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Thomas S, Donato CM, Covea S, Ratu FT, Jenney AWJ, Reyburn R, Sahu Khan A, Rafai E, Grabovac V, Serhan F, Bines JE, Russell FM. Genotype Diversity before and after the Introduction of a Rotavirus Vaccine into the National Immunisation Program in Fiji. Pathogens 2021; 10:358. [PMID: 33802966 PMCID: PMC8002601 DOI: 10.3390/pathogens10030358] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 11/20/2022] Open
Abstract
The introduction of the rotavirus vaccine, Rotarix, into the Fiji National Immunisation Program in 2012 has reduced the burden of rotavirus disease and hospitalisations in children less than 5 years of age. The aim of this study was to describe the pattern of rotavirus genotype diversity from 2005 to 2018; to investigate changes following the introduction of the rotavirus vaccine in Fiji. Faecal samples from children less than 5 years with acute diarrhoea between 2005 to 2018 were analysed at the WHO Rotavirus Regional Reference Laboratory at the Murdoch Children's Research Institute, Melbourne, Australia, and positive samples were serotyped by EIA (2005-2006) or genotyped by heminested RT-PCR (2007 onwards). We observed a transient increase in the zoonotic strain equine-like G3P[8] in the initial period following vaccine introduction. G1P[8] and G2P[4], dominant genotypes prior to vaccine introduction, have not been detected since 2015 and 2014, respectively. A decrease in rotavirus genotypes G2P[8], G3P[6], G8P[8] and G9P[8] was also observed following vaccine introduction. Monitoring the rotavirus genotypes that cause diarrhoeal disease in children in Fiji is important to ensure that the rotavirus vaccine will continue to be protective and to enable early detection of new vaccine escape strains if this occurs.
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Affiliation(s)
- Sarah Thomas
- Enteric Diseases Group, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (C.M.D.); (J.E.B.)
| | - Celeste M. Donato
- Enteric Diseases Group, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (C.M.D.); (J.E.B.)
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Sokoveti Covea
- Ministry of Health and Medical Services, Suva, Fiji; (S.C.); (F.T.R.); (A.S.K.); (E.R.)
| | - Felisita T. Ratu
- Ministry of Health and Medical Services, Suva, Fiji; (S.C.); (F.T.R.); (A.S.K.); (E.R.)
| | - Adam W. J. Jenney
- Asia-Pacific Health Group, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (A.W.J.J.); (R.R.); (F.M.R.)
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
- Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Rita Reyburn
- Asia-Pacific Health Group, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (A.W.J.J.); (R.R.); (F.M.R.)
- Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Aalisha Sahu Khan
- Ministry of Health and Medical Services, Suva, Fiji; (S.C.); (F.T.R.); (A.S.K.); (E.R.)
| | - Eric Rafai
- Ministry of Health and Medical Services, Suva, Fiji; (S.C.); (F.T.R.); (A.S.K.); (E.R.)
| | - Varja Grabovac
- Western Pacific Regional Office, World Health Organization, Manila 1000, Philippines;
| | - Fatima Serhan
- World Health Organization, 1202 Geneva, Switzerland;
| | - Julie E. Bines
- Enteric Diseases Group, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (C.M.D.); (J.E.B.)
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
- Department of Gastroenterology and Clinical Nutrition, Royal Children’s Hospital, Parkville, VIC 3052, Australia
| | - Fiona M. Russell
- Asia-Pacific Health Group, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (A.W.J.J.); (R.R.); (F.M.R.)
- Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
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Donato CM, Thomas S, Covea S, T Ratu F, Sahu Khan A, Rafai E, Bines JE. Rotavirus surveillance informs diarrhoea disease burden in the WHO Western-Pacific region. Microbiol Aust 2021. [DOI: 10.1071/ma21046] [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: 11/23/2022] Open
Abstract
The surveillance of enteric pathogens is critical in assessing the burden of diarrhoeal disease and informing vaccine programs. Surveillance supported by the World Health Organization in Fiji, Vietnam, the Lao People’s Democratic Republic, and the Philippines previously focussed on rotavirus. There is potential to expand surveillance to encompass a variety of enteric pathogens to inform vaccine development for norovirus, enterotoxigenic Escherichia coli and Shigella.
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Reyburn R, Tuivaga E, Nguyen CD, Ratu FT, Nand D, Kado J, Tikoduadua L, Jenkins K, de Campo M, Kama M, Devi R, Rafai E, Weinberger DM, Mulholland EK, Russell FM. Effect of ten-valent pneumococcal conjugate vaccine introduction on pneumonia hospital admissions in Fiji: a time-series analysis. Lancet Glob Health 2020; 9:e91-e98. [PMID: 33227258 DOI: 10.1016/s2214-109x(20)30421-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 09/04/2020] [Accepted: 09/15/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND In October, 2012, Fiji introduced routine infant immunisation with a ten-valent pneumococcal conjugate vaccine (PCV10) using three primary doses and no booster dose (3 + 0 schedule). Data are scarce for the effect of PCV in the Asia and Pacific region. We aimed to evaluate the effect of PCV10 on pneumonia hospital admissions in children younger than 5 years and adults aged 55 years and older in Fiji, 5 years after vaccine introduction. METHODS We did a time-series analysis assessing changes in pneumonia hospital admissions at three public tertiary hospitals in Fiji. Four pneumonia outcomes were evaluated: all-cause pneumonia, severe or very severe pneumonia, hypoxic pneumonia, and radiological pneumonia. Participants aged younger than 2 months, 2-23 months, 24-59 months, and 55 years and older were included. Data were extracted from the national hospital admission database according to International Classification of Diseases-tenth revision codes J10·0-18·9, J21, and J22 for all-cause pneumonia. Medical records and chest radiographs were reviewed for the main tertiary hospital to reclassify hospital admissions in children aged younger than 2 years as severe or very severe, hypoxic, or radiological pneumonia as per WHO definitions. Time-series analyses were done using the synthetic control method and multiple imputation to adjust for changes in hospital usage and missing data. FINDINGS Between Jan 1, 2007, and Dec 31, 2017, the ratio of observed cases to expected cases for all-cause pneumonia was 0·92 (95% CI 0·70-1·36) for children aged younger than 2 months, 0·86 (0·74-1·00) for children aged 2-23 months, 0·74 (0·62-0·87) for children aged 24-59 months, and 1·90 (1·53-2·31) in adults aged 55 years and older, 5 years after PCV10 introduction. These findings indicate a reduction in all-cause pneumonia among children aged 24-59 months and an increase in adults aged 55 years and older, but no change among children aged younger than 2 months. Among children aged 2-23 months, we observed declines of 21% (95% CI 5-35) for severe or very severe pneumonia, 46% (33-56) for hypoxic pneumonia, and 25% (9-38) for radiological pneumonia. Mortality reduced by 39% (95% CI 5-62) for all-cause pneumonia, bronchiolitis, and asthma admissions in children aged 2-23 months. INTERPRETATION The introduction of PCV10 was associated with a decrease in pneumonia hospital admissions in children aged 2-59 months. This is the first study in a middle-income country in the Asia and Pacific region to show the effect of PCV on pneumonia, filling gaps in the literature on the effects of PCV10 and 3 + 0 schedules. These data support decision making on PCV introduction for other low-income and middle-income countries in the region. FUNDING Department of Foreign Affairs and Trade of the Australian Government.
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Affiliation(s)
- Rita Reyburn
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | | | - Cattram D Nguyen
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital, Melbourne, VIC, Australia
| | | | - Devina Nand
- Ministry of Health and Medical Services, Suva, Fiji
| | - Joe Kado
- Fiji National University, Suva, Fiji
| | | | - Kylie Jenkins
- Australia's support to the Fiji Health Sector, Suva, Fiji
| | | | - Mike Kama
- Ministry of Health and Medical Services, Suva, Fiji
| | - Rachel Devi
- Ministry of Health and Medical Services, Suva, Fiji
| | - Eric Rafai
- Ministry of Health and Medical Services, Suva, Fiji
| | - Daniel M Weinberger
- Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - E Kim Mulholland
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital, Melbourne, VIC, Australia; London School of Hygiene & Tropical Medicine, London, UK
| | - Fiona M Russell
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital, Melbourne, VIC, Australia.
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Lindholm DE, Licciardi PV, Ratu FT, Kim Mulholland E, Nguyen CD, Russell FM. Predictors of antibody persistence to the 7-valent pneumococcal conjugate vaccine in healthy Fijian infants at 12 months of age. Vaccine 2020; 38:5095-5099. [PMID: 32580918 DOI: 10.1016/j.vaccine.2020.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 10/24/2022]
Abstract
Little is known about the predictors of antibody persistence to pneumococcal conjugate vaccines (PCV) in the context of reduced dose schedules. In Fiji, an RCT investigated 0, 1, 2 and 3 dose schedules of 7-valent PCV administered at 6, 10 and 14 weeks of age in 364 healthy infants. This study was a post-hoc analysis of the predictors of poor antibody persistence at 12 months, prior to a booster, using univariable and multivariable analyses. The strongest predictors of poor antibody persistence as measured by serotype-specific immunoglobulin G (IgG) and opsonophagocytosis (OI) assays were being of Indigenous Fijian ethnicity (IgG: adjusted odds ratio (aOR) 3.43, p < 0.001; OI: aOR 1.96, p = 0.013) and receipt of fewer than 3 doses of PCV. These findings may help to identify which children may be at an increased risk of pneumococcal disease in the context of reduced dose primary series PCV schedules.
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Affiliation(s)
- Daniel E Lindholm
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia; Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Australia
| | - Paul V Licciardi
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia; Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Australia
| | - Felisita T Ratu
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia
| | - E Kim Mulholland
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia; London School of Hygiene and Tropical Medicine, London, UK
| | - Cattram D Nguyen
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia; Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia
| | - Fiona M Russell
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia; Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Australia.
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Dunne EM, Satzke C, Ratu FT, Neal EFG, Boelsen LK, Matanitobua S, Pell CL, Nation ML, Ortika BD, Reyburn R, Jenkins K, Nguyen C, Gould K, Hinds J, Tikoduadua L, Kado J, Rafai E, Kama M, Mulholland EK, Russell FM. Effect of ten-valent pneumococcal conjugate vaccine introduction on pneumococcal carriage in Fiji: results from four annual cross-sectional carriage surveys. Lancet Glob Health 2018; 6:e1375-e1385. [PMID: 30420033 PMCID: PMC6231327 DOI: 10.1016/s2214-109x(18)30383-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/12/2018] [Accepted: 08/07/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The indirect effects of pneumococcal conjugate vaccines (PCVs) are mediated through reductions in carriage of vaccine serotypes. Data on PCVs in Asia and the Pacific are scarce. Fiji introduced the ten-valent PCV (PCV10) in 2012, with a schedule consisting of three priming doses at 6, 10, and 14 weeks of age and no booster dose (3 + 0 schedule) without catch-up. We investigated the effects of PCV10 introduction using cross-sectional nasopharyngeal carriage surveys. METHODS We did four annual carriage surveys (one pre-PCV10 and three post-PCV10) in the greater Suva area in Fiji, during 2012-15, of 5-8-week-old infants, 12-23-month-old children, 2-6-year-old children, and their caregivers (total of 8109 participants). Eligible participants were of appropriate age, had axillary temperature lower than 37°C, and had lived in the community for at least 3 consecutive months. We used purposive quota sampling to ensure a proper representation of the Fiji population. Pneumococci were detected by real-time quantitative PCR, and molecular serotyping was done with microarray. FINDINGS 3 years after PCV10 introduction, vaccine-serotype carriage prevalence declined, with adjusted prevalences (2015 vs 2012) of 0·56 (95% CI 0·34-0·93) in 5-8-week-old infants, 0·34 (0·23-0·49) in 12-23-month-olds, 0·47 (0·34-0·66) in 2-6-year-olds, and 0·43 (0·13-1·42) in caregivers. Reductions in PCV10 serotype carriage were evident in both main ethnic groups in Fiji; however, carriage of non-PCV10 serotypes increased in Indigenous Fijian infants and children. Density of PCV10 serotypes and non-PCV10 serotypes was lower in PCV10-vaccinated children aged 12-23 months than in PCV10-unvaccinated children of the same age group (PCV10 serotypes -0·56 [95% CI -0·98 to -0·15], p=0·0077; non-PCV10 serotypes -0·29 [-0·57 to -0·02], p=0·0334). INTERPRETATION Direct and indirect effects on pneumococcal carriage post-PCV10 are likely to result in reductions in pneumococcal disease, including in infants too young to be vaccinated. Serotype replacement in carriage in Fijian children, particularly Indigenous children, warrants further monitoring. Observed changes in pneumococcal density might be temporal rather than vaccine related. FUNDING Department of Foreign Affairs and Trade of the Australian Government through the Fiji Health Sector Support Program; Victorian Government's Operational Infrastructure Support Program; Bill & Melinda Gates Foundation.
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Affiliation(s)
- Eileen M Dunne
- Pneumococcal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
| | - Catherine Satzke
- Pneumococcal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia; Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, VIC, Australia
| | | | - Eleanor F G Neal
- Pneumococcal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Laura K Boelsen
- Pneumococcal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | | | - Casey L Pell
- Pneumococcal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Monica L Nation
- Pneumococcal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Belinda D Ortika
- Pneumococcal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Rita Reyburn
- Pneumococcal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Kylie Jenkins
- Fiji Health Sector Support Program, Suva, Fiji; Telethon Kids Institute, Subiaco, WA, Australia
| | - Cattram Nguyen
- Pneumococcal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Katherine Gould
- Institute for Infection and Immunity, St George's, University of London, UK; BUGS Bioscience, London Bioscience Innovation Centre, London, UK
| | - Jason Hinds
- Institute for Infection and Immunity, St George's, University of London, UK; BUGS Bioscience, London Bioscience Innovation Centre, London, UK
| | | | - Joseph Kado
- Ministry of Health and Medical Services, Suva, Fiji; Telethon Kids Institute, Subiaco, WA, Australia; College of Medicine Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Eric Rafai
- Ministry of Health and Medical Services, Suva, Fiji
| | - Mike Kama
- Ministry of Health and Medical Services, Suva, Fiji
| | - E Kim Mulholland
- Pneumococcal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia; London School of Hygiene & Tropical Medicine, London, UK
| | - Fiona M Russell
- Pneumococcal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
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Toh ZQ, Cheow KWB, Russell FM, Hoe E, Reyburn R, Fong J, Tuivaga E, Ratu FT, Nguyen CD, Matanitobua S, Reitsma A, Tabrizi SN, Garland SM, Mulholland EK, Licciardi PV. Cellular Immune Responses 6 Years Following 1, 2, or 3 Doses of Quadrivalent HPV Vaccine in Fijian Girls and Subsequent Responses to a Dose of Bivalent HPV Vaccine. Open Forum Infect Dis 2018; 5:ofy147. [PMID: 30019002 PMCID: PMC6041981 DOI: 10.1093/ofid/ofy147] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 06/18/2018] [Indexed: 12/19/2022] Open
Abstract
Background This study examined the cellular immunity of 0, 1, 2, and 3 doses of Gardasil vaccine (4vHPV) in girls after 6 years and their responses to a subsequent dose of Cervarix vaccine (2vHPV). Methods A subset of girls (n = 59) who previously received 0, 1, 2, or 3 doses of 4vHPV 6 years earlier were randomly selected from a cohort study of Fijian girls (age 15-19 years). Blood was collected before and 28 days after a dose of 2vHPV. The HPV16- and HPV18-specific cellular immune response was determined by IFNγ-ELISPOT and by measurement of cytokines in peripheral blood mononuclear cell supernatants. Results Six years after 4vHPV vaccination, HPV18-specific responses were significantly lower in the 1- (1D) or 2-dose (2D) recipients compared with 3-dose recipients (2D: IFNγ-ELISPOT: P = .008; cytokines, IFNγ: P = .002; IL-2: P = .022; TNFα: P = .016; IL-10: P = .018; 1D: IL-2: P = .031; IL-10: P = .014). These differences were no longer significant post-2vHPV. No significant differences in HPV16 responses (except IL-2, P < .05) were observed between the 2- or 1-dose recipients and 3-dose recipients. Conclusions These data suggest that cellular immunity following reduced-dose schedules was detectable after 6 years, although the responses were variable between HPV types and dosage groups. The clinical significance of this is unknown. Further studies on the impact of reduced dose schedules are needed, particularly in high-disease burden settings.
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Affiliation(s)
- Zheng Quan Toh
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | | | - Fiona M Russell
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Edwin Hoe
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Rita Reyburn
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - James Fong
- Ministry of Health and Medical Services, Suva, Fiji
| | | | | | - Cattram D Nguyen
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Andrea Reitsma
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Sepehr N Tabrizi
- Department of Obstetrics and Gynecology, The University of Melbourne, The Royal Women's Hospital and Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Regional HPV Labnet Reference Laboratory, Department of Microbiology and Infectious Disease, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Suzanne M Garland
- Department of Obstetrics and Gynecology, The University of Melbourne, The Royal Women's Hospital and Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Regional HPV Labnet Reference Laboratory, Department of Microbiology and Infectious Disease, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Edward K Mulholland
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom.,Department of Child Health, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Paul V Licciardi
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
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