Age is not just a number-synopsis of the 5th New Zealand Influenza Symposium 2019.

Presented is a synopsis of the 5th New Zealand Influenza Symposium, which focused on both uptake of the influenza vaccine and the long-term consequences of influenza. Particularly highlighted were the advantages of influenza vaccination for older adults in reducing declines in cognitive and physical health. Research findings from influenza surveillance, future of influenza vaccines and the influenza promotional campaign presented at the symposium are summarised.

Influences and policies that affect immunisation coverage-a summary review of literature.

Effective national immunisation programmes require a high proportion of the population to be immunised. Although New Zealand has made significant progress towards immunisation goals over the last two decades, immunisation coverage remains inadequate to prevent intermittent outbreaks of disease, and immunisation inequities persist between geographic, ethnic and socioeconomic groups. Here we summarise a recent literature review that was conducted to identify and examine key factors that influence immunisation coverage, timeliness of vaccinations and the core drivers that affect vaccine uptake. We conclude that well designed systems, taking a holistic approach with multiple components, gain broader community acceptance and trust; early and continual engagement with well-informed healthcare professionals builds trust and improves uptake; the family's experience during vaccination events is important; community-led vaccine advocacy is required to target specific populations to help to promote and improve access to immunisation. Coercive approaches can be marginally effective, but risk disproportionately penalising those already experiencing mistrust and hardship.

Quantifying the incidence and burden of herpes zoster in New Zealand general practice: a retrospective cohort study using a natural language processing software inference algorithm.

OBJECTIVE: To investigate the incidence of primary care presentations for herpes zoster (zoster) in a representative New Zealand population and to evaluate the utilisation of primary healthcare services following zoster diagnosis. DESIGN: A cross-sectional retrospective cohort study used a natural language processing software inference algorithm to identify general practice consultations for zoster by interrogating 22 million electronic medical record (EMR) transactions routinely recorded from January 2005 to December 2015. Data linking enabled analysis of the demographics of each case. The frequency of doctor visits was assessed prior to and after the first consultation diagnosing zoster to determine health service utilisation. SETTING: General practice, using EMRs from two primary health organisations located in the lower North Island, New Zealand. PARTICIPANTS: Thirty-nine general practices consented interrogation of their EMRs to access deidentified records for all enrolled patients. Out-of-hours and practice nurse consultations were excluded. MAIN OUTCOME MEASURES: The incidence of first and repeated zoster-related visits to the doctor across all age groups and associated patient demographics. To determine whether zoster affects workload in general practice. RESULTS: Overall, for 6 189 019 doctor consultations, the incidence of zoster was 48.6 per 10 000 patient-years (95% CI 47.6 to 49.6). Incidence increased from the age of 50 years to a peak rate of 128 per 10 000 in the age group of 80-90 years and was significantly higher in females than males (p<0.001). Over this 11-year period, incidence increased gradually, notably in those aged 80-85 years. Only 19% of patients had one or more follow-up zoster consultations within 12 months of a zoster index consultation. The frequency of consultations, for any reason, did not change between periods before and after the diagnosis. CONCLUSIONS: Zoster consultations in general practice are rare, and the burden of these cases on overall general practice caseload is low.

Outreach immunisation services in NewZealand: a review of service delivery models.

INTRODUCTION Outreach Immunisation Services (OIS) enable children who have not been immunised on time at general practice to be immunised in the community, thereby improving immunisation coverage and reducing equity gaps. AIM To identify the most effective service delivery models and make recommendations for more effective and cost-efficient OIS delivery in New Zealand. METHODS Data collection and thematic analysis through a detailed review of OIS contracts and service specifications, an online survey and in-depth interviews with stakeholders and providers, and an analysis of cost data was conducted. RESULTS In total, 28 OIS providers completed survey questionnaires, 28 OIS staff were interviewed, and cost effectiveness data were obtained from 11 providers. The surveys and interviews identified key themes around identifying clients with the highest needs, effective engagement strategies, staffing requirements, and service challenges. On average, each OIS referral costs NZ$361 (median NZ$257), and each vaccination event costs NZ$636, ranging from NZ$145 to NZ$2403. Characteristics for two separate models of service delivery were identified based on provider size. CONCLUSION There is considerable range in costs and style of OIS delivery, and efficiencies can be gained. Models need to fit with locality needs and include adequate resourcing, staff with good local knowledge, close relationships with other key child health services and preferably co-location, sustainable funding, and regular service reviews. OIS are part of an effective integrated service that relies on accurate data, positive relationships and a rapid response when children fail to present for vaccination in a timely fashion.

Pertussis control strategies: A consistent approach for New Zealand. Synopsis of Ministry of Health Workshop, April 2015.

In the past decade, pertussis has made a global resurgence, driving reconsideration of national immunisation schedules and vaccine usage. A workshop held by the Ministry of Health in 2015 discussed New Zealand's pertussis disease control strategies. Data were presented from current research into vaccine safety during pregnancy and the effectiveness of the immunisation schedule in preventing pertussis throughout childhood. The greatest burden of disease and mortality remains in infants under 1 year of age, especially infants too young to be immunised, those of Maori and Pacific ethnicity, and those living in deprivation. The workshop considered strategies including the timing of the scheduled vaccines, maternal immunisation, improving immunisation coverage, vaccination timeliness and service delivery to reduce inequalities and overall disease burden. It concluded that the current infant schedule appears to be working well to protect older infants from severe pertussis. Significant gains for reducing severe disease in vulnerable young infants could be made with improvements in maternal vaccine uptake. Other strategic directions include attention to schedule adherence and timeliness of vaccine delivery, and more effective communication approaches for healthcare professionals and the public.

Synopsis of New Zealand's inaugural Influenza Symposium - influenza is a severe vaccine- preventable disease.

Influenza is a vaccine-preventable disease that can lead to serious acute respiratory illnesses and other complications. Influenza viruses are widespread in wild avian species and infect several animal species in addition to humans. Constant evolutionary changes to the influenza virus make the disease challenging to control. In November 2014, the Immunisation Advisory Centre held New Zealand's inaugural Influenza Symposium (NZiS) to focus upon influenza and vaccine strategies in New Zealand. International and local experts discussed advances in vaccine effectiveness, safety and disease prevalence and impact. Disease surveillance and vaccine effectiveness studies are identifying those at greatest risk from influenza to target vaccination campaigns. Influenza vaccine safety is closely monitored in order to improve public confidence. In New Zealand, around 27% of the total population are vaccinated against influenza annually, with 67% coverage for those aged 65 years and over who are eligible to funded vaccine. Seasonal influenza vaccination is vigorously promoted each year to help to improve vaccine uptake. However, there are inequalities in disease impact, with the elderly and very young, socioeconomically deprived and those with Maori and Pacific Island ethnicity remaining at-risk of serious disease and hospitalisation, which may be addressed by further improving access to influenza vaccine.

Albiglutide: first global approval.

Albiglutide (Eperzan® [EU]; Tanzeum™ [US]), a glucagon-like peptide 1 receptor agonist, has been developed by GlaxoSmithKline for the treatment of type 2 diabetes mellitus (T2DM). Albiglutide has received its first global approval in this indication in the EU, for use in combination with other antihyperglycaemic agents, including basal insulin, when these drugs and diet and exercise do not provide adequate glycaemic control, and as monotherapy in patients unable to take metformin due to contraindications or intolerance when diet and exercise alone do not provide adequate glycaemic control. Albiglutide has subsequently been approved for the second-line or later treatment of T2DM as an adjunct to diet and exercise in the US. This article summarizes the milestones in the development of albiglutide leading to this first approval for the treatment of T2DM.

Acotiamide: first global approval.

Acotiamide (Acofide(®)), an oral first-in-class prokinetic drug, is under global development by Zeria Pharmaceutical Co. Ltd and Astellas Pharma Inc. for the treatment of patients with functional dyspepsia. The drug modulates upper gastrointestinal motility to alleviate abdominal symptoms resulting from hypomotility and delayed gastric emptying. It exerts its activity in the stomach via muscarinic receptor inhibition, resulting in enhanced acetylcholine release and inhibition of acetylcholinesterase activity. Unlike other prokinetic drugs that are utilized in the management of functional dyspepsia, acotiamide shows little/no affinity for serotonin or dopamine D2 receptors. Acotiamide is the world's first approved treatment for functional dyspepsia diagnosed by Rome III criteria, with its first approval occurring in Japan. Phase III trials in this patient population are in preparation in Europe, with phase II trials completed in the USA and Europe. This article summarizes the milestones in the development of acotiamide, leading to its first approval for use in patients with functional dyspepsia.