Pertussis Disease and Antenatal Vaccine Effectiveness in Australian Children.

BACKGROUND: Population-level studies of severe pertussis extending beyond infancy are sparse, and none in the context of antenatal vaccination. We compared hospitalized pertussis cases from birth to 15 years of age before and after introduction of antenatal immunization. METHODS: Active surveillance of laboratory-confirmed pertussis hospitalizations in a national network of pediatric hospitals in Australia January 2012 to June 2019. Impact of maternal vaccination was assessed by vaccine effectiveness (VE) in cases and test-negative controls with <2 months of age and by before-after comparison of age distribution of cases. Among cases eligible for one or more vaccine doses, we examined proportions age-appropriately immunized and with comorbidities by age group. RESULTS: Among 419 eligible cases, the proportion <2 months of age significantly decreased from 33.1% in 2012 to 2014 compared with 19.6% in 2016 to 2019 when mothers of only 4 of 17 (23.5%) cases <2 months of age had received antenatal vaccination. VE was estimated to be 84.3% (95% CI, 26.1-96.7). Across all years (2012-2019), of 55 cases 4-11 months of age, 21 (38%) had ≥2 vaccine doses, whereas among 155 cases ≥12 months of age, 122 (85.2%) had ≥3 vaccine doses. Prevalence of comorbidities (primarily cardiorespiratory) increased from 5 (2.1%) <6 months of age to 36 (24.2%) ≥12 months of age (P < 0.001), with 6/16 (38%) cases ≥12 months of age who required intensive care having comorbidities. CONCLUSIONS: Below the age of 12 months, prevention of severe pertussis will be maximized by high maternal antenatal vaccine uptake and timeliness of infant vaccine doses. Despite full immunization, we found children ≥12 months of age accounted for 27% of hospitalizations <15 years, with 24% having comorbities, suggesting new vaccine strategies, such as additional doses or more immunogenic vaccines, require evaluation.

Predictors of hospital readmission in infants less than 3 months old.

AIM: To examine rates and predictors of 7-day readmission in infants hospitalised before 3 months of age with infectious and non-infectious conditions. METHODS: Retrospective population-based data-linkage study of 121 854 infants from a 5-year metropolitan birth cohort (2008-2012). Cox proportional hazard models were used to examine associations between infant and maternal factors with 7-day readmission. RESULTS: A total of 11 669 (9.6%) infants were hospitalised at least once by 3 months of age (median 23 days old, 56% male) with 12 602 total index hospitalisations. Infection-related conditions accounted for 29.4% (n = 3705). Readmission within 7 days occurred after 4.8% of all index hospitalisations and 5.4% of infection-related hospitalisations. Age ≤21 days was the strongest readmission risk factor (hazard ratio 7.7 (95% confidence interval 4.7-12.7) compared to infants 61-90 days old). Other risk factors included shorter index hospitalisations, younger maternal age and multi-gravidity. CONCLUSION: Hospitalisations and readmissions occur for many young infants. Risk factors for readmission should inform risk-based management guidelines.

Advances in Vaccines to Prevent Viral Respiratory Illnesses in Children.

Childhood vaccination has played a critical role in the reduction of morbidity and mortality from communicable diseases, including specific respiratory pathogens. Acute lower respiratory infection (ALRI) of both bacterial and viral aetiology continues to impact global child health. Key bacterial pathogens including Streptococcus pneumoniae and Haemophilus influenza type b are specifically targeted with current vaccination programmes, while at present there are less effective strategies for the prevention of viral disease. Influenza vaccines, including both live attenuated intranasal vaccines and inactivated influenza vaccines, are limited by seasonal strain variation and unsustained immunity. Research into the development of a universal influenza vaccine is ongoing; potential targets are the conserved regions of the virus such as the M2e antigen and hemagglutinin stalk. Respiratory syncytial virus (RSV) and parainfluenza virus 3 (PIV3) are the viral pathogens most commonly causing ALRI in children, particularly the infant population. Currently, no vaccine exists for either virus. Over the last decade, promising advances have been made. Protection of neonates via maternal RSV immunisation is being assessed in a phase III clinical trial, with many other candidates for RSV and PIV3 at less advanced stages of development.

A 15-Year Old Burmese Girl With Hemoptysis: A Case Report.

We report the case of a 15-year-old Burmese girl who presented with hemoptysis 3 years after immigrating to Australia with a background of previously treated pulmonary tuberculosis at 6 years of age. Cavitation in the right upper lobe had originally been identified on her baseline chest radiograph following arrival to Australia; extensive investigations were conducted thereafter to exclude causes of cavitary lung disease; these were negative. Paragonimus westermani was finally diagnosed on serological grounds 3 years after this child's original presentation, with subsequent identification of P. westermani ova in sputum and in stool. Clinicians should be alert to the possibility of Paragonimiasis in children who have traveled to or originate from endemic countries who present with a clinically compatible illness. Treatment is simple and effective. Failure to consider this pathogen early may result in unnecessary investigative workup and delayed diagnosis.

Australian trachoma surveillance annual report, 2011.

Australia remains the only developed country to have endemic trachoma in some regions. Endemic levels of trachoma in Australia are found predominantly in remote and very remote Aboriginal communities. Data are collected from Aboriginal communities designated at risk for endemic trachoma (defined as a prevalence of 5% or greater among children) in the Northern Territory, South Australia and Western Australia. This report presents data collected in 2011. The World Health Organization (WHO) grading criteria were used to diagnose cases of trachoma in Aboriginal children with jurisdictions focusing screening activities on the 5-9 year age group. The prevalence of trachoma within a community was used to guide appropriate treatment strategies as a public health response. Aboriginal adults aged 40 years or older were screened for trichiasis. Population screening coverage for trichiasis in 2011 was 9% with a prevalence of 2% in those adults screened. Trachoma screening coverage of the estimated populationof children aged 5-9 years in at-risk communities was 65%. Trachoma prevalence among children aged 5-9 years who were screened was 7%. Of the communities screened, 47% were found to have no cases of active trachoma and 40% were found to have endemic levels. Treatment was required in 80 at-risk communities screened. Treatment coverage of active cases and their contacts varied between jurisdictions, ranging from 53% to 98%. This report provides evidence of increasing coverage of trachoma screening and control activities. In the Northern Territory and Western Australia, there is also evidence of a decline in the prevalence of infection that may be attributable to an improvement in control activities. Despite these apparent advances, trachoma prevalence remains at endemic levels in many communities in remote Australia. Continued efforts are required to ensure that Australia remains on track to reach the goal of elimination by 2020 or sooner.

Australian trachoma surveillance annual report, 2010.

Endemic trachoma continues to exist in remote Aboriginal communities in Australia. The National Trachoma Surveillance and Reporting Unit, established in 2006, is responsible for the collation, analysis and reporting of trachoma prevalence data and the documentation of trachoma control strategies in Australia. Data were collected from Aboriginal communities designated at-risk for endemic trachoma (defined as prevalence of 5% or greater among children) within the Northern Territory, South Australia and Western Australia. This report presents data collected in 2010. Aboriginal children aged 1-14 years were screened using the World Health Organization grading criteria to diagnose and classify individual cases of trachoma. Aboriginal adults aged 40 years or older were screened for trichiasis. Community screening coverage of the designated at-risk communities was 60% in 2010. Screening coverage of the estimated population of children aged 1-14 years and of adults aged 40 years or older in at-risk communities was 11.5% and 5%, respectively. Trachoma prevalence among children aged 1-14 years who were screened was 11%. Of the communities screened, 36% were found to have no cases of active trachoma and 55% were found to have endemic levels of trachoma. Treatment coverage of active cases and their contacts varied between jurisdictions from 64% to 90%. Trichiasis prevalence was 4% within the screened communities.