Severe Acute Respiratory Infection (SARI) due to Influenza in Post-COVID Resurgence: Disproportionate Impact on Older Maori and Pacific Peoples.

OBJECTIVE: Influenza reemerged after a 2020-2021 hiatus in 2022, but understanding the resurgence needs pre-COVID era surveillance. We compared age- and ethnicity-specific incidence of severe acute respiratory infection (SARI) from a hospital network in Auckland, New Zealand, in 2022 against a baseline, 2012-2019. METHODS: Annual and monthly influenza SARI incidence per 1000 persons by age and ethnic group between 2012 and 2022 was calculated using resident population as the denominator. The hospitals capture most severe illness of the resident population. RESULTS: Influenza SARI incidence was highest among <1 year olds (2.62; 95% CI: 1.84-3.61) during 2012-2019, lowest at 6-14 years, and did not significantly increase until 50-64 years (0.35; 95% CI: 0.27-0.45), reaching 1.19 (95% CI: 0.57-1.55) in those ≥75 years. In all age groups, incidence was at least threefold higher in Maori and Pacific Peoples. No influenza SARI was identified in 2020-2021. In 2022, despite an early peak, annual incidence (<65 years) was lower than baseline in all ethnic groups, but incidence (≥65 years) in Maori (2.06; 95% CI: 1.22-3.26) and Pacific (3.94; 95% CI: 2.97-5.13) peoples was higher in 2022 than most baseline years, whereas incidence in NMNP (0.22; 95% CI: 0.14-0.32) was lower than any baseline year. CONCLUSION: After no influenza 2020-2021, Auckland had an early, high, narrow peak in 2022. Stratification by age and ethnicity revealed striking discrepancies in incidence among Maori and Pacific adults over 65 years compared with NMNP adults, with implications for targeted vaccination strategies.

Chronic suppurative lung disease and bronchiectasis in children and adults in Australia and New Zealand.

Consensus recommendations for managing chronic suppurative lung disease (CSLD) and bronchiectasis, based on systematic reviews, were developed for Australian and New Zealand children and adults during a multidisciplinary workshop. The diagnosis of bronchiectasis requires a high-resolution computed tomography scan of the chest. People with symptoms of bronchiectasis, but non-diagnostic scans, have CSLD, which may progress to radiological bronchiectasis. CSLD/bronchiectasis is suspected when chronic wet cough persists beyond 8 weeks. Initial assessment requires specialist expertise. Specialist referral is also required for children who have either two or more episodes of chronic (> 4 weeks) wet cough per year that respond to antibiotics, or chest radiographic abnormalities persisting for at least 6 weeks after appropriate therapy. Intensive treatment seeks to improve symptom control, reduce frequency of acute pulmonary exacerbations, preserve lung function, and maintain a good quality of life. Antibiotic selection for acute infective episodes is based on results of lower airway culture, local antibiotic susceptibility patterns, clinical severity and patient tolerance. Patients whose condition does not respond promptly or adequately to oral antibiotics are hospitalised for more intensive treatments, including intravenous antibiotics. Ongoing treatment requires regular and coordinated primary health care and specialist review, including monitoring for complications and comorbidities. Chest physiotherapy and regular exercise should be encouraged, nutrition optimised, environmental pollutants (including tobacco smoke) avoided, and vaccines administered according to national immunisation schedules. Individualised long-term use of oral or nebulised antibiotics, corticosteroids, bronchodilators and mucoactive agents may provide a benefit, but are not recommended routinely.