: 10.1016/s1098-7339(97)80031-4] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Cervical plexus blocks are performed for carotid surgery to allow neurological assessment of the awake patient. The aim of this study was to establish the frequency of success, complications, and patient acceptance of the technique. METHODS One thousand superficial and deep cervical blocks were performed in 924 patients having carotid artery surgery. Data about the blocks were recorded prospectively and patients were followed up postoperatively by an independent anesthesiologist to assess patient acceptance of the technique. RESULTS Lidocaine was the most frequently used anesthetic (88%). Surgical supplementation of the blocks was required in 53% of operations. Six blocks (0.6%) had clinical evidence of intravascular injection of local anesthetic. Sedation was required in 66% of operations and conversion to general anesthesia occurred in 25 (2.5%) of operations. Ninety-one percent of patients reported no problems with the block, and 93% stated that they would have the same anesthetic for any future similar surgery. CONCLUSIONS We conclude that superficial and deep cervical plexus block has a high success rate, low complication rate, and high patient acceptance rate. Caution should, however, be exercised to ensure a low intravascular injection rate which is of most concern with this technique, because blood was aspirated in 30% of patients during performance of the block.
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Affiliation(s)
- M J Davies
- Department of Anaesthesia, St. Vincent's Hospital, Melbourne, Australia
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Blagus S, Miljanic D, Zadro M, Calvi G, Lattuada M, Riggi F, Spitaleri C, Blyth C, Karban O. 4H nucleus and the 2H(t,tp)n reaction. Phys Rev C Nucl Phys 1991; 44:325-328. [PMID: 9967403 DOI: 10.1103/physrevc.44.325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Mueller F, Blyth C. Epidemiology of sports injuries in children. Clin Sports Med 1982; 1:343-52. [PMID: 6764890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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