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1.
Vaccine ; 38(19): 3553-3559, 2020 Apr 23.
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.
Artigo em Inglês | MEDLINE | ID: mdl-32114977

RESUMO

Introduction: Invasive Haemophilus influenzae type b (Hib) disease is rare in Australia following vaccine introduction in 1993. Two deaths in vaccinated children in 2017, and the Hib booster dose moving from age 12 months to 18 months in 2018, prompted this review. Methods: Hib Case Surveillance Scheme 2000-2017 data were used to calculate incidence, incidence rate ratios (IRR) and vaccine failure (VF) trends. We used denominators from the Australian Immunisation Register to calculate incidence in immunised and unimmunised children. Results: All-age national invasive Hib disease incidence halved from 0.13 per 100,000 population in 2000 to 0.06 in 2017. Of 345 cases notified in 2000-2017, 153 were born post-2000, with 51 (33%) Aboriginal and Torres Strait Islander (Indigenous), and compared with non-Indigenous children IRR was 8.34 (95% CI: 5.83-11.79), with no evidence of decrease. Overall case fatality rate was 12.4% (19/153); 6 cases had underlying medical conditions. The overall incidence of invasive Hib disease was over 8 times higher (16.6 per 100,000) in children with no recorded doses than in children with ≥1 vaccine dose (1.9 per 100,000). VF criteria were met in 65/145 (45%) cases aged >8 weeks, of whom 7 (11%) were immunocompromised and 6 (9%) died, with no evidence of VF increase over time. Conclusion: Overall, invasive Hib disease incidence declined by 55% from 2000 to 2017, but marked disparity persists between Indigenous and non-Indigenous children. Following moving the fourth dose from 12 to 18 months in 2018, monitoring of 3-dose VFs will be important, especially in Indigenous children.


Assuntos
Infecções por Haemophilus/epidemiologia , Haemophilus influenzae tipo b , Antígenos de Bactérias , Austrália/epidemiologia , Criança , Feminino , Vacinas Anti-Haemophilus , Humanos , Programas de Imunização , Incidência , Lactente , Masculino
3.
Artigo em Inglês | MEDLINE | ID: mdl-32178602

RESUMO

We have identified a previously unrecognised cluster of a newly recognised condition - acute flaccid myelitis (AFM) - among acute flaccid paralysis (AFP) cases identified by the Australian Paediatric Active Enhanced Disease Surveillance Network (PAEDS) 2007-2017. In the 12 months before and after detection of enterovirus D68 (EV-D68) from a single AFP case in April 2016, 24 of 97 notified cases of AFP were found to be clinically compatible with AFM; of these 24 cases, ten, clustered in early 2016, met magnetic resonance imaging (MRI) criteria for AFM. Detection of emerging enteroviruses requires collection of respiratory, cerebrospinal fluid and stool specimens, and should be routine practice for all AFP cases.


Assuntos
Viroses do Sistema Nervoso Central , Infecções por Enterovirus , Mielite , Doenças Neuromusculares , Austrália/epidemiologia , Viroses do Sistema Nervoso Central/diagnóstico , Viroses do Sistema Nervoso Central/epidemiologia , Criança , Surtos de Doenças , Enterovirus Humano D , Infecções por Enterovirus/diagnóstico , Infecções por Enterovirus/epidemiologia , Humanos , Imagem por Ressonância Magnética , Mielite/diagnóstico , Mielite/epidemiologia , Doenças Neuromusculares/diagnóstico , Doenças Neuromusculares/epidemiologia
4.
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.

6.
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.

7.
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.

10.
Artigo em Inglês | MEDLINE | ID: mdl-31743099

RESUMO

Summary: Cantu syndrome, or hypertrichotic osteochondrodysplasia, is a rare, autosomal dominant genetically heterogeneous disorder. It is characterized by hypertrichosis, cardiac and skeletal anomalies and distinctive coarse facial features. We report a case where slowed growth velocity at 13 years led to identification of multiple pituitary hormone deficiencies. This adds to other reports of pituitary abnormalities in this condition and supports inclusion of endocrine monitoring in the clinical surveillance of patients with Cantu syndrome. Learning points: Cantu syndrome is a rare genetic disorder caused by pathogenic variants in the ABCC9 and KCNJ8 genes, which result in gain of function of the SUR2 or Kir6.1 subunits of widely expressed KATP channels. The main manifestations of the syndrome are varied, but most commonly include hypertrichosis, macrosomia, macrocephaly, coarse 'acromegaloid' facies, and a range of cardiac defects. Anterior pituitary dysfunction may be implicated in this disorder, and we propose that routine screening should be included in the clinical and biochemical surveillance of patients with Cantu syndrome.

11.
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.

12.
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.

13.
Clin Infect Dis ; 2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31504309

RESUMO

BACKGROUND: Despite recommendations that older adults receive acellular pertussis vaccines, data on direct effectiveness in adults aged over 50 years are sparse. METHODS: Case-control study nested within an adult cohort. Cases were identified from linked pertussis notifications and each matched to three controls on age, sex and cohort recruitment date. Cases and controls were invited to complete a questionnaire, with verification of vaccination status by their primary care provider. Vaccine effectiveness (VE) was estimated by conditional logistic regression, with adjustment for reported contact with children and area of residence. RESULTS: Of 1112 notified cases in the cohort, we had complete data for 333 cases and 506 controls. Among 172 PCR-diagnosed cases (mean age 61 years), 11.2% versus 19.5% of controls, had provider-verified pertussis vaccination, on average 3.2 years earlier. Adjusted VE against PCR-diagnosed pertussis was 52% (95%CI 15 to 73%); non-significantly higher if vaccinated within 2 years (63%, -5 to 87%). Adjusted VE was similar in adults born before 1950, presumed primed by natural infection (51%; -8% to 77%) versus those born 1950 or later who may have received whole-cell pertussis vaccine (53%; -11% to 80%); p-heterogeneity=0.9. Among 156 cases identified by single-point serology, adjusted VE was -55% (-177% to 13%). CONCLUSION: We found modest protection against PCR-confirmed pertussis among older adults (mean age 61 years, range 46-81) within five years after acellular vaccine. The most likely explanation for the markedly divergent VE estimate from cases identified by single titre serology is misclassification arising from limited diagnostic specificity in our setting.

15.
Artigo em Inglês | MEDLINE | ID: mdl-31522666

RESUMO

This tenth annual immunisation coverage report shows data for the calendar year 2016 derived from the Australian Immunisation Register (AIR) and the National Human Papillomavirus (HPV) Vaccination Program Register. After a decade of being largely stable at around 90%, 'fully immunised' coverage at the 12-month assessment age increased in 2016 to reach 93.7% for the age assessment quarterly data point in December 2016, similar to the 93.4% for the age assessment quarterly data point in December 2016 for 60 months of age. Implementation of the 'No Jab No Pay' policy may have contributed to these increases. While 'fully immunised' coverage at the 24-month age assessment milestone decreased marginally from 90.8%, in December 2015, to 89.6% for the age assessment quarterly data point in December 2016, this was likely due to the assessment algorithm being amended in December 2016 to include four doses of DTPa vaccine instead of three, following reintroduction of the 18-month booster dose. Among Indigenous children, the gap in coverage assessed at 12 months of age decreased fourfold, from 6.7 percentage points in March 2013 to only 1.7 percentage points lower than non-Indigenous children in December 2016. Since late 2012, 'fully immunised' coverage among Indigenous children at 60 months of age has been higher than for non-Indigenous children. Vaccine coverage for the nationally funded seasonal influenza vaccine program for Indigenous children aged 6 months to <5 years, which commenced in 2015, remained suboptimal nationally in 2016 at 11.6%. Changes in MMR coverage in adolescents were evaluated for the first time. Of the 411,157 ten- to nineteen-year-olds who were not recorded as receiving a second dose of MMR vaccine by 31 December 2015, 43,103 (10.5%) of them had received it by the end of 2016. Many of these catch-up doses are likely to have been administered as a result of the introduction on 1 January 2016 of the Australian Government's 'No Jab No Pay' policy. In 2016, 78.6% of girls aged 15 years had three documented doses of HPV vaccine (jurisdictional range 67.8-82.9%), whereas 72.9% of boys (up from 67.1 % in 2015) had received three doses.


Assuntos
Programas de Imunização , Vacinas contra Influenza/administração & dosagem , Vacina contra Sarampo-Caxumba-Rubéola/administração & dosagem , Vacinas contra Papillomavirus/administração & dosagem , Cobertura Vacinal , Adolescente , Adulto , Idoso , Austrália , Criança , Pré-Escolar , Feminino , Humanos , Esquemas de Imunização , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Adulto Jovem
16.
Clin Infect Dis ; 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31388670

RESUMO

BACKGROUND: Universal pneumococcal conjugate vaccine (PCV) programs began in Indigenous Australian children in 2001 and all children in 2005, changing to PCV13 in 2011. We used laboratory data for invasive pneumococcal disease (IPD) and coded hospitalisations for non-invasive pneumococcal community acquired pneumonia (PnCAP) to evaluate long-term impact. METHODS: Annual incidence (per 100,000 population) was calculated for age-specific total IPD, PCV13-non7v serotypes and PnCAP by Indigenous status. Incidence in the pre-universal PCV7 (2002-2004), early-PCV7 (2005-2007), pre-PCV13 (2008-mid 2011) and post-PCV13 (mid 2011-2016) periods was used to calculate incidence rate ratios (IRRs). RESULTS: In the total population, all-age incidence of IPD declined from 11.8 pre-PCV7 to 7.1 post-PCV13 (IRR 0.61, 95% CI 0.59-0.63) but for PnCAP declined <1 year (IRR 0.34, 95% CI 0.25-0.45) and 1-4 years (IRR 0.50, 95% CI 0.43-0.57) but increased significantly ≥5 years (IRRs 1.08 to 1.14). In Indigenous people, baseline PCV13-non7v IPD incidence was 3-fold higher, amplified by a serotype 1 epidemic in 2011. By 2015-6, although incidence of IPD and PnCAP in children <5 years decreased by 38%, neither decreased in people ≥5 years. CONCLUSIONS: 15 years post PCV and 5 years post PCV13, direct and indirect impact on IPD and PnCAP differed by age and between Indigenous and non-Indigenous people, with potential implications for long-term PCV impact in comparable settings.

18.
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.

19.
Pediatr Infect Dis J ; 38(9): 967-973, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31408056

RESUMO

BACKGROUND: Little is known about long-term invasive pneumococcal disease (IPD) incidence in children with risk factors (RFs) in populations with high coverage pneumococcal conjugate vaccine (PCV) programs. We measured IPD burden and changes with PCV use in children by RF status. METHODS: A retrospective cohort of all live births in 2001-2012 in New South Wales, Australia was linked to IPD, hospitalization and death data. RFs were identified from International Classification of Diseases codes in linked hospitalizations. For each RF adjusted hazard ratios (aHRs, using Cox models), population attributable fractions (PAFs) and changes post-PCV relative to baseline for IPD were calculated. RESULTS: One-thousand two-hundred fifty-one IPD cases occurred in ~1.1 million children in 12-year study cohort. The 75,404 children (6.8% of cohort) with RFs accounted for 255 (20.4%) IPD cases [rate (per 100,000 person-years) of 61 compared with 14 in no RFs]. Asthma was most common RF (n = 41,074; 3.6%) but highest IPD risk was in 2452 children (0.2%) with immunosuppression, splenic dysfunction or breach in cerebrospinal fluid barrier (aHR~20; PAF 0.7-1.8%) versus asthma (aHR 5.3; PAF 14.8%). Compared with 2001-2004 birth cohort (baseline), IPD incidence in PCV-eligible 2009-2012 birth cohort was 78% (95% confidence interval: -72% to -82%) less in children without RFs. IPD declined nonsignificantly (13%; 95% confidence interval: -70% to +138%) in highest IPD risk group, but by 67% (-43% to -82%) in children with other RFs. CONCLUSIONS: By 8 years of universal PCV, IPD incidence reduced significantly in all children except in the 0.2% at highest risk, for whom antibiotic prophylaxis and additional vaccine doses are recommended but compliance and effectiveness remain uncertain.

20.
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.

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