The impact of the changing pneumococcal national immunisation program among older Australians.

Australia has a universal infant pneumococcal conjugate vaccination program and until recently a universal pneumococcal polysaccharide vaccine program for non-Indigenous adults aged ≥65 years and Indigenous adults aged ≥50 years. We documented the impacts of infant and adult vaccination programs on the epidemiology of invasive pneumococcal disease (IPD) in Indigenous and non-Indigenous adults. IPD notifications from the National Notifiable Disease Surveillance System were analysed from 2002 to 2017, grouped by age, vaccine serotype group and Indigenous status. Since the universal funding of infant and elderly pneumococcal vaccination programs in January 2005, total IPD decreased by 19% in non-Indigenous adults aged ≥65 years but doubled in Indigenous adults aged ≥50 years. Vaccine uptake was suboptimal in both groups but lower in Indigenous adults. IPD due to the serotypes contained in the pneumococcal conjugate vaccines (PCV) except for serotype 3 declined markedly over the study period but were replaced by non-PCV serotypes. Serotype 3 is currently the most common in older adults. In the populations eligible for the adult 23-valent pneumococcal polysaccharide vaccine (23vPPV) program, IPD rates due to its exclusive serotypes increased to a lower extent than non-vaccine types. In 2017, non-vaccine serotypes accounted for most IPD in the older population eligible for the 23vPPV program, while it's eleven exclusive serotypes accounted for the majority of IPD in younger adults. Infant and adult pneumococcal vaccination programs in Australia have shaped the serotype-specific epidemiology of IPD in older adults. IPD remains a significant health burden for the Indigenous population. Herd immunity impact is clear for PCV serotypes excluding serotype 3 and serotype replacement is evident for non-PCV serotypes. The adult 23vPPV immunisation program appears to have partially curbed replacement with IPD due to its eleven exclusive serotypes, highlighting a potential benefit of increasing adult 23vPPV coverage in Australia.

Antigen specific vaccine hesitancy in pregnancy.

BACKGROUND: Vaccinations in pregnancy are recommended for the potential benefits of preventing severe pertussis disease in newborns and for preventing the impact of influenza on the pregnant woman, her foetus in utero and, the newborn in the first six months of life. Published data in Australia suggested that coverage rates were sub-optimal so the reasons for this were reviewed. METHODS: A cross-sectional survey of 1014 postnatal women, aged 18 years and older, who had given birth in the previous six months was undertaken on the Gold Coast in Queensland, Australia. Participants completed a brief questionnaire on provided smart tablets at public vaccination clinics or with a researcher by phone or via an on-line link. RESULTS: Just over 85% of survey respondents received a pertussis booster with many of those not receiving vaccine having had it in a recent pregnancy. Only 36.7% of respondents had an influenza vaccine in pregnancy with key barriers being belief in influenza vaccine, seasonality of parturition and a lack of recommendation from the attending obstetric carers. DISCUSSION: While maternal pertussis vaccine programs are a success, work needs to be done to improve the public perception of the risk benefit equation surrounding influenza vaccine in general, and particularly its use in pregnancy. Research is required into approaches to altering practitioner attitudes as well as how to alter public perceptions.

Healthcare worker influenza immunization vaccinate or mask policy: strategies for cost effective implementation and subsequent reductions in staff absenteeism due to illness.

BACKGROUND: A new policy requiring staff in clinical areas to vaccinate or wear a mask was implemented in British Columbia (BC) in the 2012/13 winter. This review assessed the impact of the policy on absenteeism in health care workers. METHODS: A retrospective cohort study of full-time HCW that worked prior to and during the 2012/13 influenza season in a health authority in BC. The rate of absenteeism due to all cause illness was compared between vaccinated and unvaccinated staff controlling for behaviors outside influenza season. RESULTS: Of the 10079 HCW, 77% were vaccinated. By comparison to absenteeism rates in the pre-influenza season, unvaccinated staff in winter had twice the increase in absenteeism due to all-cause illness than vaccinated staff. CONCLUSION: After controlling for baseline differences between those vaccinated and unvaccinated, influenza vaccination was associated with reduced absenteeism, saving the Health Authority substantial money. Having regular staff in attendance increases the quality of care.

The comparative effectiveness of adjuvanted and unadjuvanted trivalent inactivated influenza vaccine (TIV) in the elderly.

BACKGROUND: Influenza is associated with a high mortality and morbidity in older adults. Vaccination remains the most effective method of preventing influenza and its consequences, however, vaccine effectiveness decreases with increasing age and increasing immunosenescence. In older adults, immunogenicity studies suggest an MF59 adjuvanted influenza vaccine (ATIV, Fluad(®)) may help. METHODS: We evaluated the comparative effectiveness of ATIV, and unadjuvanted trivalent influenza vaccine (TIV) in reducing laboratory confirmed influenza in the elderly. Elderly in three health authorities during winter 2011-12 were included in a community based case control study design. Cases tested positive and controls tested negative for influenza. Subjects with known immunosuppression were excluded. Logistic regression was used to calculate the odds ratio of vaccination (vs. no vaccination) in cases and controls. ATIV and TIV effectiveness was described. RESULTS: A total of 282 eligible participants were enrolled (84 cases). Almost half (136) were in a long term care facility and were 85 years of age or older (132) vaccine effectiveness decreased with increasing age. In a variety of multivariate analyses, ATIV was significantly protective at around 60% (p=0.02), with only residence in long term care and health authority also significant. Vaccine effectiveness increased in non-long term care residents. In multivariate analyses TIV was ineffective. CONCLUSION: An MF59 adjuvanted vaccine provided significantly improved protection against influenza in the elderly.

Protective effect of single-dose adjuvanted pandemic influenza vaccine in children.

BACKGROUND: During the first wave of A/California/7/2009(H1N1) influenza, high rates of hospitalization in children under 5 years were seen in many countries. Subsequent policies for vaccinating children varied in both type of vaccine and number of doses. In Canada, children 36 months to <10 years received a single dose of 0.25 ml of the GSK adjuvanted vaccine (Arepanrix) equivalent to 1.9 microg HA. Children 6 months to 35 months received two doses as did those 36-119 months with chronic medical conditions. METHOD: We conducted a community-based case-control vaccine effectiveness (VE) review of children under 10 years with influenza like illness who were tested for H1N1 infection at the central provincial laboratory. Laboratory-confirmed influenza was the primary outcome, and vaccination status the primary exposure to assess VE after a single 0.25-ml dose. RESULTS: If vaccination was designated to be effective after 14 days, no vaccinated child had laboratory-confirmed influenza compared to 38% of controls. The VE of 100% was statistically significant for children <10 years of age and <5 years considered separately. If vaccination was considered effective after 10 days, VE dropped to 96% overall but was statistically significant and over 90% in all age subgroups, including those under 36 months. CONCLUSIONS: A single 0.25-ml dose of the GSK adjuvanted vaccine (Arepanrix) protects children against laboratory-confirmed pandemic influenza potentially avoiding any increased reactogenicity associated with second doses. Adjuvanted vaccines offer hope for improved seasonal vaccines in the future.

Nodularin uptake by seafood during a cyanobacterial bloom.

The problem of blue-green algal toxin contamination of recreational waters and drinking water catchments is well described, as is the potential contamination of associated seafood. Algal contamination of Victorian waterways is now a widespread annual occurrence and, in some regions, the intersection of blooms and commercial fishing threatens the food safety of large numbers of people. Toxin levels which produce no observed adverse effect in animal studies were used to derive safe tolerable daily intake levels. These 'acceptable levels' were then modified to protect against potential acute health risks associated with short-term exposures. National food surveys were used to derive likely seafood intakes and thus, in combination with 'safe toxin levels', health alert levels for seafood were formulated. During the summer of 2001 a bloom of Nodularia spumigena occurred in the Gippsland Lakes area of Southern Victoria. During the bloom, seafood samples were collected and nodularin concentrations were estimated. Nodularin concentrations reached levels of concern in mussels and in prawn viscera at cell counts as low as 30,000 cells/ml. Nodularin concentrations in the flesh of finfish remained low. Boiling the seafood redistributed toxin between viscera and flesh. The results were used to restrict some seafood harvesting.

Bordetella pertussis surveillance in England and Wales: 1995-7.

Available data sources on disease due to Bordetella pertussis, including notifications, hospital admissions, deaths, and an enhanced laboratory-based surveillance system commenced in January 1994, were reviewed for the period 1995-7. Pertussis notifications continued their approximately 3-year cycle although at historically reduced levels. A slight seasonal increase in late summer/early autumn existed over and above a relatively constant background rate. Over time, the proportion of pertussis cases in younger, unvaccinated children, and to a lesser extent, adolescents and young adults, is increasing. There is a continuing significant and underreported mortality associated with pertussis in the very young age group. Disease due to serotype 1,2 is on the increase despite persistent high vaccination levels and this serotype causes more severe disease. The provision of preventative antibiotics prior to disease onset reduced the severity of the disease but its use remains uncommon in England and Wales. While overall levels of pertussis notifications have declined in recent times, vaccination efficacy wanes with increasing age, and pertussis remains a significant cause of mortality and severe morbidity in the very young. This could be reduced by timely booster vaccination and increased recognition of mild disease in older cases followed by early antibiotic therapy for the very young household contacts.

Renal disease patterns in aboriginal Australians. A family-based study in a high incidence community.

OBJECTIVES: To explore the apparent excess of renal disease in a coastal Aboriginal community in the Northern Territory and to explore its familial basis. DESIGN: Families were ascertained through probands with significant proteinuria. Controls were selected from unrelated subjects living with these families. PARTICIPANTS: All surviving grandparents, parents, siblings, children and grandchildren of 16 probands were studied; there were 219 participants in all, including 58 adult control subjects. MAIN OUTCOME MEASURES: Anthropometric data included the body mass index (BMI), and resting blood pressure. Urinary protein and creatinine levels were measured and urine was examined microscopically for glomerular haematuria (more than 10 red blood cells per microL, with at least 20% dysmorphic red cells). Two hours after a 75 g glucose drink, venous blood was taken and analysed for biochemical markers including urea, creatinine, glucose and gamma-glutamyltransferase. RESULTS: Significant proteinuria (protein to creatinine ratio greater than 50 mg/mmol), provided evidence of renal disease in 30% of both case relatives and control subjects. The prevalence of proteinuria was associated with increasing age, increasing diastolic blood pressure, increasing glucose level and female sex. However, two contrasting groups of subjects were identified in that relatives of probands had more glomerular haematuria than controls (27/112 v. 3/58, P = 0.005) and this was most marked in a family with multiple probands and in the parents of probands; in contrast, controls were more likely to have hypertension and obesity. Diabetes was highly prevalent in adult study subjects (12.4%) with no difference between controls and relatives of probands. CONCLUSIONS: The very high prevalence of renal disease in Australian Aborigines parallels the situation in American Indian communities undergoing rapid cultural change. In the island Aboriginal community studied, proteinuria and glomerular haematuria are familial, possibly due to genetically influenced glomerulonephritis evoked by (unknown) environmental factors. Proteinuria associated with obesity, hypertension and diabetes is less obviously familial, and plausibly related to poor nutrition and other lifestyle factors. The high prevalence of proteinuria and other risk factors in community-based studies and the high incidence of end-stage renal disease show that there is an urgent need for effective education and prevention programs, for more active treatment of hypertension, and for further work to clarify the aetiology and pathogenesis of renal disease in Aboriginal communities.

Streptococcal infection and renal disease markers in Australian aboriginal children.

OBJECTIVE: To demonstrate an association between markers of streptococcal infection and markers of glomerulonephritis in Aboriginal children. DESIGN: A cross-sectional study of Aboriginal children of school age. SETTING: Three Aboriginal communities in the Northern Territory--two, coastal and one, desert. PARTICIPANTS: Sixty children, randomly selected from the school roll, were studied in each community; thus there were 180 children in total, aged 5-17 years. Midstream urine and venous blood was collected and swabs were taken from the pharynx and from impetiginous skin lesions or axillary skin in the absence of impetigo. Clinical records were examined for evidence of past glomerulonephritis. MAIN OUTCOME MEASURES: Swabs were cultured for beta-haemolytic streptococci and isolates were grouped; serum was tested for titres of antistreptolysin O (ASO) and antideoxyribonuclease B (anti-DNaseB). Protein and creatinine levels were measured in urine, and a ratio of protein to creatinine (UPC) of more than 50 mg protein per mmol creatinine was taken as a measure of significant proteinuria. Urine was examined microscopically for glomerular haematuria (greater than 10 red blood cells per microL with at least 20% dysmorphic red cells). RESULTS: Group A beta-haemolytic streptococci were isolated from the throat swabs of two children and from skin swabs of 25 (13.9%) children; 20 of these were from impetiginous lesions and five from normal axillary skin. beta-Haemolytic streptococci of group C or G were grown from the throat swabs of 13 (8.1%) children. The median titre of ASO (256 IU) was raised compared with a reference level, and the median titre of anti-DNaseB (3172 IU) was particularly high; ASO titres were significantly higher in 31 children with impetigo than in 149 children without impetigo. Significant proteinuria was present in 7 (3.9%) children and glomerular haematuria in 16 (8.9%). Glomerular haematuria was present in 2/7 (28%) children with proteinuria, 4/21 (19%) children with a past history of post-streptococcal glomerulonephritis, in 5/31 (16%) of those with impetigo and in 4/25 (16%) of those with positive skin cultures. However, none of these prevalences was significantly greater than the prevalence of glomerular haematuria among the other children. The prevalence of proteinuria differed significantly between communities and increased significantly with age. Furthermore, the differences in childhood proteinuria observed between communities in this study were parallel with community differences in the prevalence of proteinuria in a related study of adults. CONCLUSIONS: Group A streptococci are important causes of impetigo in Aboriginal children. Streptococcal skin infection may contribute to glomerular haematuria, proteinuria and persistent glomerulonephritis in Aboriginal children, and possibly to chronic glomerulonephritis in adult life. Public health programs are needed to reduce the prevalence of impetigo and group A streptococcal infections in Aboriginal communities; longitudinal studies are needed to test the relationship between streptococcal skin infection in Aboriginal children and chronic renal disease in later life.