Effectiveness of pneumococcal conjugate vaccine against hospital admissions for pneumonia in Australian children: a retrospective, population-based, record-linked cohort study.

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.

The Aboriginal Population Health Training Initiative: a NSW Health program established to strengthen the Aboriginal public health workforce.

OBJECTIVES: Increasing the representation of Aboriginal people in the health workforce can contribute to improving Aboriginal people's health and wellbeing by supporting the provision of more culturally appropriate health programs and services. The Aboriginal Population Health Training Initiative aims to strengthen the Aboriginal public health workforce in New South Wales (NSW), with the long-term goal of improving the health of Aboriginal people. Type of program or service: The program provides comprehensive, competency-based public health training for Aboriginal people. METHODS: Participants undertake a series of work placements in public health, and complete a Master of Public Health degree. RESULTS: A 2014 evaluation demonstrated that the program makes an important contribution to strengthening the NSW Aboriginal public health workforce. Trainees reported a high level of satisfaction with the quality of their work placements, the flexibility of the program to support their work and study, and efforts made to ensure the program's cultural safety. The program has a high trainee retention rate (17 of 18 trainees), and all graduates have successfully gained employment within the NSW health system. LESSONS LEARNT: Three key factors contribute to the success of the program: trainees undertake their training within their communities; the structure promotes the direct application of learning through simultaneous work and study; and the NSW Government shows strong leadership and support.

Flutracking weekly online community survey of influenza-like illness: 2013 and 2014.

Flutracking is a national online community influenza-like illness (ILI) surveillance system that monitors weekly ILI activity and field vaccine effectiveness. This article reports on the 2013 and 2014 findings from Flutracking. From 2013 to 2014 there was a 14.0% increase in participants who completed at least 1 survey to 21,021 participants. By the end of the 2013 and 2014 seasons, respectively 59.7% and 59.1% of all participants had received the seasonal influenza vaccine. The 2013 Flutracking national ILI weekly incidence peaked in late August at 4.3% in the unvaccinated group, 1 week earlier than national counts of laboratory confirmed influenza. The 2014 Flutracking national ILI weekly incidence also peaked in late August at 4.7% in the unvaccinated group, in the same week as national counts of laboratory confirmed influenza. A lower percentage of Flutracking participants took two or more days off from work or normal duties in 2013 (peak level 1.6%) compared with 2014 (peak level 2.5%) and sought health advice in 2013 (peak level of 1.1%) compared with 2014 (peak of 1.6%). Flutracking ILI surveillance suggests that 2014 was a moderately more intense season than 2013 and similar to 2012.

An outbreak of Salmonella Typhimurium phage type 42 associated with the consumption of raw flour.

A cluster of salmonellosis cases caused by Salmonella Typhimurium phage type 42 (STM42) emerged in New Zealand in October 2008. STM42 isolates from a wheat-based poultry feed raw material (broll; i.e., product containing wheat flour and particles of grain) had been identified in the 2 months prior to this cluster. Initial investigations indicated that eating uncooked baking mixture was associated with illness. A case-control study was conducted to test the hypothesis that there was an association between STM42 cases and consumption of raw flour or other baking ingredients. Salmonella isolates from human and non-human sources were compared using pulsed-field gel electrophoresis (PFGE) and multiple-locus variable number tandem repeat analysis (MLVA). Environmental investigations included testing flour and other baking ingredients from case homes, unopened bags of flour purchased from retail stores, and inspection of an implicated flour mill. A case-control study of 39 cases and 66 controls found cases had 4.5 times the odds of consuming uncooked baking mixture as controls (95% confidence interval [CI] 1.6-12.5, p-value 0.001). Examination of individual baking ingredients found that, after adjusting for eggs, flour had an odds ratio (OR) of 5.7 (95% CI 1.1-29.1, p-value 0.035). After adjusting for flour, eggs had an OR of 0.8 (95% CI 0.2-3.4, p-value 0.762). PFGE patterns were identical for all STM42 isolates tested; however, MLVA distinguished isolates that were epidemiologically linked to the cluster. STM42 was recovered from flour taken from four cases' homes, two unopened packs purchased from retail stores and packs from three batches of retrieved (recalled) product. This outbreak was associated with the consumption of uncooked baking mixture containing flour contaminated with STM42. The implicated flour mill initiated a voluntary withdrawal from sale of all batches of flour thought to be contaminated. Media releases informed the public about implicated flour brands and the risks of consuming uncooked baking mixture.

An outbreak of Salmonella typhimurium phage type 1 associated with watermelon in Gisborne, January 2009.

AIM: To investigate an increase in Salmonella typhimurium phage type 1 (STM1) cases identified in the Gisborne region (eastern North Island, New Zealand) in January 2009. METHODS: Initial investigations found that ham and watermelon were both consumed by a high proportion of cases. A case control study was conducted to determine if there was an association between cases of STM1 in Gisborne and consumption of ham or watermelon. Environmental investigations were conducted and included testing of ham and watermelon samples, as well as trace back of suppliers of these foods. RESULTS: The case control study included 15 cases and 40 controls and found that cases were seven times more likely to have eaten watermelon compared with controls (p=0.026). Cases were one and a half times more likely to have eaten ham compared with controls (p=0.620). Pulsed field gel electrophoresis analysis determined that cases were caused by indistinguishable STM1 isolates. Salmonella was not recovered from any food samples. Trace back found watermelons were purchased from roadside stalls and came from one grower. CONCLUSIONS: This outbreak was associated with watermelon consumption from a grower in the Gisborne region. The outbreak was most likely controlled by the implementation of chlorine washing of watermelons at the grower's pack house.

Epidemiological characteristics of the influenza A(H1N1) 2009 pandemic in the Western Pacific Region.

The first laboratory-confirmed cases of infection with pandemic influenza A(H1N1) 2009 in the Western Pacific Region were reported on 28 April 2009. By 11 June 2009, the day the pandemic was declared by the World Health Organization, nine Western Pacific Region countries and areas had reported laboratory confirmed pandemic influenza A(H1N1) 2009 cases. From April 2009 to July 2010, more than 250 000 cases and 1800 deaths from laboratory-confirmed pandemic influenza A(H1N1) 2009 were reported from 34 countries and areas in the Region. By age group region-wide, 8.6%, 41.9%, 48.3%, and 1.2% of cases were in the < 5 years, 5-14 years, 15-64 years, and 65+ years age groups, respectively; the overall crude case fatality ratio in the Western Pacific Region was 0.5%. The pandemic demonstrated that region-wide disease reporting was possible. Countries and areas of the Western Pacific Region should take this opportunity to strengthen the systems established during the pandemic to develop routine disease reporting.

Epidemiological characteristics of the influenza A(H1N1) 2009 pandemic in the Western Pacific Region

The first laboratory-confirmed cases of infection with pandemic influenza A(H1N1) 2009 in the Western Pacific Region were reported on 28 April 2009. By 11 June 2009, the day the pandemic was declared by the World Health Organization, nine Western Pacific Region countries and areas had reported laboratory-confirmed pandemic influenza A(H1N1) 2009 cases. From April 2009 to July 2010, more than 250 000 cases and 1800 deaths from laboratory-confirmed pandemic influenza A(H1N1) 2009 were reported from 34 countries and areas in the Region. By age group region-wide, 8.6%, 41.9%, 48.3%, and 1.2% of cases were in the < 5 years, 5–14 years, 15–64 years, and 65+ years age groups, respectively; the overall crude case fatality ratio in the Western Pacific Region was 0.5%. The pandemic demonstrated that region-wide disease reporting was possible. Countries and areas of the Western Pacific Region should take this opportunity to strengthen the systems established during the pandemic to develop routine disease reporting.

Influenza surveillance and immunisation in New Zealand, 1997-2006.

BACKGROUND: The national influenza surveillance in New Zealand is an essential public health component for assessing and implementing strategies to control influenza. OBJECTIVE: The aim of this study is to report the national influenza surveillance data collected during 1997-2006 in terms of the community disease burden, circulating viral strains, hospitalisations, mortality, and immunisation coverage. METHODS: The national influenza surveillance system includes sentinel general practice surveillance, laboratory-based surveillance, and hospital admission and mortality surveillance and immunisation coverage. The results obtained during 1997-2006 were analysed. RESULTS: When the last 10 years were compared to the previous years, sentinel general practice surveillance recorded a decreasing trend of influenza-like illness rates in the community. Sentinel surveillance also showed that children aged 0-4 years were the most affected. Influenza-related hospitalisation surveillance reported an increasing trend of hospital admissions particularly in children aged 0-19 years. Introduction of routine influenza vaccination among the New Zealand elderly was associated with a significant decrease of influenza-related mortality. CONCLUSIONS: This report demonstrates that an integrated virological and epidemiological surveillance system for influenza is essential for monitoring the disease burden, identifying circulating strains, guiding effective vaccination and planning for a potential pandemic.