Untargeted proteomic differences between clinical strains of methicillin-sensitive and methicillin-resistant Staphylococcusaureus.

Staphylococcus aureus is a common disease-causing bacterium that has developed resistances to a wide variety of antibiotics. This increasing antibiotic resistance has made management of these infections difficult. A better understanding of the general differences among clinical S. aureus strains beyond the well characterized resistance mechanisms may help in identifying new anti-microbial targets. This study aimed to identify and compare the general differences in protein profiles among clinical strains of S. aureus sensitive and resistant to methicillin. The proteomic profiles of five methicillin sensitive (MSSA) and five methicillin resistant (MRSA) S. aureus strains were analyzed by ultra-performance liquid chromatography-mass spectrometry. Protein identification was done using Progenesis QI for Proteomics and the UniProt S. aureus database. Proteins that play roles in virulence, metabolism, and protein synthesis were found to be present at different abundances between MSSA and MRSA (Data available via ProteomeXchange with identifier PXD021629). This study shows differences in protein profiles between antibiotic sensitive and antibiotic resistant clinical strains of S. aureus that may affect the resistance mechanism. Further research on these differences may identify new drug targets against methicillin resistant S. aureus strains.

Insights into Tear Film Stability from Babies and Young Adults: A Study of Human Meibum Lipid Conformation and Rheology.

Babies have the most stable tears and people with dry eye have the least stable tears. Meibum may contribute to tear film stability, so in this study, the hydrocarbon chain conformation and rheology of meibum from babies was studied for the first time. Infrared spectroscopy was used to measure lipid phase transitions. Rheology was measured using Langmuir film technology. Meibum from 25 donors 1 to 13 years old was compared with meibum from 18 donors 13 to 25 years old. The phase transition temperature and lipid order (stiffness) increased with increasing age from 1 to 25 years. The increase in meibum lipid order from 1 to 25 years of age may contribute to the instability of the tear film with age and contribute to films with a higher reciprocal compressibility modulus that are not as compressible and not as viscoelastic. Changes in the lipid phase transition parameters of meibum lipid with dry eye are an exacerbation of the changes observed with age. The lower reciprocal compressibility moduli of meibum films from children and babies compared with meibum from adults reiterates higher stability in their films which spread better, resist deformation, and facilitates their ability to be quickly restored after blinking.

Aggregatibacter actinomycetemcomitans osteomyelitis in a 12 year old boy: case report emphasizing the importance of tissue culture, and review of literature.

BACKGROUND: Aggregatibacter actinomycetemcomitans most commonly causes periodontitis but has been reported to infect heart valves, soft tissue, brain and lungs, and distal bones. Osteomyelitis distal to the jaw is rarely described. CASE PRESENTATION: We report an unusual and rare case of chronic osteomyelitis caused by A. actinomycetemcomitans in the toe of a paediatric patient, and review the available literature. The infection was managed with intravenous antibiotics followed by oral antibiotics. CONCLUSION: This is an unusual presentation of A. actinomycetemcomitans causing chronic osteomyelitis presumed due to nidation in a minimally damaged bone, associated with bacteraemia of an oral commensal. It occurred in the toe, without obvious dental predisposition; associated with minimal clinical disturbance and with muted immune response.

Exploring infant feeding practices: cross-sectional surveys of South Western Sydney, Singapore, and Ho Chi Minh City.

BACKGROUND: Infant feeding practices are known to influence the child's long-term health. Studies have associated obesity and other diseases with reduced breastfeeding and early introduction of high calorie beverages (HCBs). The rising prevalence of obesity is already a problem in most developed countries, especially Australia, but cultural differences are influential. Our aim is to examine and compare infant feeding practices and educational levels of respondents through questionnaires in three culturally different sites: Campbelltown (South Western Sydney), Australia, Singapore and Ho Chi Minh City, Vietnam (HCMC). METHODS: Consenting parents and carers (aged ≥18 years old) of at least one child (≤6 years old) were recruited from paediatric clinics in Campbelltown, Singapore and HCMC. Participants completed an infant feeding practices questionnaire regarding breastfeeding, beverage and solid initiation in addition to the parent's ethnicity, age, and educational level. Data was analysed quantitatively using SPSS. RESULTS: Two hundred eighty-three participants were recruited across the three sites, HCMC (n = 84), Campbelltown (n = 108), and Singapore (n = 91). 237 (82.6%) children were breastfed but in all only 100 (60.2%) were exclusively breastfed for five months or more. There was a statistical difference in rates of breast feeding between each region. HCMC (n = 18, 21.4%) had the lowest, followed by Campbelltown (n = 35, 32.4%), and then Singapore (n = 47, 51.7%). There was also a difference in rates of introduction of HCBs by 3 years of age, with those in HCMC (n = 71, 84.5%) were higher than Campbelltown (n = 71, 65.8%) and Singapore (n = 48, 52.8%). The educational level of respondents was lower in Vietnam where only 46.4% (n = 39) had completed post-secondary education, compared to 75.0% (n = 81) in Campbelltown and 75.8% (n = 69) in Singapore. CONCLUSIONS: Rates of breast feeding were inversely correlated with rates of introduction of HCB and positively related to educational achievement. Vietnam had lowest rates of breast feeding, higher rates of introduction of HCBs, and lower rates of education. Given rising rates of obesity, there is a need for more effective programmes to promote breast feeding and restrict false advertising of HCBs.

Diagnostic Accuracy of Artificial Intelligence-Based Automated Diabetic Retinopathy Screening in Real-World Settings: A Systematic Review and Meta-Analysis.

PURPOSE: To evaluate the diagnostic accuracy of artificial intelligence (AI)-based automated diabetic retinopathy (DR) screening in real-world settings. DESIGN: Systematic review and meta-analysis METHODS: We conducted a systematic review of relevant literature from January 2012 to August 2022 using databases including PubMed, Scopus and Web of Science. The quality of studies was evaluated using Quality Assessment for Diagnostic Accuracy Studies 2 (QUADAS-2) checklist. We calculated pooled accuracy, sensitivity, specificity, and diagnostic odds ratio (DOR) as summary measures. The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO - CRD42022367034). RESULTS: We included 34 studies which utilized AI algorithms for diagnosing DR based on real-world fundus images. Quality assessment of these studies indicated a low risk of bias and low applicability concern. Among gradable images, the overall pooled accuracy, sensitivity, specificity, and DOR were 81%, 94% (95% CI: 92.0-96.0), 89% (95% CI: 85.0-92.0) and 128 (95% CI: 80-204) respectively. Sub-group analysis showed that, when acceptable quality imaging could be obtained, non-mydriatic fundus images had a better DOR of 143 (95% CI: 82-251) and studies using 2 field images had a better DOR of 161 (95% CI 74-347). Our meta-regression analysis revealed a statistically significant association between DOR and variables such as the income status, and the type of fundus camera. CONCLUSION: Our findings indicate that AI algorithms have acceptable performance in screening for DR using fundus images compared to human graders. Implementing a fundus camera with AI-based software has the potential to assist ophthalmologists in reducing their workload and improving the accuracy of DR diagnosis.

Lipid order, saturation and surface property relationships: a study of human meibum saturation.

Tear film stability decreases with age however the cause(s) of the instability are speculative. Perhaps the more saturated meibum from infants may contribute to tear film stability. The meibum lipid phase transition temperature and lipid hydrocarbon chain order at physiological temperature (33 °C) decrease with increasing age. It is reasonable that stronger lipid-lipid interactions could stabilize the tear film since these interactions must be broken for tear break up to occur. In this study, meibum from a pool of adult donors was saturated catalytically. The influence of saturation on meibum hydrocarbon chain order was determined by infrared spectroscopy. Meibum is in an anhydrous state in the meibomian glands and on the surface of the eyelid. The influence of saturation on the surface properties of meibum was determined using Langmuir trough technology. Saturation of native human meibum did not change the minimum or maximum values of hydrocarbon chain order so at temperatures far above or below the phase transition of human meibum, saturation does not play a role in ordering or disordering the lipid hydrocarbon chains. Saturation did increase the phase transition temperature in human meibum by over 20 °C, a relatively high amount. Surface pressure-area studies showing the late take off and higher maximum surface pressure of saturated meibum compared to native meibum suggest that the saturated meibum film is quite molecularly ordered (stiff molecular arrangement) and elastic (molecules are able to rearrange during compression and expansion) compared with native meibum films which are more fluid agreeing with the infrared spectroscopic results of this study. In saturated meibum, the formation of compacted ordered islands of lipids above the surfactant layer would be expected to decrease the rate of evaporation compared to fluid and more loosely packed native meibum. Higher surface pressure observed with films of saturated meibum compared to native meibum suggests greater film stability especially under the high shear stress of a blink.

The Cell Wall, Cell Membrane and Virulence Factors of Staphylococcus aureus and Their Role in Antibiotic Resistance.

Antibiotic resistant strains of bacteria are a serious threat to human health. With increasing antibiotic resistance in common human pathogens, fewer antibiotics remain effective against infectious diseases. Staphylococcus aureus is a pathogenic bacterium of particular concern to human health as it has developed resistance to many of the currently used antibiotics leaving very few remaining as effective treatment. Alternatives to conventional antibiotics are needed for treating resistant bacterial infections. A deeper understanding of the cellular characteristics of resistant bacteria beyond well characterized resistance mechanisms can allow for increased ability to properly treat them and to potentially identify targetable changes. This review looks at antibiotic resistance in S aureus in relation to its cellular components, the cell wall, cell membrane and virulence factors. Methicillin resistant S aureus bacteria are resistant to most antibiotics and some strains have even developed resistance to the last resort antibiotics vancomycin and daptomycin. Modifications in cell wall peptidoglycan and teichoic acids are noted in antibiotic resistant bacteria. Alterations in cell membrane lipids affect susceptibility to antibiotics through surface charge, permeability, fluidity, and stability of the bacterial membrane. Virulence factors such as adhesins, toxins and immunomodulators serve versatile pathogenic functions in S aureus. New antimicrobial strategies can target cell membrane lipids and virulence factors including anti-virulence treatment as an adjuvant to traditional antibiotic therapy.

Antibacterial Properties of Eucalyptus globulus Essential Oil against MRSA: A Systematic Review.

Antimicrobial resistance is a huge threat against the public health sphere and is a major cause of global mortality and morbidity. Antibiotic misuse and overuse have led to the development of many resistant bacterial strains. One particular bacterium of concern is methicillin-resistant Staphylococcus aureus (MRSA), which is the most common resistant bacteria in humans. Antibiotic development has been unable to keep up with the rapid evolution of antibiotic-resistant organisms, and there is an urgent need to identify alternative agents to combat this problem. The purpose of this systematic review is to explore the literature on the antibacterial properties of Eucalyptus globulus essential oil against MRSA. The articles used in this review were obtained through a systematic search of the literature across four databases, with the timeline being between 2002 and 2022. Twenty studies were included in this review, which used various methods to investigate the antibacterial properties of E. globulus essential oil, alone or in combination with other agents, against MRSA. The findings suggest that E. globulus essential oil has antibacterial properties against MRSA, which can be enhanced when used in combination with other agents, such as other essential oils and antibiotics.

The antibacterial effectiveness of lavender essential oil against methicillin-resistant Staphylococcus aureus: a systematic review.

With the overuse and misuse of antibiotics, multi-drug resistant organisms have become a prominent issue in healthcare, increasing morbidity and mortality in affected patients. One such organism of concern is methicillin-resistant Staphylococcus aureus (MRSA) which is a leading cause of a variety of clinical infections. Therefore, in the interest of finding alternate substances to antibiotics, there has been increased interest in the antibacterial properties of lavender essential oil (LEO). This systematic review aims to collate information regarding the antibacterial properties of LEO against S. aureus and MRSA. A systematic search was conducted across four databases between the years 2002 and 2022, and through this, 23 studies were included in this paper. These studies used a variety of methods to ascertain the antibacterial effectiveness of LEO alone or in combination with other substances. Overall, there were mixed results regarding the antibacterial effectiveness of LEO against S. aureus and MRSA, with some studies reporting significant effectiveness, while other studies reporting a minimal to negligible effect. However, findings suggest that LEO works synergistically with other antibacterial substances, and it would be beneficial for additional research to be conducted in this area.

Antimicrobial Tear Lipids in the Ocular Surface Defense.

The concept of antimicrobial lipids as effectors of innate host defense is an emerging field. There is limited knowledge on the antimicrobial role of lipids in the ocular environment. Tears act as first line of defense to protect the ocular surface from infections. Antimicrobial effects of tear lipids have been demonstrated using meibomian lipids that are the source of majority of lipids in tears. This article describes the knowledge available on the antimicrobial role of tear lipids at the ocular surface and the antimicrobial potential of various lipid classes present in tears that can contribute to antimicrobial protection of the eye. Like other mucosal secretions, tears contain many proteins and lipids with known antimicrobial effects. The antimicrobial defense of tears is far stronger than can be demonstrated by the effects of individual compounds many of which are present in low concentrations but synergistic and additive interactions between them provide substantial antimicrobial protection to the ocular surface. It is inferred that antimicrobial lipids play important role in innate defense of tears, and cooperative interactions between various antimicrobial lipids and proteins in tears provide a potent host defense mechanism that is effective against a broad spectrum of pathogens and renders self-sterilizing properties to tears for keeping the microbial load low at the ocular surface.

Untargeted lipidomic differences between clinical strains of methicillin-sensitive and methicillin-resistant Staphylococcus aureus.

BACKGROUND: Staphylococcus aureus is a common cause of infectious diseases in humans. It has become resistant to many antibacterial agents making management of infections difficult. A better understanding of differences among S. aureus strains that are sensitive and resistant to antibiotics may offer insights into the resistant phenotype and identify new antimicrobial targets. This study aimed at comparing general differences in lipid profiles among clinical strains of S. aureus sensitive and resistant to antibiotics. The cell wall thickness and cell surface charge were also compared. METHODS: Five methicillin sensitive (MSSA) and five methicillin resistant (MRSA) S. aureus strains were compared both individually and as MSSA and MRSA groups in the absence of antibiotics. Lipids were compared by ultra-performance liquid chromatography-mass spectrometry, cell wall thickness was compared by scanning transmission electron microscopy and whole-cell surface charge was compared using a cytochrome c binding assay. RESULTS: Twenty-two lipid species were identified in all ten strains of S. aureus. The abundance of three lipid species (two lysyl-phosphatidylglycerol and one diglycosyldiacylglycerol) were found to be different between MSSA and MRSA. Differences in cell wall thickness were identified between strains but not between MSSA and MRSA. No difference in whole-cell surface charge was observed between MSSA and MRSA. CONCLUSION: This study shows differences in membrane lipids between antibiotic sensitive and antibiotic resistant clinical strains of S aureus that may affect resistance mechanisms related to cell membrane structure and fluidity. Further research on these differences may identify new drug targets against resistant strains.

Diagnostic Stewardship-The Impact of Rapid Diagnostic Testing for Paediatric Respiratory Presentations in the Emergency Setting: A Systematic Review.

Antimicrobial resistance is a growing public health crisis, propelled by inappropriate antibiotic prescription, in particular the over-prescription of antibiotics, prolonged duration of antibiotic therapy and the overuse of broad-spectrum antibiotics. The paediatric population, in particular, those presenting to emergency settings with respiratory symptoms, have been associated with a high rate of antibiotic prescription rates. Further research has now shown that many of these antibiotic prescriptions may have been avoided, with more targeted diagnostic methods to identify underlying aetiologies. The purpose of this systematic review was to assess the impact of rapid diagnostic testing, for paediatric respiratory presentations in the emergency setting, on antibiotic prescription rates. To review the relevant history, a comprehensive search of Medline, EMBASE and Cochrane Database of Systematic Reviews was performed. Eighteen studies were included in the review, and these studies assessed a variety of rapid diagnostic testing tools and outcome measures. Overall, rapid diagnostic testing was found to be an effective method of diagnostic antibiotic stewardship with great promise in improving antibiotic prescribing behaviours. Further studies are required to evaluate the use of rapid diagnostic testing with other methods of antibiotics stewardship, including clinical decisions aids and to increase the specificity of interventions following diagnosis to further reduce rates of antibiotic prescription.

Paediatric Antimicrobial Stewardship for Respiratory Infections in the Emergency Setting: A Systematic Review.

Antimicrobial resistance occurs due to the propensity of microbial pathogens to develop resistance to antibiotics over time. Antimicrobial stewardship programs (ASPs) have been developed in response to this growing crisis, to limit unnecessary antibiotic prescription through initiatives such as education-based seminars, prescribing guidelines, and rapid respiratory pathogen (RRP) testing. Paediatric patients who present to the emergency setting with respiratory symptoms are a particularly high-risk population susceptible to inappropriate antibiotic prescribing behaviours and are therefore an ideal cohort for focused ASPs. The purpose of this systematic review was to assess the efficacy and safety of ASPs in this clinical context. A systematic search of PubMed, Medline, EMBASE and the Cochrane Database of Systematic Reviews was conducted to review the current evidence. Thirteen studies were included in the review and these studies assessed a range of stewardship interventions and outcome measures. Overall, ASPs reduced the rates of antibiotic prescription, increased the prescription of narrow-spectrum antibiotics, and shortened the duration of antibiotic therapy. Multimodal interventions that were education-based and those that used RRP testing were found to be the most effective. Whilst we found strong evidence that ASPs are effective in reducing antibiotic prescribing, further studies are required to assess whether they translate to equivalent clinical outcomes.

Evaluation of use of essential fatty acids in topical ophthalmic preparations for dry eye.

PURPOSE: Essential fatty acids (EFAs) as dietary supplements are used in treating dry-eye for reducing inflammation at the ocular surface. Their topical application in eye drops to deliver fatty acid (FA) directly to the ocular surface requires thorough investigation. Being lipids in nature EFAs can interact with tear lipids and affect tear stability. This study aimed at investigating the biophysical interactions of EFAs with Meibomian lipids. METHODS: Rheology of mixtures of Human Meibomian lipids with EFAs (LA-linoleic acid, ALA-alpha-linolenic acid), OA (oleic acid), and GLA (gamma-linolenic acid) was studied using Langmuir trough technology on an artificial tear solution at the ocular surface temperature. Pressure-area profiles were used to determine compressibility and elasticity of the mixed films. RESULTS: LA enhanced spreading of Meibomian lipids and increased their compressibility and elasticity which can be beneficial for tear stability. ALA condensed Meibomian lipids film with less elasticity deemed unfavourable for tear stability. OA expanded Meibomian lipids but decreased elasticity at high compressions making films less stable. GLA had little or no favourable effect on tear stability. Higher concentrations of FAs made films less stable. CONCLUSIONS: EFAs or OA in topical ophthalmic preparations can affect spread and stability of the tear film lipid layer. Rheology of mixed films should be tested using Langmuir trough technology to determine suitable type and amount of a lipid additive for therapeutic eye drops. In topical applications, the omega-6 LA (not omega-3 FA) at low concentrations (20 mol%) can be beneficial for enhancing tear stability in dry eye patients.

Meibum lipid hydrocarbon chain branching and rheology after hematopoietic stem cell transplantation.

PURPOSE: Meibum from donors who have had hematological stem cell transplantations (MHSCT) are susceptible to severe dry eye symptoms and exhibit very high lipid order (stiffness) compared with meibum from donors without dry eye (Mn). Since lipid order could have functional consequences, we compared the rheology and composition of Mn and MHSCT to measure meibum compositional, structural and functional relationships. METHODS: The rheology and composition was measured using Langmuir trough and 1H NMR spectroscopy, respectively. RESULTS: MHSCT and Mn was studied from 16 to 43 donors, respectively, using NMR spectroscopy. MHSCT contained significantly 16% more straight chain and 24% less iso-chain hydrocarbons compared with Mn. The cholesteryl ester to wax ester molar ratio, and hydrocarbon chain unsaturation were not significantly different, for MHSCT compared with Mn.Surface pressure-area isotherms of meibum from 30 donors without dry-eye were grouped into 4 pools (PC) and meibum from 32 donors with dry eye who had hematopoietic stem cell transplantation (PT) were grouped into 3 pools. Above 15 years of age the Пmax and (Cs -1)max increased with age for both the PC and the PT cohorts. (Cs -1)max values were higher for PT samples compared with age matched PC samples, indicating they had higher elasticity and stiffness. A more ordered lipid could contribute to the formation of a discontinuous patchy tear film lipid layer, which in turn results in deteriorated spreading, and decreased surface elasticity. CONCLUSIONS: The composition and rheology of meibum from donors with dry eye and who have had HSCT support the idea from other studies that more ordered meibum may contribute to or be a marker of dry eye.

The in vitro antibacterial effect of permethrin and formaldehyde on Staphylococcus aureus.

Antibiotic-resistant strains of bacteria such as methicillin-resistant Staphylococcus aureus are a threat to human health, and effective treatment options against them are needed. This study aimed to determine whether the insecticide permethrin was capable of inhibiting the growth of S. aureus or if some other component of a permethrin cream was responsible for a decrease in scabies associated bacterial infection previously observed. Ten S. aureus strains were grown in the presence of permethrin and formaldehyde both alone and in combination with percent inhibition determined by viable counts. Also, a time-kill assay was conducted on S. aureus exposed to the same conditions. Finally, the morphology of S. aureus grown in the presence of permethrin was examined by scanning electron microscopy. Bacterial inhibition by permethrin ranged from 0% to 41% whereas inhibition by formaldehyde was 100%. The time-kill curves of permethrin exposed cells were very similar to the positive growth control while the formaldehyde and combination exposure showed complete inhibition even at the 0-hr time point. The scanning electron micrographs of permethrin grown S. aureus showed healthy cocci cells with no sign of cell damage. Our results show that permethrin is not capable of inhibiting the growth of bacteria enough for it to be termed bactericidal. Formaldehyde is a known antiseptic and therefore was responsible for the antibacterial effect observed after the use of permethrin cream.

Formaldehyde as an alternative to antibiotics for treatment of refractory impetigo and other infectious skin diseases.

Introduction: Antibiotic-resistant strains of bacteria are an increasing problem in hospitals and in the community. This has resulted in bacterial infections such as impetigo becoming difficult to treat. Alternative treatment options are needed. Areas covered: In this paper, a past study that assessed the health burden of scabies in North Queensland is described and from it, the potential for formaldehyde as an alternative antimicrobial treatment is discussed. In doing so, antibiotic resistance, impetigo, permethrin, and formaldehyde are introduced and the current understanding and limitations of the effects of formaldehyde on humans are outlined. The limited cases of formaldehyde resistance in bacteria are also discussed. Expert opinion: Formaldehyde is currently used as a preservative in cosmetics and medicinal creams due to its antibacterial activity. It, therefore, has the potential to be used as an alternative antibacterial treatment for infections with antibiotic-resistant bacteria. The harmful side effects of airborne formaldehyde and exposure in allergic individuals have been extensively studied. Significantly less research has been conducted on formaldehyde skin contact in healthy individuals. If formaldehyde is safe for topical use in humans, it has the potential to assist with combating antibiotic resistance.

Pediatric bloodstream infections in metropolitan Australia.

BACKGROUND: Bloodstream infections (BSIs) cause significant morbidity and mortality of children worldwide. The aim of this study was to investigate BSI in children and determine the identity of causative organism and their susceptibility patterns in a metropolitan public hospital in Australia. METHODS: We retrospectively reviewed children aged 0-16 years admitted to a public hospital from January 1, 2010 to August 31, 2014 inclusive, and whose blood cultures revealed bacteraemia. Data were collected regarding patient demographics, species of bacteria isolated, antimicrobial susceptibility of these isolates, and clinical outcomes. RESULTS: Out of 96 patients with BSI, 55 (57.3%) were males. The median age was 3.35 years (IQR 0.44-7.46), and there were 2 mortalities. Common sites of infection were the respiratory tract (16.6%, n = 16), bone and joints (15.6%, n = 15) and the urinary tract (11.5%, n = 11). The most frequent isolates were Staphylococcus aureus (27.0%), Escherichia coli (14.0%) and Streptococcus pneumoniae (12.0%). Whilst most bacterial isolates displayed susceptibility (> 90%) to common antimicrobial agents, only 57.1% (8/14) of Escherichia coli isolates were susceptible to ampicillin and 58.3% (7/12) were susceptible to co-trimoxazole. CONCLUSIONS: Gram-positive bacteria accounted for the majority of pediatric BSIs, of which invasive pneumococcal disease remains a noteworthy cause. The majority of isolates, except Escherichia coli, were susceptible to commonly used antimicrobials. This study confirms the knowledge of high rates of resistance of Escherichia coli to ampicillin. Therefore, empirical treatment should still include gentamicin. Monitoring of resistance patterns is warranted to ensure that antibiotic therapy remains appropriate.

Knowledge, attitudes and opinions towards measles and the MMR vaccine across two NSW cohorts.

OBJECTIVE: Although the number of national measles cases has greatly decreased since 1980s, there has been resurgence in disease incidence in recent years. While parental knowledge and attitudes toward both disease and vaccinations are known to influence vaccine uptake, the contribution of these factors toward vaccination rates in NSW populations has not been studied. The aim of this study was to investigate the knowledge and opinions on measles and MMR vaccine in NSW Central and North Coast regions. METHODS: Parents (n=201) of children <12 years were surveyed with a purpose design survey at public beaches at the Central Coast and community markets at the North Coast. RESULTS: Eight per cent of respondents reported not immunising their child with MMR vaccine. Most respondents recognised that measles is a highly contagious disease. Non-immunisers were found to be older, had a lower perceived severity of measles, were less likely to agree with the efficacy and safety of the vaccine, and were more likely to have encountered someone who had suffered side-effects of the vaccine. CONCLUSIONS: There is considerable concern over safety of MMR vaccine among non-immunisers. Implications for public health: Improving confidence in MMR vaccine should be a target of future public health interventions.