Health of children who experienced Australian immigration detention.

BACKGROUND: Australian immigration policy resulted in large numbers of children being held in locked detention. We examined the physical and mental health of children and families who experienced immigration detention. METHODS: Retrospective audit of medical records of children exposed to immigration detention attending the Royal Children's Hospital Immigrant Health Service, Melbourne, Australia, from January 2012 -December 2021. We extracted data on demographics, detention duration and location, symptoms, physical and mental health diagnoses and care provided. RESULTS: 277 children had directly (n = 239) or indirectly via parents (n = 38) experienced locked detention, including 79 children in families detained on Nauru or Manus Island. Of 239 detained children, 31 were infants born in locked detention. Median duration of locked detention was 12 months (IQR 5-19 months). Children were detained on Nauru/Manus Island (n = 47/239) for a median of 51 (IQR 29-60) months compared to 7 (IQR 4-16) months for those held in Australia/Australian territories (n = 192/239). Overall, 60% (167/277) of children had a nutritional deficiency, and 75% (207/277) had a concern relating to development, including 10% (27/277) with autism spectrum disorder and 9% (26/277) with intellectual disability. 62% (171/277) children had mental health concerns, including anxiety, depression and behavioural disturbances and 54% (150/277) had parents with mental illness. Children and parents detained on Nauru had a significantly higher prevalence of all mental health concerns compared with those held in Australian detention centres. CONCLUSION: This study provides clinical evidence of adverse impacts of held detention on children's physical and mental health and wellbeing. Policymakers must recognise the consequences of detention, and avoid detaining children and families.

Vaccine safety in Australia during the COVID-19 pandemic: Lessons learned on the frontline.

Surveillance of Adverse Events Following Vaccination in the Community (SAEFVIC), Victoria's vaccine safety service for reporting adverse events following immunisation (AEFI), has provided integrated spontaneous surveillance and clinical services for individuals affected by AEFI since 2007. We describe SAEFVIC's response to the COVID-19 vaccine program, and reflect on lessons learned for vaccine safety. The massive scale of the Australian COVID-19 vaccine program required rapid adaptations across all aspects of SAEFVIC's vaccine safety services. Collection of AEFI reports was streamlined and expanded, incorporating both spontaneous and active surveillance data. Dramatically increased report volumes were managed with additional staffing, and innovations to automate, filter, and triage reports for priority follow up. There were two major adverse events of special interest (AESI): thrombosis with thrombocytopaenia syndrome and myocarditis, with multiple other AESI also investigated. Rapid escalation mechanisms to respond to AESI were established, along with AESI-specific databases for enhanced monitoring. Vaccine education and training resources were developed and public-facing vaccine safety reports updated weekly. Frequent communication with local and national government and regulatory bodies, and consultation with specialist groups was essential. The COVID-19 vaccine program has highlighted the importance of vaccine safety in supporting public confidence in vaccines and informing evidence-based immunisation policy. Supporting the COVID-19 vaccine program has required flexibility in adapting to policy changes and evolving vaccine safety signals, careful triage and prioritisation, informatics innovation, and enhanced engagement with the public regarding vaccine safety. Long-term investment to continue strengthening vaccine safety systems, building on lessons learned, will be essential for the ongoing success of Australian vaccination programs.

Detecting Mycobacterium tuberculosis Infection in Children Migrating to Australia.

In 2015, Australia updated premigration screening for tuberculosis (TB) disease in children 2-10 years of age to include testing for infection with Mycobacterium tuberculosis and enable detection of latent TB infection (LTBI). We analyzed TB screening results in children <15 years of age during November 2015-June 2017. We found 45,060 child applicants were tested with interferon-gamma release assay (IGRA) (57.7% of tests) or tuberculin skin test (TST) (42.3% of tests). A total of 21 cases of TB were diagnosed: 4 without IGRA or TST, 10 with positive IGRA or TST, and 7 with negative results. LTBI was detected in 3.3% (1,473/44,709) of children, for 30 applicants screened per LTBI case detected. LTBI-associated factors included increasing age, TB contact, origin from a higher TB prevalence region, and testing by TST. Detection of TB and LTBI benefit children, but the updated screening program's effect on TB in Australia is likely to be limited.

Tuberculosis in migrants to Australia: Outcomes of a national screening program.

BACKGROUND: Few low-incidence countries are on track to achieve the ambitious target of reaching TB pre-elimination by 2035. Australia is a high-income country with a low burden of TB, which is particularly concentrated in migrant populations. As part of Australia's migration program, permanent, provisional and humanitarian visa applicants are screened for TB, along with some applicants for temporary visas. METHODS: We calculated the prevalence of all forms of active TB and bacteriologically-confirmed TB among onshore and offshore applicants for visas to Australia from July 2014 to June 2017, and investigated associated risk factors using logistic regression. FINDINGS: Visa applicants were predominantly young adults from various Asian countries. Among 2,381,217 applicants, 1263 cases of active TB were diagnosed, including 852 cases of bacteriologically-confirmed TB. Overall TB prevalence was 53.0 per 100,000, corresponding to one TB diagnosis for every 1887 applicants screened. TB rates increased with age and were higher among humanitarian applicants and those previously treated for TB, although most cases occurred in applicants without these risk factors. TB prevalence by country of origin was similar to WHO estimates for some countries, but considerably lower for others. For several highly represented countries of origin, rates appear to have fallen relative to earlier comparable studies. INTERPRETATION: Prevalence of TB among visa applicants to Australia and the consequent risk to the Australian community appear to be declining and remain low. In this context, support for TB control programs overseas and preventive interventions are likely to have the greatest impact on domestic TB burden. FUNDING: No specific funding was received for this study. JMT is a recipient of an Early Career Fellowship from the Australian National Health and Medical Research Council (APP1142638).

Personal and reported partner pornography viewing by Australian women, and association with mental health and body image.

Background Personal and partner pornography viewing may affect health and wellbeing. This study aimed to improve understanding of the effects of pornography on mental health and body image, given emerging evidence of increasing use, particularly among young people. METHODS: A cross-sectional survey was implemented, targeting people who had accessed health and fitness content via social media. Convenience sampling was used and participants were recruited via advertising on social media. RESULTS: Overall, 76% (75/99) of women reported having ever viewed pornography, and 21% had viewed pornography frequently (monthly/weekly/daily) in the prior 12 months. The association between frequent viewing and higher-risk Kessler 10 Psychological Distress Scale scores lost significance once controlled for age (adjusted OR 2.30, 95%CI 0.82-6.49, P=0.11). There was an association with frequent reported partner pornography use (monthly/weekly/daily) and increased Drive for Muscularity scores (adjusted OR 2.20, 95%CI 1.01-4.80, P=0.048). There were no other associations found with pornography use (personal or partner) and body image or mental health, although this was limited by the small sample size. Most women (85%, 41/48) reported being happy with their partner's pornography use, and in qualitative responses, indicated that pornography had minimal effect on their lives. Nevertheless, multiple qualitative responses indicated a multiplicity of perceived effects of pornography, including negative effects on body image. CONCLUSIONS: Pornography had a minor effect on mental health and body image in this study. Additional research is required to improve understanding of the effects of pornography on body image and mental health, particularly among vulnerable individuals.

Gaps in smiles and services: a cross-sectional study of dental caries in refugee-background children.

BACKGROUND: Refugees are reported to experience high rates of dental disease, although there are limited data on refugee children. The aim of this study was to report on oral health in refugee-background children in Australia, and to assess their follow-up at dental services. METHODS: Cross-sectional study of opportunistic oral health screening and subsequent dental service use in refugee-background children attending a refugee health clinic in Victoria, Australia, between November 2006-November 2010. RESULTS: 350 patients (0-18 years, mean age 8 years 7 months) had oral health screening; 241 (68.9%) were born overseas, (176 Africa, 65 other countries) and 109 (31.1%) were born in Australia to African-background families. Parents were concerned about oral health in 65/341 (19.1%) children, with specific concern about caries in only 9/341 (2.6%). On assessment, 155/336 (46.1%) had visible caries and 178/345 (51.6%) had caries experience (dmft/DMFT > 0). Where parents were concerned about caries, they were likely to be present (positive predictive value = 100%), however absence of parent concern about caries was not reassuring (negative predictive value = 56.1%).Compared to Australian-born children of African background; African-born children were more likely to be referred for further dental care (adjusted PR 1.33, 95% CI [1.02-1.73]), although there was no statistically significant difference in caries prevalence. African-born children were less likely to have caries compared to other overseas-born children (adjusted PR 0.73, 95% CI [0.58 - 0.93]). Overall 187/344 (54.4%) children were referred for further dental care; 91/124 (73.4%) attended any dental appointment. Attendance rates were 90% with a phone reminder system for appointments, attendance reduced when this system lapsed. CONCLUSIONS: Oral health is an important public health issue in refugee-background children, despite low levels of parent concern and very few parent reported caries. Routine direct oral health assessment is important in refugee-background children and co-ordinated health systems may help improve their attendance at dental services.

Human papillomavirus vaccine national catch-up program - insights into under-notification.

BACKGROUND: We analysed human papillomavirus (HPV) vaccination coverage from the 2007-2009 catch-up program for women aged 18-26 years by Division of General Practice (DGP), alongside a survey about under-notification. METHODS: Coverage rates were calculated from the National HPV Vaccination Program Register. An online survey of immunisation coordinators in DGP assessed under-notification. RESULTS: HPV vaccine coverage by DGPs varied greatly: dose 1, 22-70%; dose 2, 13-60%; dose 3, 7-49%. Most coordinators (38/52, 66%) believed that more than 80% of practices notified the register. Perceived notification barriers included being busy, not knowing how to notify, not obtaining consent, insufficient remuneration and delay in register establishment. DISCUSSION: DGP coverage varied widely. Process barriers (time and resource limitations) probably contributed to under-notification, with informational barriers (unaware how to notify) and motivational barriers (not worth the effort) secondary to this. Differences in reported coverage between DGPs and states reflect both differences in notification rates and underlying HPV vaccine coverage.

Anaphylaxis - identification, management and prevention.

OBJECTIVE: This article summarises current knowledge regarding the identification, management and prevention of anaphylaxis, highlighting risk minimisation strategies relevant to general practitioners. DISCUSSION: The most common causes of anaphylaxis are medication, food and insect venom. Medications are the most common cause of anaphylaxis in older adults, particularly antibiotics, anaesthetic drugs, nonsteroidal anti-inflammatory drugs and opiates. Food allergy is the most common cause of anaphylaxis in children, but rarely results in death. Anaphylaxis is a medical emergency requiring immediate treatment with adrenaline, as well as ongoing management. Important steps for long-term risk minimisation include avoidance of triggers, prescription of an adrenaline autoinjector, maintenance of a personalised emergency action plan for anaphylaxis, education for patients and families and regular review to optimise management.