ATAGI Targeted Review 2022: Vaccination for prevention of herpes zoster in Australia.

Abstract: In November 2016, herpes zoster (HZ) vaccination for older adults, using the live-attenuated zoster vaccine (Zostavax; ZVL) was added to the Australian National Immunisation Program (NIP) with the aim of reducing morbidity from HZ and its complications, particularly for people at increased risk. Prior to the program, there were on average 5.6 cases of HZ per 1,000 persons annually in Australia, with highest risk of disease in older and in immunocompromised people. The burden of complications of HZ, such as post-herpetic neuralgia (PHN), was also highest in older and immunocompromised groups. No formal comprehensive program evaluation has been undertaken since program commencement. This review examined published literature and available vaccine administration data to summarise the evidence and considerations underpinning current use of HZ vaccines and potential future program directions in Australia. There have been modest reductions in the incidence of HZ and its complications since program introduction. However, five years into the program, challenges remain, including suboptimal vaccine coverage and significant safety concerns arising from inadvertent use of ZVL in immunocompromised people, who are contraindicated to receive this vaccine. This reduces opportunities to offset the burden of HZ-related disease. The recombinant subunit zoster vaccine (Shingrix; RZV), first registered in Australia in 2018, became available on the Australian market in June 2021. This vaccine has higher efficacy than ZVL and, as a non-live vaccine, can be used in both immunocompetent and immunocompromised people. RZV has potential to address the unmet needs of at-risk population groups. However, it has not yet demonstrated cost-effectiveness for inclusion as a funded vaccine under the NIP. The Australian HZ vaccination program has had limited effectiveness in meeting its aim in highest risk groups. Future options and challenges anticipated in using vaccination to reduce the burden of HZ and its complications are discussed in this review.

'Like building a plane and flying it all in one go': an interview study of infection prevention and control in Australian general practice during the first 2 years of the SARS-CoV-2 pandemic.

OBJECTIVES: General practitioners (GPs) and their staff have been at the frontline of the SARS-CoV-2 pandemic in Australia. However, their experiences of responding to and managing the risks of viral transmission within their facilities are poorly described. The aim of this study was to describe the experiences, and infection prevention and control (IPC) strategies adopted by general practices, including enablers of and challenges to implementation, to contribute to our understanding of the pandemic response in this critical sector. DESIGN: Semistructured interviews were conducted in person, by telephone or online video conferencing software, between November 2020 and August 2021. PARTICIPANTS: Twenty general practice personnel working in New South Wales, Australia, including nine GPs, one general practice registrar, four registered nurses, one nurse practitioner, two practice managers and two receptionists. RESULTS: Participants described implementing wide-ranging repertoires of IPC strategies-including telehealth, screening of patients and staff, altered clinic layouts and portable outdoor shelters, in addition to appropriate use of personal protective equipment (PPE)-to manage the demands of the SARS-CoV-2 pandemic. Strategies were proactive, influenced by the varied contexts of different practices and the needs and preferences of individual GPs as well as responsive to local, state and national requirements, which changed frequently as the pandemic evolved. CONCLUSIONS: Using the 'hierarchy of controls' as a framework for analysis, we found that the different strategies adopted in general practice often functioned in concert with one another. Most strategies, particularly administrative and PPE controls, were subjected to human variability and so were less reliable from a human factors perspective. However, our findings highlight the creativity, resilience and resourcefulness of general practice staff in developing, implementing and adapting their IPC strategies amidst constantly changing pandemic conditions.

Integrating General Practice Into the Australian COVID-19 Response: A Description of the General Practitioner Respiratory Clinic Program in Australia.

Integrating primary care with the health response is key to managing pandemics and other health emergencies. In recognition of this, the Australian Government established a network of respiratory clinics led by general practitioners in response to the coronavirus disease 2019 (COVID-19) pandemic as part of broader measures aimed at supporting primary care. General practitioner (GP) respiratory clinics provide holistic face-to-face assessment and treatment to those with respiratory symptoms in an environment with strict protocols for infection prevention and control. This ensures that these patients are able to access high quality primary care while protecting the general practice workforce and other patients. The GP respiratory clinic model was developed and operationalized 10 days after the policy was announced, with the first 2 respiratory clinics opening on March 21, 2020. Subsequently a total of 150 respiratory clinics were opened and served over 800,000 patients within more than 99% of Australia's postcodes. These clinics used a standardized data collection tool that has provided the largest and most complete primary care surveillance database of respiratory illness in Australia. The success of the GP respiratory clinic model was made possible due to strong partnerships with Primary Health Networks and individual general practices that rapidly shifted operations to embrace this new approach. This article describes the development and early implementation of this model.

P2/N95 respirators & surgical masks to prevent SARS-CoV-2 infection: Effectiveness & adverse effects.

BACKGROUND: Millions of people have acquired and died from SARS-CoV-2 infection during the COVID-19 pandemic. Healthcare workers (HCWs) are required to wear personal protective equipment (PPE), including surgical masks and P2/N95 respirators, to prevent infection while treating patients. However, the comparative effectiveness of respirators and masks in preventing SARS-CoV-2 infection and the likelihood of experiencing adverse events (AEs) with wear are unclear. METHODS: Searches were carried out in PubMed, Europe PMC and the Cochrane COVID-19 Study Register to 14 June 2021. A systematic review of comparative epidemiological studies examining SARS-CoV-2 infection or AE incidence in HCWs wearing P2/N95 (or equivalent) respirators and surgical masks was performed. Article screening, risk of bias assessment and data extraction were duplicated. Meta-analysis of extracted data was carried out in RevMan. RESULTS: Twenty-one studies were included, with most having high risk of bias. There was no statistically significant difference in respirator or surgical mask effectiveness in preventing SARS-CoV-2 infection (OR 0.85, [95%CI 0.72, 1.01]). Healthcare workers experienced significantly more headaches (OR 2.62, [95%CI 1.18, 5.81]), respiratory distress (OR 4.21, [95%CI 1.46, 12.13]), facial irritation (OR 1.80, [95%CI 1.03, 3.14]) and pressure-related injuries (OR 4.39, [95%CI 2.37, 8.15]) when wearing respirators compared to surgical masks. CONCLUSION: The existing epidemiological evidence does not enable definitive assessment of the effectiveness of respirators compared to surgical masks in preventing infection. Healthcare workers wearing respirators may be more likely to experience AEs. Effective mitigation strategies are important to ensure the uptake and correct use of respirators by HCWs.

Australian guidelines for the prevention and treatment of posttraumatic stress disorder: Updates in the third edition.

OBJECTIVE: This paper describes the development of the third edition of the National Health and Medical Research Australian Guidelines for the Prevention and Treatment of Acute Stress Disorder, posttraumatic stress disorder and Complex posttraumatic stress disorder, highlighting key changes in scope, methodology, format and treatment recommendations from the previous 2013 edition of the Guidelines. METHOD: Systematic review of the international research was undertaken, with GRADE methodology used to assess the certainty of the evidence, and evidence to decision frameworks used to generate recommendations. The Guidelines are presented in an online format using MAGICApp. RESULTS: Key changes since the publication of the 2013 Guidelines include a new conditional recommendation for Child and Family Traumatic Stress Intervention for children and adolescents with symptoms within the first 3 months of trauma, and a strong recommendation for trauma-focused cognitive behaviour therapy for the child alone or with a caregiver, for those with diagnosed posttraumatic stress disorder. For adults with posttraumatic stress disorder, strong recommendations are made for specific types of trauma-focused cognitive behaviour therapy and conditional recommendations are made for five additional psychological interventions. Where medication is indicated for adults with posttraumatic stress disorder, venlafaxine is now conditionally recommended alongside sertraline, paroxetine or fluoxetine. CONCLUSION: These Guidelines, based on systematic review of the international literature, are intended to guide decision making for practitioners, service planners, funders and those seeking treatment for trauma related mental health concerns. For an Australian Guideline, a critical limitation is the absence of research on the treatment of Australian Aboriginal and Torres Strait Islander peoples. The new online format of the Australian posttraumatic stress disorder Guidelines means that they can be updated as sufficient new evidence becomes available.

Clinical care of children and adolescents with COVID-19: recommendations from the National COVID-19 Clinical Evidence Taskforce.

INTRODUCTION: The epidemiology and clinical manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are different in children and adolescents compared with adults. Although coronavirus disease 2019 (COVID-19) appears to be less common in children, with milder disease overall, severe complications may occur, including paediatric inflammatory multisystem syndrome (PIMS-TS). Recognising the distinct needs of this population, the National COVID-19 Clinical Evidence Taskforce formed a Paediatric and Adolescent Care Panel to provide living guidelines for Australian clinicians to manage children and adolescents with COVID-19 and COVID-19 complications. Living guidelines mean that these evidence-based recommendations are updated in near real time to give reliable, contemporaneous advice to Australian clinicians providing paediatric care. MAIN RECOMMENDATIONS: To date, the Taskforce has made 20 specific recommendations for children and adolescents, including definitions of disease severity, recommendations for therapy, respiratory support, and venous thromboembolism prophylaxis for COVID-19 and for the management of PIMS-TS. CHANGES IN MANAGEMENT AS A RESULT OF THE GUIDELINES: The Taskforce currently recommends corticosteroids as first line treatment for acute COVID-19 in children and adolescents who require oxygen. Tocilizumab could be considered, and remdesivir should not be administered routinely in this population. Non-invasive ventilation or high flow nasal cannulae should be considered in children and adolescents with hypoxaemia or respiratory distress unresponsive to low flow oxygen if appropriate infection control measures can be used. Children and adolescents with PIMS-TS should be managed by a multidisciplinary team. Intravenous immunoglobulin and corticosteroids, with concomitant aspirin and thromboprophylaxis, should be considered for the treatment of PIMS-TS. The latest updates and full recommendations are available at www.covid19evidence.net.au.

General Practitioners' Roles in Disaster Health Management: Perspectives of Disaster Managers.

INTRODUCTION: General Practitioners (GPs) are inevitably involved when disaster strikes their communities. Evidence of health care needs in disasters increasingly suggests benefits from greater involvement of GPs, and recent research has clarified key roles. Despite this, GPs continue to be disconnected from disaster health management (DHM) in most countries. STUDY OBJECTIVE: The aim of this study was to explore the perspectives of disaster management professionals in two countries, across a range of all-hazard disasters, regarding the roles and contributions of GPs to DHM, and to identify barriers to, and benefits of, more active engagement of GPs in disaster health care systems. METHODS: A qualitative research methodology using semi-structured interviews was conducted with a purposive sample of Disaster Managers (DMs) to explore their perspectives arising from experiences and observations of GPs during disasters from 2009 through 2016 in Australia or New Zealand. These involved all-hazard disasters including natural, man-made, and pandemic disasters. Responses were analyzed using thematic analysis. RESULTS: These findings document support from DM participants for greater integration of GPs into DHM with New Zealand DMs reporting GPs as already a valuable integrated contributor. In contrast, Australian DMs reported barriers to inclusion that needed to be addressed before sustained integration could occur. The two most strongly expressed barriers were universally expressed by Australian DMs: (1) limited understanding of the work GPs undertake, restricting DMs' ability to facilitate GP integration; and (2) DMs' difficulty engaging with GPs as a single group. Other considerations included GPs' limited DHM knowledge, limited preparedness, and their heightened vulnerability.Strategies identified to facilitate greater integration of GPs into DHM where it is lacking, such as Australia, included enhanced communication, awareness, and understanding between GPs and DMs. CONCLUSION: Experience from New Zealand shows systematic, sustained integration of GPs into DHM systems is achievable and valuable. Findings suggest key factors are collaboration between DMs and GPs at local, state, and national levels of DHM in planning and preparedness for the next disaster. A resilient health care system that maximizes capacity of all available local health resources in disasters and sustains them into the recovery should include General Practice.

"One minute it's an airborne virus, then it's a droplet virus, and then it's like nobody really knows ": Experiences of pandemic PPE amongst Australian healthcare workers.

BACKGROUND: The SARS-CoV-2 pandemic has challenged health systems globally. A key controversy has been how to protect healthcare workers (HCWs) using personal protective equipment (PPE). METHODS: Interviews were performed with 63 HCWs across two states in Australia to explore their experiences of PPE during the SARS-CoV-2 pandemic. Thematic analysis was performed. RESULTS: Four themes were identified with respect to HCWs' experience of pandemic PPE: 1. Risk, fear and uncertainty: HCWs experienced considerable fear and heightened personal and professional risk, reporting anxiety about the adequacy of PPE and the resultant risk to themselves and their families. 2. Evidence and the ambiguities of evolving guidelines: forms of evidence, its interpretation, and the perception of rapidly changing guidelines heightened distress amongst HCWs. 3. Trust and care: Access to PPE signified organisational support and care, and restrictions on PPE use were considered a breach of trust. 4. Non-compliant practice in the context of social upheaval: despite communication of evidence-based guidelines, an environment of mistrust, personal risk, and organisational uncertainty resulted in variable compliance. CONCLUSION: PPE preferences and usage offer a material signifier of the broader, evolving pandemic context, reflecting HCWs' fear, mistrust, sense of inequity and social solidarity (or breakdown). PPE therefore represents the affective (emotional) demands of professional care, as well as a technical challenge of infection prevention and control. If rationing of PPE is necessary, policymakers need to take account of how HCWs will perceive restrictions or conflicting recommendations and build trust through effective communication (including of uncertainty).

Entanglements of affect, space, and evidence in pandemic healthcare: An analysis of Australian healthcare workers' experiences of COVID-19.

The COVID-19 pandemic continues to highlight both global interconnectedness and schisms across place, context and peoples. While countries such as Australia have securitised their borders in response to the global spread of disease, flows of information and collective affect continue to permeate these boundaries. Drawing on interviews with Australian healthcare workers, we examine how their experiences of the pandemic are shaped by affect and evidence 'traveling' across time and space. Our analysis points to the limitations of global health crisis responses that focus solely on material risk and spatial separation. Institutional responses must, we suggest, also consider the affective and discursive dimensions of health-related risk environments.

General practitioners' knowledge, preparedness, and experiences of managing COVID-19 in Australia.

BACKGROUND: COVID-19 has brought unprecedented demands to general practitioners (GPs) worldwide. We examined their knowledge, preparedness, and experiences managing COVID-19 in Australia. METHODS: A cross-sectional online survey of GPs members of the Royal Australian College of General Practitioners (RACGP) was conducted between June and September 2020. RESULTS: Out of 244 survey responses, a majority of GPs (76.6%) indicated having good knowledge of COVID-19, relying mostly on state/territory department of health (84.4%) and the RACGP (76.2%) websites to source up-to-date information. Most felt prepared to manage patients with COVID-19 (75.7%), yet over half reported not receiving training in the use of PPE. The majority were concerned about contracting SARS-CoV-2, more stressed than usual, and have heavier workloads. Their greatest challenges included scarcity of PPE, personal distress, and information overload. CONCLUSION: Access to PPE, training, accurate information, and preparedness are fundamental for the successful role of general practices during outbreaks.

Health Impacts of Volcanic Activity in Oceania.

Volcanoes cause a wide range of hazardous phenomena. Close to volcanic vents, hazards can be highly dangerous and destructive and include pyroclastic flows and surges, ballistic projectiles, lava flows, lahars, thick ashfalls, and gas and aerosol emissions. Direct health impacts include trauma, burns, and exacerbation of respiratory diseases. Far-reaching volcanic hazards include volcanic ashfalls, gas and aerosol dispersion, and lahars. Within Oceania, the island arc countries of Papua New Guinea (PNG), the Solomon Islands, Vanuatu, Tonga, and New Zealand are the most at-risk from volcanic activity. Since 1500ad, approximately 10,000 lives have been lost due to volcanic activity across Oceania, with 39 lives lost since 2000. While volcano monitoring and surveillance save lives, residual risks remain from small, sudden, unheralded eruptions, such as the December 9, 2019 eruption of Whakaari/White Island volcano, New Zealand which has a death toll of 21 at the time of writing. Widespread volcanic ashfalls can affect the habitability of downwind communities by contaminating water supplies, damaging crops and buildings, and degrading indoor and outdoor air quality, as well as disrupting transport and communication networks and access to health services. While the fatality rate due to volcanic eruptions may be low, far greater numbers of people may be affected by volcanic activity with approximately 100,000 people in PNG and Vanuatu displaced since 2000. It is challenging to manage health impacts for displaced people, particularly in low-income countries where events such as eruptions occur against a background of low, variable vaccination rates, high prevalence of infectious diseases, poor sanitation infrastructure, and poor nutritional status. As a case study, the 2017-2018 eruption of Ambae volcano, Vanuatu caused no casualties but triggered two separate mandatory off-island evacuations of the entire population of approximately 11,700 people. On the neighboring island of Santo, a health disaster response was coordinated by local government and provided acute care when evacuees arrived. Involving primary care clinicians in this setting enhanced local capacity for health care provision and allowed for an improved understanding of the impact of displacement on evacuee communities.

General practitioners in the field: A qualitative study of general practitioners' experiences in disaster healthcare.

METHOD: A qualitative study using semi-structured interviews was conducted with a purposive sample of GPs who had experienced disasters in Australia or New Zealand (NZ) between 2009 and 2016. Transcripts underwent thematic analysis. RESULTS: Thirty-eight GPs reported diverse and effective contributions to disaster-response efforts. Four main themes emerged: GPs responded spontaneously to contribute; GPs adapted their usual expertise to provide disaster healthcare; personal and professional challenges experienced were consistent across different types of disaster; and unlike Australian GPs, NZ GPs felt better integrated and valued in the broader disaster-response system. DISCUSSION: The results document GPs' roles and experiences in disaster healthcare and highlight how GPs contribute to meeting crucial healthcare needs in communities during and following disasters. Better defining, integrating and supporting GP roles in disaster systems is likely to improve disaster healthcare.

Comparisons of complementary feeding indicators among children aged 6-23 months in Anglophone and Francophone West African countries.

Stunting, a consequence of suboptimal complementary feeding practices, continues to be a significant public health problem in West Africa. This paper aimed to compare rates of complementary feeding indicators among children aged 6-23 months between four Anglophone and seven Francophone West African countries. The data used for this study were the most recent Demographic and Health Surveys of the various countries, namely Ghana, Liberia, Nigeria, Sierra Leone (Anglophone countries), Benin, Burkina Faso, Cote d'Ivoire, Guinea, Mali, Niger and Senegal (Francophone countries) conducted between 2006 and 2013. The analyses were limited to last-born children aged 6-23 months and covered 34 999 children: 12 623 in the Anglophone countries and 22 376 children in the Francophone countries. Complementary feeding indicators were examined using the method proposed by the World Health Organization (WHO) in 2008. Introduction of solid, semi-solid or soft foods among children aged 6-23 months in the Anglophone countries ranged from 55.3% (Liberia) to 72.6% (Ghana). The corresponding rates for the Francophone countries ranged from 29.7% (Mali) to 65.9% (Senegal). The average rate of minimum dietary diversity for the Anglophone countries was 32.0% while that of the Francophone countries was only 10.6%. While the minimum meal frequency rates ranged between 42.0% (Sierra Leone) and 55.3% (Nigeria) for the Anglophone countries, the corresponding rates for the Francophone countries ranged between 25.1% (Mali) and 52.4% (Niger). Both the Anglophone and the Francophone countries reported alarmingly low rates of minimum acceptable diet, with the two groups of countries averaging rates of 19.9% (Anglophone) and 5.5% (Francophone). The rates of all four complementary feeding indicators across all the 11 countries fell short of the WHO's requirement for optimal complementary feeding practices. Intervention studies using cluster-randomised controlled trials are needed in order to improve the nutritional status of young children in West Africa.

Determinants of suboptimal complementary feeding practices among children aged 6-23 months in seven francophone West African countries.

Suboptimal complementary feeding practices play a crucial role in the health and development of children. The objective of this research paper was to identify factors associated with suboptimal complementary feeding practices among children aged 6-23 months in seven francophone West African countries, namely, Benin, Burkina Faso, Cote d'Ivoire, Guinea, Mali, Niger and Senegal. This study covered 22 376 children aged 6-23 months from the seven countries surveyed (Benin: 3732 children; Burkina Faso: 4205 children; Cote d'Ivoire: 2109 children, Guinea: 1944 children, Mali: 3798 children, Niger: 3451 children and Senegal: 3137 children). The most recent Demographic and Health Survey datasets of the various countries were used as data sources. A set of individual-, household- and community-level factors were used to examine the four complementary feeding indicators. Multivariate analysis revealed that the youngest age bracket (6-11 months) of children, administrative/geographical region, mother's limited or non-access to the mass media, mothers' lack of contact with a health facility, rural residence, poor households and non-working mothers were the main factors associated with suboptimal complementary feeding in the countries surveyed. Our findings highlight the need to consider broader social, cultural and economic factors when designing child nutritional interventions.

Determinants of suboptimal complementary feeding practices among children aged 6-23 months in four anglophone West African countries.

Suboptimal complementary feeding practices have a detrimental impact on a child's growth, health and development in the first two years of life. They lead to child malnutrition, which contributes to the high prevalence of stunting (38%) and underweight (28%) reported for children <5 years of age in Sub-Saharan Africa. This study analysed complementary feeding practices in four anglophone West African countries (Ghana, Liberia, Nigeria and Sierra Leone) using the most recent Demographic and Health Surveys. The study covered 12 623 children aged 6-23 months from four anglophone West African countries (Ghana: 822 children: Liberia: 1458 children, Nigeria: 8786 children and Sierra Leone: 1557 children). Four complementary feeding indicators were examined against a set of individual-, household- and community-level factors, using multiple regression analysis. Multivariate analyses found that lack of post-natal contacts with health workers, maternal illiteracy and geographical region were common determinants of delayed introduction of solid, semi-solid or soft foods across all four countries. Predictors for minimum dietary diversity, minimum meal frequency and minimum acceptable diet included children aged 6-11 months, administrative/geographical region, poorer household income and limited access to media. The authors recommend that the four anglophone West African countries studied should prioritise efforts to improve complementary feeding practices in order to reduce child morbidity and mortality. Interventional studies on complementary feeding should target those from poor and illiterate households.

The problem of suboptimal complementary feeding practices in West Africa: what is the way forward?

The objective of this paper was to review the policy implications of inadequate complementary feeding among children aged 6-23 months in West Africa. The review was undertaken from the initial results and findings from a series of studies on the comparison of complementary feeding indicators among children aged 6-23 months in four anglophone and seven francophone West African countries. It also examined a study of the determinants of suboptimal complementary feeding practices among children aged 6-23 months in those countries. Among the four complementary feeding indicators, it was only the introduction of solid, semi-solid or soft foods that was adequate among children in all the West African countries surveyed. The rates of the other complementary feeding indicators were found to be inadequate in all countries surveyed, although relatively better among children in the anglophone countries. Alarmingly, low rates of minimum acceptable diet were reported among children from both the anglophone and the francophone countries. Infants 6-11 months of age, children living in poor households, administrative/geographical regional differences and mothers' access to the media were some of the common risk factors for optimal complementary feeding practices in these countries. Assessing complementary feeding indicators and determinants of suboptimal complementary feeding practices in these West African countries is crucial to improving infant and young child feeding practices. It is recommended that governments and stakeholders of the West African countries studied make greater efforts to improve these critical practices in order to reduce child morbidity and mortality in the West Africa sub-region. Intervention studies on complementary feeding should target those socio-demographic factors that pose risks to optimal complementary feeding.