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Wang DS, Phu A, McKee K, Strasser SI, Sheils S, Weltman M, Sellar S, Davis JS, Young M, Braund A, Farrell GC, Blunn A, Harding D, Ralton L, Muller K, Davison SA, Shaw D, Wood M, Hajkowicz K, Skolen R, Davies J, Tate-Baker J, Doyle A, Tuma R, Hazeldine S, Lam W, Edmiston N, Zohrab K, Pratt W, Watson B, Zekry A, Stephens C, Clark PJ, Day M, Park G, Kim H, Wilson M, McGarity B, Menzies N, Russell D, Lam T, Boyd P, Kok J, George J, Douglas MW. Hepatitis C Virus Antiviral Drug Resistance and Salvage Therapy Outcomes Across Australia. Open Forum Infect Dis 2024; 11:ofae155. [PMID: 38651137 PMCID: PMC11034952 DOI: 10.1093/ofid/ofae155] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/15/2024] [Indexed: 04/25/2024] Open
Abstract
Background Hepatitis C virus (HCV) infection can now be cured with well-tolerated direct-acting antiviral (DAA) therapy. However, a potential barrier to HCV elimination is the emergence of resistance-associated substitutions (RASs) that reduce the efficacy of antiviral drugs, but real-world studies assessing the clinical impact of RASs are limited. Here, an analysis of the impact of RASs on retreatment outcomes for different salvage regimens in patients nationally who failed first-line DAA therapy is reported. Methods We collected data from 363 Australian patients who failed first-line DAA therapy, including: age, sex, fibrosis stage, HCV genotype, NS3/NS5A/NS5B RASs, details of failed first-line regimen, subsequent salvage regimens, and treatment outcome. Results Of 240 patients who were initially retreated as per protocol, 210 (87.5%) achieved sustained virologic response (SVR) and 30 (12.5%) relapsed or did not respond. The SVR rate for salvage regimens that included sofosbuvir/velpatasvir/voxilaprevir was 94.3% (n = 140), sofosbuvir/velpatasvir 75.0% (n = 52), elbasvir/grazoprevir 81.6% (n = 38), and glecaprevir/pibrentasvir 84.6% (n = 13). NS5A RASs were present in 71.0% (n = 210) of patients who achieved SVR and in 66.7% (n = 30) of patients who subsequently relapsed. NS3 RASs were detected in 20 patients (20%) in the SVR group and 1 patient in the relapse group. NS5B RASs were observed in only 3 patients. Cirrhosis was a predictor of relapse after retreatment, as was previous treatment with sofosbuvir/velpatasvir. Conclusions In our cohort, the SVR rate for sofosbuvir/velpatasvir/voxilaprevir was higher than with other salvage regimens. The presence of NS5A, NS5B, or NS3 RASs did not appear to negatively influence retreatment outcomes.
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Affiliation(s)
- Dao Sen Wang
- Storr Liver Centre, The Westmead Institute for Medical Research, The University of Sydney and Westmead Hospital, Sydney, NSW, Australia
| | - Amy Phu
- Storr Liver Centre, The Westmead Institute for Medical Research, The University of Sydney and Westmead Hospital, Sydney, NSW, Australia
| | - Kristen McKee
- Storr Liver Centre, The Westmead Institute for Medical Research, The University of Sydney and Westmead Hospital, Sydney, NSW, Australia
| | - Simone I Strasser
- AW Morrow Gastroenterology and Liver Centre, The University of Sydney and Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Sinead Sheils
- AW Morrow Gastroenterology and Liver Centre, The University of Sydney and Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Martin Weltman
- Department of Gastroenterology and Hepatology, Nepean Hospital, Kingswood, NSW, Australia
| | - Sue Sellar
- Department of Gastroenterology and Hepatology, Nepean Hospital, Kingswood, NSW, Australia
| | - Joshua S Davis
- Department of Infectious Diseases, University of Newcastle and John Hunter Hospital, Newcastle, NSW, Australia
| | - Mel Young
- Department of Infectious Diseases, University of Newcastle and John Hunter Hospital, Newcastle, NSW, Australia
| | - Alicia Braund
- Department of Gastroenterology and Hepatology, Gold Coast University Hospital, Southport, QLD, Australia
| | - Geoffrey C Farrell
- Department of Gastroenterology and Hepatology, Australian National University and The Canberra Hospital, Canberra, ACT, Australia
| | - Anne Blunn
- Department of Gastroenterology and Hepatology, Australian National University and The Canberra Hospital, Canberra, ACT, Australia
| | - Damian Harding
- Department of Gastroenterology and Hepatology, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
| | - Lucy Ralton
- Department of Gastroenterology and Hepatology, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
| | - Kate Muller
- Department of Gastroenterology and Hepatology, Flinders Medical Centreand Flinders University, Adelaide, SA, Australia
| | - Scott A Davison
- Department of Gastroenterology and Hepatology, University of New South Wales and Liverpool Hospital, Liverpool, NSW, Australia
| | - David Shaw
- Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Marnie Wood
- Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Krispin Hajkowicz
- Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Richard Skolen
- Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Jane Davies
- Menzies School of Health Research and Royal Darwin Hospital, Darwin, NT, Australia
| | - Jaclyn Tate-Baker
- Menzies School of Health Research and Royal Darwin Hospital, Darwin, NT, Australia
| | - Adam Doyle
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, WA, Australia
| | - Rhoda Tuma
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, WA, Australia
| | - Simon Hazeldine
- Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Wendy Lam
- Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Natalie Edmiston
- Department of Gastroenterology and Hepatology, School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Krista Zohrab
- Department of Gastroenterology and Hepatology, School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - William Pratt
- Department of Medicine, Shoalhaven Hospital, Nowra, NSW, Australia
| | - Belinda Watson
- Department of Medicine, Shoalhaven Hospital, Nowra, NSW, Australia
| | - Amany Zekry
- Department of Gastroenterology and Hepatology, St George Hospital, Kogarah, NSW, Australia
| | - Carlie Stephens
- Department of Gastroenterology and Hepatology, St George Hospital, Kogarah, NSW, Australia
| | - Paul J Clark
- Rockhampton Blood Borne Virus & Sexual Health Service and School of Medicine, University of Brisbane, Brisbane, QLD, Australia
| | - Melany Day
- Rockhampton Blood Borne Virus & Sexual Health Service and School of Medicine, University of Brisbane, Brisbane, QLD, Australia
| | - Gordon Park
- Department of Gastroenterology and Hepatology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Hami Kim
- Department of Gastroenterology and Hepatology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Mark Wilson
- Department of Gastroenterology and Hepatology, Royal Hobart Hospital, Hobart, TAS, Australia
| | | | | | - Darren Russell
- Cairns Sexual Health Service and James Cook University Cairns, St Cairns City, QLD, Australia
| | - Thao Lam
- Department of Drug Health, Western Sydney Local Health District, Westmead, NSW, Australia
| | - Peter Boyd
- Department of Medicine, Cairns Hospital, Cairns, QLD, Australia
| | - Jen Kok
- Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology-Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia
| | - Jacob George
- Storr Liver Centre, The Westmead Institute for Medical Research, The University of Sydney and Westmead Hospital, Sydney, NSW, Australia
| | - Mark W Douglas
- Storr Liver Centre, The Westmead Institute for Medical Research, The University of Sydney and Westmead Hospital, Sydney, NSW, Australia
- Centre for Infectious Diseases and Microbiology, Sydney Infectious Diseases Institute, The University of Sydney at Westmead Hospital, Sydney, NSW, Australia
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Carney M, Pelaia TM, Chew T, Teoh S, Phu A, Kim K, Wang Y, Iredell J, Zerbib Y, McLean A, Schughart K, Tang B, Shojaei M, Short KR. Host transcriptomics and machine learning for secondary bacterial infections in patients with COVID-19: a prospective, observational cohort study. Lancet Microbe 2024; 5:e272-e281. [PMID: 38310908 DOI: 10.1016/s2666-5247(23)00363-4] [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] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND Viral respiratory tract infections are frequently complicated by secondary bacterial infections. This study aimed to use machine learning to predict the risk of bacterial superinfection in SARS-CoV-2-positive individuals. METHODS In this prospective, multicentre, observational cohort study done in nine centres in six countries (Australia, Indonesia, Singapore, Italy, Czechia, and France) blood samples and RNA sequencing were used to develop a robust model of predicting secondary bacterial infections in the respiratory tract of patients with COVID-19. Eligible participants were older than 18 years, had known or suspected COVID-19, and symptoms of a recent respiratory infection. A control cohort of participants without COVID-19 who were older than 18 years and with no infection symptoms was also recruited from one Australian centre. In the pre-analysis phase, data were filtered to include only individuals with complete blood transcriptomics and patient data (ie, age, sex, location, and WHO severity score at the time of sample collection). The dataset was then divided randomly (4:1) into a training set (80%) and a test set (20%). Gene expression data in the training set and control cohort were used for differential expression analysis. Differentially expressed genes, along with WHO severity score, location, age, and sex, were used for feature selection with least absolute shrinkage and selection operator (LASSO) in the training set. For LASSO analysis, samples were excluded if gene expression data were not obtained at study admission, no longitudinal clinical information was available, a bacterial infection at the time of study admission was present, or a fungal infection in the absence of a bacterial infection was detected. LASSO regression was performed using three subsets of predictor variables: patient data alone, gene expression data alone, or a combination of patient data and gene expression data. The accuracy of the resultant models was tested on data from the test set. FINDINGS Between March, 2020, and October, 2021, we recruited 536 SARS-CoV-2-positive individuals and between June, 2013, and January, 2020, we recruited 74 participants into the control cohort. After prefiltering analysis and other exclusions, samples from 158 individuals were analysed in the training set and 47 in the test set. The expression of seven host genes (DAPP1, CST3, FGL2, GCH1, CIITA, UPP1, and RN7SL1) in the blood at the time of study admission was identified by LASSO as predictive of the risk of developing a secondary bacterial infection of the respiratory tract more than 24 h after study admission. Specifically, the expression of these genes in combination with a patient's WHO severity score at the time of study enrolment resulted in an area under the curve of 0·98 (95% CI 0·89-1·00), a true positive rate (sensitivity) of 1·00 (95% CI 1·00-1·00), and a true negative rate (specificity) of 0·94 (95% CI 0·89-1·00) in the test cohort. The combination of patient data and host transcriptomics at hospital admission identified all seven individuals in the training and test sets who developed a bacterial infection of the respiratory tract 5-9 days after hospital admission. INTERPRETATION These data raise the possibility that host transcriptomics at the time of clinical presentation, together with machine learning, can forward predict the risk of secondary bacterial infections and allow for the more targeted use of antibiotics in viral infection. FUNDING Snow Medical Research Foundation, the National Health and Medical Research Council, the Jack Ma Foundation, the Helmholtz-Association, the A2 Milk Company, National Institute of Allergy and Infectious Disease, and the Fondazione AIRC Associazione Italiana per la Ricerca contro il Cancro.
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Affiliation(s)
- Meagan Carney
- School of Mathematics and Physics, University of Queensland, Brisbane, QLD, Australia
| | - Tiana Maria Pelaia
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, NSW, Australia
| | - Tracy Chew
- Sydney Informatics Hub, Core Research Facilities, University of Sydney, Sydney, NSW, Australia
| | - Sally Teoh
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, NSW, Australia
| | - Amy Phu
- Faculty of Medicine and Health, Sydney Medical School Westmead, Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| | - Karan Kim
- Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, Sydney, NSW, Australia
| | - Ya Wang
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, NSW, Australia; The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, Sydney, NSW, Australia
| | - Jonathan Iredell
- Faculty of Medicine and Health, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia; Sydney Institute for Infectious Disease, University of Sydney, Sydney, NSW, Australia; Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Sydney, NSW, Australia; Westmead Hospital, Western Sydney Local Health District, Westmead, NSW, Australia
| | - Yoann Zerbib
- Intensive Care Department, Amiens University Hospital, Amiens, France
| | - Anthony McLean
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, NSW, Australia; The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Klaus Schughart
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, TN, USA; Institute of Virology Münster, University of Münster, Münster, Germany
| | - Benjamin Tang
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, NSW, Australia; Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, Sydney, NSW, Australia
| | - Maryam Shojaei
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, NSW, Australia; The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, Sydney, NSW, Australia.
| | - Kirsty R Short
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, QLD, Australia.
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Calzadilla-Bertot L, Jeffrey GP, Wang Z, Huang Y, Garas G, Wallace M, de Boer B, George J, Eslam M, Phu A, Ampuero J, Lucena Valera A, Romero-Gómez M, Aller de la Fuente R, Adams LA. Predicting liver-related events in NAFLD: A predictive model. Hepatology 2023; 78:1240-1251. [PMID: 36994693 DOI: 10.1097/hep.0000000000000356] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 02/14/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND AND AIMS Management of NAFLD involves noninvasive prediction of fibrosis, which is a surrogate for patient outcomes. We aimed to develop and validate a model predictive of liver-related events (LREs) of decompensation and/or HCC and compare its accuracy with fibrosis models. APPROACH AND RESULTS Patients with NAFLD from Australia and Spain who were followed for up to 28 years formed derivation (n = 584) and validation (n = 477) cohorts. Competing risk regression and information criteria were used for model development. Accuracy was compared with fibrosis models using time-dependent AUC analysis. During follow-up, LREs occurred in 52 (9%) and 11 (2.3%) patients in derivation and validation cohorts, respectively. Age, type 2 diabetes, albumin, bilirubin, platelet count, and international normalized ratio were independent predictors of LRE and were combined into a model [NAFLD outcomes score (NOS)]. The NOS model calibrated well [calibration slope, 0.99 (derivation), 0.98 (validation)] with excellent overall performance [integrated Brier score, 0.07 (derivation) and 0.01 (validation)]. A cutoff ≥1.3 identified subjects at a higher risk of LRE, (sub-HR 24.6, p < 0.001, 5-year cumulative incidence 38% vs 1.0%, respectively). The predictive accuracy at 5 and 10 years was excellent in both derivation (time-dependent AUC,0.92 and 0.90, respectively) and validation cohorts (time-dependent AUC,0.80 and 0.82, respectively). The NOS was more accurate than the fibrosis-4 or NAFLD fibrosis score for predicting LREs at 5 and 10 years ( p < 0.001). CONCLUSIONS The NOS model consists of readily available measures and has greater accuracy in predicting outcomes in patients with NAFLD than existing fibrosis models.
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Affiliation(s)
| | - Gary P Jeffrey
- Medical School, University of Western Australia, Nedlands, Western Australia, Australia
- Department of Hepatology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Zhengyi Wang
- Medical School, University of Western Australia, Nedlands, Western Australia, Australia
| | - Yi Huang
- Medical School, University of Western Australia, Nedlands, Western Australia, Australia
| | - George Garas
- Department of Hepatology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Michael Wallace
- Medical School, University of Western Australia, Nedlands, Western Australia, Australia
- Department of Hepatology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Bastiaan de Boer
- Department of Anatomic Pathology, Pathwest, Nedlands, Western Australia, Australia
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, New South Wales, Australia
| | - Mohammed Eslam
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, New South Wales, Australia
| | - Amy Phu
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, New South Wales, Australia
| | - Javier Ampuero
- Unit for the Clinical Management of Digestive Diseases and CIBEREHD, Virgen del Rocio University Hospital. Institute of Biomedicine of Seville (CSIC/US/HUVR). University of Seville, Seville, Spain
| | - Ana Lucena Valera
- Unit for the Clinical Management of Digestive Diseases and CIBEREHD, Virgen del Rocio University Hospital. Institute of Biomedicine of Seville (CSIC/US/HUVR). University of Seville, Seville, Spain
| | - Manuel Romero-Gómez
- Unit for the Clinical Management of Digestive Diseases and CIBEREHD, Virgen del Rocio University Hospital. Institute of Biomedicine of Seville (CSIC/US/HUVR). University of Seville, Seville, Spain
| | - Rocio Aller de la Fuente
- Department of Digestive Disease, Institute of Endocrinology and Nutrition, University of Valladolid, Valladolid, Spain, CIBER Infectious Diseases
| | - Leon A Adams
- Medical School, University of Western Australia, Nedlands, Western Australia, Australia
- Department of Hepatology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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Akerman A, Milogiannakis V, Jean T, Esneau C, Silva MR, Ison T, Fichter C, Lopez JA, Chandra D, Naing Z, Caguicla J, Li D, Walker G, Amatayakul-Chantler S, Roth N, Manni S, Hauser T, Barnes T, Condylios A, Yeang M, Wong M, Foster CSP, Sato K, Lee S, Song Y, Mao L, Sigmund A, Phu A, Vande More AM, Hunt S, Douglas M, Caterson I, Britton W, Sandgren K, Bull R, Lloyd A, Triccas J, Tangye S, Bartlett NW, Darley D, Matthews G, Stark DJ, Petoumenos K, Rawlinson WD, Murrell B, Brilot F, Cunningham AL, Kelleher AD, Aggarwal A, Turville SG. Emergence and antibody evasion of BQ, BA.2.75 and SARS-CoV-2 recombinant sub-lineages in the face of maturing antibody breadth at the population level. EBioMedicine 2023; 90:104545. [PMID: 37002990 PMCID: PMC10060887 DOI: 10.1016/j.ebiom.2023.104545] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND The Omicron era of the COVID-19 pandemic commenced at the beginning of 2022 and whilst it started with primarily BA.1, it was latter dominated by BA.2 and the related sub-lineage BA.5. Following resolution of the global BA.5 wave, a diverse grouping of Omicron sub-lineages emerged derived from BA.2, BA.5 and recombinants thereof. Whilst emerging from distinct lineages, all shared similar changes in the Spike glycoprotein affording them an outgrowth advantage through evasion of neutralising antibodies. METHODS Over the course of 2022, we monitored the potency and breadth of antibody neutralization responses to many emerging variants in the Australian community at three levels: (i) we tracked over 420,000 U.S. plasma donors over time through various vaccine booster roll outs and Omicron waves using sequentially collected IgG pools; (ii) we mapped the antibody response in individuals using blood from stringently curated vaccine and convalescent cohorts. (iii) finally we determine the in vitro efficacy of clinically approved therapies Evusheld and Sotrovimab. FINDINGS In pooled IgG samples, we observed the maturation of neutralization breadth to Omicron variants over time through continuing vaccine and infection waves. Importantly, in many cases, we observed increased antibody breadth to variants that were yet to be in circulation. Determination of viral neutralization at the cohort level supported equivalent coverage across prior and emerging variants with isolates BQ.1.1, XBB.1, BR.2.1 and XBF the most evasive. Further, these emerging variants were resistant to Evusheld, whilst increasing neutralization resistance to Sotrovimab was restricted to BQ.1.1 and XBF. We conclude at this current point in time that dominant variants can evade antibodies at levels equivalent to their most evasive lineage counterparts but sustain an entry phenotype that continues to promote an additional outgrowth advantage. In Australia, BR.2.1 and XBF share this phenotype and, in contrast to global variants, are uniquely dominant in this region in the later months of 2022. INTERPRETATION Whilst the appearance of a diverse range of omicron lineages has led to primary or partial resistance to clinically approved monoclonal antibodies, the maturation of the antibody response across both cohorts and a large donor pools importantly observes increasing breadth in the antibody neutralisation responses over time with a trajectory that covers both current and known emerging variants. FUNDING This work was primarily supported by Australian Medical Foundation research grants MRF2005760 (SGT, GM & WDR), Medical Research Future Fund Antiviral Development Call grant (WDR), the New South Wales Health COVID-19 Research Grants Round 2 (SGT & FB) and the NSW Vaccine Infection and Immunology Collaborative (VIIM) (ALC). Variant modeling was supported by funding from SciLifeLab's Pandemic Laboratory Preparedness program to B.M. (VC-2022-0028) and by the European Union's Horizon 2020 research and innovation programme under grant agreement no. 101003653 (CoroNAb) to B.M.
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Affiliation(s)
- Anouschka Akerman
- The Kirby Institute, University of New South Wales, New South Wales, Australia
| | | | - Tyra Jean
- Serology and Virology Division (SAViD), NSW Health Pathology, Randwick, Australia
| | - Camille Esneau
- Hunter Medical Research Institute, University of Newcastle, Callaghan, Australia
| | - Mariana Ruiz Silva
- The Kirby Institute, University of New South Wales, New South Wales, Australia
| | - Timothy Ison
- The Kirby Institute, University of New South Wales, New South Wales, Australia
| | - Christina Fichter
- The Kirby Institute, University of New South Wales, New South Wales, Australia
| | - Joseph A Lopez
- Brain Autoimmunity Group, Kids Neuroscience Centre, The Children's Hospital at Westmead, Faculty of Medicine and Health, School of Medical Sciences, New South Wales, Australia
| | - Deborah Chandra
- The Kirby Institute, University of New South Wales, New South Wales, Australia
| | - Zin Naing
- Serology and Virology Division (SAViD), NSW Health Pathology, Randwick, Australia
| | - Joanna Caguicla
- Serology and Virology Division (SAViD), NSW Health Pathology, Randwick, Australia
| | - Daiyang Li
- Serology and Virology Division (SAViD), NSW Health Pathology, Randwick, Australia
| | - Gregory Walker
- Serology and Virology Division (SAViD), NSW Health Pathology, Randwick, Australia
| | | | - Nathan Roth
- Department of Bioanalytical Sciences, Plasma Product Development, Research & Development, CSL Behring AG, Bern, Switzerland
| | - Sandro Manni
- Plasma Product Development, Research & Development, CSL Behring AG, Bern, Switzerland
| | - Thomas Hauser
- Plasma Product Development, Research & Development, CSL Behring AG, Bern, Switzerland
| | - Thomas Barnes
- Plasma Product Development, Research & Development, CSL Behring AG, Bern, Switzerland
| | - Anna Condylios
- Serology and Virology Division (SAViD), NSW Health Pathology, Randwick, Australia
| | - Malinna Yeang
- Serology and Virology Division (SAViD), NSW Health Pathology, Randwick, Australia
| | - Maureen Wong
- Serology and Virology Division (SAViD), NSW Health Pathology, Randwick, Australia
| | - Charles S P Foster
- Serology and Virology Division (SAViD), NSW Health Pathology, Randwick, Australia
| | - Kenta Sato
- Molecular Diagnostic Medicine Laboratory, Sydpath, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Sharon Lee
- Research & Education Network, Westmead Hospital, WSLHD, New South Wales, Australia
| | - Yang Song
- Research & Education Network, Westmead Hospital, WSLHD, New South Wales, Australia
| | - Lijun Mao
- Research & Education Network, Westmead Hospital, WSLHD, New South Wales, Australia
| | - Allison Sigmund
- Research & Education Network, Westmead Hospital, WSLHD, New South Wales, Australia
| | - Amy Phu
- Research & Education Network, Westmead Hospital, WSLHD, New South Wales, Australia
| | | | - Stephanie Hunt
- Royal Prince Alfred Hospital, SLHD, New South Wales, Australia
| | - Mark Douglas
- The Westmead Institute for Medical Research, Westmead, New South Wales, Australia; Centre for Infectious Diseases and Microbiology, Sydney Institute for Infectious Diseases, The University of Sydney at Westmead Hospital, Westmead, NSW, Australia
| | - Ian Caterson
- Royal Prince Alfred Hospital, SLHD, New South Wales, Australia
| | - Warwick Britton
- The Centenary Institute, University of Sydney, Camperdown, New South Wales 2050, Australia
| | - Kerrie Sandgren
- The Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Rowena Bull
- The Kirby Institute, University of New South Wales, New South Wales, Australia
| | - Andrew Lloyd
- The Kirby Institute, University of New South Wales, New South Wales, Australia
| | - Jamie Triccas
- Sydney Institute for Infectious Diseases and the Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Stuart Tangye
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Nathan W Bartlett
- Hunter Medical Research Institute, University of Newcastle, Callaghan, Australia
| | - David Darley
- St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Gail Matthews
- The Kirby Institute, University of New South Wales, New South Wales, Australia; St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Damien J Stark
- Molecular Diagnostic Medicine Laboratory, Sydpath, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Kathy Petoumenos
- The Kirby Institute, University of New South Wales, New South Wales, Australia
| | - William D Rawlinson
- Serology and Virology Division (SAViD), NSW Health Pathology, Randwick, Australia
| | - Ben Murrell
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Fabienne Brilot
- Brain Autoimmunity Group, Kids Neuroscience Centre, The Children's Hospital at Westmead, Faculty of Medicine and Health, School of Medical Sciences, New South Wales, Australia
| | - Anthony L Cunningham
- The Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Anthony D Kelleher
- The Kirby Institute, University of New South Wales, New South Wales, Australia; St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Anupriya Aggarwal
- The Kirby Institute, University of New South Wales, New South Wales, Australia
| | - Stuart G Turville
- The Kirby Institute, University of New South Wales, New South Wales, Australia.
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Shojaei M, Shamshirian A, Monkman J, Grice L, Tran M, Tan CW, Teo SM, Rodrigues Rossi G, McCulloch TR, Nalos M, Raei M, Razavi A, Ghasemian R, Gheibi M, Roozbeh F, Sly PD, Spann KM, Chew KY, Zhu Y, Xia Y, Wells TJ, Senegaglia AC, Kuniyoshi CL, Franck CL, dos Santos AFR, de Noronha L, Motamen S, Valadan R, Amjadi O, Gogna R, Madan E, Alizadeh-Navaei R, Lamperti L, Zuñiga F, Nova-Lamperti E, Labarca G, Knippenberg B, Herwanto V, Wang Y, Phu A, Chew T, Kwan T, Kim K, Teoh S, Pelaia TM, Kuan WS, Jee Y, Iredell J, O’Byrne K, Fraser JF, Davis MJ, Belz GT, Warkiani ME, Gallo CS, Souza-Fonseca-Guimaraes F, Nguyen Q, Mclean A, Kulasinghe A, Short KR, Tang B. IFI27 transcription is an early predictor for COVID-19 outcomes, a multi-cohort observational study. Front Immunol 2023; 13:1060438. [PMID: 36685600 PMCID: PMC9850159 DOI: 10.3389/fimmu.2022.1060438] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/09/2022] [Indexed: 01/07/2023] Open
Abstract
Purpose Robust biomarkers that predict disease outcomes amongst COVID-19 patients are necessary for both patient triage and resource prioritisation. Numerous candidate biomarkers have been proposed for COVID-19. However, at present, there is no consensus on the best diagnostic approach to predict outcomes in infected patients. Moreover, it is not clear whether such tools would apply to other potentially pandemic pathogens and therefore of use as stockpile for future pandemic preparedness. Methods We conducted a multi-cohort observational study to investigate the biology and the prognostic role of interferon alpha-inducible protein 27 (IFI27) in COVID-19 patients. Results We show that IFI27 is expressed in the respiratory tract of COVID-19 patients and elevated IFI27 expression in the lower respiratory tract is associated with the presence of a high viral load. We further demonstrate that the systemic host response, as measured by blood IFI27 expression, is associated with COVID-19 infection. For clinical outcome prediction (e.g., respiratory failure), IFI27 expression displays a high sensitivity (0.95) and specificity (0.83), outperforming other known predictors of COVID-19 outcomes. Furthermore, IFI27 is upregulated in the blood of infected patients in response to other respiratory viruses. For example, in the pandemic H1N1/09 influenza virus infection, IFI27-like genes were highly upregulated in the blood samples of severely infected patients. Conclusion These data suggest that prognostic biomarkers targeting the family of IFI27 genes could potentially supplement conventional diagnostic tools in future virus pandemics, independent of whether such pandemics are caused by a coronavirus, an influenza virus or another as yet-to-be discovered respiratory virus.
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Affiliation(s)
- Maryam Shojaei
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, NSW, Australia,Centre for Immunology and Allergy Research, the Westmead Institute for Medical Research, Westmead, NSW, Australia,Department of Medicine, Sydney Medical School Nepean, Nepean Hospital, University of Sydney, Penrith, NSW, Australia,*Correspondence: Arutha Kulasinghe, ; Kirsty R. Short, ; Maryam Shojaei,
| | - Amir Shamshirian
- Gastrointestinal Cancer Research Centre, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - James Monkman
- Frazer Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Laura Grice
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia,School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Minh Tran
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Chin Wee Tan
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Melbourne, VIC, Australia,Department of Medical Biology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Siok Min Teo
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Gustavo Rodrigues Rossi
- Frazer Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Timothy R. McCulloch
- Frazer Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Marek Nalos
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, NSW, Australia
| | - Maedeh Raei
- Gastrointestinal Cancer Research Centre, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Alireza Razavi
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Roya Ghasemian
- Antimicrobial Resistance Research Centre, Department of Infectious Diseases, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mobina Gheibi
- Student Research Committee, School of Allied Medical Sciences, Mazandaran University of Medical Science, Sari, Iran
| | | | - Peter D. Sly
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | - Kirsten M. Spann
- Centre for Immunology and Infection Control, Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Keng Yih Chew
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
| | - Yanshan Zhu
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
| | - Yao Xia
- School of Science, Edith Cowan University; School of Biomedical Science, University of Western Australia, Perth, WA, Australia
| | - Timothy J. Wells
- Frazer Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Alexandra Cristina Senegaglia
- Complexo Hospital de Clinicas, Universidade Federal do Paraná, Curitiba, Brazil,Core for Cell Technology, School of Medicine, PontifìciaUniversidade Católica do Paraná, Curitiba, Brazil
| | - Carmen Lúcia Kuniyoshi
- Complexo Hospital de Clinicas, Universidade Federal do Paraná, Curitiba, Brazil,Core for Cell Technology, School of Medicine, PontifìciaUniversidade Católica do Paraná, Curitiba, Brazil
| | | | | | | | - Sepideh Motamen
- Department of Medical Biotechnology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Reza Valadan
- Molecular and Cell Biology Research Centre, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran,Department of Immunology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Omolbanin Amjadi
- Gastrointestinal Cancer Research Centre, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Rajan Gogna
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark,Novo Nordisk Foundation centre for Stem Cell Biology, DanStem, Faculty of Health and Medical Sciences, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Esha Madan
- Campania Centre for the Unknown, Lisbon, Portugal
| | - Reza Alizadeh-Navaei
- Gastrointestinal Cancer Research Centre, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Liliana Lamperti
- Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, University of Concepcion, Concepcion, Chile
| | - Felipe Zuñiga
- Molecular and Translational Immunology Laboratory, Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, Universidad de Concepcion, Concepcion, Chile
| | - Estefania Nova-Lamperti
- Molecular and Translational Immunology Laboratory, Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, Universidad de Concepcion, Concepcion, Chile
| | - Gonzalo Labarca
- Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, University of Concepcion, Concepcion, Chile,Faculty of Medicine, Universidad de Concepcion, Concepcion, Chile
| | - Ben Knippenberg
- Infectious Diseases Department, Royal Darwin Hospital, Darwin, NT, Australia
| | - Velma Herwanto
- Faculty of Medicine, Universitas Tarumanagara, Jakarta, Indonesia
| | - Ya Wang
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, NSW, Australia,Centre for Immunology and Allergy Research, the Westmead Institute for Medical Research, Westmead, NSW, Australia,Department of Medicine, Sydney Medical School Nepean, Nepean Hospital, University of Sydney, Penrith, NSW, Australia
| | - Amy Phu
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, NSW, Australia,Westmead Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Tracy Chew
- Sydney Informatics Hub, Core Research Facilities, University of Sydney, Sydney, NSW, Australia
| | - Timothy Kwan
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, NSW, Australia
| | - Karan Kim
- Centre for Immunology and Allergy Research, the Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Sally Teoh
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, NSW, Australia
| | - Tiana M. Pelaia
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, NSW, Australia
| | - Win Sen Kuan
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yvette Jee
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore
| | - Jon Iredell
- Faculty of Medicine and Health, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia,Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Sydney, NSW, Australia,Westmead Hospital, Western Sydney Local Health District, Sydney, NSW, Australia
| | - Ken O’Byrne
- Queensland University of Technology, Centre for Genomics and PersonalisedHealth, School of Biomedical Sciences, Brisbane, QLD, Australia
| | - John F. Fraser
- Critical Care Research Group, The University of Queensland, Brisbane, QLD, Australia
| | - Melissa J. Davis
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Melbourne, VIC, Australia,Department of Medical Biology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia,Department of Clinical Pathology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Gabrielle T. Belz
- Frazer Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Majid E. Warkiani
- Australia Centre for Health Technologies (CHT) & Institute for Biomedical Materials & Devices (IBMD), School of Biomedical Engineering, University of Technology Sydney, Sydney, NSW, Australia
| | - Carlos Salomon Gallo
- Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, University of Concepcion, Concepcion, Chile,Exosome Biology Laboratory, Centre for Clinical Diagnostics, University of Queensland Centre for Clinical Research, Royal Brisbane and Women’s Hospital, The University of Queensland, Brisbane, QLD, Australia
| | | | - Quan Nguyen
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Anthony Mclean
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, NSW, Australia
| | - Arutha Kulasinghe
- Frazer Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia,*Correspondence: Arutha Kulasinghe, ; Kirsty R. Short, ; Maryam Shojaei,
| | - Kirsty R. Short
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia,*Correspondence: Arutha Kulasinghe, ; Kirsty R. Short, ; Maryam Shojaei,
| | - Benjamin Tang
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, NSW, Australia,Centre for Immunology and Allergy Research, the Westmead Institute for Medical Research, Westmead, NSW, Australia
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6
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Donnelley E, Teutsch S, Zurynski Y, Nunez C, Khandaker G, Lester-Smith D, Festa M, Booy R, Elliott EJ, Britton PN, Phu A, Handel D. Severe Influenza-Associated Neurological Disease in Australian Children: Seasonal Population-Based Surveillance 2008-2018. J Pediatric Infect Dis Soc 2022; 11:533-540. [PMID: 36153667 DOI: 10.1093/jpids/piac069] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/29/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Influenza-associated neurological disease (IAND) is uncommon but can result in death or neurological morbidity in children. We aimed to describe the incidence, risk factors, and outcome of children with IAND from seasonal influenza in Australia. METHODS We analyzed national, population-based, surveillance data for children aged ≤ 14 years with severe influenza and neurological involvement, over 11 Australian influenza seasons, 2008-2018, by the Australian Paediatric Surveillance Unit. RESULTS There were 633 laboratory-confirmed cases of severe influenza reported. Of these, 165 (26%) had IAND. The average annual incidence for IAND was 3.39 per million children aged ≤ 14 years. Compared to cases without neurological complications, those with IAND were more likely to have a pre-existing neurological disease (odds ratio [OR] 3.03, P < .001), but most children with IAND did not (n = 135, 82%). Children with IAND were more likely to receive antivirals (OR 1.80, P = .002), require intensive care (OR 1.79, P = .001), require ventilation (OR 1.99; P = .001), and die (OR 2.83, P = .004). CONCLUSIONS IAND is a preventable cause of mortality, predominantly in otherwise well children. Incidence estimates validate previous sentinel site estimates from Australia. IAND accounted for a quarter of all severe influenza, is associated with intensive care unit admission, and accounted for half of all influenza deaths.
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Affiliation(s)
- Erin Donnelley
- Department of General Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Suzy Teutsch
- Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Yvonne Zurynski
- Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Australian Institute of Health Innovation, National Health and Medical Research Council Partnership Centre for Health System Sustainability, Macquarie University, Sydney, New South Wales, Australia
| | - Carlos Nunez
- Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Gulam Khandaker
- Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia.,Research Division, Central Queensland University, Queensland, Australia
| | - David Lester-Smith
- Department of General Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Marino Festa
- Department of Intensive Care Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Kids Critical Care Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Robert Booy
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Elizabeth J Elliott
- Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Philip N Britton
- Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
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7
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Abstract
OBJECTIVE To evaluate the impact of fetal alcohol spectrum disorder (FASD) on child and family functioning. DESIGN Prospective survey. SETTING Multidisciplinary FASD assessment service. PATIENTS Caregivers of 35 children with FASD. MAIN OUTCOME MEASURES Child-health-related functioning (Royal Alexandra Hospital for Children Measure of Function (MOF)), family impact (Impact on Family (IOF) Scale), impact on siblings and caregiver stress. RESULTS Most caregivers were foster carers (74%). Children with FASD (median age 8.7 years; 54% male) were a median of 7.0 years at diagnosis. Regarding child-health-related functioning, 43% reported moderate, severe or major problems in at least one area on the MOF. IOF was moderate (60%) or high (34%). Poorer child-health-related functioning was associated with greater impact on family. Unaffected siblings received less parental attention and displayed anger or frustration about the affected child's needs. Caregivers reported frequent and high levels of stress. CONCLUSIONS FASD impacts children's health, and function of the family and unaffected siblings. These novel findings highlight the need for family-oriented service development.
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Affiliation(s)
- Natalie Lynette Phillips
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
| | - Marcel David Zimmet
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
| | - Amy Phu
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
| | - Meenakshi Rattan
- Department of Psychological Medicine, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
| | - Yvonne Zurynski
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia .,Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
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8
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Roskosky M, Moni G, Kawakami V, Lambert J, Brostrom-Smith C, Whitney H, Phu A, Look J, Pallickaparambil A, Kay M, Duchin J. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Transmission Associated With an Indoor Music Event That Required Proof of Full Vaccination Against Coronavirus Disease 2019 (COVID-19) Prior to Entry-Seattle, July 2021. Clin Infect Dis 2022; 75:S251-S253. [PMID: 35723277 PMCID: PMC9278201 DOI: 10.1093/cid/ciac494] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
In July 2021, Public Health-Seattle & King County investigated a coronavirus disease 2019 (COVID-19) outbreak at an indoor event intended for fully vaccinated individuals, revealing unvaccinated staff, limited masking, poor ventilation, and overcrowding. Supporting businesses to develop and implement comprehensive COVID-19 prevention plans is essential for reducing spread in these settings.
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Affiliation(s)
- Mellisa Roskosky
- Corresponding Author: Mellisa Roskosky, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta GA, 30322 ()
| | - Gwen Moni
- Public Health – Seattle & King County, Seattle, Washington
| | - Vance Kawakami
- Public Health – Seattle & King County, Seattle, Washington
| | - Joanie Lambert
- Public Health – Seattle & King County, Seattle, Washington
| | | | - Holly Whitney
- Public Health – Seattle & King County, Seattle, Washington
| | - Amy Phu
- Public Health – Seattle & King County, Seattle, Washington
| | - Jennifer Look
- Public Health – Seattle & King County, Seattle, Washington
| | | | - Meagan Kay
- Public Health – Seattle & King County, Seattle, Washington
| | - Jeff Duchin
- Public Health – Seattle & King County, Seattle, Washington
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9
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Deverell M, Phu A, Elliott EJ, Teutsch SM, Eslick GD, Stuart C, Murray S, Davis R, Dalkeith T, Christodoulou J, Zurynski YA. Health-related out-of-pocket expenses for children living with rare diseases - tuberous sclerosis and mitochondrial disorders: A prospective pilot study in Australian families. J Paediatr Child Health 2022; 58:611-617. [PMID: 34704652 DOI: 10.1111/jpc.15784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/17/2020] [Revised: 09/21/2021] [Accepted: 09/26/2021] [Indexed: 11/29/2022]
Abstract
AIM We aimed to describe health-related out-of-pocket (OOP) expenses incurred by Australian families living with children with chronic and complex diseases. METHODS A prospective pilot study of OOP expenses in families with children with tuberous sclerosis (TS) or mitochondrial disorders (MD) in 2016-2017. An initial survey assessed the family's financial situation, child's health functioning and estimated previous 6 months' and lifetime OOP expenses. Thereafter, families completed a survey each month for 6 months, prospectively tracking OOP expenses. RESULTS Initial surveys were completed by 13 families with 15 children; median age 7 years (range: 1-12); 5 with MD, 10 with TS. All families reported OOP expenses: 38% paid $2000 per annum, more than double the annual per-capita OOP costs reported for Australia by the Organisation for Economic Co-operation and Development. Eight families estimated $5000-$25 000 in OOP expenses over their child's lifetime and 62% of mothers reduced or stopped work due to caring responsibilities. Eleven families paid annual private health insurance premiums of $2000-$5122, but 72% said this was poor value-for-money. Prospective tracking by eight families (9 children) identified the median OOP expenditure was $863 (range $55-$1398) per family for 6 months. OOP spending was associated with visits to allied health professionals, non-prescription medicines, special foods, supplements and disposable items. Eight families paid for 91 prescription medications over 6 months. CONCLUSION All families caring for children with TS or MD reported OOP expenses. A larger study is needed to explore the affordability of health care for children living with a broader range of chronic diseases.
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Affiliation(s)
- Marie Deverell
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia.,Clinical Excellence Division, Government Department of Health Western Australia, Perth, Western Australia, Australia
| | - Amy Phu
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Suzy M Teutsch
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Guy D Eslick
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Clare Stuart
- Tuberous Sclerosis Australia, Sydney, New South Wales, Australia
| | - Sean Murray
- Australian Mitochondrial Disorders Foundation, Sydney, New South Wales, Australia
| | - Rebecca Davis
- Australian Mitochondrial Disorders Foundation, Sydney, New South Wales, Australia
| | - Troy Dalkeith
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - John Christodoulou
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mitochondrial Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Yvonne A Zurynski
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia.,NHMRC Partnership Centre in Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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10
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Douglas MW, Tay ESE, Wang DS, Ong ATL, Wilson C, Phu A, Kok J, Dwyer DE, Bull RA, Lloyd AR, Applegate TL, Dore GJ, Howe AY, Harrigan R, George J. Impact of an Open Access Nationwide Treatment Model on Hepatitis C Virus Antiviral Drug Resistance. Hepatol Commun 2020; 4:904-915. [PMID: 32490325 PMCID: PMC7262285 DOI: 10.1002/hep4.1496] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/07/2020] [Indexed: 12/21/2022] Open
Abstract
Direct acting antivirals (DAAs) have revolutionized hepatitis C virus (HCV) treatment, but drug resistance could undermine proposed global elimination targets. Real‐world studies are needed to inform the impact of widespread DAA treatment on antiviral resistance in the community. The prevalence and range of posttreatment resistance‐associated substitutions (RASs) was determined in Australian patients with open access to DAAs through a wide range of prescribers. NS3, NS5A, and NS5B regions were amplified by polymerase chain reaction and analyzed by population sequencing. Clinically relevant RASs were identified using online databases (ReCALL and Geno2Pheno[hcv]). Of 572 samples, 60% were from genotype 3 and 27% from genotype 1a. Ninety‐two percent of people failed a DAA regimen containing an NS5A inhibitor, including 10% with a pangenotype regimen. NS5A RASs were detected in 72% of people with genotype 1 and 80% with genotype 3. For genotype 1, there was a range of RASs across the NS5A region, while for genotype 3, the Y93H RAS predominated (72%). The prevalence of NS3 RASs was higher in people exposed to an NS3 inhibitor (35% vs. 3.9%; P < 0.0001). NS5B resistance was rare, with a single case of sofosbuvir resistance. Multiclass drug resistance was found in 33% of people exposed to both NS3 and NS5A inhibitors. Conclusion: The high prevalence of NS5A RASs among people failing DAA therapy reinforces the importance of specific retreatment regimens, ideally guided by resistance testing. The impact of multiclass drug resistance on retreatment in people exposed to both NS3 and NS5A inhibitors needs to be assessed in real‐world studies. Surveillance for increasing antiviral resistance during treatment scale‐up is essential to maintain the efficacy of current DAA regimens.
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Affiliation(s)
- Mark W Douglas
- Storr Liver Centre The Westmead Institute for Medical Research The University of Sydney and Westmead Hospital Sydney Australia.,Centre for Infectious Diseases and Microbiology Westmead Hospital Sydney Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity University of Sydney Sydney Australia
| | - Enoch S E Tay
- Storr Liver Centre The Westmead Institute for Medical Research The University of Sydney and Westmead Hospital Sydney Australia.,Centre for Infectious Diseases and Microbiology Laboratory Services NSW Health Pathology-Institute of Clinical Pathology and Medical Research Westmead Hospital Westmead Australia
| | - Dao Sen Wang
- Storr Liver Centre The Westmead Institute for Medical Research The University of Sydney and Westmead Hospital Sydney Australia
| | - Adrian T L Ong
- Storr Liver Centre The Westmead Institute for Medical Research The University of Sydney and Westmead Hospital Sydney Australia.,Centre for Infectious Diseases and Microbiology Westmead Hospital Sydney Australia
| | - Caroline Wilson
- Storr Liver Centre The Westmead Institute for Medical Research The University of Sydney and Westmead Hospital Sydney Australia
| | - Amy Phu
- Storr Liver Centre The Westmead Institute for Medical Research The University of Sydney and Westmead Hospital Sydney Australia
| | - Jen Kok
- Centre for Infectious Diseases and Microbiology Laboratory Services NSW Health Pathology-Institute of Clinical Pathology and Medical Research Westmead Hospital Westmead Australia
| | - Dominic E Dwyer
- Marie Bashir Institute for Infectious Diseases and Biosecurity University of Sydney Sydney Australia.,Centre for Infectious Diseases and Microbiology Laboratory Services NSW Health Pathology-Institute of Clinical Pathology and Medical Research Westmead Hospital Westmead Australia
| | - Rowena A Bull
- The Kirby Institute University of New South Wales Sydney Australia
| | - Andrew R Lloyd
- The Kirby Institute University of New South Wales Sydney Australia
| | | | - Gregory J Dore
- The Kirby Institute University of New South Wales Sydney Australia
| | - Anita Y Howe
- British Columbia Centre for Disease Control BC Canada
| | | | - Jacob George
- Storr Liver Centre The Westmead Institute for Medical Research The University of Sydney and Westmead Hospital Sydney Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity University of Sydney Sydney Australia
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11
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Duma SR, Mahant N, Ha A, Kim S, Phu A, Stewart K, Waugh MC, Wolfe N, Russell DC, Owler B, Krause M, Fung VSC. 078 Deep brain stimulation (DBS) for dyskinetic cerebral palsy: a pilot study. J Neurol Psychiatry 2018. [DOI: 10.1136/jnnp-2018-anzan.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
IntroductionDeep brain stimulation (DBS) targeting the internal segment of the globus pallidus (GPi) is effective for several forms of dystonia, particularly idiopathic isolated dystonia. DBS may also be helpful for some causes of chorea and other hyperkinetic disorders. A minority of people with cerebral palsy (CP) have dystonia or choreoathetoid movements (labelled dyskinetic CP). Treatment options to improve function for this group are limited. We aimed to investigate whether DBS is effective in reducing symptoms and improving function in dyskinetic CP.MethodsThis study was a randomised, placebo-controlled, double-blinded, crossover trial. Four participants (2M:2F, aged 11–48 year) with dyskinetic CP were included between 2010–2011. Participants underwent GPi DBS implantation and were randomised to active or sham stimulation for 3 months, following which their DBS stimulation was switched for a further 3 months. The Bourke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) was used to rate the severity of dystonia at baseline, 3 months after initial treatment; and 3 months after crossover treatment. The study was terminated early due to slow recruitment.ResultsOne participant had a reduction in BFMDRS score with active stimulation; this participant was the oldest and had the mildest BFMDRS score. The remainder of the participants had either no change or a slight increase in BFMDRS score. Despite this, in longer-term follow-up, 3 participants reported symptomatic improvement and continue active DBS treatment 7–8 years post-surgery.ConclusionWe did not identify a benefit of GPi DBS for dyskinetic CP in our randomised controlled trial. However, 3 participants have had symptomatic improvement on long-term follow-up, consistent with other reports of benefit with GPi DBS. Limiting factors of the study include small sample size, participant heterogeneity and study design. It was noted that the final (efficacious) stimulation parameters required open label programming to achieve and were outside of those permitted by the protocol.
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12
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Deverell M, Phu A, Zurynski Y, Elliott E. Australian Paediatric Surveillance Unit Annual Report, 2016. Commun Dis Intell (2018) 2017; 41:E288-E293. [PMID: 29720077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This report summarises the cases reported to the Australian Paediatric Surveillance Unit (APSU) of rare infectious diseases or rare complications of more common infectious diseases in children. During the calendar year 2016, there were approximately 1500 paediatricians reporting to the APSU and the monthly report card return rate was 90%. APSU continued to provide unique national data on the perinatal exposure to HIV, congenital rubella, congenital cytomegalovirus, neonatal and infant herpes simplex virus, and congenital and neonatal varicella. APSU contributed 10 unique cases of Acute Flaccid Paralysis (a surrogate for polio) - these data are combined with cases ascertained through other surveillance systems including the Paediatric Active Disease Surveillance (PAEDS) to meet the World Health Organisation surveillance target. There was a decline in the number of cases of juvenile onset Recurrent Respiratory Papillomatosis which is likely to be associated with the introduction of the National HPV Vaccination Program. The number of cases of severe complications of influenza was significantly less in 2016 (N=32) than in 2015 (N=84) and for the first time in the last nine years no deaths due to severe influenza were reported to the APSU. In June 2016 surveillance for microcephaly commenced to assist with the detection of potential cases of congenital Zika virus infection and during that time there were 21 confirmed cases - none had a relevant history to suspect congenital Zika virus infection, however, these cases are being followed up to determine the cause of microcephaly.
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Affiliation(s)
- Marie Deverell
- Australian Paediatric Surveillance Unit, Kids Research Institute, Westmead, New South Wales
- Sydney Medical School, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales
| | - Amy Phu
- Australian Paediatric Surveillance Unit, Kids Research Institute, Westmead, New South Wales
- Sydney Medical School, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales
| | - Yvonne Zurynski
- Australian Paediatric Surveillance Unit, Kids Research Institute, Westmead, New South Wales
- Sydney Medical School, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales
| | - Elizabeth Elliott
- Australian Paediatric Surveillance Unit, Kids Research Institute, Westmead, New South Wales
- Sydney Medical School, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales
- Sydney Children's Hospitals Network (Westmead), Westmead, New South Wales
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13
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Saddi V, Beggs S, Bennetts B, Harrison J, Hime N, Kapur N, Lipsett J, Nogee LM, Phu A, Suresh S, Schultz A, Selvadurai H, Sherrard S, Strachan R, Vyas J, Zurynski Y, Jaffé A. Childhood interstitial lung diseases in immunocompetent children in Australia and New Zealand: a decade's experience. Orphanet J Rare Dis 2017; 12:133. [PMID: 28743279 PMCID: PMC5526310 DOI: 10.1186/s13023-017-0637-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 04/19/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Childhood interstitial lung disease (chILD) represents a rare heterogeneous group of respiratory disorders. In the absence of randomized controlled clinical trials, global collaborations have utilized case series with an aim to standardising approaches to diagnosis and management. Australasian data are lacking. The aim of this study was to calculate prevalence and report the experience of chILD in Australasia over a decade. METHODS Paediatric pulmonologists in Australia and New Zealand involved in the care of patients aged 0-18 years with chILD completed a questionnaire on demographics, clinical features and outcomes, over a 10 year period. These data, together with data from the 2 reference genetics laboratories, were used to calculate prevalence. RESULTS One hundred fifteen cases were identified equating to a period prevalence (range) of 1.5 (0.8-2.1) cases/million for children aged 0-18years. Clinical data were provided on 106 patients: the <2 year group comprised 66 children, median age (range) 0.50 years (0.01-1.92); the ≥2 year group comprised 40 children, median age 8.2 years (2.0-18.0). Management approach was heterogeneous. Overall, 79% of patients had a good clinical outcome. Mortality rate was 7% in the study population. CONCLUSION chILD is rare in Australasia. This study demonstrates variation in the investigations and management of chILD cases across Australasia, however the general outcome is favorable. Further international collaboration will help finesse the understanding of these disorders.
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Affiliation(s)
- Vishal Saddi
- Department of Respiratory Medicine, Discipline of Paediatrics, Sydney Children’s Hospital, Randwick, Sydney, NSW 2031 Australia
| | - Sean Beggs
- Department of Paediatrics, Royal Hobart Hospital, Hobart, TAS 7000 Australia
| | - Bruce Bennetts
- Department of Molecular Genetics, The Children’s Hospital at Westmead, Sydney, NSW 2145 Australia
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Joanne Harrison
- Department of Respiratory Medicine, The Children’s Hospital, Melbourne, VIC 3052 Australia
| | - Neil Hime
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia
- Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney, NSW 2145 Australia
| | - Nitin Kapur
- Department of Respiratory Medicine, Lady Cilento Children’s Hospital, Brisbane, QLD 4101 Australia
| | - Jill Lipsett
- Anatomical Pathology, S.A. Pathology, Women’s and Children’s Hospital, Adelaide, South Australia 5154 Australia
| | - Lawrence M. Nogee
- Eudowood Neonatal Pulmonary Division, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287 USA
| | - Amy Phu
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia
- Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney, NSW 2145 Australia
| | - Sadasivam Suresh
- Department of Respiratory Medicine, Lady Cilento Children’s Hospital, Brisbane, QLD 4101 Australia
| | - André Schultz
- Department of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, WA 6008 Australia
| | - Hiran Selvadurai
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia
- Department of Respiratory Medicine, The Children’s Hospital at Westmead, Sydney, NSW 2145 Australia
| | - Stephanie Sherrard
- Department of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, WA 6008 Australia
| | - Roxanne Strachan
- Department of Respiratory Medicine, Discipline of Paediatrics, Sydney Children’s Hospital, Randwick, Sydney, NSW 2031 Australia
| | - Julian Vyas
- Department of Respiratory Paediatrics, Starship Children’s Hospital, Auckland, 1023 New Zealand
| | - Yvonne Zurynski
- Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney, NSW 2145 Australia
| | - Adam Jaffé
- School of Women’s and Children’s Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2031 Australia
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14
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Deverell M, Phu A, Zurynski YA, Elliott EJ. Australian Paediatric Surveillance Unit annual report, 2015. Commun Dis Intell (2018) 2017; 41:E181-E185. [PMID: 28899312] [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)
- Marie Deverell
- Australian Paediatric Surveillance Unit, Kids Research Institute, Westmead, New South Wales
- Sydney Medical School, Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales
| | - Amy Phu
- Australian Paediatric Surveillance Unit, Kids Research Institute, Westmead, New South Wales
- Sydney Medical School, Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales
| | - Yvonne A Zurynski
- Australian Paediatric Surveillance Unit, Kids Research Institute, Westmead, New South Wales
- Sydney Medical School, Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales
| | - Elizabeth J Elliott
- Australian Paediatric Surveillance Unit, Kids Research Institute, Westmead, New South Wales
- Sydney Medical School, Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales
- Sydney Children's Hospitals Network (Westmead), Westmead, New South Wales
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15
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Zurynski Y, Phu A, Sureshkumar P, Cherian S, Deverell M, Elliott EJ. Female genital mutilation in children presenting to Australian paediatricians. Arch Dis Child 2017; 102:509-515. [PMID: 28082321 PMCID: PMC5466924 DOI: 10.1136/archdischild-2016-311540] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 10/04/2016] [Accepted: 11/27/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The WHO reports that female genital mutilation/cutting (FGM/C) is an ancient cultural practice prevalent in many countries. FGM/C has been reported among women resident in Australia. Our paper provides the first description of FGM/C in Australian children. DESIGN Cross-sectional survey conducted in April-June 2014. SETTING Paediatricians and other child health specialists recruited through the Australian Paediatric Surveillance Unit were asked to report children aged <18 years with FGM/C seen in the last 5 years, and to provide data for demographics, FGM/C type, complications and referral for each case. PARTICIPANTS Of 1311 eligible paediatricians/child health specialists, 1003 (76.5%) responded. RESULTS Twenty-three (2.3%) respondents had seen 59 children with FGM/C and provided detailed data for 31. Most (89.7%) were identified during refugee screening and were born in Africa. Three (10.3%) were born in Australia: two had FGM/C in Australia and one in Indonesia. All parents were born overseas, mainly Africa (98.1%). Ten children had WHO FGM/C type I, five type II, five type III and six type IV. Complications in eight children included recurrent genitourinary infections, menstrual, sexual, fertility and psychological problems. Nineteen children (82.6%) were referred to obstetrics/gynaecology: 16 (69.9%) to social work and 13 (56.5%) to child protection. CONCLUSIONS This study confirms that FGM/C is seen in paediatric clinical practice within Australia. Paediatricians need cultural awareness, education and resources to help them identify children with FGM/C and/or at risk of FGM/C, to enable appropriate referral and counselling of children, families and communities to assist in the prevention of this practice.
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Affiliation(s)
- Yvonne Zurynski
- Australian Paediatric Surveillance Unit, The Children's Hospital at Westmead, Sydney, New South Wales, Australia,Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Amy Phu
- Australian Paediatric Surveillance Unit, The Children's Hospital at Westmead, Sydney, New South Wales, Australia,Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Premala Sureshkumar
- Australian Paediatric Surveillance Unit, The Children's Hospital at Westmead, Sydney, New South Wales, Australia,Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Cherian
- Refugee Health Service, Princess Margaret Hospital for Children, Perth, Western Australia, Australia,School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - Marie Deverell
- Australian Paediatric Surveillance Unit, The Children's Hospital at Westmead, Sydney, New South Wales, Australia,Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Elizabeth J Elliott
- Australian Paediatric Surveillance Unit, The Children's Hospital at Westmead, Sydney, New South Wales, Australia,Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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16
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Zurynski Y, Gonzalez A, Deverell M, Phu A, Leonard H, Christodoulou J, Elliott E. Rare disease: a national survey of paediatricians' experiences and needs. BMJ Paediatr Open 2017; 1:e000172. [PMID: 29637168 PMCID: PMC5862166 DOI: 10.1136/bmjpo-2017-000172] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/04/2017] [Accepted: 09/05/2017] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To describe the experiences of Australian paediatricians while caring for children with rare diseases, and their educational and resource needs. DESIGN A brief online survey was developed and deployed to a representative sample of 679 paediatricians from the Australian Paediatric Surveillance Unit database. RESULTS Of the 679 paediatricians, 242 (36%) completed the survey. The respondents were representative of all states and territories of Australia, urban and rural regions, and hospital and private practice. Almost all respondents (93%) had seen children with one or more of >350 different rare diseases during their career; 74% had seen a new patient with rare disease in the last 6 months. The most common problems encountered while caring for patients were: diagnostic delays (65%), lack of available treatments (40%), clinical guidelines (36%) and uncertainty where to refer for peer support (35%). Few paediatricians said that rare diseases were adequately covered during university (40%) or the Fellowship of the Royal Australasian College of Physicians (50%) training, and 28% felt unprepared to care for patients with rare diseases. Paediatricians wanted lists of specialist referral services (82%) and online educational modules about rare diseases (78%) that could be accessed via one online portal that consolidated multiple resources. Smartphone applications on rare diseases were favoured by paediatricians aged <50 years and by female paediatricians. CONCLUSIONS An online educational portal should be developed and maintained for accuracy and currency of information to support dissemination of rare disease guidelines, referral pathways and coordination services relevant to Australian paediatricians and other health professionals who care for children with rare diseases.
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Affiliation(s)
- Yvonne Zurynski
- Australian Paediatric Surveillance Unit, Kids Research Institute, Westmead, New South Wales, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Aranzazu Gonzalez
- Australian Paediatric Surveillance Unit, Kids Research Institute, Westmead, New South Wales, Australia
| | - Marie Deverell
- Australian Paediatric Surveillance Unit, Kids Research Institute, Westmead, New South Wales, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Amy Phu
- Australian Paediatric Surveillance Unit, Kids Research Institute, Westmead, New South Wales, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, West Perth, Western Australia, Australia
| | - John Christodoulou
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia.,Clinical School, Sydney Children's Hospital Network, Sydney, New South Wales, Australia.,Genetic Metabolic Disorders Research Unit, Western Sydney Genetics Program, the Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Elizabeth Elliott
- Australian Paediatric Surveillance Unit, Kids Research Institute, Westmead, New South Wales, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
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17
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Hime NJ, Zurynski Y, Fitzgerald D, Selvadurai H, Phu A, Deverell M, Elliott EJ, Jaffe A. Childhood interstitial lung disease: A systematic review. Pediatr Pulmonol 2015; 50:1383-92. [PMID: 25931270 DOI: 10.1002/ppul.23183] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [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: 06/30/2014] [Revised: 12/23/2014] [Accepted: 01/15/2015] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Childhood interstitial lung disease (chILD) is a group of rare chronic and complex disorders of variable pathology. There has been no systematic review of published chILD research. This study aimed to describe chILD classification systems, epidemiology, morbidity, treatments, outcomes, and the impact of chILD on families and the burden on health services. METHODS A systematic literature search for original studies on chILD was undertaken in the major biomedical databases to the end of December 2013. Epidemiological studies, case series and studies describing classification systems were included. Single case studies were excluded. RESULTS The search yielded 37 publications that met study criteria. Four different chILD classification systems have been proposed in the past decade. The incidence of chILD has been estimated at 0.13-16.2 cases/100,000 children/year. One to five new cases presented to individual hospitals each year. In developed countries, the median mortality was 13% (6-19%). Morbidity and outcomes were highly variable and not systematically reported. Corticosteroids and hydroxychloroquine were the most common treatments. The impact of chILD on families and the burden on health services has not been studied. CONCLUSIONS The heterogeneity of the chILD group of disorders, different determinations of what constitutes a chILD disorder and, a paucity of large epidemiological studies precludes consolidation of results across studies. Consensus on chILD classification is needed to support diagnosis and allow direct comparisons of research evidence. Active disease surveillance and international patient registries are required to advance understanding and management of chILD.
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Affiliation(s)
- Neil J Hime
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Westmead NSW 2145, Australia
| | - Yvonne Zurynski
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Westmead NSW 2145, Australia
| | - Dominic Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead NSW 2145, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney Clinical School, Sydney, Australia
| | - Hiran Selvadurai
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead NSW 2145, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney Clinical School, Sydney, Australia
| | - Amy Phu
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Westmead NSW 2145, Australia
| | - Marie Deverell
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Westmead NSW 2145, Australia
| | - Elizabeth J Elliott
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Westmead NSW 2145, Australia.,The Children's Hospital at Westmead, Sydney, Australia
| | - Adam Jaffe
- Department of Respiratory Medicine, Sydney Children's Hospital, Randwick NSW 2031, Australia.,Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, Australia
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Zhang DL, Huang Y, Yan L, Phu A, Ran X, Li SS. Thirty-eight cases of acute pancreatitis in pregnancy: a 6-year single center retrospective analysis. ACTA ACUST UNITED AC 2013; 33:361-367. [PMID: 23771661 DOI: 10.1007/s11596-013-1125-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Indexed: 02/08/2023]
Abstract
Thirty-eight pregnant inpatients with acute pancreatitis (AP) were retrospectively reviewed from 2006 to 2012 in our hospital. The incidence of pregnancy-associated AP was 2.27‰. Most (78.95%) of the attack occurred in the third trimester. The median of APACHE II score was 6 and severe AP accounted for 31.58% (12 cases). Primary diseases were absent in most cases (57.89%). The most common clinical presentations were abdominal pain (89.47%) and vomiting (68.42%). Pleural effusion and ascites were found only in the third trimester. Elevated white blood cell count, amylase and lipase were commonly found in biochemical examinations. Eleven cases required intensive care in ICU and 21 cases received caesarean section. There were 2 maternal deaths and 12 fetal losses including 4 abortions. It is concluded that AP is a rare entity in pregnancy. The incidence of pancreatitis increases with the gestational age. However, the severity is not necessarily related with the pregnancy trimesters. The diagnosis is based on clinical presentations, laboratory tests and imaging examinations. Although the treatment strategy of a pregnant woman with pancreatitis is similar to the general non-pregnant patient with AP, a multidisciplinary team consisting of gastroenterologist, gastrointestinal surgeon, radiologist, obstetrician, and ICU doctor should be set up.
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Affiliation(s)
- Dong-Lin Zhang
- Department of Pharmacy, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yi Huang
- Department of Nephrology, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Li Yan
- Department of ICU, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Amy Phu
- Department of ICU, Nepean Hospital and Nepean Clinical School, University of Sydney, Penrith, 2750, Australia
| | - Xiao Ran
- Department of ICU, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Shu-Sheng Li
- Department of ICU, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
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