Switchavidin: reversible biotin-avidin-biotin bridges with high affinity and specificity.

Switchavidin is a chicken avidin mutant displaying reversible binding to biotin, an improved binding affinity toward conjugated biotin, and low nonspecific binding due to reduced surface charge. These properties make switchavidin an optimal tool in biosensor applications for the reversible immobilization of biotinylated proteins on biotinylated sensor surfaces. Furthermore, switchavidin opens novel possibilities for patterning, purification, and labeling.

School-Level Variation in Coverage of Co-Administered dTpa and HPV Dose 1 in Three Australian States.

BACKGROUND: Australian adolescents are routinely offered HPV and dTpa (diphtheria, tetanus, pertussis) vaccines simultaneously in the secondary school vaccination program. We identified schools where HPV initiation was lower than dTpa coverage and associated school-level factors across three states. METHODS: HPV vaccination initiation rates and dTpa vaccination coverage in 2016 were calculated using vaccine databases and school enrolment data. A multivariate analysis assessed sociodemographic and school-level factors associated with HPV initiation being >5% absolute lower than dTpa coverage. RESULTS: Of 1280 schools included, the median school-level HPV initiation rate was 85% (interquartile range (IQR):75-90%) and the median dTpa coverage was 86% (IQR:75-92%). Nearly a quarter (24%) of all schools had HPV vaccination initiation >5% lower than dTpa coverage and 11 % had >10% difference. School-level factors independently associated with >5% difference were remote schools (aOR:3.5, 95% CI = 1.7-7.2) and schools in major cities (aOR:1.8, 95% CI = 1.0-3.0), small schools (aOR:3.3, 95% CI = 2.3-5.7), higher socioeconomic advantage (aOR:1.7, 95% CI = 1.1-2.6), and lower proportions of Language-background-other-than-English (aOR:1.9, 95% CI = 1.2-3.0). CONCLUSION: The results identified a quarter of schools had lower HPV than dTpa initiation coverage, which may indicate HPV vaccine hesitancy, and the difference was more likely in socioeconomically advantaged schools. As hesitancy is context specific, it is important to understand the potential drivers of hesitancy and future research needs to understand the reasons driving differential uptake.

Potential use of Western Australia's mandatory Midwives Notification System for routinely monitoring antenatal vaccine coverage

Background: Despite the maternal and infant health benefits of antenatal vaccines and availability of government-funded vaccination programs, Australia does not have a national system for routinely monitoring antenatal vaccination coverage. We evaluated the potential use of Western Australia's mandatory Midwives Notification System (MNS) as a tool for routinely monitoring antenatal vaccination coverage. Methods: Two hundred and sixty-eight women who gave birth to a live infant between August and October 2016 participated in a telephone survey of vaccines received in their most recent pregnancy. For women who reported receiving influenza and/or pertussis vaccine and whose vaccination status was documented by their vaccine provider, MNS vaccination data were compared with the vaccine provider's record as the 'gold standard.' For women who reported receiving no vaccines, MNS vaccination data were compared with self-reported information. Results: Influenza and pertussis vaccination status was complete (i.e. documented as either vaccinated or not vaccinated) for 66% and 63% of women, respectively. Sensitivity of MNS influenza vaccination data was 65.7% (95% CI 56.0-74.2%) and specificity was 53.0% (95% CI 42.4-63.4%). Sensitivity of MNS pertussis vaccination data was 62.5% (95% CI 53.3-70.9%) and specificity was 40.4% (95% CI 27.6-54.7%). There was no difference between vaccinated and unvaccinated women in the proportion of MNS records with missing or unknown vaccination information. When considering only MNS records with complete vaccination information, the sensitivity of the MNS influenza vaccination field was 91.8% (95% CI 83.0-96.9%) and the sensitivity of the MNS pertussis vaccination field was 88.0% (95% CI 76.7-95.5%). Conclusion: Due to the high proportion of records with missing or unknown vaccination status, we observed low sensitivity and specificity of antenatal vaccination data in the MNS. However, given we did not observe differential ascertainment by vaccination status, MNS records with complete information may be reliable data source for routinely monitoring antenatal vaccine coverage.

Intraseason decline in influenza vaccine effectiveness during the 2016 southern hemisphere influenza season: A test-negative design study and phylogenetic assessment.

BACKGROUND: We estimated the effectiveness of seasonal inactivated influenza vaccine and the potential influence of timing of immunization on vaccine effectiveness (VE) using data from the 2016 southern hemisphere influenza season. METHODS: Data were pooled from three routine syndromic sentinel surveillance systems in general practices in Australia. Each system routinely collected specimens for influenza testing from patients presenting with influenza-like illness. Next generation sequencing was used to characterize viruses. Using a test-negative design, VE was estimated based on the odds of vaccination among influenza-positive cases as compared to influenza-negative controls. Subgroup analyses were used to estimate VE by type, subtype and lineage, as well as age group and time between vaccination and symptom onset. RESULTS: A total of 1085 patients tested for influenza in 2016 were included in the analysis, of whom 447 (41%) tested positive for influenza. The majority of detections were influenza A/H3N2 (74%). One-third (31%) of patients received the 2016 southern hemisphere formulation influenza vaccine. Overall, VE was estimated at 40% (95% CI: 18-56%). VE estimates were highest for patients immunized within two months prior to symptom onset (VE: 60%; 95% CI: 26-78%) and lowest for patients immunized >4 months prior to symptom onset (VE: 19%; 95% CI: -73-62%). DISCUSSION: Overall, the 2016 influenza vaccine showed good protection against laboratory-confirmed infection among general practice patients. Results by duration of vaccination suggest a significant decline in effectiveness during the 2016 influenza season, indicating immunization close to influenza season offered optimal protection.

Spinal cord compression secondary to epidural abscess: the importance of prompt diagnosis and management.

A 66-year-old woman presented with a 4-day history of fever, lethargy, neck and lower back pain. Neurological examination revealed mild quadraparesis. In view of this, MRI whole spine with contrast was performed and showed extensive spinal epidural abscess extending from the cervical to lumbar region causing compression of the thecal sac, spinal cord and nerves. The patient received multiple laminectomies to decompress the spinal cord and required a prolonged course of intravenous flucloxacillin as Staphylococcus aureus was cultured from three sets of blood cultures. Although spinal epidural abscess is rare, it is important for clinicians to have a high index of suspicion; so appropriate imaging is performed to determine the diagnosis. Patient age, degree of thecal sac compression and duration of symptoms are all independently associated with poor outcome. 1.

Pretravel Health Advice Among Australians Returning From Bali, Indonesia: A Randomized Controlled Trial Protocol.

BACKGROUND: The effect of pretravel health advice (PTHA) on travel-related illness rates is poorly understood, and to date there are no published randomized controlled trials evaluating the impact of PTHA outcomes. OBJECTIVE: This study aims to determine the effect of an online PTHA intervention on travel-related illness rates in Western Australians visiting Bali, Indonesia. METHODS: Western Australian travelers to Bali will be recruited online before departure and will be randomly allocated to an intervention or control group by computer algorithm. The intervention in this study is a short animated video, with accompanying text, containing PTHA relevant to Bali. An online posttravel survey will be administered to all participants within two weeks of their return from Bali. The primary outcome is the difference in self-reported travel-related illness rates between control and intervention groups. Secondary outcomes include the difference in risk prevention behaviors and health risk knowledge between the control and intervention groups. Further secondary outcomes include whether individuals in the control group who sought external PTHA differ from those who did not with respect to risk prevention behaviors, health risk knowledge, and health risk perception, as well as the rate of self-reported travel-related illness. RESULTS: The study began recruitment in September 2016 and will conclude in September 2017. Data analysis will take place in late 2017, with results disseminated via peer-reviewed journals in early 2018. CONCLUSIONS: This will be the first randomized controlled trial to examine the effect of a novel PTHA intervention upon travel-related illness. In addition, this study builds upon the limited existing data on the effectiveness of PTHA on travel-related illness. CLINICALTRIAL: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12615001230549; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369567 (Archived by WebCite at http://www.webcitation.org/6m0G7xJg1).

Health Seeking Behaviours and Knowledge of Infectious Disease Risks in Western Australian Travellers to Southeast Asian Destinations: An Airport Survey.

As the number of Australians engaging in short-term international travel increases, so does the opportunity for importing overseas-acquired infectious diseases. This study aimed to determine knowledge of infectious disease risks and pre-travel health advice (PTHA) seeking behaviour among Western Australians travelling to Bali, Indonesia or Thailand. Passengers departing from Perth International Airport were invited to participate in a self-administered survey. The survey determined PTHA seeking behaviour, knowledge of specific disease risks, and expected disease-prevention behaviours abroad. Multivariate regression modelling was used to assess demographic and travel-related factors associated with seeking PTHA. Responses from 1334 travellers were analysed. The proportion correctly identifying specific overseas disease risks ranged from 27% to 98%. High levels of planned disease-preventive behaviours were reported; however only 32% of respondents sought PTHA for their trip, most commonly from friends/family (15%) or a GP (14%). Many travellers (87%) made online travel purchases, but few (8%) used the Internet to source PTHA. WA travellers to Bali and Thailand were unlikely to seek PTHA and knowledge varied regarding infectious disease risks associated with travel. High rates of internet use when planning travel may provide an opportunity for destination-specific health promotion messaging and should be explored.