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McHugh L, D'Antoine HA, Sarna M, Binks MJ, Moore HC, Andrews RM, Pereira GF, Blyth CC, Van Buynder P, Lust K, Regan AK. The effectiveness of maternal pertussis vaccination for protecting Aboriginal and Torres Strait Islander infants against infection, 2012-2017: a retrospective cohort study. Med J Aust 2024; 220:196-201. [PMID: 38353124 DOI: 10.5694/mja2.52220] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/10/2023] [Indexed: 03/04/2024]
Abstract
OBJECTIVES To evaluate the effectiveness of maternal pertussis vaccination for preventing pertussis infections in Aboriginal and Torres Strait Islander infants under seven months of age. STUDY DESIGN Retrospective cohort study; analysis of linked administrative health data. SETTING, PARTICIPANTS Mother-infant cohort (Links2HealthierBubs) including all pregnant women who gave birth to live infants (gestational age ≥ 20 weeks, birthweight ≥ 400 g) in the Northern Territory, Queensland, and Western Australia during 1 January 2012 - 31 December 2017. MAIN OUTCOME MEASURES Proportions of women vaccinated against pertussis during pregnancy, rates of pertussis infections among infants under seven months of age, and estimated effectiveness of maternal vaccination for protecting infants against pertussis infection, each by Indigenous status. RESULTS Of the 19 892 Aboriginal and Torres Strait Islander women who gave birth to live infants during 2012-2017, 7398 (37.2%) received pertussis vaccine doses during their pregnancy, as had 137 034 of 259 526 non-Indigenous women (52.8%; Indigenous v non-Indigenous: adjusted odds ratio, 0.66; 95% confidence interval [CI], 0.62-0.70). The annual incidence of notified pertussis infections in non-Indigenous infants declined from 16.8 (95% CI, 9.9-29) in 2012 to 1.4 (95% CI, 0.3-8.0) cases per 10 000 births in 2017; among Aboriginal and Torres Strait Islander infants, it declined from 47.6 (95% CI, 16.2-139) to 38.6 (95% CI, 10.6-140) cases per 10 000 births. The effectiveness of maternal vaccination for protecting non-Indigenous infants under seven months of age against pertussis infection during 2014-17 was 68.2% (95% CI, 51.8-79.0%); protection of Aboriginal and Torres Strait Islander infants was not statistically significant (36.1%; 95% CI, -41.3% to 71.1%). CONCLUSIONS During 2015-17, maternal pertussis vaccination did not protect Aboriginal and Torres Strait Islander infants in the NT, Queensland, and WA against infection. Increasing the pertussis vaccination rate among pregnant Aboriginal and Torres Strait Islander women requires culturally appropriate, innovative strategies co-designed in partnership with Indigenous organisations and communities.
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Affiliation(s)
| | - Heather A D'Antoine
- National Aboriginal and Torres Strait Islander Research Network, University of Queensland, Brisbane, QLD
| | - Mohinder Sarna
- Curtin University, Perth, WA
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA
| | - Michael J Binks
- Menzies School of Health Research, Darwin, NT
- Telethon Institute for Child Health Research, University of Western Australia, Perth, WA
| | - Hannah C Moore
- Telethon Institute for Child Health Research, University of Western Australia, Perth, WA
| | - Ross M Andrews
- Office of the Chief Health Officer, Queensland Health, Brisbane, QLD
| | - Gavin F Pereira
- Curtin University, Perth, WA
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Christopher C Blyth
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA
- The University of Western Australia, Perth, WA
| | | | - Karin Lust
- Royal Brisbane and Woman's Hospital Health Service District, Brisbane, QLD
| | - Annette K Regan
- Curtin University, Perth, WA
- University of San Francisco, San Francisco, CA, United States of America
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Lacey JA, Marcato AJ, Chisholm RH, Campbell PT, Zachreson C, Price DJ, James TB, Morris JM, Gorrie CL, McDonald MI, Bowen AC, Giffard PM, Holt DC, Currie BJ, Carapetis JR, Andrews RM, Davies MR, Geard N, McVernon J, Tong SYC. Evaluating the role of asymptomatic throat carriage of Streptococcus pyogenes in impetigo transmission in remote Aboriginal communities in Northern Territory, Australia: a retrospective genomic analysis. Lancet Microbe 2023; 4:e524-e533. [PMID: 37211022 DOI: 10.1016/s2666-5247(23)00068-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Streptococcus pyogenes, or group A Streptococcus (GAS), infections contribute to a high burden of disease in Aboriginal Australians, causing skin infections and immune sequelae such as rheumatic heart disease. Controlling skin infections in these populations has proven difficult, with transmission dynamics being poorly understood. We aimed to identify the relative contributions of impetigo and asymptomatic throat carriage to GAS transmission. METHODS In this genomic analysis, we retrospectively applied whole genome sequencing to GAS isolates that were collected as part of an impetigo surveillance longitudinal household survey conducted in three remote Aboriginal communities in the Northern Territory of Australia between Aug 6, 2003, and June 22, 2005. We included GAS isolates from all throats and impetigo lesions of people living in two of the previously studied communities. We classified isolates into genomic lineages based on pairwise shared core genomes of more than 99% with five or fewer single nucleotide polymorphisms. We used a household network analysis of epidemiologically and genomically linked lineages to quantify the transmission of GAS within and between households. FINDINGS We included 320 GAS isolates in our analysis: 203 (63%) from asymptomatic throat swabs and 117 (37%) from impetigo lesions. Among 64 genomic lineages (encompassing 39 emm types) we identified 264 transmission links (involving 93% of isolates), for which the probable source was asymptomatic throat carriage in 166 (63%) and impetigo lesions in 98 (37%). Links originating from impetigo cases were more frequent between households than within households. Households were infected with GAS for a mean of 57 days (SD 39 days), and once cleared, reinfected 62 days (SD 40 days) later. Increased household size and community presence of GAS and scabies were associated with slower clearance of GAS. INTERPRETATION In communities with high prevalence of endemic GAS-associated skin infection, asymptomatic throat carriage is a GAS reservoir. Public health interventions such as vaccination or community infection control programmes aimed at interrupting transmission of GAS might need to include consideration of asymptomatic throat carriage. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Jake A Lacey
- Department of Infectious Diseases, University of Melbourne, Melbourne, VIC Australia; Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC Australia
| | - Adrian J Marcato
- Department of Infectious Diseases, University of Melbourne, Melbourne, VIC Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC Australia
| | - Rebecca H Chisholm
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC Australia; Department of Mathematical and Physical Sciences, La Trobe University, Bundoora, VIC, Australia
| | - Patricia T Campbell
- Department of Infectious Diseases, University of Melbourne, Melbourne, VIC Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC Australia
| | - Cameron Zachreson
- School of Computing and Information systems, Faculty of Engineering and Information Technology, University of Melbourne, Melbourne, VIC Australia
| | - David J Price
- Department of Infectious Diseases, University of Melbourne, Melbourne, VIC Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC Australia
| | - Taylah B James
- Department of Infectious Diseases, University of Melbourne, Melbourne, VIC Australia; Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC Australia
| | - Jacqueline M Morris
- Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC Australia
| | - Claire L Gorrie
- Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC Australia
| | - Malcolm I McDonald
- Division of Tropical Health and Medicine, James Cook University, Nguma-bada Campus, Cairns, QLD, Australia
| | - Asha C Bowen
- Telethon Kids Institute, University of Western Australia and Perth Children's Hospital, Perth, WA, Australia
| | - Philip M Giffard
- Global and Tropical Healthy Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; School of Medicine, Faculty of Health, Charles Darwin University, Darwin, NT, Australia
| | - Deborah C Holt
- Global and Tropical Healthy Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; School of Medicine, Faculty of Health, Charles Darwin University, Darwin, NT, Australia
| | - Bart J Currie
- Global and Tropical Healthy Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Jonathan R Carapetis
- Telethon Kids Institute, University of Western Australia and Perth Children's Hospital, Perth, WA, Australia
| | - Ross M Andrews
- Global and Tropical Healthy Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Mark R Davies
- Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC Australia
| | - Nicholas Geard
- School of Computing and Information systems, Faculty of Engineering and Information Technology, University of Melbourne, Melbourne, VIC Australia
| | - Jodie McVernon
- Department of Infectious Diseases, University of Melbourne, Melbourne, VIC Australia; Victorian Infectious Diseases Reference Laboratory Epidemiology Unit, University of Melbourne, Melbourne, VIC Australia
| | - Steven Y C Tong
- Department of Infectious Diseases, University of Melbourne, Melbourne, VIC Australia; Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, at the Peter Doherty Institute for Infection and Immunity VIC, Australia; Global and Tropical Healthy Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
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McHugh L, Regan AK, Sarna M, Moore HC, Van Buynder P, Pereira G, Blyth CC, Lust K, Andrews RM, Crooks K, Massey P, Binks MJ. Inequity of antenatal influenza and pertussis vaccine coverage in Australia: the Links2HealthierBubs record linkage cohort study, 2012-2017. BMC Pregnancy Childbirth 2023; 23:314. [PMID: 37150828 PMCID: PMC10164451 DOI: 10.1186/s12884-023-05574-w] [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: 10/25/2022] [Accepted: 04/04/2023] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Pregnancy and early infancy are increased risk periods for severe adverse effects of respiratory infections. Aboriginal and/or Torres Strait Islander (respectfully referred to as First Nations) women and children in Australia bear a disproportionately higher burden of respiratory diseases compared to non-Indigenous women and infants. Influenza vaccines and whooping cough (pertussis) vaccines are recommended and free in every Australian pregnancy to combat these infections. We aimed to assess the equity of influenza and/or pertussis vaccination in pregnancy for three priority groups in Australia: First Nations women; women from culturally and linguistically diverse (CALD) backgrounds; and women living in remote areas or socio-economic disadvantage. METHODS We conducted individual record linkage of Perinatal Data Collections with immunisation registers/databases between 2012 and 2017. Analysis included generalised linear mixed model, log-binomial regression with a random intercept for the unique maternal identifier to account for clustering, presented as prevalence ratios (PR) and 95% compatibility intervals (95%CI). RESULTS There were 445,590 individual women in the final cohort. Compared with other Australian women (n = 322,848), First Nations women (n = 29,181) were less likely to have received both recommended antenatal vaccines (PR 0.69, 95% CI 0.67-0.71) whereas women from CALD backgrounds (n = 93,561) were more likely to have (PR 1.16, 95% CI 1.10-1.13). Women living in remote areas were less likely to have received both vaccines (PR 0.75, 95% CI 0.72-0.78), and women living in the highest areas of advantage were more likely to have received both vaccines (PR 1.44, 95% CI 1.40-1.48). CONCLUSIONS Compared to other groups, First Nations Australian families, those living in remote areas and/or families from lower socio-economic backgrounds did not receive recommended vaccinations during pregnancy that are the benchmark of equitable healthcare. Addressing these barriers must remain a core priority for Australian health care systems and vaccine providers. An extension of this cohort is necessary to reassess these study findings.
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Affiliation(s)
- Lisa McHugh
- School of Public Health, Division of Medicine, University of Queensland, Brisbane, Qld, 4001, Australia.
| | - Annette K Regan
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
- Wesfarmers Centre for Vaccines & Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
| | - Mohinder Sarna
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
- Wesfarmers Centre for Vaccines & Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
| | - Hannah C Moore
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
- Wesfarmers Centre for Vaccines & Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
| | - Paul Van Buynder
- School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
- enAble Institute, Curtin University, Perth, WA, Australia
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Christopher C Blyth
- Wesfarmers Centre for Vaccines & Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
- School of Medicine, The University of Western Australia, Perth, WA, Australia
- Department of Paediatric Infectious Diseases, Perth Children's Hospital, Perth, WA, Australia
- Department of Microbiology, PathWest Laboratory Medicine, Perth, WA, Australia
| | - Karin Lust
- Women's and Newborn Service, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Department of Medicine, The University of Queensland, Brisbane Queensland, Australia
| | - Ross M Andrews
- Australian National University Canberra, Canberra, Australia
| | - Kristy Crooks
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Peter Massey
- College of Medicine and Dentistry, James Cook University, Queensland, Australia
| | - Michael J Binks
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
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Mchugh L, Van Buynder P, Sarna M, Andrews RM, Moore HC, Binks MJ, Pereira G, Blyth CC, Lust K, Foo D, Regan AK. Timing and temporal trends of influenza and pertussis vaccinations during pregnancy in three Australian jurisdictions: The Links2HealthierBubs population-based linked cohort study, 2012-2017. Aust N Z J Obstet Gynaecol 2023; 63:27-33. [PMID: 35696340 PMCID: PMC10952684 DOI: 10.1111/ajo.13548] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 05/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Antenatal inactivated influenza (IIV) and pertussis-containing vaccines (dTpa) offer protection against severe respiratory infections for pregnant women and infants <6 months of age. Both vaccines are recommended in pregnancy; however, little is known about temporal or jurisdictional trends and predictors of uptake. AIMS To identify gaps and predictors of IIV and/or dTpa vaccinations in Australian pregnancies from 2012 to 2017. MATERIALS AND METHODS We conducted a probabilistically linked, multi-jurisdictional population-based cohort study, drawing from perinatal data collections and immunisation databases. We used a generalised linear mixed model with a random effect term to account for clustering of multiple pregnancies within mothers, to calculate vaccination uptake, and identify predictors of uptake by maternal demographic, pregnancy, and health characteristics. RESULTS Of 591 868 unique pregnancies, IIV uptake was 15%, dTpa 27% and 12% received both vaccines. Pertussis vaccinations in First Nations pregnancies were 20% lower than non-Indigenous pregnancies; dTpa was strongly associated with IIV uptake (risk ratio (RR): 8.60, 95% CI 8.48-8.73). This trend was temporally and jurisdictionally consistent. First Nations women were more likely to have had IIV in pregnancy before the introduction of dTpa in the pregnancy program: (RR: 1.48, 95% CI 1.40-1.57), but less likely after dTpa implementation (RR: 0.78, 95% CI 0.76-0.80). CONCLUSIONS Inequity in vaccine uptake between First Nations and non-Indigenous pregnancies, and dismal rates of vaccination in pregnancy overall need urgent review, particularly before the next influenza pandemic or pertussis outbreak. If antenatal dTpa is driving IIV uptake, changes in antenatal healthcare practices are needed to ensure vaccines are offered equitably and optimally to protect against infection.
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Affiliation(s)
- Lisa Mchugh
- School of Public HealthUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Paul Van Buynder
- School of Medicine and DentistryGriffith UniversitySouthportQueenslandAustralia
| | - Mohinder Sarna
- Curtin School of Population HealthCurtin UniversityPerthWestern AustraliaAustralia
- Wesfarmers Centre for Vaccines & Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
| | - Ross M. Andrews
- Australian National UniversityCanberraAustralian Capital TerritoryAustralia
| | - Hannah C. Moore
- Curtin School of Population HealthCurtin UniversityPerthWestern AustraliaAustralia
- Wesfarmers Centre for Vaccines & Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
| | - Michael J. Binks
- Menzies School of Health ResearchDarwinNorthern TerritoryAustralia
| | - Gavin Pereira
- Curtin School of Population HealthCurtin UniversityPerthWestern AustraliaAustralia
- Wesfarmers Centre for Vaccines & Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
- enAble InstituteCurtin UniversityPerthWestern AustraliaAustralia
- Centre for Fertility and Health (CeFH)Norwegian Institute of Public HealthOsloNorway
| | - Christopher C. Blyth
- Wesfarmers Centre for Vaccines & Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
- School of MedicineThe University of Western AustraliaPerthWestern AustraliaAustralia
- Department of Paediatric Infectious DiseasesPerth Children's HospitalPerthWestern AustraliaAustralia
- Department of MicrobiologyPathWest Laboratory MedicinePerthWestern AustraliaAustralia
| | - Karin Lust
- Women's and Newborn ServiceRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- Department of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - Damien Foo
- Curtin School of Population HealthCurtin UniversityPerthWestern AustraliaAustralia
- Wesfarmers Centre for Vaccines & Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
| | - Annette K. Regan
- Curtin School of Population HealthCurtin UniversityPerthWestern AustraliaAustralia
- Wesfarmers Centre for Vaccines & Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
- School of Nursing and Health ProfessionsUniversity of San FranciscoSan FranciscoCaliforniaUSA
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Martinovich KM, Seppanen EJ, Bleakley AS, Clark SL, Andrews RM, Richmond PC, Binks MJ, Thornton RB, Kirkham LAS. Evidence of maternal transfer of antigen-specific antibodies in serum and breast milk to infants at high-risk of S. pneumoniae and H. influenzae disease. Front Immunol 2022; 13:1005344. [PMID: 36211411 PMCID: PMC9535341 DOI: 10.3389/fimmu.2022.1005344] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/24/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Children in low-mid income countries, and First Nations children in high-income countries, experience disproportionately high rates of Streptococcus pneumoniae and Haemophilus influenzae infections and diseases including pneumonia and otitis media. We previously observed that infants from Papua New Guinea had no evidence of waning maternal immunity for H. influenzae-specific antibodies. In this study, we assessed S. pneumoniae and H. influenzae antibody titres in Australian First Nation mothers and infants to determine antigen-specific antibody ontogenies and whether H. influenzae antibody titres in infants were due to low maternal antibody titres or lack of placental transfer. Methods Breast milk, infant nasopharyngeal swabs and ear assessment data were collected 1-, 2-, 7-months post-birth as well as maternal, cord and 7-month-old infant sera, from 85 Australian Aboriginal and Torres Strait Islander mother-infant pairs. Serum IgG and breast milk IgG and IgA antibody titres to S. pneumoniae antigens (PspA1, PspA2, CbpA, Ply) and H. influenzae antigens (PD, ChimV4, OMP26, rsPilA) were measured. Results IgG titres in maternal and cord sera were similar for all antigens, except Ply (higher in cord; p=0.004). Sera IgG titres at 7-months of age were lower than cord sera IgG titres for all S. pneumoniae antigens (p<0.001). Infant sera IgG titres were higher than cord sera for H. influenzae PD (p=0.029), similar for OMP26 (p=0.817) and rsPilA (p=0.290), and lower for ChimV4 (p=0.004). Breast milk titres were similar for all antigens at 1, 2 and 7-months except OMP26 IgA (lower at 7-months than 1-month; p=0.035), PspA2 IgG (p=0.012) and Ply IgG that increased by 7-months (p=0.032). One third of infants carried nontypeable Haemophilus influenzae (NTHi), 45% carried S. pneumoniae and 52% had otitis media (OM) observed at least once over the 7-months. 73% of infants who carried either S. pneumoniae or NTHi, also had otitis media observed. Conclusions Similarities between maternal and cord IgG titres, and absence of waning, support a lack of maternal H. influenzae IgG antibodies available for cross-placental transfer. Increased maternal anti-PD IgG could offer some protection from early carriage with NTHi, and maternal immunisation strategies should be considered for passive-active immunisation of infants to protect against S. pneumoniae and H. influenzae diseases. Trial registration ClinicalTrials.gov NCT00714064 and NCT00310349.
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Affiliation(s)
- Kelly M. Martinovich
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
| | - Elke J. Seppanen
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
| | - Amy S. Bleakley
- Menzies School of Health Research Charles, Darwin University, Darwin, NT, Australia
| | - Sharon L. Clark
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
- School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Ross M. Andrews
- Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Peter C. Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
- School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Michael J. Binks
- Menzies School of Health Research Charles, Darwin University, Darwin, NT, Australia
| | - Ruth B. Thornton
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
- Centre for Child Health Research, University of Western Australia, Perth, WA, Australia
| | - Lea-Ann S. Kirkham
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
- Centre for Child Health Research, University of Western Australia, Perth, WA, Australia
- *Correspondence: Lea-Ann S. Kirkham,
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Bialasiewicz S, May M, Tozer S, Day R, Bernard A, Zaugg J, Gartrell K, Alexandersen S, Chamings A, Wang CYT, Clark J, Grimwood K, Heney C, Schlapbach LJ, Ware RS, Speers D, Andrews RM, Lambert S. Novel Human Parechovirus 3 Diversity, Recombination, and Clinical Impact Across 7 Years: An Australian Story. J Infect Dis 2022; 227:278-287. [PMID: 35867852 PMCID: PMC9833435 DOI: 10.1093/infdis/jiac311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 07/12/2022] [Accepted: 07/21/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND A novel human parechovirus 3 Australian recombinant (HPeV3-AR) strain emerged in 2013 and coincided with biennial outbreaks of sepsis-like illnesses in infants. We evaluated the molecular evolution of the HPeV3-AR strain and its association with severe HPeV infections. METHODS HPeV3-positive samples collected from hospitalized infants aged 5-252 days in 2 Australian states (2013-2020) and from a community-based birth cohort (2010-2014) were sequenced. Coding regions were used to conduct phylogenetic and evolutionary analyses. A recombinant-specific polymerase chain reaction was designed and utilized to screen all clinical and community HPeV3-positive samples. RESULTS Complete coding regions of 54 cases were obtained, which showed the HPeV3-AR strain progressively evolving, particularly in the 3' end of the nonstructural genes. The HPeV3-AR strain was not detected in the community birth cohort until the initial outbreak in late 2013. High-throughput screening showed that most (>75%) hospitalized HPeV3 cases involved the AR strain in the first 3 clinical outbreaks, with declining prevalence in the 2019-2020 season. The AR strain was not statistically associated with increased clinical severity among hospitalized infants. CONCLUSIONS HPeV3-AR was the dominant strain during the study period. Increased hospital admissions may have been from a temporary fitness advantage and/or increased virulence.
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Affiliation(s)
- Seweryn Bialasiewicz
- Correspondence: Seweryn Bialasiewicz, MSc, PhD, Australian Centre for Ecogenomics, The University of Queensland, Level 5, Bldg 76, St Lucia, QLD 4072, Australia ()
| | | | - Sarah Tozer
- Children’s Health Queensland Hospital and Health Service, Centre for Children’s Health Research, South Brisbane, Australia
| | - Rebecca Day
- Children’s Health Queensland Hospital and Health Service, Centre for Children’s Health Research, South Brisbane, Australia
| | - Anne Bernard
- QCIF Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, St Lucia, Australia
| | - Julian Zaugg
- School of Chemistry and Molecular Biosciences, The University of Queensland, Australian Centre for Ecogenomics, St Lucia, Australia
| | - Kyana Gartrell
- Children’s Health Queensland Hospital and Health Service, Centre for Children’s Health Research, South Brisbane, Australia
| | - Soren Alexandersen
- School of Medicine, Deakin University, Geelong, Australia,Statens Serum Institut, Copenhagen, Denmark
| | | | - Claire Y T Wang
- Children’s Health Queensland Hospital and Health Service, Centre for Children’s Health Research, South Brisbane, Australia
| | - Julia Clark
- Children’s Health Queensland Hospital and Health Service, South Brisbane, Australia
| | - Keith Grimwood
- School of Medicine and Dentistry, Menzies Health Institute Queensland, Griffith University, Southport, Australia,Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Southport, Australia
| | - Claire Heney
- Department of Microbiology, Pathology Queensland, Herston, Australia
| | - Luregn J Schlapbach
- Children’s Health Queensland Hospital and Health Service, South Brisbane, Australia,Department of Intensive Care and Neonatology, Children’s Research Center, University Children’s Hospital Zürich, Zürich, Switzerland
| | - Robert S Ware
- School of Medicine and Dentistry, Menzies Health Institute Queensland, Griffith University, Southport, Australia
| | - David Speers
- Department of Microbiology, PathWest Laboratory Medicine Western Australia, Queen Elizabeth II Medical Centre, Nedlands, Australia,School of Medicine, University of Western Australia, Crawley, Australia
| | - Ross M Andrews
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
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Lynch KD, Brian G, Ahwang T, Newie T, Newie V, Perrett C, Wharton G, Brown A, Tozer S, Kaldor JM, Whop LJ, Andrews RM, Lambert SB. Discord between presence of follicular conjunctivitis and Chlamydia trachomatis infection in a single Torres Strait Island community: a cross-sectional survey. Aust N Z J Public Health 2022; 46:155-160. [PMID: 34978363 DOI: 10.1111/1753-6405.13179] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 08/01/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Recent surveys identified trachomatous inflammation - follicular (TF) at endemic levels in the Torres Strait Islands; however, local health staff do not report trachomatous trichiasis (TT) in adults. We undertook a cross-sectional survey involving eye examination and microbiological testing to better understand this disconnect. METHODS We examined 169 of 207 (82%) residents and collected ocular swabs for polymerase chain reaction (PCR) testing for Chlamydia trachomatis. Other viral PCR tests and bacterial culture were also performed. RESULTS TF prevalence in children aged 5-9 years was 23% (7/30). No ocular C. trachomatis was identified by PCR. For the 72 participants (43%) with follicles, bacterial culture was positive for 11 (15%) individuals. No individual had trachomatous trichiasis. CONCLUSIONS Follicular conjunctivitis consistent with TF was prevalent but ocular C. trachomatis and cicatricial trachoma were absent. Non-chlamydial infections or environmental causes of follicular conjunctivitis may be causing TF in this community. Implications for public health: In similar settings, reliance on simplified clinical assessment alone may lead to an overestimation of the public health problem posed by trachoma. Consideration should be given to incorporating C. trachomatis PCR, and in certain settings, a detailed clinical exam could be performed by an experienced ophthalmologist during prevalence surveys.
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Affiliation(s)
- Kathleen D Lynch
- Communicable Diseases Branch, Prevention Division, Queensland Health.,UQ Centre for Clinical Research, The University of Queensland
| | - Garry Brian
- Communicable Diseases Branch, Prevention Division, Queensland Health.,Torres and Cape Hospital and Health Service, Queensland
| | | | - Tomi Newie
- Torres and Cape Hospital and Health Service, Queensland
| | | | | | - Ghislaine Wharton
- Torres and Cape Hospital and Health Service, Queensland.,Cairns Eye & Laser Centre, Cairns, Queensland
| | - Anthony Brown
- Torres and Cape Hospital and Health Service, Queensland
| | - Sarah Tozer
- UQ Centre for Clinical Research, The University of Queensland
| | | | - Lisa J Whop
- Menzies School of Health Research, Charles Darwin University, Northern Territory.,National Centre for Epidemiology and Population Health, The Australian National University, Australian Capital Territory
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Northern Territory.,National Centre for Epidemiology and Population Health, The Australian National University, Australian Capital Territory
| | - Stephen B Lambert
- Communicable Diseases Branch, Prevention Division, Queensland Health.,UQ Centre for Clinical Research, The University of Queensland.,National Centre for Epidemiology and Population Health, The Australian National University, Australian Capital Territory
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8
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Marsh CK, Sheppeard V, Tobin S, Gilmour R, Andrews RM. Drivers of the summer influenza epidemic in New South Wales, 2018-19. Med J Aust 2021; 216:33-38. [PMID: 34549433 DOI: 10.5694/mja2.51266] [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: 01/15/2021] [Revised: 06/16/2021] [Accepted: 06/22/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess the extent to which the 2018-19 New South Wales summer influenza epidemic was associated with overseas or domestic travel and with seasonal influenza vaccination status. DESIGN, SETTING Unmatched case-control study, based on an online survey distributed from the NSW Notifiable Conditions Information Management System (NCIMS) to people for whom mobile phone numbers were available. PARTICIPANTS A case was defined as a person with notified laboratory-confirmed influenza with onset of illness between 1 December 2018 and 21 March 2019. People with notified pertussis infections (confirmed or probable) were selected as controls. MAIN OUTCOME MEASURES Notified influenza infection, by travel and contact with unwell overseas travellers in the week before onset of illness and seasonal influenza vaccination status (as the primary exposures). RESULTS Valid survey responses were provided by 648 of 2806 invited people with notified influenza (23%) and 257 of 796 invited people with notified pertussis (32%). The demographic characteristics of the respondents were similar to those of the source population (7251 cases, 2254 controls). During the first two months of the summer of 2018-19, notified influenza was more likely for people who had travelled overseas or had contact with an ill overseas traveller in the week before symptom onset (adjusted OR [aOR], 6.99; 95% CI, 3.59-13.6), but not during the second two months (aOR, 1.63; 95% CI, 0.79-3.35). Influenza vaccination status was not associated with the likelihood of notified influenza. CONCLUSIONS Travel-related factors were early drivers of the 2018-19 NSW summer influenza epidemic; local transmission sustained the outbreak despite unfavourable conditions later in summer. Our findings prompted re-evaluation of recommendations for pre-travel vaccination in NSW. The role of travel in out-of-season influenza outbreaks should be considered in other temperate zones.
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9
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Hansen M, Bowden E, Currie BJ, Ward L, Andrews RM, Dhurrkay RG, Gurruwiwi GG, Kearns T. Strongyloides stercoralis seropositivity is not associated with increased symptoms in a remote Aboriginal community. Intern Med J 2021; 51:1286-1291. [PMID: 32372503 DOI: 10.1111/imj.14884] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/27/2020] [Accepted: 04/27/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Strongyloides stercoralis is a soil-transmitted helminth, endemic in remote Aboriginal and Torres Strait Islander communities in northern Australia with estimates of prevalences up to 60%. Hyperinfection in the setting of immunosuppression is a rare, but well recognised cause of significant morbidity and mortality. However, the morbidity associated with chronic uncomplicated infection is less well characterised. AIMS To measure the prevalence of symptoms potentially attributable to S. stercoralis infection and their association with seropositivity. METHODS This retrospective matched case-control study reviewed records of primary healthcare presentations for symptoms in the 12 months before and after an ivermectin mass drug administration (MDA) in a remote Aboriginal community. RESULTS One hundred and seventy-five S. stercoralis seropositive cases were matched with 175 seronegative controls. The most frequently reported symptom overall in the 12 months prior to the MDA was cough followed by abdominal pain, weight loss/malnutrition, diarrhoea and pruritis. Seropositive cases were not more likely than matched controls to have symptoms typically attributed to strongyloidiasis. In the seropositive cohort, we found no difference in symptoms in the 12 months before and after an ivermectin MDA despite a reduction in seroprevalence. CONCLUSION We found no evidence to suggest that S. stercoralis seropositivity was associated with increased symptoms when compared to matched seronegative controls. Treatment with ivermectin did not reduce symptoms in seropositive cases. Without evidence to support that population-based screening or treatment programmes reduce symptoms, the emphasis must remain on identifying and managing those few individuals with immunosuppression that predisposes them to potentially life-threatening hyperinfection.
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Affiliation(s)
- Martin Hansen
- Infectious Diseases Department, Royal Darwin Hospital, Northern Territory, Australia
| | - Emily Bowden
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Bart J Currie
- Infectious Diseases Department, Royal Darwin Hospital, Northern Territory, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Linda Ward
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | | | | | - Therese Kearns
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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10
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McHugh L, O'Grady KAF, Nolan T, Richmond PC, Wood N, Marshall HS, Lambert SB, Chatfield MD, Perrett KP, Binks P, Binks MJ, Andrews RM. National predictors of influenza vaccine uptake in pregnancy: the FluMum prospective cohort study, Australia, 2012-2015. Aust N Z J Public Health 2021; 45:455-461. [PMID: 34411398 DOI: 10.1111/1753-6405.13130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 04/01/2021] [Accepted: 05/01/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Ascertain predictors of inactivated influenza vaccine (IIV) uptake in pregnancy in mother-infant pairs from six Australian sites over four consecutive influenza seasons (2012-2015). METHODS Prospective observational cohort study calculating proportions of unvaccinated and vaccinated pregnancies. Multivariable logistic regression calculating adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) to determine demographic, pregnancy and birth characteristics as predictors of IIV uptake in pregnancy. RESULTS Uptake of IIV was 36% (n=3,651/9,878) with only 3-4% during the first trimester. Validation of IIV receipt was obtained for 77% of vaccinated participants. Predictors of IIV uptake in pregnancy were: healthcare provider recommendation to have IIV during pregnancy (aOR 7.04 [95%CI 5.83-8.50]): GP (aOR 4.12 [95%CI 3.43-4.98]), obstetrician (aOR 4.41 [95%CI 3.45-5.64]), midwife (aOR 1.88 [95%CI 1.51-2.36]); previous IIV within 12 months of their current pregnancy (aOR 2.87 [95%CI 2.36-3.50]); and pertussis vaccination during the current pregnancy (aOR 4.88 [95%CI 4.08-5.83]). Conclusions and implications for public health: Healthcare provider discussions with pregnant women about the risks associated with influenza infection during pregnancy and early infancy and evidence about the safety and effectiveness of IIV are required. Recommending and offering IIV in pregnancy needs to be included in these discussions to improve uptake.
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Affiliation(s)
- Lisa McHugh
- Menzies School of Health Research, Charles Darwin University, Northern Territory.,School of Public Health, The University of Queensland
| | - Kerry-Ann F O'Grady
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, Queensland University of Technology
| | - Terry Nolan
- Peter Doherty Institute for Infection and Immunity, The University of Melbourne, and Murdoch Children's Research Institute
| | - Peter C Richmond
- Perth Children's Hospital, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and Division of Paediatrics, University of Western Australia, New South Wales
| | - Nicholas Wood
- National Centre for Immunisation Research and Surveillance (NCIRS) and The Faculty of Medicine and Health, University of Sydney, New South Wales
| | - Helen S Marshall
- Women's and Children's Health Network and Robinson Research Institute and Adelaide Medical School, The University of Adelaide, South Australia
| | - Stephen B Lambert
- Research School of Population Health, Australian National University, Australian Capital Territory
| | - Mark D Chatfield
- Menzies School of Health Research, Charles Darwin University, Northern Territory.,Faculty of Medicine, The University of Queensland
| | - Kirsten P Perrett
- Murdoch Children's Research Institute, Royal Children's Hospital and Department of Paediatrics, The University of Melbourne, Victoria
| | - Paula Binks
- Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Michael J Binks
- Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Northern Territory.,Research School of Population Health, Australian National University, Australian Capital Territory
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11
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McMillan M, Chandrakumar A, Wang HLR, Clarke M, Sullivan TR, Andrews RM, Ramsay M, Marshall HS. Effectiveness of Meningococcal Vaccines at Reducing Invasive Meningococcal Disease and Pharyngeal Neisseria meningitidis Carriage: A Systematic Review and Meta-analysis. Clin Infect Dis 2021; 73:e609-e619. [PMID: 33212510 DOI: 10.1093/cid/ciaa1733] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 08/09/2020] [Accepted: 11/12/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Invasive meningococcal disease (IMD), caused by Neisseria meningitidis, leads to significant morbidity and mortality worldwide. This review aimed to establish the effectiveness of meningococcal vaccines at preventing IMD and N. meningitidis pharyngeal carriage. METHODS A search within PubMed, Embase, Scopus, and unpublished studies up to 1 February 2020 was conducted. RESULTS After removal of duplicates, 8565 studies were screened and 27 studies included. Protection was provided by meningococcal C vaccines for group C IMD (odds ratio [OR], 0.13 [95% confidence interval {CI}, .07-.23]), outer membrane vesicle (OMV) vaccines against group B IMD (OR, 0.35 [95% CI, .25-.48]), and meningococcal A, C, W, Y (MenACWY) vaccines against group ACWY IMD (OR, 0.31 [95% CI, .20-.49]). A single time series analysis found a reduction following an infant 4CMenB program (incidence rate ratio, 0.25 [95% CI, .19-.36]). Multivalent MenACWY vaccines did not reduce carriage (relative risk [RR], 0.88 [95% CI, .66-1.18]), unlike monovalent C vaccines (RR, 0.50 [95% CI, .26-.97]). 4CMenB vaccine had no effect on group B carriage (RR, 1.12 [95% CI, .90-1.40]). There was also no reduction in group B carriage following MenB-FHbp vaccination (RR, 0.98 [95% CI, .53-1.79]). CONCLUSIONS Meningococcal conjugate C, ACWY, and OMV vaccines are effective at reducing IMD. A small number of studies demonstrate that monovalent C conjugate vaccines reduce pharyngeal N. meningitidis carriage. There is no evidence of carriage reduction for multivalent MenACWY, OMV, or recombinant MenB vaccines, which has implications for immunization strategies. CLINICAL TRIALS REGISTRATION CRD42018082085 (PROSPERO).
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Affiliation(s)
- Mark McMillan
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia.,Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Abira Chandrakumar
- Central Adelaide Local Health Network, South Australia Health, Adelaide, South Australia, Australia
| | - Hua Lin Rachael Wang
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Michelle Clarke
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia.,Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Thomas R Sullivan
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia,Australia.,School of Public Health, University of Adelaide, Adelaide, South Australia, 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
| | - Mary Ramsay
- Immunisation Department, Public Health England, London, United Kingdom
| | - Helen S Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia.,Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
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12
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McMillan M, Walters L, Sullivan T, Leong LEX, Turra M, Lawrence A, Koehler AP, Finn A, Andrews RM, Marshall HS. Impact of Meningococcal B (4CMenB) Vaccine on Pharyngeal Neisseria meningitidis Carriage Density and Persistence in Adolescents. Clin Infect Dis 2021; 73:e99-e106. [PMID: 32447370 DOI: 10.1093/cid/ciaa610] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 05/19/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Higher density of Neisseria meningitidis carriage may be associated with transmission of the meningococcus. Our aim was to establish the impact of meningococcal B (4CMenB) vaccine on N. meningitidis carriage density. METHODS We compared 4CMenB vaccine to control among 913 South Australian students aged approximately 15-18 years in a cluster randomized trial who had N. meningitidis carriage at 12 months. Oropharyngeal swabs were collected at baseline and 12 months later to detect N. meningitidis carriage. Colony-forming units per milliliter (CFU/mL) were estimated by generating a standard curve that plotted quantitative polymerase chain reaction cycle threshold values against log-normalized CFU. RESULTS Among the 913 students with N. meningitidis carriage at 12 months, there was no difference in mean carriage density between the vaccinated (n = 434; 3.80 log CFU/mL [standard deviation {SD}, 1.29]) and control group (n = 479; 3.73 log CFU/mL [SD, 1.30]; P = .51). Higher N. meningitidis carriage density at baseline was associated with an increase in the odds of persistent carriage at 12 months (n = 504; odds ratio [OR] per 1.0 log CFU/mL increase in density, 1.36 [95% confidence interval {CI}, 1.17-1.58]; P < .001). Students with baseline carriage who were vaccinated had decreased persistent N. meningitidis carriage at 12 months compared to unvaccinated students (81/260 [31%] vs 105/244 [43%]; OR, 0.60 [95% CI, .40-.90]; P = .01). CONCLUSIONS 4CMenB vaccine did not reduce carriage density of N. meningitidis 12 months postvaccination, despite increased carriage clearance. Higher carriage density is likely to enable transmission through prolonged periods of population exposure. CLINICAL TRIALS REGISTRATION NCT03089086.
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Affiliation(s)
- Mark McMillan
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia.,Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Luke Walters
- Microbiology and Infectious Diseases Directorate, South Australia Pathology, Adelaide, South Australia, Australia
| | - Thomas Sullivan
- South Australian Health and Medical Research Institute Women and Kids, Adelaide, South Australia, Australia.,School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Lex E X Leong
- Microbiology and Infectious Diseases Directorate, South Australia Pathology, Adelaide, South Australia, Australia
| | - Mark Turra
- Microbiology and Infectious Diseases Directorate, South Australia Pathology, Adelaide, South Australia, Australia
| | - Andrew Lawrence
- Microbiology and Infectious Diseases Directorate, South Australia Pathology, Adelaide, South Australia, Australia
| | - Ann P Koehler
- Communicable Disease Control Branch, SA Health, Adelaide, South Australia, Australia
| | - Adam Finn
- Bristol Children's Vaccine Centre, School of Cellular and Molecular Medicine and School of Population Health Sciences, University of Bristol, Bristol, England
| | - 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
| | - Helen S Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia.,Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
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13
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Kearns T, Diaz A, Whop LJ, Moore SP, Condon JR, Andrews RM, Katzenellenbogen JM, Matthews V, Wang W, Johnston T, Taylor C, Potts B, Kathage A, Suleman A, Stanley L, Mitchell L, Garvey G, Williamson D. Investigating inequities in cardiovascular care and outcomes for Queensland Aboriginal and Torres Strait Islander people: protocol for a hospital-based retrospective cohort data linkage project. BMJ Open 2021; 11:e043304. [PMID: 33741666 PMCID: PMC7986649 DOI: 10.1136/bmjopen-2020-043304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Cardiovascular disease (CVD) represents a significant burden of disease for Aboriginal and Torres Strait Islander people, a population that continues to experience a lower life expectancy than other Australians. The aim of the Better Cardiac Care Data Linkage project is to describe patient care pathways and to identify disparities in care and health outcomes between Aboriginal and Torres Strait Islander people and other Queensland residents diagnosed with CVD in the state of Queensland. METHODS This is a population-based retrospective cohort study using linked regional, state and national health and administrative data collections to describe disparities in CVD healthcare in primary and secondary prevention settings and during hospitalisation. The CVD cohort will be identified from the Queensland Hospital Admitted Patient Data Collection for admissions that occurred between 1 July 2010 and 31 June 2016 and will include relevant International Classification of Disease codes for ischaemic heart disease, congestive heart failure, stroke, acute rheumatic fever and rheumatic heart disease. Person-level data will be linked by Data Linkage Queensland and the Australian Institute of Health and Welfare (AIHW) in accordance with ethical and public health approvals to describe the patient journey prior to, during and post the hospital admission. ANALYSIS This project will focus largely on descriptive epidemiological measures and multivariate analysis of clinical care standards and outcomes for Aboriginal and Torres Strait Islander people compared with other Queenslanders, including identification of risk factors for suboptimal care and change over time. Variation in care pathways and patient outcomes will be compared by Indigenous status, sex, age group, remoteness of residence, year of index hospitalisation and socioeconomic status. Cox models for time-to-event data and mixed models or generalised estimating equations for longitudinal data will be used to measure change over time where temporal effects exist. ETHICS AND DISSEMINATION Ethical approval has been granted by Human Research Ethics Committees of the Prince Charles Hospital (HREC/15/QPCH/289) and the AIHW (EO2016-1-233). The Northern Territory Department of Health and Menzies School of Health Research have also provided reciprocal ethical approval of the project (HREC 2019-3490). The deidentified results will be summarised in a report and shared with investigators, advisory groups, Queensland Health and key stakeholders. Findings will be disseminated through workshops, conferences and will be published in peer-reviewed journals.
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Affiliation(s)
- Therese Kearns
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Abbey Diaz
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Lisa J Whop
- College of Health and Medicine, National Centre for Epidemiology and Population Health, Canberra, Australian Capital Territory, Australia
| | - Suzanne P Moore
- College of Nursing and Midwifery, Charles Darwin University, Brisbane, Queensland, Australia
| | - John R Condon
- Menzies School of Health Research, Charles Darwin University, Melbourne, Victoria, Australia
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Brisbane, Queensland, Australia
| | - Judith M Katzenellenbogen
- School of Population and Global Health, University of Western Australia, Crawley, Western Australia, Australia
| | - Veronica Matthews
- University Centre for Rural Health, North Coast, The University of Sydney, Lismore, New South Wales, Australia
| | - William Wang
- Faculty of Medicine, University of Queensland, Woolloongabba, Queensland, Australia
- Cardiology, Princess Alexandra Hospital Health Service District, Woolloongabba, Queensland, Australia
| | - Trisha Johnston
- Data Linkage Queensland, Queensland Health, Brisbane, Queensland, Australia
| | - Catherine Taylor
- Queensland Record Linkage Group, Queensland Health, Brisbane, Queensland, Australia
| | - Boyd Potts
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Alex Kathage
- Aboriginal and Torres Strait Islander Health Division, Queensland Health, Brisbane, Queensland, Australia
| | - Abdulla Suleman
- Aboriginal and Torres Strait Islander Health Division, Queensland Health, Brisbane, Queensland, Australia
| | - Lucy Stanley
- Aboriginal and Torres Strait Islander Health Division, Queensland Health, Brisbane, Queensland, Australia
| | - Louise Mitchell
- Aboriginal and Torres Strait Islander Health Division, Queensland Health, Brisbane, Queensland, Australia
| | - Gail Garvey
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Brisbane, Queensland, Australia
| | - Daniel Williamson
- Aboriginal and Torres Strait Islander Health Division, Queensland Health, Brisbane, Queensland, Australia
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14
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Blyth CC, Jayasinghe S, Andrews RM. A Rationale for Change: An Increase in Invasive Pneumococcal Disease in Fully Vaccinated Children. Clin Infect Dis 2021; 70:680-683. [PMID: 31209491 DOI: 10.1093/cid/ciz493] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/16/2019] [Accepted: 06/08/2019] [Indexed: 11/14/2022] Open
Abstract
Increasing numbers of cases of invasive pneumococcal disease in fully vaccinated children have occurred in Australia since 2013. A review of cases informed a change from a "3 + 0" infant schedule (13-valent pneumococcal conjugate vaccine at 2, 4, and 6 months) to a "2 + 1" schedule (2, 4, and 12 months).
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Affiliation(s)
- Christopher C Blyth
- School of Medicine, University of Western Australia, Perth.,Perth Children's Hospital, Nedlands.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, West Perth
| | - Sanjay Jayasinghe
- National Centre for Immunisation Research and Surveillance for Vaccine Preventable Diseases, Westmead.,Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Darwin.,National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
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15
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Lydeamore MJ, Campbell PT, Price DJ, Wu Y, Marcato AJ, Cuningham W, Carapetis JR, Andrews RM, McDonald MI, McVernon J, Tong SYC, McCaw JM. Estimation of the force of infection and infectious period of skin sores in remote Australian communities using interval-censored data. PLoS Comput Biol 2020; 16:e1007838. [PMID: 33017395 PMCID: PMC7561265 DOI: 10.1371/journal.pcbi.1007838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/15/2020] [Accepted: 04/01/2020] [Indexed: 11/19/2022] Open
Abstract
Prevalence of impetigo (skin sores) remains high in remote Australian Aboriginal communities, Fiji, and other areas of socio-economic disadvantage. Skin sore infections, driven primarily in these settings by Group A Streptococcus (GAS) contribute substantially to the disease burden in these areas. Despite this, estimates for the force of infection, infectious period and basic reproductive ratio-all necessary for the construction of dynamic transmission models-have not been obtained. By utilising three datasets each containing longitudinal infection information on individuals, we estimate each of these epidemiologically important parameters. With an eye to future study design, we also quantify the optimal sampling intervals for obtaining information about these parameters. We verify the estimation method through a simulation estimation study, and test each dataset to ensure suitability to the estimation method. We find that the force of infection differs by population prevalence, and the infectious period is estimated to be between 12 and 20 days. We also find that optimal sampling interval depends on setting, with an optimal sampling interval between 9 and 11 days in a high prevalence setting, and 21 and 27 days for a lower prevalence setting. These estimates unlock future model-based investigations on the transmission dynamics of skin sores.
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Affiliation(s)
- Michael J Lydeamore
- School of Mathematics and Statistics, The University of Melbourne, Melbourne, Australia
- Department of Infectious Diseases, The Alfred and Central Clinical School, Monash University, Melbourne, Australia
| | - Patricia T Campbell
- Peter Doherty Institute for Infection and Immunity, The Royal Melbourne Hospital and The University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia
| | - David J Price
- Peter Doherty Institute for Infection and Immunity, The Royal Melbourne Hospital and The University of Melbourne, Melbourne, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Yue Wu
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Adrian J Marcato
- Peter Doherty Institute for Infection and Immunity, The Royal Melbourne Hospital and The University of Melbourne, Melbourne, Australia
| | - Will Cuningham
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Jonathan R Carapetis
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- Perth Children's Hospital, Perth, Australia
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- National Centre for Epidemiology & Population Health, Australian National University, Canberra, Australia
| | - Malcolm I McDonald
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | - Jodie McVernon
- Peter Doherty Institute for Infection and Immunity, The Royal Melbourne Hospital and The University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Steven Y C Tong
- Peter Doherty Institute for Infection and Immunity, The Royal Melbourne Hospital and The University of Melbourne, Melbourne, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - James M McCaw
- School of Mathematics and Statistics, The University of Melbourne, Melbourne, Australia
- Peter Doherty Institute for Infection and Immunity, The Royal Melbourne Hospital and The University of Melbourne, Melbourne, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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Binks MJ, Beissbarth J, Oguoma VM, Pizzutto SJ, Leach AJ, Smith-Vaughan HC, McHugh L, Andrews RM, Webby R, Morris PS, Chang AB. Acute lower respiratory infections in Indigenous infants in Australia's Northern Territory across three eras of pneumococcal conjugate vaccine use (2006-15): a population-based cohort study. Lancet Child Adolesc Health 2020; 4:425-434. [PMID: 32450122 DOI: 10.1016/s2352-4642(20)30090-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 03/06/2020] [Accepted: 03/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The burden of acute lower respiratory infection (ALRI) in Indigenous children of Australia's Northern Territory is among the highest globally. No published data exists on the effect of pneumococcal conjugate vaccine (PCV) introduction on ALRIs in this population beyond 2005. The aim of this study was to describe the rates of ALRI admissions to hospital in Indigenous infants in the Northern Territory from 2006 to 2015, across three periods of different PCV use. We hypothesised that broader valency PCVs would be more effective against hospitalisations for pneumonia. METHODS We did a retrospective population-based cohort study of Indigenous infants born in the Northern Territory followed up until age 12 months. Data were from administrative hospital and perinatal datasets. International classification of diseases codes (tenth revision, Australian modification; ICD-10AM) were used to identify respiratory hospitalisations of interest: all-cause ALRI, all-cause pneumonia, bacterial pneumonia, viral pneumonia, influenza-like illness (ILI), respiratory syncytial virus ALRI (RSV-ALRI), and pneumococcal ALRI. Incidence rates were compared between PCV eras (7-valent PCV [PCV7], 2006-09; 10-valent PCV [PCV10], 2009-11; and 13-valent PCV [PCV13], 2011-15) using interrupted time trend analysis and negative binomial regression. FINDINGS For children born between Jan 1, 2006, and Dec 31, 2015, 4138 ALRI episodes (31% of all hospitalisations) occurred among 2888 (20%) of the 14 594 infants. The overall ALRI hospitalisation rate was 29·7 episodes per 100 child-years. Prominent risk factors associated with ALRI hospitalisation were living in a remote community or the Central desert region, being born preterm or with low birthweight. ALRI rates were lowest in the PCV13 era, in association with a significant reduction in bacterial pneumonia hospitalisations in the PCV13 era compared with the PCV10 (incidence rate ratio 0·68, 95% CI 0·57-0·81) and PCV7 (0·70, 0·60-0·81) eras. In contrast, RSV-ALRI rates were 4·9 episodes per 100 child-years in each era. INTERPRETATION A 30% reduction in bacterial-coded pneumonia hospitalisations in the Northern Territory during the era of PCV13 immunisation supports its ongoing use in the region. Despite the reduction, one in five Indigenous infants born in the region continue to be hospitalised with an ALRI in their first year of life. Future gains require multifaceted environmental and biomedical approaches. FUNDING National Health and Medical Research Council of Australia.
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Affiliation(s)
- Michael J Binks
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | - Jemima Beissbarth
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Victor M Oguoma
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Susan J Pizzutto
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Amanda J Leach
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Heidi C Smith-Vaughan
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Lisa McHugh
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Ross M Andrews
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Rosalind Webby
- Centre for Disease Control, Department of Health, Darwin, NT, Australia
| | - Peter S Morris
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Department of Paediatrics, Royal Darwin Hospital, Darwin, NT, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia
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Howarth T, Brunette R, Davies T, Andrews RM, Patel BK, Tong S, Barzi F, Kearns TM. Correction: Antibiotic use for Australian Aboriginal children in three remote Northern Territory communities. PLoS One 2020; 15:e0233533. [PMID: 32407375 PMCID: PMC7224520 DOI: 10.1371/journal.pone.0233533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0231798.].
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18
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McHugh L, Marshall HS, Perrett KP, Nolan T, Wood N, Lambert SB, Richmond P, Ware RS, Binks P, Binks MJ, Andrews RM. The Safety of Influenza and Pertussis Vaccination in Pregnancy in a Cohort of Australian Mother-Infant Pairs, 2012-2015: The FluMum Study. Clin Infect Dis 2020; 68:402-408. [PMID: 30475988 DOI: 10.1093/cid/ciy517] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/17/2018] [Indexed: 01/22/2023] Open
Abstract
Background Inactivated influenza vaccine (IIV) and pertussis vaccination are recommended in pregnancy. Limited safety data exist for women who received IIV vaccine during the first trimester of pregnancy or received both vaccines in pregnancy. We assessed adverse birth outcomes between vaccinated and unvaccinated pregnancies. Methods Among prospectively enrolled Australian "FluMum" participants (2012-2015), primary exposure was receipt and timing of IIV during pregnancy. Primary outcomes included preterm birth, low birthweight at term (LBWT), and small for gestational age (SGA). We compared birth outcomes for IIV in pregnancy with women unvaccinated in pregnancy using Cox proportional hazard ratios (HRs) with 95% confidence intervals (CIs). Adjusted HRs (aHRs) controlled for potential confounding variables. Sensitivity analyses were conducted in a subgroup of women who received pertussis vaccination during pregnancy to assess whether associations between IIV and adverse outcomes were maintained after adjusting for pertussis vaccination. Results Among 8827 participants in our study, women who received IIV in pregnancy did not have an elevated risk of an adverse birth outcome compared with unvaccinated pregnant women: preterm births (HR, 1.10 [95% CI, .92-1.31]; P = .28); LBWT (HR, 1.05 [95% CI, .76-1.44]; P = .77); or SGA (HR, 0.99 [95% CI, .86-1.15]; P = .94). Adjustment for pertussis vaccination during pregnancy yielded similar results: preterm births (aHR, 1.05 [95% CI, .82-1.34]; P = .69); LBWT (aHR, 0.81 [95% CI, .50-1.29]; P = .37); SGA (aHR, 0.92 [95% CI, .74-1.14]; P = .43). There was no evidence of elevated risk by trimester of IIV. Conclusions No significant associations were found between maternal IIV or pertussis vaccination in pregnancy and adverse birth outcomes, regardless of the trimester of pregnancy a vaccination was given compared to unvaccinated pregnancies.
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Affiliation(s)
- Lisa McHugh
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory
| | - Helen S Marshall
- Women's and Children's Health Network, Robinson Research Institute and Adelaide Medical School, University of Adelaide, South Australia
| | - Kirsten P Perrett
- Murdoch Children's Research Institute, Royal Children's Hospital and School of Population and Global Health, University of Melbourne, Victoria
| | - Terry Nolan
- Murdoch Children's Research Institute, Royal Children's Hospital and School of Population and Global Health, University of Melbourne, Victoria
| | - Nicholas Wood
- National Centre for Immunisation Research and Surveillance, Sydney Children's Hospitals Network, Discipline of Child and Adolescent Health, University of Sydney, New South Wales
| | - Stephen B Lambert
- Child Health Research Centre, School of Medicine, University of Queensland, Brisbane
| | - Peter Richmond
- University of Western Australia, Division of Paediatrics and Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane
| | - Paula Binks
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory
| | - Michael J Binks
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory.,National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
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Hughes CJR, Turner S, Andrews RM, Vitkin A, Jacobs JR. Matrix metalloproteinases regulate ECM accumulation but not larval heart growth in Drosophila melanogaster. J Mol Cell Cardiol 2020; 140:42-55. [PMID: 32105665 DOI: 10.1016/j.yjmcc.2020.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/12/2020] [Accepted: 02/19/2020] [Indexed: 02/06/2023]
Abstract
The Drosophila heart provides a simple model to examine the remodelling of muscle insertions with growth, extracellular matrix (ECM) turnover, and fibrosis. Between hatching and pupation, the Drosophila heart increases in length five-fold. If major cardiac ECM components are secreted remotely, how is ECM "self assembly" regulated? We explored whether ECM proteases were required to maintain the morphology of a growing heart while the cardiac ECM expanded. An increase in expression of Drosophila's single tissue inhibitor of metalloproteinase (TIMP), or reduced function of metalloproteinase MMP2, resulted in fibrosis and ectopic deposition of two ECM Collagens; type-IV and fibrillar Pericardin. Significant accumulations of Collagen-IV (Viking) developed on the pericardium and in the lumen of the heart. Congenital defects in Pericardin deposition misdirected further assembly in the larva. Reduced metalloproteinase activity during growth also increased Pericardin fibre accumulation in ECM suspending the heart. Although MMP2 expression was required to remodel and position cardiomyocyte cell junctions, reduced MMP function did not impair expansion of the heart. A previous study revealed that MMP2 negatively regulates the size of the luminal cell surface in the embryonic heart. Cardiomyocytes align at the midline, but do not adhere to enclose a heart lumen in MMP2 mutant embryos. Nevertheless, these embryos hatch and produce viable larvae with bifurcated hearts, indicating a secondary pathway to lumen formation between ipsilateral cardiomyocytes. MMP-mediated remodelling of the ECM is required for organogenesis, and to prevent assembly of excess or ectopic ECM protein during growth. MMPs are not essential for normal growth of the Drosophila heart.
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Affiliation(s)
- C J R Hughes
- Dept. Biology, McMaster University, Hamilton, Canada.
| | - S Turner
- Dept. Biology, McMaster University, Hamilton, Canada.
| | - R M Andrews
- Dept. Biology, McMaster University, Hamilton, Canada.
| | - A Vitkin
- Dept. Biomedical Physics, University of Toronto, Toronto, Cananda.
| | - J R Jacobs
- Dept. Biology, McMaster University, Hamilton, Canada.
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20
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Vaz Nery S, Traub RJ, McCarthy JS, Clarke NE, Amaral S, Llewellyn S, Weking E, Richardson A, Campbell SJ, Gray DJ, Vallely AJ, Williams GM, Andrews RM, Clements ACA. WASH for WORMS: A Cluster-Randomized Controlled Trial of the Impact of a Community Integrated Water, Sanitation, and Hygiene and Deworming Intervention on Soil-Transmitted Helminth Infections. Am J Trop Med Hyg 2020; 100:750-761. [PMID: 30628573 DOI: 10.4269/ajtmh.18-0705] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Water, sanitation, and hygiene (WASH) interventions have been proposed as an important complement to deworming programs for sustainable control of soil-transmitted helminth (STH) infections. We aimed to determine whether a community-based WASH program had additional benefits in reducing STH infections compared with community deworming alone. We conducted the WASH for WORMS cluster-randomized controlled trial in 18 rural communities in Timor-Leste. Intervention communities received a WASH intervention that provided access to an improved water source, promoted improved household sanitation, and encouraged handwashing with soap. All eligible community members in intervention and control arms received albendazole every 6 months for 2 years. The primary outcomes were infection with each STH, measured using multiplex real-time quantitative polymerase chain reaction. We compared outcomes between study arms using generalized linear mixed models, accounting for clustering at community, household, and individual levels. At study completion, the integrated WASH and deworming intervention did not have an effect on infection with Ascaris spp. (relative risk [RR] 2.87, 95% confidence interval [CI]: 0.66-12.48, P = 0.159) or Necator americanus (RR 0.99, 95% CI: 0.52-1.89, P = 0.987), compared with deworming alone. At the last follow-up, open defecation was practiced by 66.1% (95% CI: 54.2-80.2) of respondents in the control arm versus 40.2% (95% CI: 25.3-52.6) of respondents in the intervention arm (P = 0.005). We found no evidence that the WASH intervention resulted in additional reductions in STH infections beyond that achieved with deworming alone over the 2-year trial period. The role of WASH on STH infections over a longer period of time and in the absence of deworming remains to be determined.
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Affiliation(s)
- Susana Vaz Nery
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia.,Research School of Population Health, Australian National University, Canberra, Australia
| | - Rebecca J Traub
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, Australia
| | - James S McCarthy
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Naomi E Clarke
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Salvador Amaral
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Stacey Llewellyn
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - Alice Richardson
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Suzy J Campbell
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Darren J Gray
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Andrew J Vallely
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
| | - Gail M Williams
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.,Research School of Population Health, Australian National University, Canberra, Australia
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Perth, Australia.,Research School of Population Health, Australian National University, Canberra, Australia
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21
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Katelaris AL, Andrews RM, McAnulty J. The impact of rapid molecular diagnostic testing for respiratory viruses on outcomes for emergency department patients. Med J Aust 2019; 212:94-94.e1. [PMID: 31821557 DOI: 10.5694/mja2.50443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Anthea L Katelaris
- Health Protection NSW, Sydney, NSW.,National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
| | - Ross M Andrews
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT.,Menzies School of Health Research, Charles Darwin University, Tiwi, NT
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22
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Aw JYH, Clarke NE, McCarthy JS, Traub RJ, Amaral S, Huque MH, Andrews RM, Gray DJ, Clements ACA, Vaz Nery S. Giardia duodenalis infection in the context of a community-based deworming and water, sanitation and hygiene trial in Timor-Leste. Parasit Vectors 2019; 12:491. [PMID: 31627736 PMCID: PMC6798381 DOI: 10.1186/s13071-019-3752-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 08/07/2019] [Accepted: 10/14/2019] [Indexed: 12/26/2022] Open
Abstract
Background Giardiasis is a common diarrhoeal disease caused by the protozoan Giardia duodenalis. It is prevalent in low-income countries in the context of inadequate access to water, sanitation and hygiene (WASH), and is frequently co-endemic with neglected tropical diseases such as soil-transmitted helminth (STH) infections. Large-scale periodic deworming programmes are often implemented in these settings; however, there is limited evidence for the impact of regular anthelminthic treatment on G. duodenalis infection. Additionally, few studies have examined the impact of WASH interventions on G. duodenalis. Methods The WASH for WORMS cluster randomised controlled trial was conducted in remote communities in Manufahi municipality, Timor-Leste, between 2012 and 2016. All study communities received four rounds of deworming with albendazole at six-monthly intervals. Half were randomised to additionally receive a community-level WASH intervention following study baseline. We measured G. duodenalis infection in study participants every six months for two years, immediately prior to deworming, as a pre-specified secondary outcome of the trial. WASH access and behaviours were measured using questionnaires. Results There was no significant change in G. duodenalis prevalence in either study arm between baseline and the final study follow-up. We found no additional benefit of the community-level WASH intervention on G. duodenalis infection (relative risk: 1.05, 95% CI: 0.72–1.54). Risk factors for G. duodenalis infection included living in a household with a child under five years of age (adjusted odds ratio, aOR: 1.35, 95% CI: 1.04–1.75), living in a household with more than six people (aOR: 1.32, 95% CI: 1.02–1.72), and sampling during the rainy season (aOR: 1.23, 95% CI: 1.04–1.45). Individuals infected with the hookworm Necator americanus were less likely to have G. duodenalis infection (aOR: 0.71, 95% CI: 0.57–0.88). Conclusions Prevalence of G. duodenalis was not affected by a community WASH intervention or by two years of regular deworming with albendazole. Direct household contacts appear to play a dominant role in driving transmission. We found evidence of antagonistic effects between G. duodenalis and hookworm infection, which warrants further investigation in the context of global deworming efforts. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12614000680662. Registered 27 June 2014, retrospectively registered. https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366540.![]()
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Affiliation(s)
- Jessica Y H Aw
- Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Naomi E Clarke
- Research School of Population Health, Australian National University, Canberra, ACT, Australia. .,The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW, Australia.
| | - James S McCarthy
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Rebecca J Traub
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Salvador Amaral
- Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Md Hamidul Huque
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW, Australia
| | - Ross M Andrews
- Research School of Population Health, Australian National University, Canberra, ACT, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Darren J Gray
- Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Archie C A Clements
- Research School of Population Health, Australian National University, Canberra, ACT, Australia.,Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Susana Vaz Nery
- Research School of Population Health, Australian National University, Canberra, ACT, Australia.,The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW, Australia
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23
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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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McHugh L, Binks MJ, Gao Y, Andrews RM, Ware RS, Snelling T, Kildea S. Influenza vaccination in pregnancy among a group of remote dwelling Aboriginal and Torres Strait Islander mothers in the Northern Territory: The 1+1 Healthy Start to Life study. ACTA ACUST UNITED AC 2019; 43. [PMID: 31426733 DOI: 10.33321/cdi.2019.43.33] [Citation(s) in RCA: 4] [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] [Indexed: 12/11/2022]
Abstract
Remote-living Aboriginal and Torres Strait Islander women experience a higher burden of influenza infection during pregnancy than any other Australian women. Despite recommendations of inactivated influenza vaccination (IIV) in pregnancy, uptake and safety data are scarce for this population. We examined uptake of IIV in pregnancy and report adverse birth outcomes amongst a predominantly unvaccinated group of remote-living Aboriginal and Torres Strait Islander women from the Northern Territory (NT), using data from the 1+1 Healthy Start to Life study. Data were deterministically linked with the NT Immunisation Register to ascertain IIV exposure in pregnant women during 2003-2006 and 2009-2011 inclusive. Overall, IIV uptake in pregnancy was 3% (n=20/697 pregnancies); 0% (0/414) pre-influenza A(H1N1)pdm09 and 7% (20/293) post-influenza A(H1N1)pdm09 (2009-2011). Vaccine uptake was poor in this cohort and it is unclear at what stage this policy failure occurred. Women with known comorbidities and/or high risk factors were not targeted for vaccination. Much larger study participant numbers are required to validate between group comparisons but there was no clinically nor statistically significant difference in median gestational ages (38 weeks for both groups), mean infant birthweights (3,001 g unvaccinated vs 3,175 g IIV vaccinated), nor birth outcomes between the few women who received IIV in pregnancy and those who did not. There were no stillbirths in women who received an IIV in pregnancy.
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Affiliation(s)
- Lisa McHugh
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
| | - Michael J Binks
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
| | - Yu Gao
- Mater Midwifery Research Unit - University of Queensland, Women's Health and Newborn Services (Maternity) Mater Health Service; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia; Applied Epidemiology Program, National Centre for Epidemiology & Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Tom Snelling
- Infectious Disease Implementation Research, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia; Perth Children's Hospital, Perth, Western Australia, Australia; Curtin University, School of Public Health, Perth, Western Australia, Australia
| | - Sue Kildea
- Mater Research Institute - University of Queensland, Women's Health and Newborn Services (Maternity) Mater Health Service; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia
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McHugh L, Crooks K, Creighton A, Binks M, Andrews RM. Safety, equity and monitoring: a review of the gaps in maternal vaccination strategies for Aboriginal and Torres Strait Islander women. Hum Vaccin Immunother 2019; 16:371-376. [PMID: 31368832 DOI: 10.1080/21645515.2019.1649552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Influenza and pertussis infections are disproportionately higher among Aboriginal and Torres Strait Islander women and their infants compared to other Australians. These infections are potentially preventable through vaccination in pregnancy; however, there is a lack of systematic monitoring and therefore knowledge of vaccine uptake, safety and effectiveness in Australia, and specifically among Aboriginal and Torres Strait Islander women. The limited data available suggest there is a lower uptake of maternal vaccination among Aboriginal and Torres Strait Islander women compared to non-Aboriginal and Torres Strait Islander women, and this review seeks to explore potential reasons and the knowledge gaps in this regard. Other key gaps include the equitable access to quality antenatal care for Aboriginal and Torres Strait Islander women; and pregnancy loss <20 weeks gestation. Furthermore, our review highlights the importance of addressing these gaps in maternal vaccination strategies in partnership with Aboriginal and Torres Strait Islander peoples.
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Affiliation(s)
- Lisa McHugh
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
| | - Kristy Crooks
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia.,Hunter New England Local Health District, Population Health, Wallsend, New South Wales, Australia
| | - Amy Creighton
- Hunter New England Local Health District, Population Health, Wallsend, New South Wales, Australia
| | - Michael Binks
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia.,Department of Population Health, National Centre for Epidemiology, Australian National University, Canberra, Australian Capital Territory, Australia
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Romani L, Whitfeld MJ, Koroivueta J, Kama M, Wand H, Tikoduadua L, Tuicakau M, Koroi A, Andrews RM, Kaldor JM, Steer AC. Mass Drug Administration for Scabies - 2 Years of Follow-up. N Engl J Med 2019; 381:186-187. [PMID: 31242358 DOI: 10.1056/nejmc1808439] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Lucia Romani
- University of New South Wales, Sydney, NSW, Australia
| | | | - Josefa Koroivueta
- Fiji Ministry of Women, Children and Poverty Alleviation, Suva, Fiji
| | - Mike Kama
- Fiji Ministry of Health and Medical Services, Suva, Fiji
| | - Handan Wand
- University of New South Wales, Sydney, NSW, Australia
| | | | | | - Aminiasi Koroi
- Fiji Ministry of Health and Medical Services, Suva, Fiji
| | - Ross M Andrews
- Menzies School of Health Research, Darwin, NT, Australia
| | - John M Kaldor
- University of New South Wales, Sydney, NSW, Australia
| | - Andrew C Steer
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
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McHugh L, Binks M, Ware RS, Snelling T, Nelson S, Nelson J, Dunbar M, Mulholland EK, Andrews RM. Birth outcomes in Aboriginal mother-infant pairs from the Northern Territory, Australia, who received 23-valent polysaccharide pneumococcal vaccination during pregnancy, 2006-2011: The PneuMum randomised controlled trial. Aust N Z J Obstet Gynaecol 2019; 60:82-87. [PMID: 31198999 DOI: 10.1111/ajo.13002] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 04/23/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Pregnant women and infants <6 months old have a high baseline risk for pneumococcal disease compared to the general population, particularly among Indigenous populations living in poverty and low-resource settings. Efficacy trials of pneumococcal vaccination in pregnancy examining adverse birth outcomes are lacking. AIMS We report adverse birth events as secondary outcomes from the 'PneuMum' randomised controlled trial of 23-valent pneumococcal polysaccharide vaccination (23vPPV) in pregnancy (August 2006-January 2011). MATERIALS AND METHODS Australian Aboriginal women aged 17-39 years with singleton uncomplicated pregnancies were randomised (1:2 ratio) to receive 23vPPV or no 23vPPV in pregnancy at 30-36 weeks gestation. We compared risks of stillbirth, preterm birth, low birthweight (LBW), and small for gestational age (SGA) between vaccinated and unvaccinated pregnant women. Cox proportional hazard ratios (HRs) were calculated on an intention-to-treat basis. RESULTS Among 227 enrolled participants, 75 (33%) received 23vPPV in pregnancy. Risk differences in adverse birth outcomes between 23vPPV vaccinated and unvaccinated pregnant women were; preterm birth 9% vs 4% (HR 2.79; 95% CI 0.94-8.32) P = 0.07; LBW 9% vs 5% (HR 2.09; 95% CI 0.76-5.78) P = 0.15; and SGA 15% vs 17% (HR 1.02; 95% CI 0.50-2.06) P = 0.96. There were no stillbirths. CONCLUSIONS We found a numerically higher rate of preterm births among women who received 23vPPV in pregnancy compared to unvaccinated pregnant women. Although further investigation with larger participant numbers is needed to better evaluate this safety signal, the contribution of safety results from smaller studies using appropriate data analysis methodologies is critical, particularly as more clinical trials in pneumococcal vaccination in pregnancy are progressing.
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Affiliation(s)
- Lisa McHugh
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
| | - Michael Binks
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Tom Snelling
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Sandra Nelson
- Top End Health Service, Top End West, Northern Territory, Australia
| | - Jane Nelson
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
| | - Melissa Dunbar
- Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, Inala, Queensland, Australia
| | - E Kim Mulholland
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,London School of Hygiene and Tropical Medicine, London, UK
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia.,National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
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28
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Vaz Nery S, Clarke NE, Richardson A, Traub R, McCarthy JS, Gray DJ, Vallely AJ, Williams GM, Andrews RM, Campbell SJ, Clements ACA. Risk factors for infection with soil-transmitted helminths during an integrated community level water, sanitation, and hygiene and deworming intervention in Timor-Leste. Int J Parasitol 2019; 49:389-396. [PMID: 30802450 DOI: 10.1016/j.ijpara.2018.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 08/08/2018] [Revised: 12/10/2018] [Accepted: 12/12/2018] [Indexed: 01/21/2023]
Abstract
Water, sanitation and hygiene interventions have been advocated as important complements to deworming programs to improve soil-transmitted helminth control. Evidence for the impact of water, sanitation and hygiene on soil-transmitted helminth infections is mixed, and based mainly on cross-sectional studies. In this study, we assessed associations between individual- and household-level water, sanitation and hygiene variables and soil-transmitted helminth infections, using data collected during the 2 year follow-up study period of the WASH for WORMS randomised controlled trial in Timor-Leste. Data were collected across four surveys, conducted at 6 monthly intervals in 23 communities. We analysed water, sanitation and hygiene and sociodemographic variables as risk factors for infection with Necator americanus, Ascaris spp., and undifferentiated soil-transmitted helminth infection, using generalised linear mixed models to account for clustering at community, household and participant levels. Water, sanitation and hygiene risk factors were examined both concurrently and with a 6 month lag period that coincided with the most recent deworming. The analysis included 2333 participants. Factors associated with N. americanus infection included age group, male sex (adjusted odds ratio (aOR) 3.1, 95% confidence interval (CI) 2.4-4.2), working as a farmer (aOR 1.7, 95% CI 1.2-2.4), and completing secondary school or higher (aOR 0.29, 95% CI 0.16-0.53). Risk factors for Ascaris spp. infection included age group, living in a dwelling with more than six people (aOR 1.6, 95% CI 1.1-2.3), having a tube well or borehole as the household water source (aOR 3.7, 95% CI 1.3-10.8), and using a latrine shared between households 6 months previously (aOR 2.3, 95% CI 1.2-4.3). Handwashing before eating was protective against infection with any soil-transmitted helminth (aOR 0.79, 95% CI 0.65-0.95). In the context of regular deworming, few water, sanitation and hygiene-related factors were associated with soil-transmitted helminth infections. Future research examining the role of water, sanitation and hygiene in soil-transmitted helminth transmission is required, particularly in low transmission settings after cessation of deworming. Identifying improved indicators for measuring water, sanitation and hygiene behaviours is also a key priority.
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Affiliation(s)
- Susana Vaz Nery
- Research School of Population Health, Australian National University, Canberra ACT 0200, Australia.
| | - Naomi E Clarke
- Research School of Population Health, Australian National University, Canberra ACT 0200, Australia
| | - Alice Richardson
- Research School of Population Health, Australian National University, Canberra ACT 0200, Australia
| | - Rebecca Traub
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, VIC 3052, Australia
| | - James S McCarthy
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia; School of Medicine, University of Queensland, Brisbane, QLD 4006, Australia
| | - Darren J Gray
- Research School of Population Health, Australian National University, Canberra ACT 0200, Australia
| | - Andrew J Vallely
- Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
| | - Gail M Williams
- School of Public Health, University of Queensland, Brisbane, QLD 4006, Australia
| | - Ross M Andrews
- Research School of Population Health, Australian National University, Canberra ACT 0200, Australia; Menzies School of Health Research, Charles Darwin University, Darwin, NT 0811, Australia
| | - Suzy J Campbell
- Research School of Population Health, Australian National University, Canberra ACT 0200, Australia
| | - Archie C A Clements
- Research School of Population Health, Australian National University, Canberra ACT 0200, Australia
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29
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Cuningham W, McVernon J, Lydeamore MJ, Andrews RM, Carapetis J, Kearns T, Clucas D, Dhurrkay RG, Tong SYC, Campbell PT. High burden of infectious disease and antibiotic use in early life in Australian Aboriginal communities. Aust N Z J Public Health 2019; 43:149-155. [PMID: 30727032 DOI: 10.1111/1753-6405.12876] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/01/2018] [Accepted: 12/01/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To quantify the childhood infectious disease burden and antibiotic use in the Northern Territory's East Arnhem region through synthesis and analysis of historical data resources. METHODS We combined primary health clinic data originally reported in three separate publications stemming from the East Arnhem Healthy Skin Project (Jan-01 to Sep-07). Common statistical techniques were used to explore the prevalence of infectious conditions and the seasonality of infections, and to measure rates of antibiotic use. RESULTS There was a high monthly prevalence of respiratory (mean: 32% [95% confidence interval (CI): 20%, 34%]) and skin (mean: 20% [95%CI: 19%, 22%]) infectious syndromes, with upper respiratory tract infections (mean: 29% [95%CI: 27%, 31%]) and skin sores (mean: 15% [95%CI: 14%, 17%]) the most common conditions. Antibiotics were frequently prescribed with 95% (95%CI: 91%, 97%) of children having received at least one antibiotic prescription by their first birthday, and 47% having received six antibiotic prescriptions; skin sores being a key driver. CONCLUSIONS Early life infections drive high antibiotic prescribing rates in remote Aboriginal communities. Implications for public health: Eliminating skin disease could reduce antibiotic use by almost 20% in children under five years of age in this population.
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Affiliation(s)
- Will Cuningham
- Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute for Infection and Immunity, The Royal Melbourne Hospital and The University of Melbourne, Victoria.,Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Jodie McVernon
- Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute for Infection and Immunity, The Royal Melbourne Hospital and The University of Melbourne, Victoria.,Melbourne School of Population and Global Health, The University of Melbourne, Victoria
| | - Michael J Lydeamore
- School of Mathematics and Statistics, The University of Melbourne, Victoria.,Murdoch Children's Research Institute, The Royal Children's Hospital, Victoria
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Northern Territory.,National Centre for Epidemiology and Population Health, Australian National University, Australian Capital Territory
| | - Jonathan Carapetis
- Telethon Kids Institute, The University of Western Australia and Princess Margaret Hospital for Children, Western Australia
| | - Therese Kearns
- Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Danielle Clucas
- Clinical Haematology, The Alfred Hospital and Monash Medical Centre, Victoria
| | | | - Steven Y C Tong
- Menzies School of Health Research, Charles Darwin University, Northern Territory.,Victorian Infectious Diseases Service, The Royal Melbourne Hospital, and Doherty Department University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Victoria
| | - Patricia T Campbell
- Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute for Infection and Immunity, The Royal Melbourne Hospital and The University of Melbourne, Victoria.,Murdoch Children's Research Institute, The Royal Children's Hospital, Victoria
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30
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May PJ, Tong SYC, Steer AC, Currie BJ, Andrews RM, Carapetis JR, Bowen AC. Treatment, prevention and public health management of impetigo, scabies, crusted scabies and fungal skin infections in endemic populations: a systematic review. Trop Med Int Health 2019; 24:280-293. [PMID: 30582783 PMCID: PMC6850630 DOI: 10.1111/tmi.13198] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We conducted a systematic review of the treatment, prevention and public health control of skin infections including impetigo, scabies, crusted scabies and tinea in resource‐limited settings where skin infections are endemic. The aim is to inform strategies, guidelines and research to improve skin health in populations that are inequitably affected by infections of the skin and the downstream consequences of these. The systematic review is reported according to the PRISMA statement. From 1759 titles identified, 81 full text studies were reviewed and key findings outlined for impetigo, scabies, crusted scabies and tinea. Improvements in primary care and public health management of skin infections will have broad and lasting impacts on overall quality of life including reductions in morbidity and mortality from sepsis, skeletal infections, kidney and heart disease.
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Affiliation(s)
- Philippa J May
- Northern Territory Centre for Disease Control, Casuarina, Australia
| | - Steven Y C Tong
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Parkville, Australia.,Menzies School of Health Research, Charles Darwin University, Casuarina, Australia
| | - Andrew C Steer
- Royal Children's Hospital, Parkville, Australia.,Murdoch Children's Research Institute, University of Melbourne, Parkville, Australia
| | - Bart J Currie
- Menzies School of Health Research, Charles Darwin University, Casuarina, Australia.,Royal Darwin Hospital, Casuarina, Australia
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Casuarina, Australia.,National Centre for Epidemiology & Population Health, Australian National University, Canberra, Australia
| | - Jonathan R Carapetis
- Perth Children's Hospital, Nedlands, Australia.,Wesfarmers Centre for Vaccines and Infectious Diseases, University of Western Australia, Nedlands, Australia.,School of Medicine, University of Western Australia, Nedlands, Australia
| | - Asha C Bowen
- Menzies School of Health Research, Charles Darwin University, Casuarina, Australia.,Perth Children's Hospital, Nedlands, Australia.,Wesfarmers Centre for Vaccines and Infectious Diseases, University of Western Australia, Nedlands, Australia.,School of Medicine, University of Western Australia, Nedlands, Australia.,University of Notre Dame Australia, Fremantle, Australia
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31
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McNamara GI, Creeth HDJ, Harrison DJ, Tansey KE, Andrews RM, Isles AR, John RM. Loss of offspring Peg3 reduces neonatal ultrasonic vocalizations and increases maternal anxiety in wild-type mothers. Hum Mol Genet 2019; 27:440-450. [PMID: 29186532 PMCID: PMC5886183 DOI: 10.1093/hmg/ddx412] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 11/13/2017] [Accepted: 11/21/2017] [Indexed: 12/22/2022] Open
Abstract
Depression and anxiety are the most common mental health conditions during pregnancy and can impair the normal development of mother-infant interactions. These adversities are associated with low birth weight and increased risk of behavioural disorders in children. We recently reported reduced expression of the imprinted gene PATERNALLY EXPRESSED GENE 3 (PEG3) in placenta of human infants born to depressed mothers. Expression of Peg3 in the brain has previously been linked maternal behaviour in rodents, at least in some studies, with mutant dams neglecting their pups. However, in our human study decreased expression was in the placenta derived from the fetus. Here, we examined maternal behaviour in response to reduced expression of Peg3 in the feto-placental unit. Prenatally we found novelty reactivity was altered in wild-type females carrying litters with a null mutation in Peg3. This behavioural alteration was short-lived and there were no significant differences the transcriptomes of either the maternal hypothalamus or hippocampus at E16.5. In contrast, while maternal gross maternal care was intact postnatally, the exposed dams were significantly slower to retrieve their pups and displayed a marked increase in anxiety. We also observed a significant reduction in the isolation-induced ultrasonic vocalizations (USVs) emitted by mutant pups separated from their mothers. USVs are a form of communication known to elicit maternal care suggesting Peg3 mutant pups drive the deficit in maternal behaviour. These data support the hypothesis that reduced placental PEG3 in human pregnancies occurs as a consequence of prenatal depression but leaves scope for feto-placental Peg3 dosage, during gestation, influencing aspects of maternal behaviour.
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Affiliation(s)
- G I McNamara
- Biomedicine Division, School of Biosciences, Cardiff University, Cardiff CF10 3AX, UK
| | - H D J Creeth
- Biomedicine Division, School of Biosciences, Cardiff University, Cardiff CF10 3AX, UK
| | - D J Harrison
- Biomedicine Division, School of Biosciences, Cardiff University, Cardiff CF10 3AX, UK
| | - K E Tansey
- Core Bioinformatics and Statistics Team, College of Biomedical & Life Sciences
| | - R M Andrews
- Systems Immunity University Research Institute, Cardiff University, Cardiff CF10 3XQ, UK
| | - A R Isles
- MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - R M John
- Biomedicine Division, School of Biosciences, Cardiff University, Cardiff CF10 3AX, UK
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McMillan M, Walters L, Mark T, Lawrence A, Leong LEX, Sullivan T, Rogers GB, Andrews RM, Marshall HS. B Part of It study: a longitudinal study to assess carriage of Neisseria meningitidis in first year university students in South Australia. Hum Vaccin Immunother 2019; 15:987-994. [PMID: 30513251 PMCID: PMC6605849 DOI: 10.1080/21645515.2018.1551672] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objectives:N. meningitidis carriage in Australia is poorly understood. This study aimed to estimate prevalence and risk factors for carriage of N. meningitidis in South Australian university students. We also sought to identify whether delayed freezing of oropharyngeal samples altered PCR positivity, cycle threshold, or culture positivity. Methods: Oropharyngeal swabs were taken from first year university students and repeated after 3 months, with risk factor questionnaires completed at both visits. Specimens were subjected to real-time PCR screening for the presence of specific meningococcal DNA. Results: The study enrolled 421 individuals, 259 returned at 3 months. At baseline, 56% of participants were female and 1.9% smokers. Carriage of N. meningitidis at baseline was 6.2% (95% CI, [4.2%, 8.9%]). Visiting a bar more than once a week (OR 9.07; [2.44, 33.72]) and intimate kissing (OR 4.37; [1.45, 13.14]) were associated with increased carriage. After imputing missing data, the point estimate for carriage at 3 months was 8.6% compared to 6.2% at baseline (OR 1.42; 0.91 to 2.20). Recovery of N. meningitidis on selective agar was significantly reduced in cryovials frozen at 48 hours compared to 6 hours (24/26, 92.3% vs. 14/26, 53.9%, p = 0.002). Conclusion: Attending bars and engaging in intimate kissing is associated with oropharyngeal carriage in South Australian university students. Adolescent meningococcal vaccine programs should be implemented at school, prior to increased attendance at bars, intimate contact, and carriage acquisition. Delaying freezing of oropharyngeal specimens longer than 16 hours reduces yield of N. meningitidis by culture but not PCR detection.
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Affiliation(s)
- Mark McMillan
- a Vaccinology and Immunology Research Trials Unit , Women's and Children's Health Network , Adelaide , SA , Australia.,b Robinson Research Institute and Adelaide Medical School , The University of Adelaide , Adelaide , SA , Australia
| | - Luke Walters
- c Microbiology and Infectious Diseases Directorate , SA Pathology , Adelaide , SA , Australia
| | - Turra Mark
- c Microbiology and Infectious Diseases Directorate , SA Pathology , Adelaide , SA , Australia
| | - Andrew Lawrence
- c Microbiology and Infectious Diseases Directorate , SA Pathology , Adelaide , SA , Australia
| | - Lex E X Leong
- d South Australian Health & Medical Research Institute (SAHMRI) , Adelaide , SA , Australia
| | - Thomas Sullivan
- e School of Public Health , The University of Adelaide , Adelaide , SA , Australia
| | - Geraint B Rogers
- d South Australian Health & Medical Research Institute (SAHMRI) , Adelaide , SA , Australia
| | - Ross M Andrews
- f Menzies School of Health Research , Charles Darwin University , Darwin , Northern Territory , Australia.,g National Centre for Epidemiology & Population Health , Australian National University , Canberra , Australian Capital Territory , Australia
| | - Helen S Marshall
- a Vaccinology and Immunology Research Trials Unit , Women's and Children's Health Network , Adelaide , SA , Australia.,b Robinson Research Institute and Adelaide Medical School , The University of Adelaide , Adelaide , SA , Australia
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33
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Binks MJ, Moberley SA, Balloch A, Leach AJ, Nelson S, Hare KM, Wilson C, Nelson J, Morris PS, Ware RS, Tang MLK, Torzillo PJ, Carapetis JR, Mulholland K, Andrews RM. Impact of the 23-valent pneumococcal polysaccharide vaccination in pregnancy against infant acute lower respiratory infections in the Northern Territory of Australia. Pneumonia (Nathan) 2018; 10:13. [PMID: 30603376 PMCID: PMC6305569 DOI: 10.1186/s41479-018-0057-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 11/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Indigenous children in Australia's Northern Territory are densely colonised with the pneumococcus within weeks of birth antecedent to a high prevalence of acute lower respiratory infection (ALRI). We assessed the impact of the 23-valent pneumococcal polysaccharide vaccine (23vPPV) in pregnancy against infant ALRI in this setting. METHODS In an open label, allocation concealed, outcome-assessor blinded, randomised controlled trial conducted in the Northern Territory of Australia, healthy Indigenous women aged 17-39 years were randomised to receive the 23vPPV during pregnancy (n = 75; 30-36 weeks gestation), at birth (n = 75), or at 7 months post-partum (n = 77). Randomisation was stratified by community of residence. In a secondary analysis, we compared the incidence of ALRI hospitalisations and ALRI clinic presentations (ascertained from electronic medical records) among infants of pregnancy vaccinees versus infants of mothers not vaccinated in pregnancy (controls) in the first year of life. RESULTS ALRI hospitalisation incidence was 12.3 per 100 child-years among infants of pregnancy vaccinees compared with 15.8 per 100 child-years among controls (hazard ratio (HR) 0.77, 95%CI 0.29-2.03). ALRI hospitalisations were more common among remote compared to urban infants (27.7 versus 8.6 per 100 child-years). Stratification by dwelling highlighted a differential antenatal vaccine effect against ALRI hospitalisations (urban HR 2.45, 95%CI 0.60-9.99; remote HR 0.21, 95%CI 0.04-1.08). ALRI clinic presentation incidence was similar among infants of pregnancy vaccinees and controls. CONCLUSIONS In this small study, antenatal 23vPPV vaccination was not associated with a reduced incidence of infant ALRI hospitalisations or ALRI clinic presentations during the first year of life. A potential differential effect between urban and remote settings warrants further investigation. TRIAL REGISTRATION PneuMum; ClinicalTrials.gov NCT00714064.
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Affiliation(s)
- Michael J. Binks
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory 0810 Australia
| | - Sarah A. Moberley
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory 0810 Australia
| | - Anne Balloch
- Murdoch Children’s Research Institute, University of Melbourne, Royal Children’s Hospital, Melbourne, Victoria Australia
| | - Amanda J. Leach
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory 0810 Australia
| | - Sandra Nelson
- Department of Health and Families, Darwin, Northern Territory Australia
| | - Kim M. Hare
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory 0810 Australia
| | - Cate Wilson
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory 0810 Australia
| | - Jane Nelson
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory 0810 Australia
| | - Peter S. Morris
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory 0810 Australia
| | - Robert S. Ware
- Menzies Health Institute Queensland, Griffith University, Gold Coast; Child Health Research Centre, School of Medicine, The University of Queensland, Queensland, Brisbane, Australia
| | - Mimi L. K. Tang
- Murdoch Children’s Research Institute, University of Melbourne, Royal Children’s Hospital, Melbourne, Victoria Australia
| | | | - Jonathan R. Carapetis
- Telethon Kids Institute, University of Western Australia, Perth Children’s Hospital, Perth, Western Australia Australia
| | - Kim Mulholland
- Murdoch Children’s Research Institute, University of Melbourne, Royal Children’s Hospital, Melbourne, Victoria Australia
| | - Ross M. Andrews
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory 0810 Australia
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory Australia
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34
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Lydeamore MJ, Campbell PT, Regan DG, Tong SYC, Andrews RM, Steer AC, Romani L, Kaldor JM, McVernon J, McCaw JM. A biological model of scabies infection dynamics and treatment informs mass drug administration strategies to increase the likelihood of elimination. Math Biosci 2018; 309:163-173. [PMID: 30149021 DOI: 10.1016/j.mbs.2018.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 05/11/2018] [Accepted: 08/18/2018] [Indexed: 11/18/2022]
Abstract
Infections with Sarcoptes scabiei, or scabies, remain common in many disadvantaged populations. Mass drug administration (MDA) has been used in such settings to achieve a rapid reduction in infection and transmission, with the goal of eliminating the public health burden of scabies. While prevalence has been observed to fall substantially following such an intervention, in some instances resurgence of infection to baseline levels has occurred over several years. To explore the biology underpinning this phenomenon, we have developed a theoretical model of scabies life-cycle and transmission dynamics in a homogeneously mixing population, and simulate the impact of mass drug treatment strategies acting on egg and mite life cycle stages (ovicidal) or mites alone (non-ovicidal). In order to investigate the dynamics of the system, we first define and calculate the optimal interval between treatment doses. We calculate the probability of eradication as a function of the number of optimally-timed successive treatment doses and the number of years over which a program is run. For the non-ovicidal intervention, we first show that at least two optimally-timed doses are required to achieve eradication. We then demonstrate that while more doses over a small number of years provides the highest chance of eradication, a similar outcome can be achieved with fewer doses delivered annually over a longer period of time. For the ovicidal intervention, we find that doses should be delivered as close together as possible. This work provides a platform for further research into optimal treatment strategies which may incorporate heterogeneity of transmission, and the interplay between MDA and enhancement of continuing scabies surveillance and treatment strategies.
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Affiliation(s)
- M J Lydeamore
- School of Mathematics and Statistics, The University of Melbourne, Australia; Murdoch Childrens Research Institute, The Royal Children's Hospital, Melbourne, Australia
| | - P T Campbell
- Peter Doherty Institute for Infection and Immunity, The Royal Melbourne Hospital and The University of Melbourne, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Australia; Murdoch Childrens Research Institute, The Royal Children's Hospital, Melbourne, Australia
| | - D G Regan
- Kirby Institute, University of New South Wales, UNSW, Australia
| | - S Y C Tong
- Peter Doherty Institute for Infection and Immunity, The Royal Melbourne Hospital and The University of Melbourne, Australia; Menzies School of Health Research, Charles Darwin University, Australia
| | - R M Andrews
- Menzies School of Health Research, Charles Darwin University, Australia; National Centre for Epidemiology & Population Health, Australian National University, Australia
| | - A C Steer
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Melbourne, Australia
| | - L Romani
- Kirby Institute, University of New South Wales, UNSW, Australia
| | - J M Kaldor
- Kirby Institute, University of New South Wales, UNSW, Australia
| | - J McVernon
- Peter Doherty Institute for Infection and Immunity, The Royal Melbourne Hospital and The University of Melbourne, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Australia; Murdoch Childrens Research Institute, The Royal Children's Hospital, Melbourne, Australia
| | - J M McCaw
- School of Mathematics and Statistics, The University of Melbourne, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Australia; Peter Doherty Institute for Infection and Immunity, The Royal Melbourne Hospital and The University of Melbourne, Australia; Murdoch Childrens Research Institute, The Royal Children's Hospital, Melbourne, Australia.
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Aung PTZ, Cuningham W, Hwang K, Andrews RM, Carapetis JR, Kearns T, Clucas D, McVernon J, Simpson JA, Tong SY, Campbell PT. Scabies and risk of skin sores in remote Australian Aboriginal communities: A self-controlled case series study. PLoS Negl Trop Dis 2018; 12:e0006668. [PMID: 30044780 PMCID: PMC6078322 DOI: 10.1371/journal.pntd.0006668] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 08/06/2018] [Accepted: 07/09/2018] [Indexed: 11/21/2022] Open
Abstract
Background Skin sores caused by Group A streptococcus (GAS) infection are a major public health problem in remote Aboriginal communities. Skin sores are often associated with scabies, which is evident in scabies intervention programs where a significant reduction of skin sores is seen after focusing solely on scabies control. Our study quantifies the strength of association between skin sores and scabies among Aboriginal children from the East Arnhem region in the Northern Territory. Methods and results Pre-existing datasets from three published studies, which were conducted as part of the East Arnhem Healthy Skin Project (EAHSP), were analysed. Aboriginal children were followed from birth up to 4.5 years of age. Self-controlled case series design was used to determine the risks, within individuals, of developing skin sores when infected with scabies versus when there was no scabies infection. Participants were 11.9 times more likely to develop skin sores when infected with scabies compared with times when no scabies infection was evident (Incidence Rate Ratio (IRR) 11.9; 95% CI 10.3–13.7; p<0.001), and this was similar across the five Aboriginal communities. Children had lower risk of developing skin sores at age ≤1 year compared to at age >1 year (IRR 0.8; 95% CI 0.7–0.9). Conclusion The association between scabies and skin sores is highly significant and indicates a causal relationship. The public health importance of scabies in northern Australia is underappreciated and a concerted approach is required to recognise and eliminate scabies as an important precursor of skin sores. Skin sores, also known as impetigo, are highly contagious bacterial skin infections, which are found commonly in school children and occasionally in adults. Skin sores are prevalent in disadvantaged or resource-poor settings. In Australia, about two thirds of Aboriginal children suffer from skin sores by their first birthday. If untreated or treated poorly, skin sores can eventually cause heart and kidney problems. It is also believed that scabies, another common skin infection in Aboriginal children, can increase the risk of developing skin sores by allowing the bacteria to enter the skin more easily through breaks in the skin. Our research explored the following: if scabies is a risk factor for skin sores then what is the strength of the association between the two conditions.
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Affiliation(s)
- Phyo Thu Zar Aung
- Victorian Infectious Disease Reference Laboratory, The Royal Melbourne Hospital and The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Will Cuningham
- Victorian Infectious Disease Reference Laboratory, The Royal Melbourne Hospital and The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Kerry Hwang
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Ross M. Andrews
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- National Centre for Epidemiology & Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Jonathan R. Carapetis
- Telethon Kids Institute, University of Western Australia and Perth Children’s Hospital, Perth, Western Australia, Australia
| | - Therese Kearns
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Danielle Clucas
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jodie McVernon
- Victorian Infectious Disease Reference Laboratory, The Royal Melbourne Hospital and The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, The Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Julie Ann Simpson
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Steven Y.C. Tong
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital and The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- * E-mail:
| | - Patricia Therese Campbell
- Victorian Infectious Disease Reference Laboratory, The Royal Melbourne Hospital and The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, The Royal Children’s Hospital, Melbourne, Victoria, Australia
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Vaz Nery S, Qi J, Llewellyn S, Clarke NE, Traub R, Gray DJ, Vallely AJ, Williams GM, Andrews RM, McCarthy JS, Clements ACA. Use of quantitative PCR to assess the efficacy of albendazole against Necator americanus and Ascaris spp. in Manufahi District, Timor-Leste. Parasit Vectors 2018; 11:373. [PMID: 29954461 PMCID: PMC6025744 DOI: 10.1186/s13071-018-2838-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 04/09/2018] [Indexed: 11/21/2022] Open
Abstract
Background Soil-transmitted helminths (STHs) including Ascaris lumbricoides, Necator americanus, Ancylostoma spp. and Trichuris trichiura are cause of significant global morbidity. To mitigate their disease burden, at-risk groups in endemic regions receive periodic mass drug administration using anthelmintics, most commonly albendazole and mebendazole. Assessing the efficacy of anthelmintic drugs is important for confirming that these regimens are working effectively and that drug resistance has not emerged. In this study we aimed to characterise the therapeutic efficacy of albendazole against Ascaris spp. and N. americanus in Timor-Leste, using a quantitative polymerase chain reaction (qPCR) method for parasite detection and quantification. Results A total of 314 participants from 8 communities in Timor-Leste provided stool samples before and 10–14 days after the administration of a single 400 mg dose of albendazole. Helminth infection status and infection intensity (measured in Ct-values and relative fluorescence units) were determined using qPCR. Efficacy was determined by examining the cure rates and infection intensity reduction rates. Albendazole was found to be highly efficacious against Ascaris spp., with a cure rate of 91.4% (95% CI: 85.9–95.2%) and infection intensity reduction rate of 95.6% (95% CI: 88.3–100%). The drug was less efficacious against N. americanus with a cure rate of 58.3% (95% CI: 51.4–64.9%) and infection intensity reduction rate of 88.9% (95% CI: 84.0–97.0%). Conclusions The observed cure rates and infection intensity reduction rates obtained for Ascaris spp. and to a lower extent N. americanus, demonstrate the continued efficacy of albendazole against these species and its utility as a mass chemotherapy agent in Timor-Leste. Furthermore, this study demonstrates the usefulness of qPCR as a method to measure the efficacy of anthelminthic drugs. Additional research is necessary to translate Ct-values into eggs per gram in a systematic way. Trial registration Australian and New Zealand Clinical Trials Registry 12614000680662 (registered 27 June 2014).
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Affiliation(s)
- Susana Vaz Nery
- Research School of Population Health, Australian National University, 62 Mills Rd, Canberra, 2601, ACT, Australia. .,Present Address: Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, 2052, NSW, Australia.
| | - Jessica Qi
- Medical School, Australian National University, Building 42, Canberra, ACT, 2601, Australia
| | - Stacey Llewellyn
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, 300 Herston Rd, Brisbane, QLD 4006, Australia
| | - Naomi E Clarke
- Research School of Population Health, Australian National University, 62 Mills Rd, Canberra, 2601, ACT, Australia
| | - Rebecca Traub
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, 3052, Australia
| | - Darren J Gray
- Research School of Population Health, Australian National University, 62 Mills Rd, Canberra, 2601, ACT, Australia
| | - Andrew J Vallely
- Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, 2052, NSW, Australia
| | - Gail M Williams
- School of Public Health, The University of Queensland, Corner of Herston Road and Wyndham Street, Brisbane, QLD 4006, Australia
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT 0811, Australia
| | - James S McCarthy
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, 300 Herston Rd, Brisbane, QLD 4006, Australia
| | - Archie C A Clements
- Research School of Population Health, Australian National University, 62 Mills Rd, Canberra, 2601, ACT, Australia
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McHugh L, Andrews RM, Ware RS. Birth outcomes for Australian mother-infant pairs who received an influenza vaccine during pregnancy 2012-2014: The FluMum study. Vaccine 2018; 35:4492-4493. [PMID: 28818441 DOI: 10.1016/j.vaccine.2017.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 05/31/2017] [Accepted: 06/02/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Lisa McHugh
- Centre for Child Development and Education, Menzies School of Health Research, Spring Hill, Brisbane 4000, Queensland, Australia. http://www.menzies.edu.au
| | - Ross M Andrews
- Centre for Child Development and Education, Menzies School of Health Research, Spring Hill, Brisbane 4000, Queensland, Australia
| | - Robert S Ware
- Centre for Child Development and Education, Menzies School of Health Research, Spring Hill, Brisbane 4000, Queensland, Australia
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Gidding HF, McCallum L, Fathima P, Moore HC, Snelling TL, Blyth CC, Jayasinghe S, Giele C, de Klerk N, Andrews RM, McIntyre PB. Effectiveness of a 3 + 0 pneumococcal conjugate vaccine schedule against invasive pneumococcal disease among a birth cohort of 1.4 million children in Australia. Vaccine 2018; 36:2650-2656. [PMID: 29627233 DOI: 10.1016/j.vaccine.2018.03.058] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 01/30/2018] [Revised: 03/16/2018] [Accepted: 03/21/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Most studies use indirect cohort or case-control methods to estimate vaccine effectiveness (VE) of 7- and 13-valent pneumococcal conjugate vaccines (PCV7 and PCV13) against invasive pneumococcal disease (IPD). Neither method can measure the benefit vaccination programs afford the unvaccinated and many studies were unable to estimate dose-specific VE. We linked Australia's national immunisation register with health data from two states to calculate IPD incidence by vaccination status and VE for a 3 + 0 PCV schedule (doses at 2, 4, 6 months, no booster) among a cohort of 1.4 million births. METHODS Births records for 2001-2012 were probabilistically linked to IPD notifications, hospitalisations, deaths, and vaccination history (available until December 2013). IPD rates in vaccinated and unvaccinated children <2 years old were compared using Cox proportional hazards models (adjusting for potential confounders), with VE = (1 - adjusted hazard ratio) × 100. Separate models were performed for all-cause, PCV7, PCV13 and PCV13-non-PCV7 serotype-specific IPD, and for Aboriginal and non-Aboriginal children. RESULTS Following introduction of universal PCV7 in 2005, rates of PCV7 serotype and all-cause IPD in unvaccinated children declined 89.5% and 61.4%, respectively, to be similar to rates in vaccinated children. Among non-Aboriginal children, VEs for 3 doses were 94.2% (95%CI: 81.9-98.1) for PCV7 serotype-specific IPD, 85.6% (95%CI: 60.5-94.8) for PCV13-non-PCV7 serotype-specific IPD and 80.1% (95%CI: 59.4-90.3) for all-cause IPD. There were no statistically significant differences between the VEs for 3 doses and for 1 or 2 doses against PCV13 and PCV13-non-PCV7 serotype-specific IPD, or between Aboriginal and non-Aboriginal children. CONCLUSION Our population-based cohort study demonstrates that >90% coverage in the first year of a universal 3 + 0 PCV program provided high population-level protection, predominantly attributable to strong herd effects. The size of the cohort enabled calculation of robust dose-specific VE estimates for important population sub-groups relevant to vaccination policies internationally.
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Affiliation(s)
- H F Gidding
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia; National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia.
| | - L McCallum
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia.
| | - P Fathima
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.
| | - H C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.
| | - T L Snelling
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia; Department of Infectious Diseases, Princess Margaret Hospital, Perth, WA, Australia; Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia; School of Public Health, Curtin University, Perth, WA, Australia.
| | - C C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia; Department of Infectious Diseases, Princess Margaret Hospital, Perth, WA, Australia; School of Medicine, University of Western Australia, Perth, WA, Australia; Department of Microbiology, PathWest Laboratory Medicine WA, Princess Margaret Hospital, Perth, WA, Australia.
| | - S Jayasinghe
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia; Discipline of Child and Adolescent Health, Medical School, University of Sydney, Sydney, Australia.
| | - C Giele
- Communicable Disease Control Directorate, Department of Health Western Australia, Perth, WA, Australia.
| | - N de Klerk
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.
| | - R 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.
| | - P B McIntyre
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia; Discipline of Child and Adolescent Health, Medical School, University of Sydney, Sydney, Australia; School of Public Health, Medical School, University of Sydney, Sydney, Australia.
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Shield JM, Kearns TM, Garŋgulkpuy J, Walpulay L, Gundjirryirr R, Bundhala L, Djarpanbuluwuy V, Andrews RM, Judd J. Cross-Cultural, Aboriginal Language, Discovery Education for Health Literacy and Informed Consent in a Remote Aboriginal Community in the Northern Territory, Australia. Trop Med Infect Dis 2018; 3:tropicalmed3010015. [PMID: 30274413 PMCID: PMC6136616 DOI: 10.3390/tropicalmed3010015] [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: 12/10/2017] [Revised: 01/20/2018] [Accepted: 01/20/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Education for health literacy of Australian Aboriginal people living remotely is challenging as their languages and worldviews are quite different from English language and Western worldviews. Becoming health literate depends on receiving comprehensible information in a culturally acceptable manner. Methods: The study objective was to facilitate oral health literacy through community education about scabies and strongyloidiasis, including their transmission and control, preceding an ivermectin mass drug administration (MDA) for these diseases. A discovery education approach where health concepts are connected to cultural knowledge in the local language was used. Aboriginal and non-Aboriginal educators worked collaboratively to produce an in-depth flip-chart of the relevant stories in the local language and to share them with clan elders and 27% of the population. Results: The community health education was well received. Feedback indicated that the stories were being discussed in the community and that the mode of transmission of strongyloidiasis was understood. Two-thirds of the population participated in the MDA. This study documents the principles and practice of a method of making important Western health knowledge comprehensible to Aboriginal people. This method would be applicable wherever language and culture of the people differ from language and culture of health professionals.
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Affiliation(s)
- Jennifer M. Shield
- ARDS Aboriginal Corporation, Winnellie, NT 0821, Australia
- Department of Pharmacy and Applied Science, La Trobe University, Bendigo, VIC 3552, Australia
- Correspondence: ; Tel.: +61-455-138-444
| | - Thérèse M. Kearns
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0811, Australia; (T.M.K.); (L.W.); (R.G.); (V.D.); (R.M.A.)
| | | | - Lisa Walpulay
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0811, Australia; (T.M.K.); (L.W.); (R.G.); (V.D.); (R.M.A.)
- Yalu’ Marŋgithinyaraw, Galiwin’ku, NT 0822, Australia;
| | - Roslyn Gundjirryirr
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0811, Australia; (T.M.K.); (L.W.); (R.G.); (V.D.); (R.M.A.)
- Yalu’ Marŋgithinyaraw, Galiwin’ku, NT 0822, Australia;
| | - Leanne Bundhala
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0811, Australia; (T.M.K.); (L.W.); (R.G.); (V.D.); (R.M.A.)
- Yalu’ Marŋgithinyaraw, Galiwin’ku, NT 0822, Australia;
| | - Veronica Djarpanbuluwuy
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0811, Australia; (T.M.K.); (L.W.); (R.G.); (V.D.); (R.M.A.)
- Yalu’ Marŋgithinyaraw, Galiwin’ku, NT 0822, Australia;
| | - Ross M. Andrews
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0811, Australia; (T.M.K.); (L.W.); (R.G.); (V.D.); (R.M.A.)
| | - Jenni Judd
- School of Health, Medical and Applied Sciences, Central Queensland University, Bundaberg, QLD 4670, Australia;
- College of Medicine and Dentistry, Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD 4811, Australia
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Archer BN, Chiu CK, Jayasinghe SH, Richmond PC, McVernon J, Lahra MM, Andrews RM, McIntyre PB. Epidemiology of invasive meningococcal B disease in Australia, 1999-2015: priority populations for vaccination. Med J Aust 2017; 207:382-387. [PMID: 29092704 DOI: 10.5694/mja16.01340] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 04/13/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe trends in the age-specific incidence of serogroup B invasive meningococcal disease (IMD) in Australia, 1999-2015. DESIGN, SETTING, PARTICIPANTS Analysis in February 2017 of de-identified notification data from the Australian National Notifiable Diseases Surveillance System of all notifications of IMD in Australia with a recorded diagnosis date during 1999-2015.Major outcomes: IMD notification rates in Australia, 1999-2015, by age, serogroup, Indigenous status, and region. RESULTS The incidence of meningococcal serogroup B (MenB) disease declined progressively from 1.52 cases per 100 000 population in 2001 to 0.47 per 100 000 in 2015. During 2006-2015, MenB accounted for 81% of IMD cases with a known serogroup; its highest incidence was among infants under 12 months of age (11.1 [95% CI, 9.81-12.2] per 100 000), children aged 1-4 years (2.82 [95% CI, 2.52-3.15] per 100 000), and adolescents aged 15-19 years (2.40 [95% CI, 2.16-2.67] per 100 000). Among the 473 infants under 2 years of age with MenB, 43% were under 7 months and 69% under 12 months of age. The incidence of meningococcal serogroup C (MenC) disease prior to the introduction of the MenC vaccine in 2003 was much lower in infants than for MenB (2.60 cases per 100 000), the rate peaking in people aged 15-19 years (3.32 per 100 000); the overall case fatality rate was also higher (MenC, 8%; MenB, 4%). The incidence of MenB disease was significantly higher among Indigenous than non-Indigenous Australians during 2006-2015 (incidence rate ratio [IRR], 3.8; 95% CI, 3.3-4.5). CONCLUSIONS Based on disease incidence at its current low endemic levels, priority at risk age/population groups for MenB vaccination include all children between 2 months and 5 years of age, Indigenous children under 10 years of age, and all adolescents aged 15-19 years. Given marked variation in meningococcal disease trends over time, close scrutiny of current epidemiologic data is essential.
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Affiliation(s)
- Brett N Archer
- National Centre for Immunisation Research and Surveillance (NCIRS), Sydney, NSW
| | - Clayton K Chiu
- National Centre for Immunisation Research and Surveillance (NCIRS), Sydney, NSW
| | - Sanjay H Jayasinghe
- National Centre for Immunisation Research and Surveillance (NCIRS), Sydney, NSW
| | - Peter C Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA
| | - Jodie McVernon
- Victorian Infectious Diseases Reference Laboratory, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC
| | - Monica M Lahra
- Neisseria Reference Laboratory and WHO Collaborating Centre for Sexually Transmitted Diseases, Prince of Wales Hospital, Sydney, NSW
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Darwin, NT
| | - Peter B McIntyre
- National Centre for Immunisation Research and Surveillance (NCIRS), Sydney, NSW
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Abstract
Maternal immunization has the potential to reduce the burden of infectious diseases in the pregnant woman and her infant. Many countries now recommend immunization against influenza at any stage of pregnancy and against pertussis in the third trimester. Despite evidence of the safety and effectiveness of these vaccines when administered during pregnancy, uptake generally remains low for influenza and moderate for pertussis vaccine. Enhancing confidence in both immunization providers and pregnant women by increasing the evidence-base for the safety and effectiveness of vaccines during pregnancy, improving communication and access by incorporating immunization into standard models of antenatal care are likely to improve uptake. Developing a framework for implementation of vaccines for pregnant women which is cognizant of local and national cultural, epidemiological, behavioral and societal factors will enable a smooth transition and high uptake for new vaccines currently in development for pregnant women.
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Affiliation(s)
- H Marshall
- a Paediatrics, Women's and Children's Health Network , Adelaide, South Australia and Robinson Research Institute and School of Medicine, University of Adelaide , Adelaide , South Australia , Australia
| | - M McMillan
- a Paediatrics, Women's and Children's Health Network , Adelaide, South Australia and Robinson Research Institute and School of Medicine, University of Adelaide , Adelaide , South Australia , Australia
| | - R M Andrews
- b Menzies School of Health Research , Brisbane , Queensland , Australia
| | - K Macartney
- c Sydney Medical School, Sydney, New South Wales, Australia; Department of Infectious Diseases and Microbiology , The Children's Hospital at Westmead, Sydney, New South Wales, Australia; National Centre for Immunization Research and Surveillance , Sydney , New South Wales , Australia
| | - K Edwards
- d Vanderbilt University , Nashville , TN , USA
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Gidding HF, McCallum L, Fathima P, Snelling TL, Liu B, de Klerk N, Blyth CC, Sheppeard V, Andrews RM, Jorm L, McIntyre PB, Moore HC. Probabilistic linkage of national immunisation and state-based health records for a cohort of 1.9 million births to evaluate Australia's childhood immunisation program. Int J Popul Data Sci 2017; 2:406. [PMID: 32934996 PMCID: PMC7299480 DOI: 10.23889/ijpds.v2i1.406] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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] [Indexed: 11/02/2022] Open
Abstract
Introduction Several countries have developed national immunisation registers, but only the Nordic countries have linked their registers to other health data in order to comprehensively evaluate the `real world' effectiveness of vaccines. Nordic countries can link datasets deterministically using the national person identifier, but most countries, including Australia, don't have such an identifier to enable this type of linkage. Objectives To describe the process for assembling a linked study cohort that will enable the conduct of population-based studies related to immunisation and immunisation policy. Methods National death and immunisation databases along with state health data (notifications of vaccine preventable diseases, perinatal data, hospital admissions and emergency department presentations) up until December 2013 were probabilistically linked (using demographic details) for children born between 1996 and 2012 in two states: Western Australia and New South Wales (42% of Australia's population, combined). Results After exclusions there were 1.95 million children in the study cohort (live born children with both a birth and perinatal record which represents 97.5% of all live births in the state perinatal data collections - our source population) and 18.0 million person years of follow up (mean: 9.2 years per child). The characteristics of children in the cohort were generally similar to those only included in state perinatal databases and outcome measures were in keeping with expected figures from unlinked data sources. However, the lack of a dynamic national population register meant immigrants could not be included. Conclusions We have been able to develop a similarly comprehensive system to the Nordic countries based on probabilistic linkage methods. Our experience should provide encouragement to other countries with national immunisation registers looking to establish similar systems.
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Affiliation(s)
- H F Gidding
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia.,National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| | - L McCallum
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - P Fathima
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - T L Snelling
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.,Department of Infectious Diseases, Princess Margaret Hospital, Perth, WA, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,School of Public Health, Curtin University, Perth, WA, Australia
| | - B Liu
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - N de Klerk
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - C C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.,Department of Infectious Diseases, Princess Margaret Hospital, Perth, WA, Australia.,School of Medicine, University of Western Australia, Perth, WA, Australia.,Department of Microbiology, PathWest Laboratory Medicine WA, Princess Margaret Hospital, Perth, WA, Australia
| | - V Sheppeard
- Communicable Diseases, Health Protection NSW, NSW Ministry of Health, NSW, Australia
| | - R M Andrews
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - L Jorm
- Centre for Big Data Research in Health, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - P B McIntyre
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| | - H C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
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Kearns TM, Currie BJ, Cheng AC, McCarthy J, Carapetis JR, Holt DC, Page W, Shield J, Gundjirryirr R, Mulholland E, Ward L, Andrews RM. Strongyloides seroprevalence before and after an ivermectin mass drug administration in a remote Australian Aboriginal community. PLoS Negl Trop Dis 2017; 11:e0005607. [PMID: 28505198 PMCID: PMC5444847 DOI: 10.1371/journal.pntd.0005607] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 05/25/2017] [Accepted: 04/27/2017] [Indexed: 01/01/2023] Open
Abstract
Background Strongyloides seroprevalence is hyper-endemic in many Australian Aboriginal and Torres Strait Islander communities, ranging from 35–60%. We report the impact on Strongyloides seroprevalence after two oral ivermectin mass drug administrations (MDAs) delivered 12 months apart in a remote Australian Aboriginal community. Methods Utilizing a before and after study design, we measured Strongyloides seroprevalence through population census with sequential MDAs at baseline and month 12. Surveys at months 6 and 18 determined changes in serostatus. Serodiagnosis was undertaken by ELISA that used sonicated Strongyloides ratti antigen to detect anti-Strongyloides IgG. Non-pregnant participants weighing ≥15 kg were administered a single 200 μg/kg ivermectin dose, repeated after 10–42 days if Strongyloides and/or scabies was diagnosed; others followed a standard alternative algorithm. A questionnaire on clinical symptoms was administered to identify adverse events from treatment and self-reported symptoms associated with serostatus. Findings We surveyed 1013 participants at the baseline population census and 1060 (n = 700 from baseline cohort and 360 new entrants) at month 12. Strongyloides seroprevalence fell from 21% (175/818) at baseline to 5% at month 6. For participants from the baseline cohort this reduction was sustained at month 12 (34/618, 6%), falling to 2% at month 18 after the second MDA. For new entrants to the cohort at month 12, seroprevalence reduced from 25% (75/297) to 7% at month 18. Strongyloides positive seroconversions for the baseline cohort six months after each MDA were 2.5% (4/157) at month 6 and 1% at month 18, whilst failure to serorevert remained unchanged at 18%. At 12 months, eosinophilia was identified in 59% of baseline seropositive participants and 89% of seropositive new entrants, compared with 47%baseline seronegative participants and 51% seronegative new entrants. Seropositivity was not correlated with haemoglobin or any self-reported clinical symptoms. Clinical symptoms ascertained on the day of treatment and 24–72 hrs after, did not identify any adverse events. Significance Two community ivermectin MDAs delivered 12 months apart by trained Aboriginal researchers in collaboration with non-Indigenous researchers resulted in a sustained and significant reduction in Strongyloides seroprevalence over 18 months. Similar reductions were seen in the baseline cohort and new entrants. We were invited by one community in East Arnhem Land to develop and deliver an ivermectin MDA to reduce the prevalence of Strongyloides and scabies. We demonstrated a sustained reduction in Strongyloides seroprevalence following the ivermectin MDA. Strongyloides is endemic in many Australian Aboriginal and Torres Strait Islander communities with seroprevalence ranging from 35–60%. Utilizing a before and after study design, we measured Strongyloides seroprevalence by ELISA through population census with sequential MDAs at baseline and month 12. Strongyloides seroprevalence reduced from 21% at baseline to 5% at month 6 after the first MDA. For the baseline cohort this reduction was sustained at month 12, falling to 2% at month 18 after the second MDA. For new entrants to the cohort at month 12, seroprevalence reduced from 25% to 7%.
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Affiliation(s)
- Therese M. Kearns
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- * E-mail:
| | - Bart J. Currie
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Allen C. Cheng
- School of Public Health and Preventive Medicine, Monash University and Infection Prevention and Healthcare Epidemiology Unit, Alfred Health Melbourne, Australia
| | - James McCarthy
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Jonathan R. Carapetis
- Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, Australia
| | - Deborah C. Holt
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Wendy Page
- Miwatj Health Aboriginal Corporation, Nhulunbuy, Australia
| | - Jennifer Shield
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Roslyn Gundjirryirr
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | | | - Linda Ward
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Ross M. Andrews
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
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Campbell SJ, Nery SV, D’Este CA, Gray DJ, McCarthy JS, Traub RJ, Andrews RM, Llewellyn S, Vallely AJ, Williams GM, Clements ACA. Investigations into the association between soil-transmitted helminth infections, haemoglobin and child development indices in Manufahi District, Timor-Leste. Parasit Vectors 2017; 10:192. [PMID: 28424091 PMCID: PMC5395746 DOI: 10.1186/s13071-017-2084-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 03/09/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Timor-Leste has a high prevalence of soil-transmitted helminth (STH) infections. High proportions of the population have been reported as being anaemic, and extremely high proportions of children as stunted or wasted. There have been no published analyses of the contributions of STH to these morbidity outcomes in Timor-Leste. METHODS Using baseline cross-sectional data from 24 communities (18 communities enrolled in a cluster randomised controlled trial, and identically-collected data from six additional communities), analyses of the association between STH infections and community haemoglobin and child development indices were undertaken. Stool samples were assessed for STH using qPCR and participant haemoglobin, heights and weights were measured. Questionnaires were administered to collect demographic and socioeconomic data. Intensity of infection was categorised using correlational analysis between qPCR quantification cycle values and eggs per gram of faeces equivalents, with algorithms generated from seeding experiments. Mixed-effects logistic and multinomial regression were used to assess the association between STH infection intensity classes and anaemia, and child stunting, wasting and underweight. RESULTS Very high stunting (60%), underweight (60%), and wasting (20%) in children, but low anaemia prevalence (15%), were found in the study communities. STH were not significantly associated with morbidity outcomes. Male children and those in the poorest socioeconomic quintile were significantly more likely to be moderately and severely stunted. Male children were significantly more likely than female children to be severely underweight. Increasing age was also a risk factor for being underweight. Few risk factors emerged for wasting in these analyses. CONCLUSIONS According to World Health Organization international reference standards, levels of child morbidity in this population constitute a public health emergency, although the international reference standards need to be critically evaluated for their applicability in Timor-Leste. Strategies to improve child development and morbidity outcomes, for example via nutrition and iron supplementation programmes, are recommended for these communities. Despite the apparent lack of an association from STH in driving anaemia, stunting, wasting and underweight, high endemicity suggests a need for STH control strategies. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12614000680662 ; retrospectively registered.
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Affiliation(s)
- Suzy J. Campbell
- Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, 62 Mills Rd, Acton, ACT 2601 Australia
| | - Susana V. Nery
- Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, 62 Mills Rd, Acton, ACT 2601 Australia
| | - Catherine A. D’Este
- Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, 62 Mills Rd, Acton, ACT 2601 Australia
| | - Darren J. Gray
- Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, 62 Mills Rd, Acton, ACT 2601 Australia
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, 300 Herston Rd, Brisbane, QLD 4006 Australia
- School of Public Health, University of Queensland, Herston Rd, Brisbane, QLD 4006 Australia
| | - James S. McCarthy
- School of Public Health, University of Queensland, Herston Rd, Brisbane, QLD 4006 Australia
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, 300 Herston Rd, Brisbane, QLD 4006 Australia
| | - Rebecca J. Traub
- Faculty of Veterinary and Agricultural Science, The University of Melbourne, Parkville, VIC 3010 Australia
| | - Ross M. Andrews
- Menzies School of Health Research, Charles Darwin University, Ellengowan Dr, Casuarina, NT 0810 Australia
| | - Stacey Llewellyn
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, 300 Herston Rd, Brisbane, QLD 4006 Australia
| | - Andrew J. Vallely
- Kirby Institute, University of New South Wales, Wallace Wurth Building, High St, Kensington, NSW 2052 Australia
| | - Gail M. Williams
- School of Public Health, University of Queensland, Herston Rd, Brisbane, QLD 4006 Australia
| | - Archie C. A. Clements
- Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, 62 Mills Rd, Acton, ACT 2601 Australia
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Lewin SR, Andrews RM, McVernon J, Milland J, Smith MZ, Sorrell TC. Developing research priorities for Australia's response to infectious disease emergencies. Commun Dis Intell (2018) 2017; 41:E1-E3. [PMID: 28385132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Sharon R Lewin
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne and The Royal Melbourne Hospital, Melbourne, Victoria
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Victoria
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Jodie McVernon
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne and The Royal Melbourne Hospital, Melbourne, Victoria
| | - Julie Milland
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne and The Royal Melbourne Hospital, Melbourne, Victoria
| | - Miranda Z Smith
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne and The Royal Melbourne Hospital, Melbourne, Victoria
| | - Tania C Sorrell
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney and Westmead Institute for Medical Research, The University of Sydney, New South Wales
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Campbell SJ, Nery SV, Wardell R, D’Este CA, Gray DJ, McCarthy JS, Traub RJ, Andrews RM, Llewellyn S, Vallely AJ, Williams GM, Clements ACA. Water, Sanitation and Hygiene (WASH) and environmental risk factors for soil-transmitted helminth intensity of infection in Timor-Leste, using real time PCR. PLoS Negl Trop Dis 2017; 11:e0005393. [PMID: 28346536 PMCID: PMC5383321 DOI: 10.1371/journal.pntd.0005393] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 04/06/2017] [Accepted: 02/06/2017] [Indexed: 11/18/2022] Open
Abstract
Background No investigations have been undertaken of risk factors for intensity of soil-transmitted helminth (STH) infection in Timor-Leste. This study provides the first analysis of risk factors for intensity of STH infection, as determined by quantitative PCR (qPCR), examining a broad range of water, sanitation and hygiene (WASH) and environmental factors, among communities in Manufahi District, Timor-Leste. Methods A baseline cross-sectional survey of 18 communities was undertaken as part of a cluster randomised controlled trial, with additional identically-collected data from six other communities. qPCR was used to assess STH infection from stool samples, and questionnaires administered to collect WASH, demographic, and socioeconomic data. Environmental information was obtained from open-access sources and linked to infection outcomes. Mixed-effects multinomial logistic regression was undertaken to assess risk factors for intensity of Necator americanus and Ascaris infection. Results 2152 participants provided stool and questionnaire information for this analysis. In adjusted models incorporating WASH, demographic and environmental variables, environmental variables were generally associated with infection intensity for both N. americanus and Ascaris spp. Precipitation (in centimetres) was associated with increased risk of moderate-intensity (adjusted relative risk [ARR] 6.1; 95% confidence interval [CI] 1.9–19.3) and heavy-intensity (ARR 6.6; 95% CI 3.1–14.1) N. americanus infection, as was sandy-loam soil around households (moderate-intensity ARR 2.1; 95% CI 1.0–4.3; heavy-intensity ARR 2.7; 95% CI 1.6–4.5; compared to no infection). For Ascaris, alkaline soil around the household was associated with reduced risk of moderate-intensity infection (ARR 0.21; 95% CI 0.09–0.51), and heavy-intensity infection (ARR 0.04; 95% CI 0.01–0.25). Few WASH risk factors were significant. Conclusion In this high-prevalence setting, strong risk associations with environmental factors indicate that anthelmintic treatment alone will be insufficient to interrupt STH transmission, as conditions are favourable for ongoing environmental transmission. Integrated STH control strategies should be explored as a priority. We present a detailed analysis of WASH, environmental and demographic factors associated with intensity of STH infection in Manufahi District, Timor-Leste, using qPCR. Investigation of risk factors for intensity of STH infection is rarely undertaken, and prior analyses have used microscopic-based eggs per gram of faeces (epg) measures, which are of lower diagnostic accuracy than qPCR. Additionally, few analyses have investigated combined WASH and environmental risk factors in association with STH. This is important due to the extensive potential interrelatedness of environmental, social, behavioural and host factors in any given setting influencing STH survival and transmission. This analysis uses categorical intensity of infection variables for Necator americanus and Ascaris spp., and advanced statistical modelling to adjust for multinomial intensity outcomes, dependency of observations, effects of poverty, and confounding from other measured variables. As such, this analysis provides a comprehensive assessment of risk factors for STH in Manufahi District, Timor-Leste. This is of importance for development of policy and programmatic decisions; risk factors need to be considered not only for their clinical and statistical significance, but more broadly in terms of what may represent modifiable pathways for STH transmission.
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Affiliation(s)
- Suzy J. Campbell
- Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Acton, Australian Capital Territory, Australia
- * E-mail:
| | - Susana V. Nery
- Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Acton, Australian Capital Territory, Australia
| | - Rebecca Wardell
- Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Acton, Australian Capital Territory, Australia
| | - Catherine A. D’Este
- Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Acton, Australian Capital Territory, Australia
| | - Darren J. Gray
- Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Acton, Australian Capital Territory, Australia
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - James S. McCarthy
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Rebecca J. Traub
- Faculty of Veterinary and Agricultural Science, The University of Melbourne, Parkville, Victoria, Australia
| | - Ross M. Andrews
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Stacey Llewellyn
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Andrew J. Vallely
- Kirby Institute, University of New South Wales, Wallace Wurth Building, Kensington, New South Wales, Australia
| | - Gail M. Williams
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Archie C. A. Clements
- Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Acton, Australian Capital Territory, Australia
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McHugh L, Andrews RM, Lambert SB, Viney KA, Wood N, Perrett KP, Marshall HS, Richmond P, O'Grady KAF. Birth outcomes for Australian mother-infant pairs who received an influenza vaccine during pregnancy, 2012-2014: The FluMum study. Vaccine 2017; 35:1403-1409. [PMID: 28190746 DOI: 10.1016/j.vaccine.2017.01.075] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 11/10/2016] [Revised: 01/27/2017] [Accepted: 01/30/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION In Australia, influenza vaccination is recommended for all women who will be pregnant during the influenza season. Vaccine safety and effectiveness are key concerns and influencers of uptake for both vaccine providers and families. We assessed the safety of receiving an influenza vaccination during any trimester of pregnancy with respect to preterm births and infant birthweight. METHODS We conducted a nested retrospective cohort study of 'FluMum' participants (2012-2014). Our primary exposure of interest was influenza vaccination during pregnancy. The primary outcomes of interest were infant birthweight and weeks' gestation at birth for live singleton infants. Analyses included comparisons of these birth outcomes by vaccination status and trimester of pregnancy an influenza vaccine was given. We calculated means, proportions, and relative risks and performed multivariable logistic regression for potential confounding factors. RESULTS In the 7126 mother-infant pairs enrolled in this study, mean maternal age at infant birth was 31.7years. Influenza vaccine uptake in pregnancy was 34%. Most mothers with a known date of vaccination received a vaccine in the second trimester (51%). Those mothers with a co-morbidity or risk factor were 13% more likely to have influenza vaccine during pregnancy compared to other mothers (RR 1.13, 95% CI 1.04-1.24, p=0.007). Mean weeks' gestation at birth was 38.7 for the vaccinated and 38.8 for the unvaccinated group (p=0.051). Infants in the vaccinated group weighed 15g less in birthweight compared to the unvaccinated infants (95% CI -12.8 to 42.2, p=0.29). CONCLUSION Results arising from this large Australian cohort study are reassuring with respect to two critical safety outcomes; preterm births and low infant birthweights. Studies examining a broader range of birth outcomes following influenza vaccination during pregnancy are required, particularly now that maternal vaccination in pregnancy has expanded to include pertussis as well as influenza.
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Affiliation(s)
- Lisa McHugh
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia; The University of Queensland Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia; Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia.
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
| | - Stephen B Lambert
- The University of Queensland Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Kerri A Viney
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Nicholas Wood
- National Centre for Immunisation Research and Surveillance, Sydney Children's Hospitals Network, Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten P Perrett
- Vaccine and Immunisation Research Group, Murdoch Children's Research Institute and School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Helen S Marshall
- Women's and Children's Health Network, Robinson Research Institute and School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Peter Richmond
- University of Western Australia, School of Paediatrics and Child Health and Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Kerry-Ann F O'Grady
- Institute of Health & Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology, South Brisbane, Queensland, Australia
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Moberley SA, Lawrence J, Johnston V, Andrews RM. Influenza vaccination coverage among pregnant Indigenous women in the Northern Territory of Australia. Commun Dis Intell (2018) 2016; 40:E340-E346. [PMID: 28278407] [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: 06/06/2023]
Abstract
Pregnant Aboriginal and Torres Strait Islander women are at particular risk of severe illness and high attack rates of influenza infection. In Australia, routine seasonal influenza vaccination is currently strongly recommended for all pregnant women and women planning pregnancy, and is provided free of charge for all pregnant women. We sought to determine vaccination coverage, describe the trends and characteristics associated with influenza vaccine uptake and determine the validity of self-reported influenza vaccination in a population of Indigenous pregnant women who were participants of a vaccine trial, prior to and during the 2009 H1N1 influenza pandemic. Vaccine coverage over the study period was 16% (35/214), increasing from 2.2% (3/136) in the period preceding the pandemic (2006-2009) to 41% (32/78) in the intra-pandemic period (2009-2010). Self-report was not a reliable estimate of verified vaccination status in the pre-pandemic period (κ=0.38) but was reliable in the intra-pandemic period (κ=0.91). None of the socio-demographic characteristics that we examined were associated with vaccine uptake. Whilst the increase in maternal influenza coverage rates are encouraging and indicate a willingness of pregnant Indigenous women to be vaccinated, the majority of women remained unvaccinated. Activities to improve influenza vaccination coverage for Indigenous pregnant women and monitor vaccine uptake remain a priority. Commun Dis Intell 2016;40(3):E340-E346.
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Affiliation(s)
- Sarah A Moberley
- Post-doctoral Fellow, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Jolie Lawrence
- Medical Student, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria
| | - Vanessa Johnston
- Post-doctoral Fellow, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Ross M Andrews
- Deputy Director, Menzies School of Health Research, Charles Darwin University, Northern Territory
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Campbell SJ, Nery SV, D'Este CA, Gray DJ, McCarthy JS, Traub RJ, Andrews RM, Llewellyn S, Vallely AJ, Williams GM, Amaral S, Clements ACA. Water, sanitation and hygiene related risk factors for soil-transmitted helminth and Giardia duodenalis infections in rural communities in Timor-Leste. Int J Parasitol 2016; 46:771-779. [PMID: 27616734 DOI: 10.1016/j.ijpara.2016.07.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 02/25/2016] [Revised: 07/11/2016] [Accepted: 07/12/2016] [Indexed: 10/21/2022]
Abstract
There is little evidence on prevalence or risk factors for soil transmitted helminth infections in Timor-Leste. This study describes the epidemiology, water, sanitation and hygiene, and socioeconomic risk factors of STH and intestinal protozoa amongst communities in Manufahi District, Timor-Leste. As part of a cluster randomised controlled trial, a baseline cross-sectional survey was conducted across 18 villages, with data from six additional villages. Stool samples were assessed for soil transmitted helminth and protozoal infections using quantitative PCR (qPCR) and questionnaires administered to collect water, sanitation and hygiene and socioeconomic data. Risk factors for infection were assessed using multivariable mixed-effects logistic regression, stratified by age group (preschool, school-aged and adult). Overall, soil transmitted helminth prevalence was 69% (95% Confidence Interval 67-71%), with Necator americanus being most common (60%; 95% Confidence Interval 58-62%) followed by Ascaris spp. (24%; 95% Confidence Interval 23-26%). Ascaris-N. americanus co-infection was common (17%; 95% Confidence Interval 15%-18%). Giardia duodenalis was the main protozoan identified (13%; 95% Confidence Interval 11-14%). Baseline water, sanitation and hygiene infrastructure and behaviours were poor. Although risk factors varied by age of participants and parasite species, risk factors for N. americanus infection included, generally, age in years, male sex, and socioeconomic quintile. Risk factors for Ascaris included age in years for children, and piped water to the yard for adults. In this first known assessment of community-based prevalence and associated risk factors in Timor-Leste, soil transmitted helminth infections were highly prevalent, indicating a need for soil transmitted helminth control. Few associations with water, sanitation and hygiene were evident, despite water, sanitation and hygiene being generally poor. In our water, sanitation and hygiene we will investigate implications of improving WASH on soil transmitted helminth infection in impoverished communities.
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Affiliation(s)
- Suzy J Campbell
- Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, 62 Mills Rd, Acton, ACT 2601, Australia.
| | - Susana V Nery
- Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, 62 Mills Rd, Acton, ACT 2601, Australia
| | - Catherine A D'Este
- Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, 62 Mills Rd, Acton, ACT 2601, Australia
| | - Darren J Gray
- Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, 62 Mills Rd, Acton, ACT 2601, Australia; Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, 300 Herston Rd, Brisbane, QLD 4006, Australia; School of Public Health, University of Queensland, Herston Rd, Brisbane, QLD 4006, Australia
| | - James S McCarthy
- School of Public Health, University of Queensland, Herston Rd, Brisbane, QLD 4006, Australia; Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, 300 Herston Rd, Brisbane, QLD 4006, Australia
| | - Rebecca J Traub
- Faculty of Veterinary and Agricultural Science, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Ellengowan Dr, Casuarina, NT 0810, Australia
| | - Stacey Llewellyn
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, 300 Herston Rd, Brisbane, QLD 4006, Australia
| | - Andrew J Vallely
- Kirby Institute, University of New South Wales, Wallace Wurth Building, High St, Kensington, NSW 2052, Australia
| | - Gail M Williams
- School of Public Health, University of Queensland, Herston Rd, Brisbane, QLD 4006, Australia
| | - Salvador Amaral
- Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, 62 Mills Rd, Acton, ACT 2601, Australia
| | - Archie C A Clements
- Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, 62 Mills Rd, Acton, ACT 2601, Australia
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Binks MJ, Smith-Vaughan HC, Marsh R, Chang AB, Andrews RM. Cord blood vitamin D and the risk of acute lower respiratory infection in Indigenous infants in the Northern Territory. Med J Aust 2016; 204:238. [PMID: 27031398 DOI: 10.5694/mja15.00798] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 12/10/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To assess vitamin D status in Indigenous mothers and infants in the Northern Territory, and to determine whether cord blood vitamin D levels are correlated with the risk of infant hospitalisation for acute lower respiratory infection (ALRI). DESIGN AND PARTICIPANTS Within a nested cohort of 109 Indigenous mother-infant pairs recruited between 2006 and 2011, we used liquid chromatography-mass spectrometry to measure vitamin D (25(OH)D3) levels in maternal blood during pregnancy (n = 33; median gestation, 32 weeks [range, 28-36 weeks]) and at birth (n = 106; median gestation, 39 weeks [range, 34-41 weeks]), in cord blood (n = 84; median gestation, 39 weeks [range, 36-41 weeks]), and in infant blood at age 7 months (n = 37; median age, 7.1 months [range, 6.6-8.1 months]). MAIN OUTCOME MEASURE ALRI hospitalisations during the first 12 months of infancy, identified using International Classification of Diseases coding (J09-J22, A37-A37.9). RESULTS Compared with mean 25(OH)D3 levels in maternal blood during pregnancy (104 nmol/L), mean levels were 23% lower in maternal blood at birth (80 nmol/L) and 48% lower in cord blood samples (54 nmol/L). The mean cord blood 25(OH)D3 concentration in seven infants subsequently hospitalised for an ALRI was 37 nmol/L (95% CI, 25-48 nmol/L), lower than the 56 nmol/L (95% CI, 51-61 nmol/L) in the 77 infants who were not hospitalised with an ALRI (P = 0.025). CONCLUSIONS Cord blood 25(OH)D3 concentrations were about half those in maternal blood during the third trimester of pregnancy (about 7 weeks earlier). Most cord blood levels (80%) were classified as vitamin D insufficient (< 75 nmol/L) by existing guidelines, and were lower among infants who were subsequently hospitalised with an ALRI.
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Affiliation(s)
| | | | - Robyn Marsh
- Menzies School of Health Research, Darwin, NT
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