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Kaczmarek MC, Schlebusch S, Ware RS, Coulthard MG, McEniery JA, Lambert SB. Diagnostic testing in influenza and pertussis related paediatric intensive care unit admissions,Queensland, Australia, 1997-2013. Commun Dis Intell (2018) 2017; 41:E308-E317. [PMID: 29864384] [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
Severe respiratory infections make up a large proportion of Australian paediatric intensive care unit (ICU) admissions each year. Identification of the causative pathogen is important and informs clinical management. We investigated the use of polymerase chain reaction (PCR) in the ICU-setting using data collated by the Australian and New Zealand Paediatric Intensive Care (ANZPIC) Registry from five ICUs in Queensland, Australia. We describe diagnostic testing use among pertussis and influenza-related paediatric ICU admissions between 01 January 1997 and 31 December 2013.
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Affiliation(s)
- Marlena C Kaczmarek
- The University of Queensland, School of Public Health, Brisbane Australia
- UQ Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane Australia
| | - Sanmarie Schlebusch
- Microbiology Division, Mater Pathology, Brisbane Australia
- The University of Queensland, School of Medicine, Brisbane Australia
| | - Robert S Ware
- The University of Queensland, School of Public Health, Brisbane Australia
- UQ Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane Australia
| | - Mark G Coulthard
- Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane Australia
- Academic Discipline of Paediatrics and Child Health, School of Medicine, The University of Queensland, Brisbane Australia
| | - Julie A McEniery
- Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane Australia
| | - Stephen B Lambert
- UQ Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane Australia
- Communicable Diseases Branch, Queensland Health, Brisbane Australia
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Kaczmarek MC, Ware RS, Nimmo GR, Robson JMB, Lambert SB. Pertussis Seasonality Evident in Polymerase Chain Reaction and Serological Testing Data, Queensland, Australia. J Pediatric Infect Dis Soc 2016; 5:214-7. [PMID: 27199473 DOI: 10.1093/jpids/piu144] [Citation(s) in RCA: 8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/23/2014] [Indexed: 11/13/2022]
Abstract
We investigated the seasonality of pertussis in Queensland, Australia, between 2008 and 2011 using notification and laboratory data. Polymerase chain reaction and serology testing data demonstrate that in the vaccine era, pertussis remains a seasonal illness, with annual peaks in summer months, and that the seasonality of notification data is masked by testing trends.
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Affiliation(s)
- Marlena C Kaczmarek
- Queensland Children's Medical Research Institute, Children's Health Queensland Hospitals and Health Service, Brisbane, Queensland, Australia School of Population Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Robert S Ware
- Queensland Children's Medical Research Institute, Children's Health Queensland Hospitals and Health Service, Brisbane, Queensland, Australia School of Population Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Graeme R Nimmo
- Pathology Queensland Central Laboratory, Brisbane, Queensland, Australia Griffith University School of Medicine, Southport, Queensland, Australia
| | | | - Stephen B Lambert
- Queensland Children's Medical Research Institute, Children's Health Queensland Hospitals and Health Service, Brisbane, Queensland, Australia Communicable Diseases Unit, Queensland Health, Brisbane, Queensland, Australia
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Kaczmarek MC, Ware RS, McEniery JA, Coulthard MG, Lambert SB. Epidemiology of pertussis-related paediatric intensive care unit (ICU) admissions in Australia, 1997-2013: an observational study. BMJ Open 2016; 6:e010386. [PMID: 27053270 PMCID: PMC4823423 DOI: 10.1136/bmjopen-2015-010386] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To review the epidemiology of pertussis-related intensive care unit (ICU) admissions across Australia, over a 17-year period. DESIGN Retrospective descriptive study. SETTING Australian ICUs contributing data to the Australian and New Zealand Paediatric Intensive Care (ANZPIC) Registry. The number of contributing ICUs increased over the study period, from 8 specialist paediatric ICUs in 1997 to 8 specialist paediatric and 13 general ICUs in 2013. PARTICIPANTS All paediatric (<16 years) ICU admissions, coded as pertussis-related, between 1 January 1997 and 31 December 2013. RESULTS A total of 373 pertussis-coded ICU admissions were identified in the ANZPIC Registry over the study period. Of these cases, 52.8% occurred during the 4 years of the recent Australian epidemic (2009-2012). ICU admissions were most likely to occur in infants aged younger than 6 weeks (41.8%, n=156) and aged 6 weeks to 4 months (42.9%, n=160). The median length of stay for pertussis-related ICU admissions was 3.6 days, with 77.5% of cases staying in ICU for <7 days. Approximately half of all admissions (54.8%) required some form of respiratory support, with 32.7% requiring invasive respiratory support. Over the study period, 23 deaths were recorded (6.2% of pertussis-related ICU admissions), of which 20 (87.0%) were infants <4 months old. CONCLUSIONS Pertussis-related ICU admissions occur primarily in infants too young to be fully protected from active immunisation. More needs to be done to protect these high-risk infants, such as maternal immunisation.
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Affiliation(s)
- Marlena C Kaczmarek
- UQ Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Robert S Ware
- UQ Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Julie A McEniery
- Division of Critical Care, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
| | - Mark G Coulthard
- Division of Critical Care, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
- Academic Discipline of Paediatrics and Child Health, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Stephen B Lambert
- UQ Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Communicable Diseases Branch, Queensland Health, Brisbane, Queensland, Australia
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Kaczmarek MC, Ware RS, Coulthard MG, McEniery J, Lambert SB. Epidemiology of Australian Influenza-Related Paediatric Intensive Care Unit Admissions, 1997-2013. PLoS One 2016; 11:e0152305. [PMID: 27023740 PMCID: PMC4811543 DOI: 10.1371/journal.pone.0152305] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 03/11/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Influenza virus predictably causes an annual epidemic resulting in a considerable burden of illness in Australia. Children are disproportionately affected and can experience severe illness and complications, which occasionally result in death. METHODS We conducted a retrospective descriptive study using data collated in the Australian and New Zealand Paediatric Intensive Care (ANZPIC) Registry of influenza-related intensive care unit (ICU) admissions over a 17-year period (1997-2013, inclusive) in children <16 years old. National laboratory-confirmed influenza notifications were used for comparison. RESULTS Between 1997 and 2013, a total of 704 influenza-related ICU admissions were recorded, at a rate of 6.2 per 1,000 all-cause ICU admissions. Age at admission ranged from 0 days and 15.9 years (median = 2.1 years), with 135 (19.2%) aged <6 months. Pneumonia/pneumonitis and bronchiolitis were the most common primary diagnoses among influenza-related admissions (21.9% and 13.6%, respectively). More than half of total cases (59.2%) were previously healthy (no co-morbidities recorded), and in the remainder, chronic lung disease (16.7%) and asthma (12.5%) were the most common co-morbidities recorded. Pathogen co-detection occurred in 24.7% of cases, most commonly with respiratory syncytial virus or a staphylococcal species. Median length of all ICU admissions was 3.2 days (range 2.0 hours- 107.4 days) and 361 (51.3%) admissions required invasive respiratory support for a median duration of 4.3 days (range 0.2 hours- 107.5 days). There were 27 deaths recorded, 14 (51.9%) in children without a recorded co-morbidity. CONCLUSION Influenza causes a substantial number of ICU admissions in Australian children each year with the majority occurring in previously healthy children.
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Affiliation(s)
- Marlena C Kaczmarek
- Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia.,The University of Queensland, School of Public Health, Brisbane, Australia.,Queensland Children's Medical Research Institute, Brisbane, Australia
| | - Robert S Ware
- Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia.,The University of Queensland, School of Public Health, Brisbane, Australia.,Queensland Children's Medical Research Institute, Brisbane, Australia
| | - Mark G Coulthard
- Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, Australia.,Academic Discipline of Paediatrics and Child Health, School of Medicine, The University of Queensland, Brisbane, Australia
| | - Julie McEniery
- Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, Australia
| | - Stephen B Lambert
- Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia.,Queensland Children's Medical Research Institute, Brisbane, Australia.,Communicable Diseases Unit, Queensland Health, Brisbane, Australia
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Kaczmarek MC, Duong UT, Ware RS, Lambert SB, Kelly HA. The risk of fever following one dose of trivalent inactivated influenza vaccine in children aged ≥6 months to <36 months: a comparison of published and unpublished studies. Vaccine 2013; 31:5359-65. [PMID: 24055353 DOI: 10.1016/j.vaccine.2013.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 09/02/2013] [Accepted: 09/06/2013] [Indexed: 11/25/2022]
Abstract
There are limited summary data published on the risk of fever and febrile seizures in children following influenza vaccination. We performed a review of the risk of fever and febrile seizures following receipt of trivalent inactivated influenza vaccine (TIV) in children aged ≥6 months to <36 months, searching PubMED and Google Scholar for English language articles from 2000 onwards, and initiated or ongoing unpublished studies since September 2007 using Clinicaltrials.gov. Exclusions included other vaccine co-administration, missing ages or participant numbers, or unmeasured fever. We reviewed articles and collated results using a standard data extraction template. We identified a total of 909 published papers and unpublished trials from a search conducted on 23 January 2013, 669 from Google Scholar, 114 from PubMed and 126 from the Clinicaltrials.gov online database. After excluding 890 published papers or unpublished trials, 5 published papers and 14 unpublished trials were included in this review. Extracted data on number of events, children at risk and time of follow-up were converted to the risk of fever, which was averaged per week of follow-up (referred to as 'averaged weekly risk'). Following one dose of TIV, the median averaged weekly risk of any fever (≥37.5°C) was 26.0% (range 10.3-70.0%) in unpublished trials compared to 8.2% (range 5.3-28.3%) in published papers (p=0.04). The median averaged weekly risk of severe fever (≥39.0°C) was 3.2% (range 0-10.0%) and 2.0% (range 0.6-17.0%), respectively (p=0.91). Variation in the reporting of fever by participant age groups, time since vaccination and the definition or measurement of fever resulted in a wide range of risk estimates. Reporting of febrile reactions should be standardised to allow comparison between manufacturers and influenza seasons.
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Affiliation(s)
- Marlena C Kaczmarek
- Queensland Children's Medical Research Institute, The University of Queensland, and Children's Health Service, Queensland Health, Brisbane, Queensland, Australia; School of Population Health, The University of Queensland, Brisbane, Queensland, Australia; Epidemiology Unit, Victorian Infectious Diseases Reference Laboratory, Melbourne, Victoria, Australia.
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Kaczmarek MC, Valenti L, Kelly HA, Ware RS, Britt HC, Lambert SB. Sevenfold rise in likelihood of pertussis test requests in a stable set of Australian general practice encounters, 2000–2011. Med J Aust 2013; 198:624-8. [DOI: 10.5694/mja13.10044] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 05/15/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Marlena C Kaczmarek
- Queensland Children's Medical Research Institute, Brisbane, QLD
- School of Population Health, University of Queensland, Brisbane, QLD
- Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC
| | - Lisa Valenti
- Family Medicine Research Centre, School of Public Health, University of Sydney, Sydney, NSW
| | - Heath A Kelly
- Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC
| | - Robert S Ware
- Queensland Children's Medical Research Institute, Brisbane, QLD
- School of Population Health, University of Queensland, Brisbane, QLD
| | - Helena C Britt
- Family Medicine Research Centre, School of Public Health, University of Sydney, Sydney, NSW
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