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1.
Vaccine ; 2020 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-32220516

RESUMO

BACKGROUND: In the context of co-morbid illness and increasing age, data on excess morbidity from pertussis in older adults is crucial for immunisation policy but has been largely limited to case-series. METHODS: We designed a matched case-control study nested within a population-based cohort of 267,153 adults aged ≥45 years in New South Wales, Australia (The 45 and Up Study cohort). Excess hospital bed days, emergency department (ED) admissions, general practitioner (GP) visits, and prescriptions were estimated using negative binomial regression models. An additional self-controlled analysis was also conducted to validate the main models, and to evaluate results for those with either asthma or a body mass index (BMI)≥30 compared to those without these risk factors. RESULTS: Based on 524 pairs of PCR-confirmed pertussis cases and matched controls, we estimated an excess healthcare utilisation per case of 2.5 prescriptions (95% CI: 0.2-4.7), of which 1.1 (95% CI: 0.5-2.2) were antibiotics, 2.3 GP visits (95% CI: 2.0-2.6), and 0.1 ED admissions (95% CI: 0.1-0.2). Compared to those 45-64 years, cases ≥65 years had a significantly greater excess for all prescriptions (1.1 vs 4.7/case), antibiotic prescriptions (0.1 vs 2.2/case), and ED admissions (0.1 vs 0.2/case), but no significant excess of respiratory-related hospital bed days. An additional self-controlled analysis confirmed that cases with either asthma or BMI≥30 had higher overall healthcare utilisation but this was not associated with pertussis infection. CONCLUSION: We found a substantial excess outpatient healthcare burden among adults aged 65 years and over with PCR-confirmed pertussis, supporting further evaluation of preventive measures.

2.
Ecol Appl ; : e02107, 2020 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-32096578

RESUMO

Urban streams are often severely impaired due to channelization, high loads of nutrients and contaminants, and altered land cover in the watershed. Physical restoration of stream channels is widely used to offset the effects of urbanization on streams, with the goal of improving ecosystem structure and function. However, these efforts are rarely guided by strategic analysis of the factors that mediate the responsiveness of stream ecosystems to restoration. Given that ecological gradients from headwater streams to mainstem rivers are ubiquitous, we posited that location within a river network could mediate the benefits of channel restoration. We studied existing stream restorations in Milwaukee, Wisconsin, to determine (1) whether restorations improve ecosystem function (e.g., nutrient uptake, whole-stream metabolism) and (2) how ecosystem responses vary by position in the urban river network. We quantified a suite of physicochemical and biological metrics in six pairs of contiguous restored and concrete channel reaches, spanning gradients in baseflow discharge (19-196 L/s) and river network position (i.e., headwater to mainstem). Hydrology differed dramatically between the restored and concrete reaches; water velocity was reduced 2- to 13-fold while water residence time was 50-5,000% greater in adjacent restored reaches. Restored reaches had shorter nutrient uptake lengths for ammonium, nitrate, and phosphate, as well as higher whole-stream metabolism. Furthermore, the majority of reaches were autotrophic (i.e., gross primary production > ecosystem respiration), which is not common in stream ecosystems. The difference in ecosystem functioning between restored and unrestored reaches was generally largest in headwaters and declined to equivalence in mainstem restorations. Our results suggest that headwater sites offer higher return on investment compared to larger downstream channels, where ecosystem responsiveness is low. If this pattern proves to be general, the scaling of ecosystem responses with river size could be integrated into planning guidelines for urban stream restorations to enhance the societal and ecological benefits of these expensive interventions.

3.
Vaccine ; 38(11): 2572-2577, 2020 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-32037225

RESUMO

There are limited long-term data on seroprevalence of neutralising antibody (nAb) to the three poliovirus serotypes following the switch from oral polio vaccine (OPV) to inactivated polio vaccine (IPV). In Australia, combination vaccines containing IPV replaced OPV in late 2005. Using serum and plasma specimens collected during 2012 and 2013, we compared prevalence of nAb to poliovirus type 1 (PV1), type 2 (PV2) and type 3 (PV3) in birth cohorts with differing IPV and OPV eligibility from an Australian population-based sample. In the total sample of 1673 persons aged 12 months to 99 years, 85% had nAb against PV1, 83% PV2 and 67% PV3. In the cohort 12 to <18 years (eligible for 4 OPV doses, last dose 8-14 years prior), a significantly lower proportion had nAb than in the 7 to <12 year cohort (eligible for 3 OPV doses and an IPV booster, last dose 3-8 years prior) for all poliovirus types: [PV1: 87.1% vs. 95.9% (P = 0.01), PV2: 80.4% vs. 92.9% (P = 0.003) and PV3: 38.1% vs. 84.0% (P < 0.0001)]. These data suggest individual-level immunity may be better maintained when an OPV primary schedule is boosted by IPV, and support inclusion of an IPV booster in travel recommendations for young adults who previously received only OPV.

4.
J Fish Biol ; 96(2): 456-468, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31814124

RESUMO

We assessed the prevalence of life history variation across four of the five native amphidromous Hawai'ian gobioids to determine whether some or all exhibit evidence of partial migration. Analysis of otolith Sr.: Ca concentrations affirmed that all are amphidromous and revealed evidence of partial migration in three of the four species. We found that 25% of Lentipes concolor (n = 8), 40% of Eleotris sandwicensis (n = 20) and 29% of Stenogobius hawaiiensis (n = 24) did not exhibit a migratory life-history. In contrast, all individuals of Sicyopterus stimpsoni (n = 55) included in the study went to sea as larvae. Lentipes concolor exhibited the shortest mean larval duration (LD) at 87 days, successively followed by E. sandwicensis (mean LD = 102 days), S. hawaiiensis (mean LD = 114 days) and S. stimpsoni (mean LD = 120 days). These findings offer a fresh perspective on migratory life histories that can help improve efforts to conserve and protect all of these and other at-risk amphidromous species that are subject to escalating anthropogenic pressures in both freshwater and marine environments.

5.
Vaccine ; 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31628032

RESUMO

BACKGROUND: Receiving vaccines at or close to their due date (vaccination timeliness) is a now key measure of program performance. However, studies comprehensively examining predictors of delayed infant vaccination are lacking. We aimed to identify predictors of short and longer-term delays in diphtheria-tetanus-pertussis (DTP) vaccination by dose number and ethnicity. METHODS: Perinatal, notification, death and immunisation databases were linked for 1.3 million births in 2000-11 from two Australian states (Western Australia and New South Wales), with follow-up data until 2013. Ordinal logistic regression was used to estimate adjusted relative risks (RR) by degree of delay. Separate models were constructed for each vaccine dose and for Aboriginal and non-Aboriginal children. RESULTS: Each dose-specific cohort included at least 49,000 Aboriginal and 1.1 million non-Aboriginal children. Delayed receipt was more common among Aboriginal than non-Aboriginal children (eg for the first dose of DTP [DTP1] 19.4 v 8.1%). Risk factors for delayed vaccination were strongest for DTP1, and delayed receipt of DTP1 was a key driver of subsequent delays; every week DTP1 was delayed was associated with a 1.6 to 2-fold increased risk of delayed DTP2 receipt. For DTP1, ≥3 previous pregnancies (the only factor more strongly associated with longer than shorter delays; RR ≥5 compared to no previous pregnancies), and children born to mothers <20 years of age (RR ≥2 compared to ≥35 years) were at highest risk of delay. Other independent predictors were prematurity, maternal smoking during pregnancy, and being born in Western Australia (if Aboriginal) or another country in the Oceania region. CONCLUSION: The sub-populations at risk for delayed vaccination we have identified are likely generalisable to other high-income settings. Measures to improve their dose 1 timeliness, particularly for children with older siblings, are likely to have significant flow-on benefits for timeliness of later doses.

6.
PLoS One ; 14(10): e0216580, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31639142

RESUMO

Maintaining sustainable fisheries requires understanding the influence of technological advances on catch efficiency, as technological creep can ultimately contribute to increased efficiency. Fisheries using light sources for attraction could be widely impacted by the shift to light emitting diode (LED) light systems. We studied the transition from kerosene lanterns to LED lamps in Lake Tanganyika, East Africa, examining factors that led to adoption as well as the impact of the new light sources on fish catch and composition. We used a combination of field experiments with catch assessments, fisher surveys, underwater light spectra measurements, and cost assessments to evaluate the impact of switching from kerosene to LED lamps. Overall, we found a very rapid rate of adoption of homemade outdoor LED light systems in Lake Tanganyika. Most of the batteries used to power these lamps were charged from the city power grid, rather than photovoltaic cells, although the potential exists for a reduction in greenhouse gas emissions. The LED light spectra was distinct from the kerosene light and penetrated much deeper into the water column. Regardless of light type, most of the fish caught within the two dominant species were below maturity. Although the LED lamps were associated with a slight increase in catch, environmental factors, particularly distance offshore, were generally more important in determining fish catch size and composition. The main advantages of the LED lamps were the lower operating costs and their robustness in bad weather. Thus, the primary effect of the use of battery-powered LED lighting systems to attract fish in Lake Tanganyika appears to reduce economic costs and increasing efficiency. However, overall the lake's fishery remains vulnerable to overfishing.

8.
Vaccine ; 37(39): 5835-5843, 2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31443995

RESUMO

OBJECTIVES: Rotavirus vaccines (RV), included in Australia's National Immunisation Program from mid-July 2007, are unique in strict time limits for administration. Here, we report on timeliness of RV uptake, compare cumulative RV coverage to age 12 months with DTPa, and assess factors associated with receipt of RV among Aboriginal and non-Aboriginal children. METHODS: Birth records for 681,456 children born in two Australian states in 2007-2012 were probabilistically linked to national immunisation records. We assessed on-time coverage (defined as receipt of vaccine dose between 4 days prior to scheduled date and the recommended upper limit) for RV and compared this to diphtheria-tetanus-pertussis (DTPa) vaccine. Logistic regression modelling was used to assess independent determinants of receipt of RV. RESULTS: Compared to non-Aboriginal infants, on-time RV coverage was lower for all doses among Aboriginal infants. Post the upper age limit of RV dose2, DTPa dose2 coverage increased by 9-16% to ≥90%, whereas RV coverage remained around 77% (Aboriginal) and 85% (non-Aboriginal). Compared to first-born children, the adjusted odds of receiving ≥1 RV dose if born to a mother with ≥3 previous births was 0.30 (95%CI: 0.27-0.34) among Aboriginal, and 0.53 (95%CI: 0.51-0.55) among non-Aboriginal children. Prematurity (<33 weeks), low birthweight (<1500 g), maternal age <20 years, maternal smoking during pregnancy and living in a disadvantaged area were independently associated with decreased vaccine uptake. CONCLUSIONS: Aboriginal children are at greater risk of rotavirus disease than non-Aboriginal children and delayed vaccine receipt is substantially higher. Although specific programs targeting groups at risk of delayed vaccination might improve RV coverage, relaxation of upper age restrictions is most readily implementable, and its overall risk-benefit should be evaluated.

9.
Lancet Child Adolesc Health ; 3(10): 713-724, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31439496

RESUMO

BACKGROUND: Reductions in pneumonia hospitalisations following introduction of pneumococcal conjugate vaccines (PCVs) have been reported from high-incidence and low-incidence settings but long-term data comparing vaccinated with unvaccinated children are sparse. METHODS: We did a retrospective, population-based, record-linkage cohort study in Australian children using administrative health data from the Western Australian Midwives' Notification System and New South Wales Perinatal Data Collection, and the birth and death registries in both states. PCV vaccination details, pneumonia-coded hospital admissions, and invasive pneumococcal disease notification records were individually linked for children born between 2001 and 2012. The primary outcome was defined as the first hospital admission for all-cause pneumonia. Cox models were used to calculate adjusted hazard ratios (HR) to estimate the effect of PCV doses on pneumonia-coded hospital admissions by Aboriginal status, birth period, remoteness, and pneumonia diagnostic category in children younger than 2 years. Person-time of follow-up time for each child started at birth and was censored at the earliest of first hospital admission for all-cause pneumonia, death, invalid PCV dose, when the child reached age 24 months, or the end date of the study period (Dec 31, 2013) FINDINGS: The study cohort comprised 1 365 893 children liveborn between Jan 1, 2001, and Dec 31, 2012, of whom 66 484 (4·9%) were identified as Aboriginal. The overall rate for all-cause pneumonia hospital admissions for children younger than 2 years over the entire study period was 17·6/1000 child-years in Aboriginal children and 5·5/1000 child-years in non-Aboriginal children. Compared with children born between 2001 and 2004 (ie, the pre-universal PCV period), the incidence of pneumonia-coded hospital admissions decreased in both vaccinated (6·5 vs 5·7 per 1000 child-years [12% reduction, 95% CI 3-21; p=0·01]) and unvaccinated non-Aboriginal children (6·8 vs 3·7 [45% reduction; 41-49]) born 2005-12 (the universal PCV period); among Aboriginal children, declines were significant only among those vaccinated (27·4 vs 14·1 [49% reduction, 40-55]). Among Aboriginal children born 2005-12, the risk of pneumonia-coded hospital admission after three doses of PCV was lower than those unvaccinated (adjusted HR 0·83, 95% CI 0·65-0·99) but, among non-Aboriginal children, the risk was similar (adjusted HR 1·09, 0·98-1·22). Overall, remote-born Aboriginal children had the highest incidence of hospital admission for pneumonia and among children born 2005-12, the adjusted risk was 37% lower (adjusted HR 0·63, 95% CI 0·42-0·96) among those fully vaccinated than those unvaccinated. INTERPRETATION: Reductions in pneumonia-coded hospital admissions in unvaccinated children predominated in non-Aboriginal children with low incidence of pneumonia but were not significant in Aboriginal children with high incidence. These findings have potential implications for measuring PCV effect using a non-specific endpoint such as all-cause pneumonia in high-incidence populations. FUNDING: Commonwealth Government Collaborative Research Infrastructure Strategy and Education Investment Fund Super Science Initiative and the Australian National Health and Medical Research Council.

10.
Proc Biol Sci ; 286(1907): 20190966, 2019 07 24.
Artigo em Inglês | MEDLINE | ID: mdl-31311475

RESUMO

Wild meat (or 'bushmeat') hunting is nearly ubiquitous across the tropics and is very often unsustainable-driving declines and extirpation of numerous mammal populations. Loss of these animals can alter the transport of nutrients within and between ecosystems. But whether the physical removal of vertebrate carcasses and the nutrients that they store can reduce overall nutrient availability in ecosystems has been little explored. At 32 sites on three continents, we show that annual phosphorus (P) loss via mammal exploitation was low relative to the rate of atmospheric P deposition. But at four sites in Africa and Southeast Asia, removal of P in the skeletons of hunted mammals exceeded the atmospheric input of this nutrient by 10-fold or more. Because P is the growth-limiting nutrient for many tropical terrestrial ecosystems and certain large mammals, the imbalance created by the removal of mammal biomass under very high hunting scenarios could reduce ecosystem carrying capacity if no compensatory P additions occur in the system. This biogeochemical perspective on bushmeat exploitation raises further concerns about harvest sustainability and human food security in areas where hunting rates are high and ecosystem P inputs low.

11.
Pediatr Infect Dis J ; 38(8): 860-865, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30985507

RESUMO

BACKGROUND: Finnish studies have shown a significant impact of 10-valent pneumococcal conjugate vaccine (PCV10) on nonnotified clinically suspected invasive pneumococcal disease (IPD). We used a similar vaccine probe design to estimate PCV7 and PCV13 impact in Australian children. METHODS: Season and age-matched pre-PCV7 cohorts (born in 2002-2004) were compared with PCV7-early and PCV7-late, and PCV13-eligible cohorts. Using linked notification and hospitalization data, we calculated relative rate reductions (RRRs) and absolute rate reductions (ARRs) for notified IPD, and nonnotified clinically suspected IPD or unspecified sepsis (first hospitalization with an International Classification of Diseases 10th Revision-Australian Modification code: A40.3/G00.1/M00.1 or A40.9/A41.9/A49.9/G00/I30.1/M00, respectively). RESULTS: Significant reductions in all outcomes were observed comparing PCV7-early and PCV7-late and PCV13-eligible to pre-PCV7 cohorts. RRRs were high for both notified and nonnotified clinically suspected IPD (range 71%-91%), but ARRs were lower for nonnotified (5-6/100,000 person-years) than for notified cases (59-70/100,000 person-years). RRRs for the combined outcome of nonnotified clinically suspected IPD or unspecified sepsis were lower at 21%-24% for PCV7-eligible cohorts and 36% for the PCV13-eligible cohort, but ARRs were considerable due to the high pre-PCV7 rates (ARR 37-31/100,000 person-years for PCV7-early and PCV7-late cohorts and 54/100,000 person-years for PCV13). CONCLUSIONS: This study provides a quantitative estimate of the total burden of IPD preventable by PCV7 and PCV13 vaccination programs in Australia. ARRs (compared with prevaccination) were significant but smaller than in Finland (122/100,000 for the combined outcome) and longer-term follow-up is required to determine the additional impact of PCV13 above that seen for PCV7. Country-specific studies are needed to accurately estimate the burden of pneumococcal disease preventable by vaccination and cost-effectiveness of PCV vaccination programs.

13.
Sci Adv ; 5(1): eaav0486, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30662951

RESUMO

River ecosystems receive and process vast quantities of terrestrial organic carbon, the fate of which depends strongly on microbial activity. Variation in and controls of processing rates, however, are poorly characterized at the global scale. In response, we used a peer-sourced research network and a highly standardized carbon processing assay to conduct a global-scale field experiment in greater than 1000 river and riparian sites. We found that Earth's biomes have distinct carbon processing signatures. Slow processing is evident across latitudes, whereas rapid rates are restricted to lower latitudes. Both the mean rate and variability decline with latitude, suggesting temperature constraints toward the poles and greater roles for other environmental drivers (e.g., nutrient loading) toward the equator. These results and data set the stage for unprecedented "next-generation biomonitoring" by establishing baselines to help quantify environmental impacts to the functioning of ecosystems at a global scale.

14.
Environ Manage ; 63(3): 396-407, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30645675

RESUMO

Cisco (Coregonus artedi) are an important indicator species for cold-water lake habitats in the Great Lakes region, and many populations have been extirpated at their southern range limit over the last century. Understanding the roles of climate and water quality in these extirpations should inform protection of cold-water fishes. Using the water temperature at the depth where dissolved oxygen falls to 3 mg L-1 (TDO3) as a metric, we investigated the roles of climate and water quality as drivers of habitat availability for cisco in Lake Mendota, WI, USA from 1976 to 2013. We find that summer (Jun-Aug) air temperatures, spring (Mar-May) phosphorus load, and spring inflow influence summer TDO3. Warm air temperatures lead to the greatest increases in TDO3, whereas reduced phosphorus loads can reduce TDO3, thus alleviating oxythermal stress. Under air temperatures expected under the A1B climate change scenario, a 25% reduction in phosphorus load would stabilize TDO3 at current levels, while a 75% reduction in phosphorus loading would be required to expand oxythermal habitat. Costs of these reductions are estimated to range from US$16.9 million (-25%) to US$155-167 million (-75%) over a 20-year period but may be feasible by expanding upon current watershed phosphorus reduction initiatives if sustained funding were available. Identifying targeted reductions will become increasingly important throughout the region as warmer temperatures and longer stratification reduces cool- and cold-water fish habitat in many Midwestern lakes under the expected future climate.


Assuntos
Lagos , Salmonidae , Animais , Mudança Climática , Ecossistema , Great Lakes Region
15.
J Infect ; 78(3): 220-225, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30528868

RESUMO

OBJECTIVES: To examine the impact of Australia's single dose infant varicella vaccination program, we assessed single dose varicella vaccine effectiveness (VE) in preventing hospitalised disease using two methods. METHODS: Clinically confirmed varicella cases from the Paediatric Active Enhanced Disease Surveillance (PAEDS) sentinel network were age-matched to 20 controls obtained from the Australian Immunisation Register. Conditional logistic regression models were used to estimate VE and compared with estimates obtained using our second approach. RESULTS: There were 78 hospitalised varicella cases during the post vaccine introduction period from January 2008 to December 2015, who were eligible for funded varicella vaccination. Median age at onset was 4.5 years and more than half (59%) were vaccinated. The majority of children received one vaccine brand (Varilrix, GSK). The estimated case-control VE for one dose of vaccine against hospitalised varicella was 64.7% (95% CI: 43.3-78.0%); estimates using the screening method were not significantly different. Exclusion of children who were immunocompromised did not significantly alter VE estimates. CONCLUSIONS: Although Australia's program has impacted on the burden of varicella disease, single dose VE against varicella hospitalisation is only moderate. Greater reductions in varicella disease could potentially be achieved by incorporation of a second vaccine dose into the program to minimise breakthrough disease and interrupt virus circulation.

16.
Artigo em Inglês | MEDLINE | ID: mdl-31891824

RESUMO

BACKGROUND: Rates of food allergy have increased markedly in Australia and other high- income countries in recent years. On the basis of ecological observations, and the known immunologic characteristics of whole-cell pertussis (wP) compared with acellular pertussis (aP) vaccines, we hypothesized that wP vaccination in infancy protects against the development of food allergy. OBJECTIVE: To determine whether infants who receive wP in infancy were less likely to develop IgE-mediated food allergy than those who received aP. METHODS: Retrospective cohort-nested case-control study of Australian children born in the period 1997 to 1999, the period of transition from using wP-containing to aP-containing vaccines. Children diagnosed with IgE-mediated food allergy were individually matched to 10 controls by date of birth, socioeconomic decile, and jurisdiction of birth. The odds ratio of vaccination with wP versus aP among cases and matched controls was calculated using conditional logistic regression. RESULTS: The odds ratio of receiving the first dose as wP (rather than aP) among cases of food allergy compared with controls was 0.77 (95% CI, 0.62-0.95). The results of secondary analyses (any dose as wP vs aP-only, and wP-only vs aP-only) were broadly similar. CONCLUSIONS: Australian infants who received wP vaccines were less likely to be diagnosed with food allergy in childhood than contemporaneous children who received aP vaccines. If a protective effect is confirmed in a randomized controlled trial, wP or mixed wP and aP vaccination schedules could form part of an effective strategy for combating the rise in food allergies.

17.
Behav Processes ; 157: 230-237, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30352272

RESUMO

The sensory modalities used by predatory fish to detect and capture prey are a key dimension of their foraging strategy. Determining the sensory cues that guide predation can also further conservation efforts under environmental change, and address the welfare of research animals. Here, we experimentally manipulated the sensory modalities used by adult zebrafish (Danio rerio) when foraging for larval conspecifics in captivity. We used minimally invasive techniques to test the consequences of eliminating visual, olfactory, and mechanosensory cues for predator behavior and success. Our results indicate that zebrafish require visual cues, but not olfactory or mechanosensory input. Reducing the visual contrast between prey and their surroundings decreased capture rates, suggesting that contrast underlies visual foraging. Video recordings of zebrafish during foraging indicate that they actively hunt larval fish, rather than employing a sit-and-wait approach. Together, our findings indicate adult zebrafish rely on visual cues to guide an active predation strategy.


Assuntos
Comportamento Predatório/fisiologia , Percepção Visual/fisiologia , Peixe-Zebra/fisiologia , Animais , Feminino , Masculino , Mecanorreceptores/fisiologia , Percepção Olfatória/fisiologia
18.
Artigo em Inglês | MEDLINE | ID: mdl-30318003

RESUMO

This study evaluates trends in tetanus immunity and epidemiology over the last two decades in Australia, drawing on two national serological surveys and national tetanus morbidity data, to justify current Australian adult tetanus booster recommendations. We compare tetanus immunity level between two national serosurveys, and examine incidence trends using the most accurate estimation of the true number of cases by correcting for under-ascertainment. Tetanus immunity in people aged <60 years is high, but the elderly, particularly the female elderly, may not be adequately protected. Over the past twenty years older people have regularly accounted for the highest number of tetanus cases, with an increasing proportion of cases. Despite a positive decrease in tetanus incidence, there remains a significant burden in the elderly population of an entirely preventable disease. Supplying a funded booster dose of dTpa at 65 years would be, potentially, an effective strategy to prevent tetanus cases in Australia.

19.
Artigo em Inglês | MEDLINE | ID: mdl-30318004

RESUMO

We report the results of the 2007 national serological survey of immunity to diphtheria in Australia to assess the impact of recent schedule changes on diphtheria immunity, and the adequacy of current policy in the context of increased international travel of people and pathogens. Residual sera (n =1656) collected opportunistically from Australian laboratories in 2007 were tested for diphtheria antibody levels using an enzyme immunoassay, with the protective threshold defined as ≥0.1 IU/mL. About 40% of adults aged ≥30 years are susceptible to diphtheria; following the removal of the 18 month booster and its replacement with a dose in adolescence offered through school-based dTpa vaccination program, 59% of children aged 3 years were susceptible to diphtheria, whilst adolescents demonstrated improved immunity. There is no apparent boosting of diphtheria immunity from meningococcal group C conjugate (MenCV) or seven-valent pneumococcal conjugate (7vPCV) vaccines in relevant age groups. Australians who travel to diphtheria-endemic areas should be up-to-date with their vaccinations. Close monitoring of population immunity levels against diphtheria remains important to ensure that immunity does not decline to a level where wide-spread transmission would be possible.

20.
Artigo em Inglês | MEDLINE | ID: mdl-30277170

RESUMO

This study assessed the impact of the staged introduction of universal infant and adolescent catch-up hepatitis B vaccination programs on the prevalence of immunity and past hepatitis B virus (HBV) infection in targeted cohorts over almost a decade in Australia. We compared the prevalence of immunity in relevant cohorts of children and adolescents in repeated national serological surveys conducted in 1998-99, 2002 and 2007. Residual sera (n =2210) collected opportunistically from Australian laboratories in 2007 were tested for antibody to hepatitis B surface antigen (anti-HBs) indicating vaccine-induced immunity; sera from persons aged 12-29 years with anti-HBs detected (n =386) were then tested for hepatitis B core antibody (anti-HBc) to identify past hepatitis B infection. In 2007, compared with the baseline period of 1998-99, anti-HBs prevalence had increased significantly in all age groups below 24 years, more than doubling in target children. Prevalence of anti-HBc was zero in the 12-14 years and reduces by 71% in those aged 15-19 years. The hepatitis B vaccination protected a significant number of targeted adolescents with a modest vaccine uptake (57% to 60% nationally). In a setting without incentives or school entry requirements, adolescent vaccination coverage was significantly higher when delivered by school-based rather than GP-based mechanisms. A cohort of children was growing up in Australia with high prevalence of vaccine-induced immunity against hepatitis B, providing the best opportunity for controlling HBV infection in Australia.

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