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Halley C, Honeywill C, Kang J, Pierse N, Robertson O, Rawlinson W, Stelzer-Braid S, Willink R, Crane J. Preventing upper respiratory tract infections with prophylactic nasal carrageenan: a feasibility study. Future Microbiol 2023; 18:1319-1328. [PMID: 37830932 DOI: 10.2217/fmb-2021-0122] [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: 05/05/2021] [Accepted: 08/04/2023] [Indexed: 10/14/2023] Open
Abstract
Aim: To observe upper respiratory tract infection (URTI) symptoms, rhinovirus levels and compliance with daily carrageenan nasal spray. Methods: 102 adults were randomized to carrageenan or saline placebo three times daily for 8 weeks and URTI symptoms were recorded. A control group (n = 42) only recorded URTI symptoms. Participants collected nasal swabs when symptomatic. Results: Regular daily carrageenan prophylaxis resulted in consistent but nonsignificant reductions in URTI symptoms versus the placebo group. Saline placebo decreased and increased some cold symptoms compared with no treatment. Conclusion: Daily prophylactic administration of antiviral carrageenan may not significantly reduce URTI symptoms. Due to low compliance, use in a population with specific reasons to avoid URTIs may be more appropriate. Disease-specific outcomes may be more useful than symptom reporting.
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Affiliation(s)
- Caroline Halley
- Department of Medicine, University of Otago, 23A Mein Street, Wellington, 6021, New Zealand
| | - Claire Honeywill
- Department of Medicine, University of Otago, 23A Mein Street, Wellington, 6021, New Zealand
| | - Janice Kang
- Department of Medicine, University of Otago, 23A Mein Street, Wellington, 6021, New Zealand
| | - Nevil Pierse
- Department of Public Health, University of Otago, 23A Mein Street, Wellington, 6021, New Zealand
| | - Oliver Robertson
- Department of Public Health, University of Otago, 23A Mein Street, Wellington, 6021, New Zealand
| | - William Rawlinson
- Virology Research Laboratory, Level 3 Campus Centre, Prince of Wales Hospital, Randwick, NSW 2031, Australia
| | - Sacha Stelzer-Braid
- Virology Research Laboratory, Level 3 Campus Centre, Prince of Wales Hospital, Randwick, NSW 2031, Australia
- University of New South Wales, Sydney, NSW 2052, Australia
| | - Robin Willink
- Biostatistical Group, University of Otago, 23A Mein Street, Wellington, 6021, New Zealand
| | - Julian Crane
- Department of Medicine, University of Otago, 23A Mein Street, Wellington, 6021, New Zealand
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Howden-Chapman P, Crane J, Keall M, Pierse N, Baker MG, Cunningham C, Amore K, Aspinall C, Bennett J, Bierre S, Boulic M, Chapman R, Chisholm E, Davies C, Fougere G, Fraser B, Fyfe C, Grant L, Grimes A, Halley C, Logan-Riley A, Nathan K, Olin C, Ombler J, O’Sullivan K, Pehi T, Penny G, Phipps R, Plagman M, Randal E, Riggs L, Robson B, Ruru J, Shaw C, Schrader B, Teariki MA, Telfar Barnard L, Tiatia R, Toy-Cronin B, Tupara H, Viggers H, Wall T, Wilkie M, Woodward A, Zhang W. He Kāinga Oranga: reflections on 25 years of measuring the improved health, wellbeing and sustainability of healthier housing. J R Soc N Z 2023. [DOI: 10.1080/03036758.2023.2170427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- Philippa Howden-Chapman
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Julian Crane
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Michael Keall
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Nevil Pierse
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Michael G. Baker
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Chris Cunningham
- Research Centre for Hauora & Health, Massey University, Wellington, New Zealand
| | - Kate Amore
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Clare Aspinall
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Julie Bennett
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Sarah Bierre
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Mikael Boulic
- School of the Built Environment, Massey University, Auckland, New Zealand
| | - Ralph Chapman
- School of Geography, Environment and Earth Sciences, Te Herenga Waka, Victoria University of Wellington, New Zealand
| | - Elinor Chisholm
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Cheryl Davies
- Tu Kotahi Māori Asthma Trust, Wainuiomata, Lower Hutt, New Zealand
| | - Geoff Fougere
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Brodie Fraser
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Caro Fyfe
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Libby Grant
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Arthur Grimes
- Motu Economic and Public Policy Research, Wellington, New Zealand
| | - Caroline Halley
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Amber Logan-Riley
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Kim Nathan
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Crystal Olin
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Jenny Ombler
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Kimberley O’Sullivan
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Tiria Pehi
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Guy Penny
- EMPlan Services Ltd, Wellington, New Zealand
| | - Robyn Phipps
- Faculty of Architecture and Design Innovation, Te Herenga Waka, Victoria University of Wellington, Wellington, New Zealand
| | - Manfred Plagman
- Building Research Association of New Zealand, Porirua, New Zealand
| | - Edward Randal
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Lynn Riggs
- Motu Economic and Public Policy Research, Wellington, New Zealand
| | - Bridget Robson
- Eru Pomare Māori Health Research Centre, University of Otago, Wellington, New Zealand
| | - Jacinta Ruru
- Faculty of Law, University of Otago, Dunedin, New Zealand
| | - Caroline Shaw
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Ben Schrader
- Stout Research Centre, Te Herenga Waka, Victoria University of Wellington, Wellington, New Zealand
| | - Mary Anne Teariki
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Lucy Telfar Barnard
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Ramona Tiatia
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | | | - Hope Tupara
- Research Centre for Hauora & Health, Massey University, Wellington, New Zealand
| | - Helen Viggers
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | | | - Marg Wilkie
- Research Centre for Hauora & Health, Massey University, Wellington, New Zealand
| | - Alistair Woodward
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Wei Zhang
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
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Baker MG, Gurney J, Moreland NJ, Bennett J, Oliver J, Williamson DA, Pierse N, Wilson N, Merriman TR, Percival T, Jackson C, Edwards R, Mow FC, Thomson WM, Zhang J, Lennon D. Risk factors for acute rheumatic fever: A case-control study. Lancet Reg Health West Pac 2022; 26:100508. [PMID: 36213134 PMCID: PMC9535428 DOI: 10.1016/j.lanwpc.2022.100508] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain an inequitable cause of avoidable suffering and early death in many countries, including among Indigenous Māori and Pacific populations in New Zealand. There is a lack of robust evidence on interventions to prevent ARF. This study aimed to identify modifiable risk factors, with the goal of producing evidence to support policies and programs to decrease rates of ARF. METHODS A case-control study was undertaken in New Zealand using hospitalised, first episode ARF cases meeting a standard case-definition. Population controls (ratio of 3:1) were matched by age, ethnicity, socioeconomic deprivation, location, sex, and recruitment month. A comprehensive, pre-tested questionnaire was administered face-to-face by trained interviewers. FINDINGS The study included 124 cases and 372 controls. Multivariable analysis identified strong associations between ARF and household crowding (OR 3·88; 95%CI 1·68-8·98) and barriers to accessing primary health care (OR 2·07; 95% CI 1·08-4·00), as well as a high intake of sugar-sweetened beverages (OR 2·00; 1·13-3·54). There was a marked five-fold higher ARF risk for those with a family history of ARF (OR 4·97; 95% CI 2·53-9·77). ARF risk was elevated following self-reported skin infection (aOR 2·53; 1·44-4·42) and sore throat (aOR 2·33; 1·49-3·62). INTERPRETATION These globally relevant findings direct attention to the critical importance of household crowding and access to primary health care as strong modifiable causal factors in the development of ARF. They also support a greater focus on the role of managing skin infections in ARF prevention. FUNDING This research was funded by the Health Research Council of New Zealand (HRC) Rheumatic Fever Research Partnership (supported by the New Zealand Ministry of Health, Te Puni Kōkiri, Cure Kids, Heart Foundation, and HRC) award number 13/959.
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Affiliation(s)
- Michael G. Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
- Maurice Wilkins Centre, The University of Auckland, Auckland, New Zealand
| | - Jason Gurney
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nicole J. Moreland
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre, The University of Auckland, Auckland, New Zealand
| | - Julie Bennett
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jane Oliver
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Victoria, Australia
| | - Deborah A. Williamson
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Reference Laboratory at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Nevil Pierse
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nigel Wilson
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Starship Children's Hospital, Auckland, New Zealand
- Green Lane Paediatric and Congenital Cardiac Services, Auckland, New Zealand
| | - Tony R. Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, United States of America
| | - Teuila Percival
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Moana Research, Auckland, New Zealand
| | | | - Richard Edwards
- Department of Public Health, University of Otago, Wellington, New Zealand
| | | | | | - Jane Zhang
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Diana Lennon
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Fraser B, Chun S, Pehi T, Jiang T, Johnson E, Ombler J, McMinn C, Pierse N. Post-housing first outcomes amongst a cohort of formerly homeless youth in Aotearoa New Zealand. J R Soc N Z 2022. [DOI: 10.1080/03036758.2022.2088572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Brodie Fraser
- Department of Public Health, Te Whare Wānanga o Otāgo ki Pōneke – University of Otago, Wellington, New Zealand
| | - Saera Chun
- Department of Public Health, Te Whare Wānanga o Otāgo ki Pōneke – University of Otago, Wellington, New Zealand
| | - Tiria Pehi
- Department of Public Health, Te Whare Wānanga o Otāgo ki Pōneke – University of Otago, Wellington, New Zealand
| | - Terence Jiang
- Department of Public Health, Te Whare Wānanga o Otāgo ki Pōneke – University of Otago, Wellington, New Zealand
| | - Ellie Johnson
- Department of Public Health, Te Whare Wānanga o Otāgo ki Pōneke – University of Otago, Wellington, New Zealand
| | - Jenny Ombler
- Department of Public Health, Te Whare Wānanga o Otāgo ki Pōneke – University of Otago, Wellington, New Zealand
| | | | - Nevil Pierse
- Department of Public Health, Te Whare Wānanga o Otāgo ki Pōneke – University of Otago, Wellington, New Zealand
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Nathan K, Robertson O, Atatoa Carr P, Howden-Chapman P, Pierse N. Residential mobility and potentially avoidable hospitalisations in a population-based cohort of New Zealand children. J Epidemiol Community Health 2022; 76:606-612. [PMID: 35292510 DOI: 10.1136/jech-2021-218509] [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: 11/26/2021] [Accepted: 02/05/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Residential moves are common in early childhood and associations have been found between residential mobility and adverse child health and well-being outcomes. Although there are studies on potentially avoidable hospitalisations (PAH) in children, few have examined PAH in relation to residential mobility. Our aim, therefore, was to investigate residential mobility and PAH in a population-based cohort of New Zealand children. METHODS Using a retrospective cohort design, we analysed data from the Integrated Data Infrastructure for a cohort of 314 283 children born since the start of 2004, who had at least one residential address recorded by 2 years of age. Residential mobility was derived from address data and PAH were determined from hospital discharge data. RESULTS Half of the cohort children (52%) experienced at least one residential move by 2 years of age, and 22% experienced two or more moves. Fifteen per cent of the cohort experienced one or more PAH between 2 and 4 years of age. A linear association between residential mobility and PAH was found (relative risk (RR)=1.18, CI 1.17 to 1.19) and this remained robust when adjusting for several covariates. Sensitivity analyses for ambulatory care sensitive hospitalisations (ACSH) and PAH attributable to the housing/physical environment (PAH-HE) produced results very similar to those for PAH (ACSH: adjusted RR (aRR)=1.10, CI 1.09 to 1.11; PAH-HE: aRR=1.11, CI 1.10 to 1.12). CONCLUSION This study found a linear association between higher residential mobility and an increased likelihood of PAH in young children. Avenues for further investigation are suggested.
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Affiliation(s)
- Kim Nathan
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Oliver Robertson
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Polly Atatoa Carr
- Te Ngira: Institute for Population Research, University of Waikato, Hamilton, New Zealand
| | | | - Nevil Pierse
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
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Fraser B, Chisholm E, Pierse N. "You're so powerless": Takatāpui/LGBTIQ+ people's experiences before becoming homeless in Aotearoa New Zealand. PLoS One 2021; 16:e0259799. [PMID: 34928948 PMCID: PMC8687556 DOI: 10.1371/journal.pone.0259799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/27/2021] [Indexed: 11/18/2022] Open
Abstract
Little is known in Aotearoa New Zealand about experiences of homelessness amongst Takatāpui/LGBTIQ+ identifying people, despite growing international literature regarding LGBTIQ+ homelessness. Using data from semi-structured interviews with eight people who identified as Takatāpui/LGBTIQ+ and had experienced homelessness, this paper explores their experiences prior to becoming homeless. These experiences are placed into the categories of: the pervasiveness of instability (especially in regards to family relationships, finances, and housing), having to grow up fast due to social and material conditions, experiences of looking for housing in stressed markets, and systems failures that resulted in a lack of autonomy. These results show that instability and systems failures are key contributors to Takatāpui/LGBTIQ+ people becoming homeless in Aotearoa New Zealand.
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Affiliation(s)
- Brodie Fraser
- He Kāinga Oranga, Department of Public Health, University of Otago, Wellington, Aoteaora New Zealand
- * E-mail:
| | - Elinor Chisholm
- He Kāinga Oranga, Department of Public Health, University of Otago, Wellington, Aoteaora New Zealand
| | - Nevil Pierse
- He Kāinga Oranga, Department of Public Health, University of Otago, Wellington, Aoteaora New Zealand
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Oliver J, Bennett J, Thomas S, Zhang J, Pierse N, Moreland NJ, Williamson DA, Jack S, Baker M. Preceding group A streptococcus skin and throat infections are individually associated with acute rheumatic fever: evidence from New Zealand. BMJ Glob Health 2021; 6:bmjgh-2021-007038. [PMID: 34887304 PMCID: PMC8663084 DOI: 10.1136/bmjgh-2021-007038] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 07/29/2021] [Accepted: 11/17/2021] [Indexed: 01/23/2023] Open
Abstract
Introduction Acute rheumatic fever (ARF) is usually considered a consequence of group A streptococcus (GAS) pharyngitis, with GAS skin infections not considered a major trigger. The aim was to quantify the risk of ARF following a GAS-positive skin or throat swab. Methods This retrospective analysis used pre-existing administrative data. Throat and skin swab data (1 866 981 swabs) from the Auckland region, New Zealand and antibiotic dispensing data were used (2010–2017). Incident ARF cases were identified using hospitalisation data (2010–2018). The risk ratio (RR) of ARF following swab collection was estimated across selected features and timeframes. Antibiotic dispensing data were linked to investigate whether this altered ARF risk following GAS detection. Results ARF risk increased following GAS detection in a throat or skin swab. Māori and Pacific Peoples had the highest ARF risk 8–90 days following a GAS-positive throat or skin swab, compared with a GAS-negative swab. During this period, the RR for Māori and Pacific Peoples following a GAS-positive throat swab was 4.8 (95% CI 3.6 to 6.4) and following a GAS-positive skin swab, the RR was 5.1 (95% CI 1.8 to 15.0). Antibiotic dispensing was not associated with a reduction in ARF risk following GAS detection in a throat swab (antibiotics not dispensed (RR: 4.1, 95% CI 2.7 to 6.2), antibiotics dispensed (RR: 4.3, 95% CI 2.5 to 7.4) or in a skin swab (antibiotics not dispensed (RR: 3.5, 95% CI 0.9 to 13.9), antibiotics dispensed (RR: 2.0, 95% CI 0.3 to 12.1). Conclusions A GAS-positive throat or skin swab is strongly associated with subsequent ARF, particularly for Māori and Pacific Peoples. This study provides the first population-level evidence that GAS skin infection can trigger ARF.
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Affiliation(s)
- Jane Oliver
- The Peter Doherty Institute for Infection and Immunity, Department of Infectious Diseases, University of Melbourne, Melbourne, Victoria, Australia
| | - Julie Bennett
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Sally Thomas
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Jane Zhang
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Nevil Pierse
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Nicole J Moreland
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - Deborah A Williamson
- The Peter Doherty Institute for Infection and Immunity, Department of Infectious Diseases, University of Melbourne, Melbourne, Victoria, Australia
| | - Susan Jack
- Southern District Health Board, Dunedin, Otago, New Zealand
| | - Michael Baker
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
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Abstract
Housing is poorly constructed for the New Zealand climate and is a major cause of poor health and premature mortality. Private rental housing is older and in poorer condition than public housing and owner-occupied housing. This special issue describes four different approaches to improving housing, which have implications for international housing, health, and well-being policies. The first approach looks at generating the evidence base for improving the quality of the rental sector; the second, the aftereffects of the Christchurch earthquake and the unprecedented role taken by the central government to override local government and community involvement in rebuilding housing and regenerating the city; the third, measuring the effectiveness of the remediation of public housing; and finally, community-based partnerships between community workers and academics to improve the housing of children who have been hospitalized for housing-sensitive hospitalizations.
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Oliver J, Robertson O, Zhang J, Marsters BL, Sika-Paotonu D, Jack S, Bennett J, Williamson DA, Wilson N, Pierse N, Baker MG. Ethnically Disparate Disease Progression and Outcomes among Acute Rheumatic Fever Patients in New Zealand, 1989-2015. Emerg Infect Dis 2021; 27. [PMID: 34153221 PMCID: PMC8237904 DOI: 10.3201/eid2707.203045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We investigated outcomes for patients born after 1983 and hospitalized with initial acute rheumatic fever (ARF) in New Zealand during 1989-2012. We linked ARF progression outcome data (recurrent hospitalization for ARF, hospitalization for rheumatic heart disease [RHD], and death from circulatory causes) for 1989-2015. Retrospective analysis identified initial RHD patients <40 years of age who were hospitalized during 2010-2015 and previously hospitalized for ARF. Most (86.4%) of the 2,182 initial ARF patients did not experience disease progression by the end of 2015. Progression probability after 26.8 years of theoretical follow-up was 24.0%; probability of death, 1.0%. Progression was more rapid and ≈2 times more likely for indigenous Māori or Pacific Islander patients. Of 435 initial RHD patients, 82.2% had not been previously hospitalized for ARF. This young cohort demonstrated low mortality rates but considerable illness, especially among underserved populations. A national patient register could help monitor, prevent, and reduce ARF progression.
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Oliver J, Upton A, Jack SJ, Pierse N, Williamson DA, Baker MG. Distribution of Streptococcal Pharyngitis and Acute Rheumatic Fever, Auckland, New Zealand, 2010-2016. Emerg Infect Dis 2021; 26:1113-1121. [PMID: 32441618 PMCID: PMC7258449 DOI: 10.3201/eid2606.181462] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Group A Streptococcus (GAS) pharyngitis is a key initiator of acute rheumatic fever (ARF). In New Zealand, ARF cases occur more frequently among persons of certain ethnic and socioeconomic groups. We compared GAS pharyngitis estimates (1,257,058 throat swab samples) with ARF incidence (792 hospitalizations) in Auckland during 2010–2016. Among children 5–14 years of age in primary healthcare clinics, GAS pharyngitis was detected in similar proportions across ethnic groups (≈19%). Relative risk for GAS pharyngitis was moderately elevated among children of Pacific Islander and Māori ethnicities compared with those of European/other ethnicities, but risk for ARF was highly elevated for children of Pacific Islander and Māori ethnicity compared with those of European/other ethnicity. That ethnic disparities are much higher among children with ARF than among those with GAS pharyngitis implies that ARF is driven by factors other than rate of GAS pharyngitis alone.
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11
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Fraser B, White M, Cook H, Chisholm E, Ombler J, Chun S, Tareha H, Pierse N. Service usage of a cohort of formerly homeless women in Aotearoa New Zealand. SSM Popul Health 2021; 15:100842. [PMID: 34169140 PMCID: PMC8209275 DOI: 10.1016/j.ssmph.2021.100842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 06/01/2021] [Accepted: 06/05/2021] [Indexed: 11/14/2022] Open
Abstract
Purpose The aim of this paper is to explore government service usage across the domains of health, justice, and social development and tax for a cohort of formerly homeless people in Aotearoa New Zealand, focusing specifically on the experiences of women. The Integrated Data Infrastructure is used, which links our de-identified cohort data with administrative data from various Aotearoa New Zealand Government departments. Results Of the cohort of 390, the majority (53.8%) were women. These women were more likely to be younger (57.1% were aged 25–44), indigenous Māori (78.6%), and have children (81.4%). These women had lower incomes, and higher rates of welfare benefit receipt, when compared to men in the cohort and a control group of women from the wider population. Conclusions The cohort were primarily female, younger, Māori, and parents. They earned much less than their non-homeless counterparts, and relied heavily on government support. The neoliberalisation of the welfare state, high rates of women's poverty, and the gendered nature of parenthood means that women's homelessness is distinct from men's homelessness. The cohort had distinct government service usage when compared to a cohort of homeless men, and non-homeless women. The cohort were more likely to be Māori, younger, and parents. The cohort required greater levels of income support than homeless men and non-homeless women.
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Affiliation(s)
- Brodie Fraser
- He Kāinga Oranga, University of Otago, Wellington, New Zealand
| | - Maddie White
- Institute for Public Health and Nursing Research, University of Bremen, Germany
| | - Hera Cook
- He Kāinga Oranga, University of Otago, Wellington, New Zealand
| | - Elinor Chisholm
- He Kāinga Oranga, University of Otago, Wellington, New Zealand
| | - Jenny Ombler
- He Kāinga Oranga, University of Otago, Wellington, New Zealand
| | - Saera Chun
- He Kāinga Oranga, University of Otago, Wellington, New Zealand
| | | | - Nevil Pierse
- He Kāinga Oranga, University of Otago, Wellington, New Zealand
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Robertson O, Nathan K, Howden-Chapman P, Baker MG, Atatoa Carr P, Pierse N. Residential mobility for a national cohort of New Zealand-born children by area socioeconomic deprivation level and ethnic group. BMJ Open 2021; 11:e039706. [PMID: 33419901 PMCID: PMC7799129 DOI: 10.1136/bmjopen-2020-039706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The aims of this study are to describe area deprivation levels and changes that occur during residential moves involving New Zealand children from birth to their fourth birthday, and to assess whether these changes vary by ethnicity. DESIGN Longitudinal administrative data. SETTING Children born in New Zealand from 2004 to 2018. PARTICIPANTS All (565 689) children born in New Zealand with at least one recorded residential move. OUTCOME MEASURES A longitudinal data set was created containing lifetime address histories for our cohort. This was linked to the New Zealand Deprivation Index, a measure of small area deprivation. Counts of moves from each deprivation level to each other deprivation level were used to construct transition matrices. RESULTS Children most commonly moved to an area with the same level of deprivation. This was especially pronounced in the most and least deprived areas. The number of moves observed also increased with deprivation. Māori and Pasifika children were less likely to move to, or remain in low-deprivation areas, and more likely to move to high-deprivation areas. They also had disproportionately high numbers of moves. CONCLUSION While there was evidence of mobility between deprivation levels, the most common outcome of a move was no change in area deprivation. The most deprived areas had the highest number of moves. Māori and Pasifika children were over-represented in high-deprivation areas and under-represented in low-deprivation areas. They also moved more frequently than the overall population of 0 to 3 year olds.
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Affiliation(s)
- Oliver Robertson
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Kim Nathan
- Department of Public Health, University of Otago, Wellington, New Zealand
| | | | | | - Polly Atatoa Carr
- National Institute of Demographic and Economic Analysis, University of Waikato, Hamilton, New Zealand
| | - Nevil Pierse
- Department of Public Health, University of Otago, Wellington, New Zealand
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Robertson O, Nathan K, Howden-Chapman P, Baker M, Carr PA, Pierse N. Residential Mobility and Changes in Deprivation Levels For 0 – 4 Year Olds in New Zealand. Int J Popul Data Sci 2020. [DOI: 10.23889/ijpds.v5i5.1553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
IntroductionHigh residential mobility has been shown to have a negative impact on young children, with long-term consequences for their physical and mental health, and social outcomes. Understanding the broad trends in moves and differentiating between moves to neighbourhoods which are likely to have ‘positive’ or ‘negative’ consequences is an important question in the residential mobility literature, with important implications for public policy and children’s health.
Objectives and ApproachThe aims of this study are to describe the level and changes in neighbourhood deprivation that occur during residential moves involving children aged 0–4 years of age in New Zealand, and to assess whether these changes differ for children of different ethnicities.
Our cohort is 565,689 children born in New Zealand from 2004 to 2018. The dataset of residential moves is created using the full address notification table from the Integrated Data Infrastructure, a set of government data tables that have been linked and anonymised by Statistics New Zealand.
ResultsWhile there is a reasonable amount of mobility in terms of the deprivation of the area in which a child lives, the most likely outcome of a move is that it will be to an area with the same level of deprivation. This is especially true for the most and least deprived areas. Areas of high deprivation have the highest levels of churn and residential mobility. Māori and Pasifika children have lower levels of socioeconomic mobility and are more likely to move into and to stay in, areas of high deprivation.
Conclusion / ImplicationsChildren living in highly deprived areas are likely to stay in high deprivation areas. Children living in these areas also move more frequently than the general population. Māori and Pasifika children are overrepresented in high deprivation areas, and on average they move more frequently than the group of all children aged 0 – 4.
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Pierse N, White M, Ombler J, Davis C, Chisholm E, Baker M, Howden-Chapman P. Well Homes Initiative: A Home-Based Intervention to Address Housing-Related Ill Health. Health Educ Behav 2020; 47:836-844. [PMID: 33148038 DOI: 10.1177/1090198120911612] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Six thousand children are hospitalized each year in New Zealand with housing sensitive conditions, and 86.2% of these children are rehospitalized during childhood. The Healthy Homes Initiative, set up by the Ministry of Health, and implemented in Wellington through Well Homes, carries out housing assessments and delivers a range of housing interventions. METHOD Housing assessments were carried out by trained community workers. Philanthropic funding was received for the interventions through a local charitable trust. RESULTS Well Homes saw 895 families. Mold in the home was the most commonly recorded area of poor housing quality, in 836 homes (93%). Partial or complete lack of insulation was also common, with 452 records (51%) having a documented need for further assessment and either an upgrade or full installation. Eighty-three percent of homes had insufficient sources of heating. A total of 5,537 interventions were delivered. Bedding, heaters, and draft stopping were delivered over 90% of the time. In contrast, insulation and carpets were only delivered 40% of the time. Interventions were least likely to be delivered in private rental housing. DISCUSSION Targeted interventions using social partnerships can deliver housing improvements for relatively little health spending. Well Homes provides immediate and practical interventions, education, connection with social agencies, and advocacy for more substantial structural home improvements to help families keep their home warmer, drier, and healthier. This approach will be strengthened when combined with a new regulatory framework to raise the standards of private rental housing.
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Affiliation(s)
- Nevil Pierse
- University of Otago Wellington, Wellington, New Zealand
| | - Maddie White
- University of Otago Wellington, Wellington, New Zealand
| | - Jenny Ombler
- University of Otago Wellington, Wellington, New Zealand
| | - Cheryl Davis
- Tū Kotahi Māori Asthma and Research Trust, Lower Hutt, Wellington, New Zealand
| | | | - Michael Baker
- University of Otago Wellington, Wellington, New Zealand
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Telfar Barnard L, Howden-Chapman P, Pierse N. Renting Poorer Housing: Ecological Relationships Between Tenure, Dwelling Condition, and Income and Housing-Sensitive Hospitalizations in a Developed Country. Health Educ Behav 2020; 47:816-824. [PMID: 33148039 DOI: 10.1177/1090198120945923] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous research has shown two-way associations between rental tenure, poorer housing quality, and health outcomes, but little research has looked at relative housing contributions to health outcomes. AIMS We investigated whether tenure and/or dwelling condition were associated with housing-sensitive hospitalizations and whether any association differed by income. METHOD Using a data set of housing characteristics matched to hospitalization records, rental tenure data, and income quintiles, we modeled differences in housing-sensitive hospitalization rates by ecological-level tenure and housing condition, controlling for age-group and mean temperatures. RESULTS There were clear associations between income, tenure, and house condition, and winter-associated hospitalization risk. In the adjusted model, the largest risk differences were associated with neighborhoods with low income (risk ratio [RR] = 1.48) and high rental tenure (RR = 1.41). There was a nonsignificant difference for housing condition (RR = 1.04). DISCUSSION Rental tenure and poor housing condition were risks for housing-sensitive hospitalization, but the association with income was stronger. Higher income households may be better able to offset quality and tenure-related health risks. This research illustrates the inverse housing law: Those most vulnerable, with most need for good-quality housing, are least likely to have it. Income inequity is inbuilt in tenure, quality, and health burden relationships. CONCLUSION These findings suggest that measures to address health inequities should include improvements to both tenure security and housing quality, particularly in low-income areas. However, policymakers aiming to reduce overall hospitalization rates should focus their efforts on reducing fuel poverty and improving the affordability of quality housing.
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Abstract
BACKGROUND A robust evidence base is needed to develop sustainable cross-party solutions for public housing to promote well-being. The provision of public housing is politically contentious in New Zealand, as in many liberal democracies. Depending on the government, policies oscillate between encouraging sales of public housing stock and reducing investment and maintenance, and large-scale investment, provision, and regeneration of public housing. AIM We aimed to develop frameworks to evaluate the impact of public housing regeneration on tenant well-being at the apartment, complex, and community levels, and to inform future policies. METHOD Based on a systems approach and theory of change models, we developed a mixed methods quasi-experimental before-and-after outcomes evaluation frameworks, with control groups, for three public housing sites. This evaluation design had flexibility to accommodate real-world complexities, inherent in evaluating large-scale public health interventions, while maintaining scientific rigor to realize the full effects of interventions. RESULTS Three evaluation frameworks for housing were developed. The evaluation at the apartment level confirmed proof of concept and viability of the framework and approach. This also showed that minor draught-stopping measures had a relatively big impact on indoor temperature and thermal comfort, which subsequently informed healthy housing standards. The complex and community-level evaluations are ongoing due to longer regeneration timeframes. CONCLUSION Public housing is one of central government's larger social sector interventions, with Kāinga Ora - Homes and Communities the largest Crown entity. Evaluating public housing policies is important to develop an evidence base to inform best practice, rational, decision-making policy for the public as well as the private sector.
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Baker MG, Gurney J, Oliver J, Moreland NJ, Williamson DA, Pierse N, Wilson N, Merriman TR, Percival T, Murray C, Jackson C, Edwards R, Foster Page L, Chan Mow F, Chong A, Gribben B, Lennon D. Risk Factors for Acute Rheumatic Fever: Literature Review and Protocol for a Case-Control Study in New Zealand. Int J Environ Res Public Health 2019; 16:E4515. [PMID: 31731673 PMCID: PMC6888501 DOI: 10.3390/ijerph16224515] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/06/2019] [Accepted: 11/08/2019] [Indexed: 02/06/2023]
Abstract
Acute rheumatic fever (ARF) and its sequela, rheumatic heart disease (RHD), have largely disappeared from high-income countries. However, in New Zealand (NZ), rates remain unacceptably high in indigenous Māori and Pacific populations. The goal of this study is to identify potentially modifiable risk factors for ARF to support effective disease prevention policies and programmes. A case-control design is used. Cases are those meeting the standard NZ case-definition for ARF, recruited within four weeks of hospitalisation for a first episode of ARF, aged less than 20 years, and residing in the North Island of NZ. This study aims to recruit at least 120 cases and 360 controls matched by age, ethnicity, gender, deprivation, district, and time period. For data collection, a comprehensive pre-tested questionnaire focussed on exposures during the four weeks prior to illness or interview will be used. Linked data include previous hospitalisations, dental records, and school characteristics. Specimen collection includes a throat swab (Group A Streptococcus), a nasal swab (Staphylococcus aureus), blood (vitamin D, ferritin, DNA for genetic testing, immune-profiling), and head hair (nicotine). A major strength of this study is its comprehensive focus covering organism, host and environmental factors. Having closely matched controls enables the examination of a wide range of specific environmental risk factors.
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Affiliation(s)
- Michael G Baker
- Department of Public Health, University of Otago, Wellington 6021, New Zealand; (J.G.); (J.O.); (N.P.); (R.E.)
| | - Jason Gurney
- Department of Public Health, University of Otago, Wellington 6021, New Zealand; (J.G.); (J.O.); (N.P.); (R.E.)
| | - Jane Oliver
- Department of Public Health, University of Otago, Wellington 6021, New Zealand; (J.G.); (J.O.); (N.P.); (R.E.)
| | - Nicole J Moreland
- School of Medical Sciences, University of Auckland, Auckland 1010, New Zealand;
| | - Deborah A Williamson
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne 3010, Australia;
| | - Nevil Pierse
- Department of Public Health, University of Otago, Wellington 6021, New Zealand; (J.G.); (J.O.); (N.P.); (R.E.)
| | - Nigel Wilson
- Green Lane Paediatric and Congenital Cardiac Services, Starship Children’s Hospital, Auckland District Health Board, Auckland 1023; New Zealand;
- Department of Paediatrics, University of Auckland, Auckland 1142, New Zealand;
| | - Tony R Merriman
- Biochemistry Department, University of Otago, Dunedin 9054, New Zealand;
| | - Teuila Percival
- School of Population Health, University of Auckland, Auckland 1142, New Zealand;
- KidzFirst Children’s Hospital, Auckland 1640, New Zealand;
| | - Colleen Murray
- Faculty of Dentistry, University of Otago, Dunedin 9054, New Zealand (L.F.P.)
| | - Catherine Jackson
- Auckland Regional Public Health Service, Auckland District Health Board, Auckland 0622, New Zealand;
| | - Richard Edwards
- Department of Public Health, University of Otago, Wellington 6021, New Zealand; (J.G.); (J.O.); (N.P.); (R.E.)
| | - Lyndie Foster Page
- Faculty of Dentistry, University of Otago, Dunedin 9054, New Zealand (L.F.P.)
| | | | - Angela Chong
- CBG Health Research Ltd, Auckland 0651, New Zealand; (A.C.); (B.G.)
| | - Barry Gribben
- CBG Health Research Ltd, Auckland 0651, New Zealand; (A.C.); (B.G.)
| | - Diana Lennon
- Department of Paediatrics, University of Auckland, Auckland 1142, New Zealand;
- KidzFirst Children’s Hospital, Auckland 1640, New Zealand;
- Starship Children’s Hospital, Auckland District Health Board, Auckland 1023, New Zealand
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Lawson-Te Aho K, Fariu-Ariki P, Ombler J, Aspinall C, Howden-Chapman P, Pierse N. A principles framework for taking action on Māori/Indigenous Homelessness in Aotearoa/New Zealand. SSM Popul Health 2019; 8:100450. [PMID: 31367669 PMCID: PMC6646741 DOI: 10.1016/j.ssmph.2019.100450] [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: 01/29/2019] [Revised: 06/18/2019] [Accepted: 07/12/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The objective of this research was to develop a principles framework to guide action on Māori/Indigenous homelessness in Aotearoa incorporating Rangatiratanga (Māori self-determination), Whānau Ora (Government policy that places Māori families at the center of funding, policy and services) and Housing First. METHOD Three pathways were identified as creating opportunities for action on Māori homelessness: Te Tiriti o Waitangi/Treaty of Waitangi is the Māori self-determination pathway; Whānau Ora, a government-sponsored policy supports whānau/family as the pathway for Māori wellbeing and disparities reduction; and Housing First, an international pathway with local application for homelessness that is being implemented in parts of Aotearoa. The potential opportunities of the three pathways shaped interviews with authoritative Māori about Māori principles (derived from the three pathways) for addressing Māori homelessness. Twenty interviews were conducted with Māori experts using Kaupapa Māori research processes, eliciting advice about addressing Māori homelessness. A principles framework called Whare Ōranga was developed to synthesise these views. RESULTS Addressing Māori homelessness must be anchored in rights-based and culturally aligned practice empowered by Māori worldviews, principles and processes. Te Tiriti o Waitangi, which endorses Māori tribal self-determination and authority, and Whānau Ora as a government obligation to reduce inequities in Māori homelessness, are the foundations for such action. Colonisation and historical trauma are root causes of Māori homelessness. Strong rights-based frameworks are needed to enact decolonisation and guide policy. These frameworks exist in Tino Rangatiratanga/Māori self-determination and Whānau Ora. CONCLUSION Whare Ōranga: An Indigenous Housing Interventions Principles Framework was developed in Aotearoa/New Zealand to end Māori homelessness. Future research is needed on the practical application of this framework in ending Māori homelessness. Moreover, the use value of the Whare Ōranga Framework as a workable approach to ending homelessness in other indigenous populations is yet to be considered.
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Affiliation(s)
- Keri Lawson-Te Aho
- Eru Pomare Centre for Hauora Māori, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Paikea Fariu-Ariki
- Eru Pomare Centre for Hauora Māori, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jenny Ombler
- He Kāinga Oranga, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Clare Aspinall
- He Kāinga Oranga, Department of Public Health, University of Otago, Wellington, New Zealand
| | | | - Nevil Pierse
- He Kāinga Oranga, Department of Public Health, University of Otago, Wellington, New Zealand
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Nathan K, Robertson O, Atatoa Carr P, Howden-Chapman P, Pierse N. Residential mobility and socioemotional and behavioural difficulties in a preschool population cohort of New Zealand children. J Epidemiol Community Health 2019; 73:947-953. [DOI: 10.1136/jech-2019-212436] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 06/15/2019] [Accepted: 06/22/2019] [Indexed: 11/04/2022]
Abstract
BackgroundFindings regarding early residential mobility and increased risk for socioemotional and behavioural (SEB) difficulties in preschool children are mixed, with some studies finding no evidence of an association once known covariates are controlled for. Our aim was to investigate residential mobility and SEB difficulties in a population cohort of New Zealand (NZ) children.MethodsData from the Integrated Data Infrastructure were examined for 313 164 children born in NZ since 2004 who had completed the Before School Check at 4 years of age. Residential mobility was determined from address data. SEB difficulty scores were obtained from the Strengths and Difficulties Questionnaire administered as part of the Before School Check.ResultsThe prevalence of residential mobility was 69%; 12% of children had moved ≥4 times. A linear association between residential mobility and increased SEB difficulties was found (B=0.58), which remained robust when controlling for several known covariates. Moves >10 km and moving to areas of higher socioeconomic deprivation were associated with increased SEB difficulties (B=0.08 and B=0.09, respectively), while residential mobility before 2 years of age was not. Children exposed to greater residential mobility were 8% more likely to obtain SEB difficulties scores of clinical concern than children exposed to fewer moves (adjusted OR 1.08).ConclusionThis study found a linear association between residential mobility and increased SEB difficulties in young children. This result highlights the need to consider residential mobility as a risk factor for SEB difficulties in the preschool years.
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Pierse N, Ombler J, White M, Aspinall C, McMinn C, Atatoa-Carr P, Nelson J, Hawkes K, Fraser B, Cook H, Howden-Chapman P. Service usage by a New Zealand Housing First cohort prior to being housed. SSM Popul Health 2019; 8:100432. [PMID: 31289743 PMCID: PMC6593313 DOI: 10.1016/j.ssmph.2019.100432] [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: 01/23/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 11/17/2022] Open
Abstract
Background The Ending Homelessness in New Zealand: Housing First research programme is evaluating outcomes for people housed in a Housing First programme run by The People's Project in Hamilton, New Zealand. This baseline results paper uses administrative data to look at the scope and duration of their interactions with government services. Methods We linked our de-identified cohort to the Integrated Data Infrastructure (IDI). This database contains administrative data on most services provided by the New Zealand Government to citizens. Linkage rates in all datasets were above 90%. This paper reports on the use of government services by the cohort before being housed. We focus on the domains of health, justice and income support. Results The cohort of 390 people had over 200,000 recorded interactions across a range of services in their lifetime. The most common services were health, justice and welfare. The homeless cohort had used the services at rates far in excess of the general population. Unfortunately these did not prevent them from becoming homeless. Conclusion These preliminary findings show the homeless population have important service delivery needs and a very high level of interaction with government services. This highlights the importance of analysing the contributing factors towards homelessness; for evaluation of interventions such as Housing First, and for understanding the need for integrated systems of government policy and practice to prevent homelessness. This paper also provides the baseline for post-Housing First evaluations. A homeless cohort in New Zealand had a high rate of service usage leading up to engagement with Housing First services. The cohort appeared in government linked data at higher rates than the general population. The cohort had over 200,000 interactions with government services within the five years prior to being housed by Housing First services. This paper shows the need for a systems-wide strategy to prevent homelessness.
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Affiliation(s)
- Nevil Pierse
- He Kainga Oranga/Housing and Health Research Group, University of Otago Wellington, New Zealand
| | - Jenny Ombler
- He Kainga Oranga/Housing and Health Research Group, University of Otago Wellington, New Zealand
| | - Maddie White
- He Kainga Oranga/Housing and Health Research Group, University of Otago Wellington, New Zealand
| | - Clare Aspinall
- He Kainga Oranga/Housing and Health Research Group, University of Otago Wellington, New Zealand
| | | | - Polly Atatoa-Carr
- National Institute for Demographic and Economic Analysis, University of Waikato, New Zealand
| | | | | | - Brodie Fraser
- He Kainga Oranga/Housing and Health Research Group, University of Otago Wellington, New Zealand
| | - Hera Cook
- He Kainga Oranga/Housing and Health Research Group, University of Otago Wellington, New Zealand
| | - Philippa Howden-Chapman
- He Kainga Oranga/Housing and Health Research Group, University of Otago Wellington, New Zealand
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Jack SJ, Williamson DA, Galloway Y, Pierse N, Zhang J, Oliver J, Milne RJ, Mackereth G, Jackson CM, Steer AC, Carapetis JR, Baker MG. Primary prevention of rheumatic fever in the 21st century: evaluation of a national programme. Int J Epidemiol 2019; 47:1585-1593. [PMID: 30060070 DOI: 10.1093/ije/dyy150] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2018] [Indexed: 11/13/2022] Open
Abstract
Background Acute rheumatic fever (ARF) has largely disappeared from high-income countries. However, in New Zealand (NZ) rates remain high in indigenous (Māori) and Pacific populations. In 2011, NZ launched an intensive and unparalleled primary Rheumatic Fever Prevention Programme (RFPP). We evaluated the impact of the school-based sore throat service component of the RFPP. Methods The evaluation used national trends of all-age first episode ARF hospitalisation rates before (2009-11) and after (2012-16) implementation of the RFPP. A retrospective cohort study compared first-episode ARF incidence during time-not-exposed (23 093 207 person-days) and time-exposed (68 465 350 person-days) with a school-based sore throat service among children aged 5-12 years from 2012 to 2016. Results Following implementation of the RFPP, the national ARF incidence rate declined by 28% from 4.0 per 100 000 [95% confidence interval (CI) 3.5-4.6] at baseline (2009-11) to 2.9 per 100 000 by 2016 (95% CI 2.4-3.4, P <0.01). The school-based sore throat service effectiveness overall was 23% [95% CI -6%-44%; rate ratio (RR) 0.77, 95% CI 0.56-1.06]. Effectiveness was greater in one high-risk region with high coverage (46%, 95% CI 16%-66%; RR 0.54, 95% CI 0.34-0.84). Conclusions Population-based primary prevention of ARF through sore throat management may be effective in well-resourced settings like NZ where high-risk populations are geographically concentrated. Where high-risk populations are dispersed, a school-based primary prevention approach appears ineffective and is expensive.
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Affiliation(s)
- Susan J Jack
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.,Health Intelligence Team, Institute of Environmental Science and Research, Wellington, New Zealand
| | - Deborah A Williamson
- Health Intelligence Team, Institute of Environmental Science and Research, Wellington, New Zealand.,Doherty Applied Microbial Genomics, University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.,Microbiological Diagnostic Unit Public Health Laboratory, University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Yvonne Galloway
- Health Intelligence Team, Institute of Environmental Science and Research, Wellington, New Zealand
| | - Nevil Pierse
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jane Zhang
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jane Oliver
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Richard J Milne
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Graham Mackereth
- Health Intelligence Team, Institute of Environmental Science and Research, Wellington, New Zealand
| | - Catherine M Jackson
- Planning, Funding and Outcomes, Waitemata and Auckland District Health Board, Auckland, New Zealand
| | - Andrew C Steer
- Centre for International Child Health, University of Melbourne, Melbourne, VIC, Australia.,Department of General Medicine, Royal Children's Hospital, Melbourne, VIC, Australia.,Group A Streptococcal Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Jonathan R Carapetis
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,Infectious Diseases Department, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Michael G Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
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Walker GJ, Stelzer-Braid S, Shorter C, Honeywill C, Wynn M, Willenborg C, Barnes P, Kang J, Pierse N, Crane J, Howden-Chapman P, Rawlinson WD. Viruses associated with acute respiratory infection in a community-based cohort of healthy New Zealand children. J Med Virol 2019; 94:454-460. [PMID: 31017663 PMCID: PMC7228279 DOI: 10.1002/jmv.25493] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 12/16/2022]
Abstract
Acute respiratory infections (ARIs) are a major cause of morbidity among children. Respiratory viruses are commonly detected in both symptomatic and asymptomatic periods. The rates of infection and community epidemiology of respiratory viruses in healthy children needs further definition to assist interpretation of molecular diagnostic assays in this population. Children otherwise healthy aged 1 to 8 years were prospectively enrolled in the study during two consecutive winters, when ARIs peak in New Zealand. Parents completed a daily symptom diary for 8 weeks, during which time they collected a nasal swab from the child for each clinical ARI episode. A further nasal swab was collected by research staff during a clinic visit at the conclusion of the study. All samples were tested for 15 respiratory viruses commonly causing ARI using molecular multiplex polymerase chain reaction assays. There were 575 ARIs identified from 301 children completing the study, at a rate of 1.04 per child‐month. Swabs collected during an ARI were positive for a respiratory virus in 76.8% (307 of 400), compared with 37.3% (79 of 212) of swabs collected during asymptomatic periods. The most common viruses detected were human rhinovirus, coronavirus, parainfluenza viruses, influenzavirus, respiratory syncytial virus, and human metapneumovirus. All of these were significantly more likely to be detected during ARIs than asymptomatic periods. Parent‐administered surveillance is a useful mechanism for understanding infectious disease in healthy children in the community. Interpretation of molecular diagnostic assays for viruses must be informed by understanding of local rates of asymptomatic infection by such viruses. During winter, children experienced acute respiratory infections at a rate of 1.04/month. A virus was detected in 76.8% of acute respiratory infections. Specific viruses are more likely to be associated with respiratory symptoms.
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Affiliation(s)
- Gregory J Walker
- Virology Research Laboratory, Prince of Wales Hospital, Sydney, New South Wales, Australia.,School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Sacha Stelzer-Braid
- Virology Research Laboratory, Prince of Wales Hospital, Sydney, New South Wales, Australia.,School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Caroline Shorter
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Claire Honeywill
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Matthew Wynn
- Virology Research Laboratory, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Christiana Willenborg
- Virology Research Laboratory, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Phillipa Barnes
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Janice Kang
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Nevil Pierse
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Julian Crane
- Department of Medicine, University of Otago, Wellington, New Zealand
| | | | - William D Rawlinson
- Virology Research Laboratory, Prince of Wales Hospital, Sydney, New South Wales, Australia.,School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Serology and Virology Division, South Eastern Area Laboratory Services Microbiology, Prince of Wales Hospital, Sydney, Australia.,School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
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Chisholm E, Pierse N, Davies C, Howden-Chapman P. Promoting health through housing improvements, education and advocacy: Lessons from staff involved in Wellington's Healthy Housing Initiative. Health Promot J Austr 2019; 31:7-15. [PMID: 30920685 DOI: 10.1002/hpja.247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 03/23/2019] [Indexed: 11/07/2022] Open
Abstract
ISSUE ADDRESSED Improving the conditions of housing through programs that trigger when children are hospitalised has the potential to prevent further ill-health and re-hospitalisations. Exploring the attitudes and beliefs of staff involved in such a program assists in understanding the advantages and challenges of this approach. METHODS We interviewed 21 people involved in a regional initiative to improve the health outcomes of children through referral to a housing program. Interviews were recorded and transcribed. Transcripts were subsequently subjected to qualitative thematic analysis. RESULTS Participants identified a number of factors that were key to the success of the program, such as: visiting the home, having health and energy organisations work together, and an integrated approach that includes interventions as well as education and advocacy. Key challenges to the program's aim of improving health outcomes for children were landlords' reluctance to implement improvements, homeowners' inability to afford improvements, limitations to staff resources, and client stress and income constraints, which meant that some interventions did not necessarily lead to housing improvements. CONCLUSIONS Efforts to improve health outcomes through housing interventions should be supported by funding and regulatory initiatives that encourage property owners to implement recommended interventions. SO WHAT?: This program represents an encouraging step towards health promotion through housing interventions and education. However, the initiative cannot fully counter structural challenges such as poor quality housing, and lack of housing and energy affordability. This study highlights the potential for a holistic approach to health promotion in housing, which integrates health initiatives with advocacy for regulatory support.
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Affiliation(s)
- Elinor Chisholm
- He Kainga Oranga, The Housing and Health Research Programme, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nevil Pierse
- He Kainga Oranga, The Housing and Health Research Programme, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Cheryl Davies
- Tū Kotahi Māori Asthma Trust, Wellington, New Zealand
| | - Philippa Howden-Chapman
- He Kainga Oranga, The Housing and Health Research Programme, Department of Public Health, University of Otago, Wellington, New Zealand
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24
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Kristono GA, Shorter C, Pierse N, Crane J, Siebers R. Endotoxin, cat, and house dust mite allergens in electrostatic cloths and bedroom dust. J Occup Environ Hyg 2019; 16:89-96. [PMID: 30325697 DOI: 10.1080/15459624.2018.1536827] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Environmental exposure to endotoxin, Fel d I (cat) allergen and Der p I (house dust mite) allergen have been associated with asthma symptoms and have been measured in the environment using various sampling methods, including the electrostatic dust collector. The objectives of this study were to investigate whether levels of endotoxin and allergens were detectable in electrostatic dust collectors and to examine the correlation of allergen and endotoxin levels between electrostatic dust collectors and vacuum sampling methods (floor dust and mattress dust). Electrostatic cloths, bedroom floor dust and mattress dust samples from a subset of 60 homes were randomly selected from the Health of Occupants of Mouldy Homes study for allergen and endotoxin analysis. Fel d I and Der p I allergens were analyzed by double monoclonal antibody ELISA and endotoxin by the kinetic Limulus amoebocyte lysate assay. An enhanced ELISA method was used to analyze Der p I in the electrostatic cloths. Endotoxin was detected in all samples, however Fel d I and Der p I were not detected in all electrostatic dust collector samples (detection in 53% and 15% of cloths respectively). No correlations were found between cloth and dust samples for endotoxin or Der p I, but moderate-to-strong correlations were found between all three sampling methods for Fel d I (rs = 0.612-0.715, p < 0.001). Poor correlation was found between floor dust and mattress dust samples for Der p I (rs = 0.256, p = 0.048). Electrostatic dust collectors may provide a way to measure airborne dust and allergen. Given the moderate-to-low correlations with vacuum dust sampling, this may present a unique measurement system which, when collected alongside traditional vacuum dust sampling, could provide additional exposure measures. Further studies are required to correlate endotoxin and allergen levels measured by electrostatic dust collector with air sampling and to explore the relationships between these bioaerosols, environmental factors and asthma.
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Affiliation(s)
- Gisela A Kristono
- a Wellington Asthma Research Group, Department of Medicine , University of Otago , Wellington , New Zealand
| | - Caroline Shorter
- a Wellington Asthma Research Group, Department of Medicine , University of Otago , Wellington , New Zealand
| | - Nevil Pierse
- b Department of Public Health , University of Otago , Wellington , New Zealand
| | - Julian Crane
- a Wellington Asthma Research Group, Department of Medicine , University of Otago , Wellington , New Zealand
| | - Robert Siebers
- a Wellington Asthma Research Group, Department of Medicine , University of Otago , Wellington , New Zealand
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25
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Berry MJ, Foster T, Rowe K, Robertson O, Robson B, Pierse N. Gestational Age, Health, and Educational Outcomes in Adolescents. Pediatrics 2018; 142:peds.2018-1016. [PMID: 30381471 DOI: 10.1542/peds.2018-1016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES As outcomes for extremely premature infants improve, up-to-date, large-scale studies are needed to provide accurate, contemporary information for clinicians, families, and policy makers. We used nationwide New Zealand data to explore the impact of gestational age on health and educational outcomes through to adolescence. METHODS We performed a retrospective cohort study of all births in New Zealand appearing in 2 independent national data sets at 23 weeks' gestation or more. We report on 2 separate cohorts: cohort 1, born January 1, 2005 to December 31, 2015 (613 521 individuals), used to study survival and midterm health and educational outcomes; and cohort 2, born January 1, 1998 to December 31, 2000, and surviving to age 15 years (146 169 individuals), used to study high school educational outcomes. Outcomes described by gestational age include survival, hospitalization rates, national well-being assessment outcomes at age 4 years, rates of special education support needs in primary school, and national high school examination results. RESULTS Ten-year survival increased with gestational age from 66% at 23 to 24 weeks to >99% at term. All outcomes measured were strongly related to gestational age. However, most extremely preterm children did not require special educational support and were able to sit for their national high school examinations. CONCLUSIONS Within a publicly funded health system, high-quality survival is achievable for most infants born at periviable gestations. Outcomes show improvement with gestational ages to term. Outcomes at early-term gestation are poorer than for children born at full term.
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Affiliation(s)
- Mary J Berry
- Departments of Paediatrics and Child Health and .,Capital and Coast District Health Board, Wellington, New Zealand; and
| | - Tim Foster
- Public Health, University of Otago, Wellington, Wellington, New Zealand.,Hawke's Bay District Health Board, Napier, New Zealand
| | - Kate Rowe
- Capital and Coast District Health Board, Wellington, New Zealand; and
| | - Oliver Robertson
- Public Health, University of Otago, Wellington, Wellington, New Zealand
| | - Bridget Robson
- Public Health, University of Otago, Wellington, Wellington, New Zealand
| | - Nevil Pierse
- Public Health, University of Otago, Wellington, Wellington, New Zealand
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26
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Thompson MG, Pierse N, Sue Huang Q, Prasad N, Duque J, Claire Newbern E, Baker MG, Turner N, McArthur C. Influenza vaccine effectiveness in preventing influenza-associated intensive care admissions and attenuating severe disease among adults in New Zealand 2012–2015. Vaccine 2018; 36:5916-5925. [DOI: 10.1016/j.vaccine.2018.07.028] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/08/2018] [Accepted: 07/15/2018] [Indexed: 12/26/2022]
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Oliver J, Foster T, Williamson DA, Pierse N, Baker MG. Using preceding hospital admissions to identify children at risk of developing acute rheumatic fever. J Paediatr Child Health 2018; 54:499-505. [PMID: 29168244 DOI: 10.1111/jpc.13786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/24/2017] [Accepted: 10/01/2017] [Indexed: 11/26/2022]
Abstract
AIMS New Zealand (NZ) Māori and Pacific children have high rates of acute rheumatic fever (ARF). Around 150 new cases arise each year. As part of the national ARF prevention programme, funding is available to improve housing. To obtain maximum benefit from interventions, an effective tool is needed for targeting high-risk children. This study aimed to assess the effectiveness of using hospitalisations for identifying children at risk of subsequent ARF. METHODS Three potentially avoidable hospitalisation (PAH) groups were investigated, including diseases thought to be influenced by housing. All were developed using expert opinion or systematic reviews. These were: (i) the PAH conditions associated with the housing environment (PAHHE) group; (ii) the Crowding group; and (iii) the Ministry of Health (MoH) group. We analysed NZ public hospital discharge data (2000-2014). The prevalence of ARF among patients hospitalised in each group was calculated to estimate sensitivity and potential effectiveness. The number needed to screen (NNS) to identify one ARF case was estimated as a measure of efficiency. RESULTS Nearly one-third of ARF patients experienced a PAH as children (before developing ARF). Sensitivity for detecting future ARF ranged from <5% (MoH group) to 27% (PAHHE group). NNS ranged from 502.4 (PAHHE) to 707.5 (MoH). CONCLUSIONS Because ARF is relatively rare, observing hospitalisations is not particularly efficient for targeting prevention activities for this condition alone. However, housing interventions are likely to improve multiple outcomes; thus, the hospital setting is still useful for identifying at-risk children who could benefit from such programmes.
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Affiliation(s)
- Jane Oliver
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Tim Foster
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Deborah A Williamson
- Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Nevil Pierse
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Michael G Baker
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
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Oliver J, Foster T, Kvalsvig A, Williamson DA, Baker MG, Pierse N. Risk of rehospitalisation and death for vulnerable New Zealand children. Arch Dis Child 2018; 103:327-334. [PMID: 28735258 DOI: 10.1136/archdischild-2017-312671] [Citation(s) in RCA: 8] [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: 01/11/2017] [Revised: 06/09/2017] [Accepted: 06/12/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVES There is considerable need to improve the effectiveness of healthcare to reduce morbidity and mortality. Child hospitalisations are influenced by determinants of health, including the home environment. Our aims were: (1) To investigate whether children hospitalised with potentially avoidable conditions thought to be associated with the home have an increased risk of rehospitalisation and death, (2) To investigate whether children hospitalised with particular subgroups of potentially avoidable conditions have an increased risk of rehospitalisation and death, (3) To assess the usefulness of these subgroups for identifying at-risk children. DESIGN We used four existing groups of potentially avoidable conditions developed based on expert opinion: 1. the potentially avoidable hospitalisations (PAH) group, associated with social/environmental conditions, 2. the potentially avoidable hospitalisations attributable (at least in part) to the home environment (PAHHE) group, 3. the crowding group, and 4. the Ministry of Health (MoH) group. We analysed national New Zealand hospital discharge data (2000-2014). Rehospitalisation and death were described using Kaplan-Meier curves. Group effectiveness for identifying at-risk children was assessed using Cox proportional hazard models with children hospitalised for non-PAH conditions as comparison. RESULTS In total, 1425085 hospital admissions occurred, for 683115 unique children. Rehospitalisation was relatively common (71.0%). Death was rare (0.6%). All groups performed moderately well identifying at-risk children. Children with PAH have increased risk of rehospitalisation (adjusted HR (aHR):2.30-3.60) and death (aHR:3.07-10.44). PAH group had highest sensitivity (75.1%). The MoH group has the highest positive predictive value (rehospitalisation: 86.2%, death: 2.5%). CONCLUSIONS Children in the MoH group are very likely to benefit from housing interventions. Rehospitalisation and early mortality are useful assessment measures. Rehospitalisation exerts a considerable burden, and child deaths are catastrophic.
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Affiliation(s)
| | - Tim Foster
- University of Otago Wellington, Wellington
| | | | - Deborah A Williamson
- Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
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Oliver J, Malliya Wadu E, Pierse N, Moreland NJ, Williamson DA, Baker MG. Group A Streptococcus pharyngitis and pharyngeal carriage: A meta-analysis. PLoS Negl Trop Dis 2018; 12:e0006335. [PMID: 29554121 PMCID: PMC5875889 DOI: 10.1371/journal.pntd.0006335] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [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: 12/17/2017] [Revised: 03/29/2018] [Accepted: 02/21/2018] [Indexed: 01/22/2023] Open
Abstract
Objective Antibiotic treatment of Group A Streptococcus (GAS) pharyngitis is important in acute rheumatic fever (ARF) prevention, however clinical guidelines for prescription vary. GAS carriers with acute viral infections may receive antibiotics unnecessarily. This review assessed the prevalence of GAS pharyngitis and carriage in different settings. Methods A random-effects meta-analysis was performed. Prevalence estimates for GAS+ve pharyngitis, serologically-confirmed GAS pharyngitis and asymptomatic pharyngeal carriage were generated. Findings were stratified by age group, recruitment method and country income level. Medline and EMBASE databases were searched for relevant literature published between 1 January 1946 and 7 April 2017. Studies reporting prevalence data on GAS+ve or serologically-confirmed GAS pharyngitis that stated participants exhibited symptoms of pharyngitis or upper respiratory tract infection (URTI) were included. Included studies reporting the prevalence of asymptomatic GAS carriage needed to state participants were asymptomatic. Results 285 eligible studies were identified. The prevalence of GAS+ve pharyngitis was 24.1% (95% CI: 22.6–25.6%) in clinical settings (which used ‘passive recruitment’ methods), but less in sore throat management programmes (which used ‘active recruitment’, 10.0%, 8.1–12.4%). GAS+ve pharyngitis was more prevalent in high-income countries (24.3%, 22.6–26.1%) compared with low/middle-income countries (17.6%, 14.9–20.7%). In clinical settings, approximately 10% of children swabbed with a sore throat have serologically-confirmed GAS pharyngitis, but this increases to around 50–60% when the child is GAS culture-positive. The prevalence of serologically-confirmed GAS pharyngitis was 10.3% (6.6–15.7%) in children from high-income countries and their asymptomatic GAS carriage prevalence was 10.5% (8.4–12.9%). A lower carriage prevalence was detected in children from low/middle income countries (5.9%, 4.3–8.1%). Conclusions In active sore throat management programmes, if the prevalence of GAS detection approaches the asymptomatic carriage rate (around 6–11%), there may be little benefit from antibiotic treatment as the majority of culture-positive patients are likely carriers. Treating sore throats caused by Group A Streptococcus infections (GAS pharyngitis) with antibiotics is important for preventing acute rheumatic fever (ARF). It is impossible to distinguish patients with true GAS pharyngitis infections from GAS carriers with pharyngitis caused by viral infections when throat swab culturing alone is used to diagnose GAS pharyngitis. Carriers are not likely to benefit from antibiotic treatment, but may receive treatment unnecessarily. Reported rates of GAS pharyngitis and carriage vary considerably depending on the setting. Thus it is difficult to ascertain which groups are likely to benefit significantly from active sore throat management programmes which treat GAS pharyngitis in order to prevent ARF. We performed a meta-analysis to estimate the prevalence of GAS pharyngitis and asymptomatic carriage in different settings. Approximately 10% of all children swabbed for a sore throat in clinical settings have true GAS pharyngitis, but this increases to around 55% if the children have GAS detected in their throat using swab cultures. In active sore throat management programmes, the prevalence of GAS detection is lower than in clinical settings and if it declines towards 8% (the asymptomatic carriage level), there may be little benefit in treating GAS culture-positive patients with antibiotics.
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Affiliation(s)
- Jane Oliver
- University of Otago Wellington, Newtown, Wellington, New Zealand
| | | | - Nevil Pierse
- University of Otago Wellington, Newtown, Wellington, New Zealand
| | - Nicole J. Moreland
- Maurice Wilkins Centre and School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - Deborah A. Williamson
- University of Otago Wellington, Newtown, Wellington, New Zealand
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Michael G. Baker
- University of Otago Wellington, Newtown, Wellington, New Zealand
- * E-mail:
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Shorter C, Crane J, Pierse N, Barnes P, Kang J, Wickens K, Douwes J, Stanley T, Täubel M, Hyvärinen A, Howden-Chapman P. Indoor visible mold and mold odor are associated with new-onset childhood wheeze in a dose-dependent manner. Indoor Air 2018; 28:6-15. [PMID: 28779500 DOI: 10.1111/ina.12413] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 07/30/2017] [Indexed: 06/07/2023]
Abstract
Evidence is accumulating that indoor dampness and mold are associated with the development of asthma. The underlying mechanisms remain unknown. New Zealand has high rates of both asthma and indoor mold and is ideally placed to investigate this. We conducted an incident case-control study involving 150 children with new-onset wheeze, aged between 1 and 7 years, each matched to two control children with no history of wheezing. Each participant's home was assessed for moisture damage, condensation, and mold growth by researchers, an independent building assessor and parents. Repeated measures of temperature and humidity were made, and electrostatic dust cloths were used to collect airborne microbes. Cloths were analyzed using qPCR. Children were skin prick tested for aeroallergens to establish atopy. Strong positive associations were found between observations of visible mold and new-onset wheezing in children (adjusted odds ratios ranged between 1.30 and 3.56; P ≤ .05). Visible mold and mold odor were consistently associated with new-onset wheezing in a dose-dependent manner. Measurements of qPCR microbial levels, temperature, and humidity were not associated with new-onset wheezing. The association between mold and new-onset wheeze was not modified by atopic status, suggesting a non-allergic association.
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Affiliation(s)
- Caroline Shorter
- Wellington Asthma Research Group, Department of Medicine, University of Otago, Wellington, New Zealand
| | - Julian Crane
- Wellington Asthma Research Group, Department of Medicine, University of Otago, Wellington, New Zealand
| | - Nevil Pierse
- He Kainga Oranga/Housing and Health Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Phillipa Barnes
- Wellington Asthma Research Group, Department of Medicine, University of Otago, Wellington, New Zealand
| | - Janice Kang
- Wellington Asthma Research Group, Department of Medicine, University of Otago, Wellington, New Zealand
| | - Kristin Wickens
- Wellington Asthma Research Group, Department of Medicine, University of Otago, Wellington, New Zealand
| | - Jeroen Douwes
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Thorsten Stanley
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Martin Täubel
- Department of Health Protection, National Institute for Health and Welfare (THL), Kuopio, Finland
| | - Anne Hyvärinen
- Department of Health Protection, National Institute for Health and Welfare (THL), Kuopio, Finland
| | - Philippa Howden-Chapman
- He Kainga Oranga/Housing and Health Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
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Khieu TQT, Pierse N, Telfar-Barnard LF, Zhang J, Huang QS, Baker MG. Modelled seasonal influenza mortality shows marked differences in risk by age, sex, ethnicity and socioeconomic position in New Zealand. J Infect 2017; 75:225-233. [PMID: 28579304 DOI: 10.1016/j.jinf.2017.05.017] [Citation(s) in RCA: 7] [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: 02/01/2017] [Revised: 05/06/2017] [Accepted: 05/24/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Influenza is responsible for a large number of deaths which can only be estimated using modelling methods. Such methods have rarely been applied to describe the major socio-demographic characteristics of this disease burden. METHODS We used quasi Poisson regression models with weekly counts of deaths and isolates of influenza A, B and respiratory syncytial virus for the period 1994 to 2008. RESULTS The estimated average mortality rate was 13.5 per 100,000 people which was 1.8% of all deaths in New Zealand. Influenza mortality differed markedly by age, sex, ethnicity and socioeconomic position. Relatively vulnerable groups were males aged 65-79 years (Rate ratio (RR) = 1.9, 95% CI: 1.9, 1.9 compared with females), Māori (RR = 3.6, 95% CI: 3.6, 3.7 compared with European/Others aged 65-79 years), Pacific (RR = 2.4, 95% CI: 2.4, 2.4 compared with European/Others aged 65-79 years) and those living in the most deprived areas (RR = 1.8, 95% CI: 1.3, 2.4) for New Zealand Deprivation (NZDep) 9&10 (the most deprived) compared with NZDep 1&2 (the least deprived). CONCLUSIONS These results support targeting influenza vaccination and other interventions to the most vulnerable groups, in particular Māori and Pacific people and men aged 65-79 years and those living in the most deprived areas.
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Affiliation(s)
- Trang Q T Khieu
- Department of Public Health, University of Otago, Wellington, New Zealand; Health Environment Management Agency, Ministry of Health of Viet Nam, Ha Noi, Viet Nam.
| | - Nevil Pierse
- Department of Public Health, University of Otago, Wellington, New Zealand
| | | | - Jane Zhang
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Q Sue Huang
- WHO National Influenza Centre, Institute of Environmental Science & Research, Wellington, New Zealand
| | - Michael G Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
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Oliver JR, Pierse N, Stefanogiannis N, Jackson C, Baker MG. Acute rheumatic fever and exposure to poor housing conditions in New Zealand: A descriptive study. J Paediatr Child Health 2017; 53:358-364. [PMID: 28052445 DOI: 10.1111/jpc.13421] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/31/2016] [Accepted: 10/31/2016] [Indexed: 11/29/2022]
Abstract
AIM Acute rheumatic fever (ARF) is an important public health problem in low- and middle-income countries and in certain populations in high-income countries. Indigenous Australians, and New Zealand Māori and Pacific people, have incidence rates among the highest in the world. We aimed to investigate ARF cases' housing conditions and sore throat treatment to identify opportunities for improving ARF prevention in New Zealand. METHODS Recently diagnosed cases and their care givers were interviewed. Information was obtained about the cases' demographics, housing circumstances and conditions, and sore throat treatment preceding ARF. RESULTS We interviewed 55 cases. Most (75%) lived in rental housing and reported multiple measures of deprivation. Common exposures were household crowding (58%), bed-sharing (49%), dampness and mould (76%), cold (82%) and co-habiting with smokers (71%). Experiencing sore throat in the weeks before ARF was recalled by 62%, with 29% seeing a doctor or nurse and 13% of the total sample receiving antibiotics. CONCLUSIONS The environmental conditions reported could contribute to high group A Streptococcus transmission and susceptibility to infection, thus increasing ARF risk. Sore throat treatment has important limitations as an intervention, particularly as 38% of participants did not recall sore throat preceding the diagnosis. The results support the need to improve rental housing. Interventions promoting minimum enforceable standards in social housing and private rental sectors (such as a housing warrant of fitness) could support these changes. A rigorous investigation, such as a case control study, is needed to explore risk factors further.
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Oliver J, Wadu EM, Pierse N, Moreland N, Williamson D, Baker M. Group a Streptococcus pharyngitis and pharyngeal carriage a systematic review. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.11.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Keall MD, Pierse N, Howden-Chapman P, Guria J, Cunningham C, Baker MG. 206 Cost-benefit analysis of fall injuries prevented by a programme of home modifications. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Keall MD, Pierse N, Howden-Chapman P, Guria J, Cunningham CW, Baker MG. Cost–benefit analysis of fall injuries prevented by a programme of home modifications: a cluster randomised controlled trial. Inj Prev 2016; 23:22-26. [DOI: 10.1136/injuryprev-2015-041947] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 05/18/2016] [Accepted: 05/24/2016] [Indexed: 11/03/2022]
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36
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Pierse N, Carter K, Bierre S, Law D, Howden-Chapman P. Examining the role of tenure, household crowding and housing affordability on psychological distress, using longitudinal data. J Epidemiol Community Health 2016; 70:961-6. [DOI: 10.1136/jech-2015-206716] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 04/15/2016] [Indexed: 11/04/2022]
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Lane CR, Carville KS, Pierse N, Kelly HA. Seasonal influenza vaccine effectiveness estimates: Development of a parsimonious case test negative model using a causal approach. Vaccine 2016; 34:1070-6. [PMID: 26795366 DOI: 10.1016/j.vaccine.2016.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 07/30/2015] [Revised: 11/30/2015] [Accepted: 01/04/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Influenza vaccine effectiveness (VE) is increasingly estimated using the case-test negative study design. Cases have a symptom complex consistent with influenza and test positive for influenza, while non-cases have the same symptom complex but test negative. We aimed to determine a parsimonious logistic regression model for this study design when applied to patients in the community. METHODS To determine the minimum covariate set required, we used a previously published systematic review to find covariates and restriction criteria commonly included in case-test negative logistic regression models. Covariates were assessed for inclusion using a directed acyclic graph. We used data from the Victorian Influenza Sentinel Practice Network from 2007 to 2013, excluding the pandemic year of 2009, to test the model. VE was estimated as (1-adjusted OR) * 100%. Changes in model fit from addition of specified covariates were examined. Restriction criteria were examined using change in VE estimate. VE was estimated for each year, all years aggregated, and for influenza type and sub-type. RESULTS Using publicly available software, the directed acyclic graph indicated that covariates specifying age, time within the influenza season, immunocompromising comorbid conditions and year or study site, where applicable, were required for closure. The inclusion of sex was not required. Inclusions and exclusions were validated when testing the variables (when collected) with our data. Restriction by time between onset and swab was supported by the data. VE for all years aggregated was estimated as 53% (95%CI 38, 64). VE was estimated as 42% (95%CI 19, 59) for H3N2, 75% (95%CI 51, 88) for H1N1pdm09 and 63% (95%CI 38, 79) for influenza B. CONCLUSION Theoretical covariates specified by the directed acyclic graph were validated when tested against surveillance data. A parsimonious model using the case test negative design allows regular estimates of VE and aggregated estimates by year.
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Affiliation(s)
- C R Lane
- Epidemiology Unit, Victorian Infectious Disease Reference Laboratory at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia.
| | - K S Carville
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia.
| | - N Pierse
- University of Otago, Wellington, New Zealand.
| | - H A Kelly
- Epidemiology Unit, Victorian Infectious Disease Reference Laboratory at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia.
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Bissielo A, Pierse N, Huang QS, Thompson MG, Kelly H, Mishin VP, Turner N. Effectiveness of seasonal influenza vaccine in preventing influenza primary care visits and hospitalisation in Auckland, New Zealand in 2015: interim estimates. Euro Surveill 2016; 21:30101. [DOI: 10.2807/1560-7917.es.2016.21.1.30101] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 12/22/2015] [Indexed: 11/20/2022] Open
Abstract
Preliminary results for influenza vaccine effectiveness (VE) against acute respiratory illness with circulating laboratory-confirmed influenza viruses in New Zealand from 27 April to 26 September 2015, using a case test-negative design were 36% (95% confidence interval (CI): 11–54) for general practice encounters and 50% (95% CI: 20–68) for hospitalisations. VE against hospitalised influenza A(H3N2) illnesses was moderate at 53% (95% CI: 6–76) but improved compared with previous seasons.
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Affiliation(s)
- A Bissielo
- Institute of Environmental Science and Research, Wellington, New Zealand
| | - N Pierse
- University of Otago, Wellington, New Zealand
| | - QS Huang
- Institute of Environmental Science and Research, Wellington, New Zealand
| | - MG Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, United States
| | - H Kelly
- Victorian Infectious Diseases Reference Laboratory, Melbourne, Australia
| | - VP Mishin
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, United States
| | - N Turner
- University of Auckland, Auckland, New Zealand
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Pierse N, Kelly H, Thompson MG, Bissielo A, Radke S, Huang QS, Baker MG, Turner N. Influenza vaccine effectiveness for hospital and community patients using control groups with and without non-influenza respiratory viruses detected, Auckland, New Zealand 2014. Vaccine 2015; 34:503-509. [PMID: 26685091 DOI: 10.1016/j.vaccine.2015.11.073] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 08/12/2015] [Revised: 11/26/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND We aimed to estimate the protection afforded by inactivated influenza vaccine, in both community and hospital settings, in a well characterised urban population in Auckland during 2014. METHODS We used two different comparison groups, all patients who tested negative for influenza and only those patients who tested negative for influenza and had a non-influenza respiratory virus detected, to calculate the vaccine effectiveness in a test negative study design. Estimates were made separately for general practice outpatient consultations and hospitalised patients, stratified by age group and by influenza type and subtype. Vaccine status was confirmed by electronic record for general practice patients and all respiratory viruses were detected by real time polymerase chain reaction. RESULTS 1039 hospitalised and 1154 general practice outpatient consultations met all the study inclusion criteria and had a respiratory sample tested for influenza and other respiratory viruses. Compared to general practice patients, hospitalised patients were more likely to be very young or very old, to be Māori or Pacific Islander, to have a low income and to suffer from chronic disease. Vaccine effectiveness (VE) adjusted for age and other participant characteristics using all influenza negative controls was 42% (95% CI: 16 to 60%) for hospitalised and 56% (95% CI: 35 to 70%) for general practice patients. The vaccine appeared to be most effective against the influenza A(H1N1)pdm09 strain with an adjusted VE of 62% (95% CI:38 to 77%) for hospitalised and 59% (95% CI:36 to 74%) for general practice patients, using influenza virus negative controls. Similar results found when patients testing positive for a non-influenza respiratory virus were used as the control group. CONCLUSION This study contributes to validation of the test negative design and confirms that inactivated influenza vaccines continue to provide modest but significant protection against laboratory-confirmed influenza.
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Affiliation(s)
- Nevil Pierse
- The University of Otago, Wellington, PO Box 7343, Wellington South 6242, New Zealand.
| | - Heath Kelly
- The Australian National University, Canberra 0200, ACT Australia; Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC, Australia.
| | - Mark G Thompson
- Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | - Ange Bissielo
- Institute of Environmental Science and Research, Upper Hutt Wellington, New Zealand.
| | - Sarah Radke
- The University of Auckland, Private Bag 92019, Victoria St West, Auckland, New Zealand.
| | - Q Sue Huang
- Institute of Environmental Science and Research, Upper Hutt Wellington, New Zealand.
| | - Michael G Baker
- The University of Otago, Wellington, PO Box 7343, Wellington South 6242, New Zealand.
| | - Nikki Turner
- The University of Auckland, Private Bag 92019, Victoria St West, Auckland, New Zealand.
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Oliver J, Baker MG, Pierse N, Carapetis J. Comparison of approaches to rheumatic fever surveillance across Organisation for Economic Co-operation and Development countries. J Paediatr Child Health 2015; 51:1071-7. [PMID: 26174709 DOI: 10.1111/jpc.12969] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2015] [Indexed: 11/29/2022]
Abstract
AIM Rheumatic fever (RF) prevention, control and surveillance are increasingly important priorities in New Zealand (NZ) and Australia. We compared RF surveillance across Organisation for Economic Co-operation and Development (OECD) member countries to assist in benchmarking and identifying useful approaches. METHODS A structured literature review was completed using Medline and PubMed databases, investigating RF incidence rates. Surveillance methods were noted. Health department websites were searched to assess whether addressing RF was a Government priority. RESULTS Of 32 OECD member countries, nine reported RF incidence rates after 1999. Highest rates were seen in indigenous Australians, and NZ Māori and Pacific peoples. NZ and Australian surveillance systems are highly developed, with notification and register data compiled regularly. Only these two Governments appeared to prioritise RF surveillance and control. Other countries relied mainly on hospitalisation data. There is a lack of standardisation across incidence rate calculations. Israel and Italy may have relatively high RF rates among developed countries. CONCLUSIONS RF lingers in specific populations in OECD member countries. At a minimum, RF registers are needed in higher incidence countries. Countries with low RF incidences should periodically review surveillance information to ensure rates are not increasing.
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Affiliation(s)
- Jane Oliver
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Michael G Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nevil Pierse
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jonathan Carapetis
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
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Shorter C, Täubel M, Pierse N, Douwes J, Howden-Chapman P, Hyvärinen A, Crane J. Objective assessment of domestic mold contamination using quantitative PCR. J Allergy Clin Immunol 2015; 137:622-4. [PMID: 26277598 DOI: 10.1016/j.jaci.2015.06.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 06/09/2015] [Accepted: 06/24/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Caroline Shorter
- Wellington Asthma Research Group, Department of Medicine, University of Otago, Wellington, New Zealand.
| | - Martin Täubel
- Department of Health Protection, National Institute for Health and Welfare (THL), Kuopio, Finland
| | - Nevil Pierse
- He Kainga Oranga/Housing and Health Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jeroen Douwes
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Philippa Howden-Chapman
- He Kainga Oranga/Housing and Health Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Anne Hyvärinen
- Department of Health Protection, National Institute for Health and Welfare (THL), Kuopio, Finland
| | - Julian Crane
- Wellington Asthma Research Group, Department of Medicine, University of Otago, Wellington, New Zealand
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Khieu TQ, Pierse N, Telfar-Barnard LF, Huang QS, Baker MG. Estimating the contribution of influenza to hospitalisations in New Zealand from 1994 to 2008. Vaccine 2015; 33:4087-92. [DOI: 10.1016/j.vaccine.2015.06.080] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 05/08/2015] [Accepted: 06/22/2015] [Indexed: 10/23/2022]
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Keall MD, Pierse N, Howden-Chapman P, Cunningham C, Cunningham M, Guria J, Baker MG. Home modifications to reduce injuries from falls in the home injury prevention intervention (HIPI) study: a cluster-randomised controlled trial. Lancet 2015; 385:231-8. [PMID: 25255696 DOI: 10.1016/s0140-6736(14)61006-0] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Despite the considerable injury burden attributable to falls at home among the general population, few effective safety interventions have been identified. We tested the safety benefits of home modifications, including handrails for outside steps and internal stairs, grab rails for bathrooms, outside lighting, edging for outside steps, and slip-resistant surfacing for outside areas such as decks and porches. METHODS We did a single-blind, cluster-randomised controlled trial of households from the Taranaki region of New Zealand. To be eligible, participants had to live in an owner-occupied dwelling constructed before 1980 and at least one member of every household had to be in receipt of state benefits or subsidies. We randomly assigned households by electronic coin toss to either immediate home modifications (treatment group) or a 3-year wait before modifications (control group). Household members in the treatment group could not be masked to their assigned status because modifications were made to their homes. The primary outcome was the rate of falls at home per person per year that needed medical treatment, which we derived from administrative data for insurance claims. Coders who were unaware of the random allocation analysed text descriptions of injuries and coded injuries as all falls and injuries most likely to be affected by the home modifications tested. To account for clustering at the household level, we analysed all injuries from falls at home per person-year with a negative binomial generalised linear model with generalised estimating equations. Analysis was by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12609000779279. FINDINGS Of 842 households recruited, 436 (n=950 individual occupants) were randomly assigned to the treatment group and 406 (n=898 occupants) were allocated to the control group. After a median observation period of 1148 days (IQR 1085-1263), the crude rate of fall injuries per person per year was 0.061 in the treatment group and 0.072 in the control group (relative rate 0.86, 95% CI 0.66-1.12). The crude rate of injuries specific to the intervention per person per year was 0.018 in the treatment group and 0.028 in the control group (0.66, 0.43-1.00). A 26% reduction in the rate of injuries caused by falls at home per year exposed to the intervention was estimated in people allocated to the treatment group compared with those assigned to the control group, after adjustment for age, previous falls, sex, and ethnic origin (relative rate 0.74, 95% CI 0.58-0.94). Injuries specific to the home-modification intervention were cut by 39% per year exposed (0.61, 0.41-0.91). INTERPRETATION Our findings suggest that low-cost home modifications and repairs can be a means to reduce injury in the general population. Further research is needed to identify the effectiveness of particular modifications from the package tested. FUNDING Health Research Council of New Zealand.
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Siebers R, Wu FFF, Shorter C, Pierse N, Crane J. Effect of repeated freeze/thawing of household dust extracts on β-(1,3)-glucan levels. J Occup Environ Hyg 2015; 12:D1-D3. [PMID: 25411832 DOI: 10.1080/15459624.2014.963590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
β-(1,3)-glucan exposure from household dust has been shown to be associated with respiratory symptoms and thus is increasingly being measured in epidemiological studies. Various factors are known to influence its measurement; however, no studies have assessed the effects of sample extract freeze-thawing on β-(1,3)-glucan. The aim of this study was to assess the effects of repeated freeze-thawing of household dust extracts on levels of β-(1,3)-glucan. Forty random household dust samples were extracted with 0.3 M NaOH and aliquots of extracts stored at -20 °C were subjected to one, two, and three freeze-thaw cycles. They were analyzed for β-(1,3)-glucan by the Limulus amoebocyte assay (LAL) and results compared to freshly extracted samples (paired Pearson's t-test on logged values). Initial freezing of house dust extracts results in a significant decline in β-(1,3)-glucan. However, repeated freeze/thawing (up to three times) does not results in any further decline in β-(1,3)-glucan levels.
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Affiliation(s)
- Robert Siebers
- a Wellington Asthma Research Group, School of Medicine and Health Sciences , University of Otago , Wellington , New Zealand
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45
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Turner N, Pierse N, Huang QS, Radke S, Bissielo A, Thompson MG, Kelly H. Interim estimates of the effectiveness of seasonal trivalent inactivated influenza vaccine in preventing influenza hospitalisations and primary care visits in Auckland, New Zealand, in 2014. Euro Surveill 2014; 19:20934. [PMID: 25358042] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
We present preliminary results of influenza vaccine effectiveness (VE) in New Zealand using a case test-negative design for 28 April to 31 August 2014. VE adjusted for age and time of admission among all ages against severe acute respiratory illness hospital presentation due to laboratory-confirmed influenza was 54% (95% CI: 19 to 74) and specifically against A(H1N1)pdm09 was 65% (95% CI:33 to 81). For influenza-confirmed primary care visits, VE was 67% (95% CI: 48 to 79) overall and 73% (95% CI: 50 to 85) against A(H1N1)pdm09.
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Affiliation(s)
- N Turner
- The University of Auckland, Auckland, New Zealand
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46
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Turner N, Pierse N, Huang QS, Radke S, Bissielo A, Thompson MG, Kelly H, on behalf of the SHIVERS investigation team C. Interim estimates of the effectiveness of seasonal trivalent inactivated influenza vaccine in preventing influenza hospitalisations and primary care visits in Auckland, New Zealand, in 2014. Euro Surveill 2014. [DOI: 10.2807/1560-7917.es2014.19.42.20934] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We present preliminary results of influenza vaccine effectiveness (VE) in New Zealand using a case test-negative design for 28 April to 31 August 2014. VE adjusted for age and time of admission among all ages against severe acute respiratory illness hospital presentation due to laboratory-confirmed influenza was 54% (95% CI: 19 to 74) and specifically against A(H1N1)pdm09 was 65% (95% CI:33 to 81). For influenza-confirmed primary care visits, VE was 67% (95% CI: 48 to 79) overall and 73% (95% CI: 50 to 85) against A(H1N1)pdm09.
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Affiliation(s)
- N Turner
- The University of Auckland, Auckland, New Zealand
| | - N Pierse
- University of Otago, Wellington, New Zealand
| | - Q S Huang
- Institute of Environmental Science and Research, Wellington, New Zealand
| | - S Radke
- The University of Auckland, Auckland, New Zealand
- Institute of Environmental Science and Research, Wellington, New Zealand
| | - A Bissielo
- Institute of Environmental Science and Research, Wellington, New Zealand
| | - M G Thompson
- Influenza Division, United States Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - H Kelly
- Victorian Infectious Diseases Reference Laboratory, Melbourne, Australia
- Australian National University, Canberra, Australia
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Turner N, Pierse N, Bissielo A, Huang QS, Radke S, Baker M, Widdowson MA, Kelly H. Effectiveness of seasonal trivalent inactivated influenza vaccine in preventing influenza hospitalisations and primary care visits in Auckland, New Zealand, in 2013. Euro Surveill 2014; 19:20884. [PMID: 25188614 PMCID: PMC4627593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
This study reports the first vaccine effectiveness (VE) estimates for the prevention of general practice visits and hospitalisations for laboratory-confirmed influenza from an urban population in Auckland, New Zealand, in the same influenza season (2013). A case test-negative design was used to estimate propensity-adjusted VE in both hospital and community settings. Patients with a severe acute respiratory infection (SARI) or influenza-like illness (ILI) were defined as requiring hospitalisation (SARI) or attending a general practice (ILI) with a history of fever or measured temperature ≥38 °C, cough and onset within the past 10 days. Those who tested positive for influenza virus were cases while those who tested negative were controls. Results were analysed to 7 days post symptom onset and adjusted for the propensity to be vaccinated and the timing during the influenza season. Influenza vaccination provided 52% (95% CI: 32 to 66) protection against laboratory-confirmed influenza hospitalisation and 56% (95% CI: 34 to 70) against presenting to general practice with influenza. VE estimates were similar for all types and subtypes. This study found moderate effectiveness of influenza vaccine against medically attended and hospitalised influenza in New Zealand, a temperate, southern hemisphere country during the 2013 winter season.
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Affiliation(s)
- Nikki Turner
- The University of Auckland, Private Bag 92019, Victoria St West, Auckland, New Zealand
| | - Nevil Pierse
- The University of Otago, Wellington, PO Box 7343 Wellington South 6242, New Zealand
| | - Ange Bissielo
- Institute of Environmental Science and Research, PO Box Box 40-158 Upper Hutt 5140 Wellington, New Zealand
| | - Q Sue Huang
- Institute of Environmental Science and Research, PO Box Box 40-158 Upper Hutt 5140 Wellington, New Zealand
| | - Sarah Radke
- The University of Auckland, Private Bag 92019, Victoria St West, Auckland, New Zealand
| | - Michael Baker
- The University of Otago, Wellington, PO Box 7343 Wellington South 6242, New Zealand
| | | | - Heath Kelly
- The Australian National University, Canberra, ACT 0200 Australia and the Victorian Infectious Diseases Reference Laboratory, 10 Wrecklyn St, North Menbourne VIC 3051 Melbourne, Australia
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Turner N, Pierse N, Bissielo A, Huang QS, Radke S, Baker MG, Widdowson MA, Kelly H, on behalf of the SHIVERS investigation team C. Effectiveness of seasonal trivalent inactivated influenza vaccine in preventing influenza hospitalisations and primary care visits in Auckland, New Zealand, in 2013. Euro Surveill 2014. [DOI: 10.2807/1560-7917.es2014.19.34.20884] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- N Turner
- The University of Auckland, Auckland, New Zealand
| | - N Pierse
- University of Otago, Wellington, New Zealand
| | - A Bissielo
- Institute of Environmental Science and Research, Wellington, New Zealand
| | - Q S Huang
- Institute of Environmental Science and Research, Wellington, New Zealand
| | - S Radke
- The University of Auckland, Auckland, New Zealand
- Institute of Environmental Science and Research, Wellington, New Zealand
| | - M G Baker
- University of Otago, Wellington, New Zealand
| | - M A Widdowson
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - H Kelly
- Victorian Infectious Diseases Reference Laboratory, Melbourne, Australia
- Australian National University, Canberra, Australia
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Oliver J, Pierse N, Baker MG. Improving rheumatic fever surveillance in New Zealand: results of a surveillance sector review. BMC Public Health 2014; 14:528. [PMID: 24885018 PMCID: PMC4049392 DOI: 10.1186/1471-2458-14-528] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 01/22/2014] [Accepted: 05/06/2014] [Indexed: 12/17/2022] Open
Abstract
Background The New Zealand (NZ) Government has made a strong commitment to reduce the incidence of rheumatic fever (RF) by two thirds, to 1.4 cases per 100,000, by mid-2017. We reviewed the NZ RF surveillance sector, aiming to identify potential improvements which would support optimal RF control and prevention activities. Methods This review used a recently developed surveillance sector review method. Interviews with 36 key informants were used to describe the sector, assess it and identify its gaps. Priorities for improvement and implementation strategies were determined following discussion with these key informants, with policy advisors and within the research team. Results Key improvements identified included the need for a comprehensive RF surveillance strategy, integrated reporting and an online national RF register. At a managerial level this review provided evidence for system change and built support for this across the surveillance sector. Conclusions The surveillance sector review approach can be added to the small set of tools currently available for developing and evaluating surveillance systems. This new approach is likely to prove useful as we confront the challenges of combating new emerging infectious diseases, responding to global environmental changes, and reducing health inequalities.
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Affiliation(s)
- Jane Oliver
- University of Otago, PO Box 7343, 23A Mein Street, Newtown, Wellington 6242, New Zealand.
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Turner N, Pierse N, Bissielo A, Huang QS, Baker MG, Widdowson MA, Kelly H. The effectiveness of seasonal trivalent inactivated influenza vaccine in preventing laboratory confirmed influenza hospitalisations in Auckland, New Zealand in 2012. Vaccine 2014; 32:3687-93. [PMID: 24768730 DOI: 10.1016/j.vaccine.2014.04.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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: 11/05/2013] [Revised: 03/24/2014] [Accepted: 04/02/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Few studies report the effectiveness of trivalent inactivated influenza vaccine (TIV) in preventing hospitalisation for influenza-confirmed respiratory infections. Using a prospective surveillance platform, this study reports the first such estimate from a well-defined ethnically diverse population in New Zealand (NZ). METHODS A case test-negative design was used to estimate propensity adjusted vaccine effectiveness. Patients with a severe acute respiratory infection (SARI), defined as a patient of any age requiring hospitalisation with a history of a fever or a measured temperature ≥38°C and cough and onset within the past 7 days, admitted to public hospitals in South and Central Auckland were eligible for inclusion in the study. Cases were SARI patients who tested positive for influenza, while non-cases (controls) were SARI patients who tested negative. Results were adjusted for the propensity to be vaccinated and the timing of the influenza season. RESULTS The propensity and season adjusted vaccine effectiveness (VE) was estimated as 39% (95% CI 16;56). The VE point estimate against influenza A (H1N1) was lower than for influenza B or influenza A (H3N2) but confidence intervals were wide and overlapping. Estimated VE was 59% (95% CI 26;77) in patients aged 45-64 years but only 8% (-78;53) in those aged 65 years and above. CONCLUSION Prospective surveillance for SARI has been successfully established in NZ. This study for the first year, the 2012 influenza season, has shown low to moderate protection by TIV against influenza positive hospitalisation.
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Affiliation(s)
- Nikki Turner
- The University of Auckland, Private Bag 92019, Victoria St West, Auckland, New Zealand.
| | - Nevil Pierse
- The University of Otago, PO Box 7343 Wellington South 6242, Wellington, New Zealand.
| | - Ange Bissielo
- Institute of Environmental Science and Research, PO Box 40-158 Upper Hutt 5140, Wellington, New Zealand.
| | - Q Sue Huang
- Institute of Environmental Science and Research, PO Box 40-158 Upper Hutt 5140, Wellington, New Zealand.
| | - Michael G Baker
- The University of Otago, PO Box 7343 Wellington South 6242, Wellington, New Zealand.
| | | | - Heath Kelly
- The Australian National University, Canberra 0200, ACT, Australia; Victorian Infectious Diseases Reference Laboratory, 10 Wrecklyn St., North Melbourne, 3051 Melbourne, VIC, Australia.
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