The tolerability of a combined hepatitis A and typhoid vaccine in children aged 2-16 years: an observational study.

BACKGROUND: Combined hepatitis A and typhoid vaccines have been widely used globally and proven to be safe, well tolerated and efficacious in adults. The combined hepatitis A and typhoid vaccine (Vivaxim) available in Australia is licenced for use from age 16 years but the monovalent components are approved for use from age 2 years. Advantages of a single injection have led to widespread 'off-label' use of Vivaxim in children. This study aimed to investigate the tolerability of Vivaxim in children aged 2-16 years. METHODS: A prospective observational study was conducted at Travel Medicine Alliance clinics across Australia. Children who required vaccination for both hepatitis A and typhoid were offered the option of receiving Vivaxim. Parents were contacted 3 days post-vaccination and asked to respond to a questionnaire on adverse events following immunization (AEFIs). Reactions to Vivaxim were compared with reported reactions to the monovalent vaccines. RESULTS: Our study included 425 children who received Vivaxim, including 189 (44.5%) who received other vaccines on the same day. No serious AEFIs were reported, and 26.8% did not experience any side effects. In children who did not receive other vaccines in the same arm as Vivaxim (n = 325), most common local reactions were sore arm (70.5%), redness (16.0%) and swelling (11.1%). Reports of local AEFIs in our subjects was significantly more common than those reported for the individual monovalent vaccines. In children who did not receive other vaccines on the same day (n = 236), the most common systemic reactions were tiredness/lethargy/malaise (5.9%), headache (4.2%), fever (3.4%) and sore muscles and joints (3.4%). Fever was more common in children aged <6 years. Less than 5% of children reported missing school, sport or other regular activities. CONCLUSIONS: Vivaxim was well tolerated in children aged 2-16 years. Parents should be advised about AEFIs to Vivaxim so that they can make informed decisions about vaccination options.

Pretravel advice and hepatitis A immunization among Australian travelers.

BACKGROUND: More Australians are traveling to overseas destinations where preventable infectious diseases, such as hepatitis A, are endemic. Yet, there is only limited data concerning the extent to which Australians seek travel advice and vaccination before their departures. METHOD: Annual telephone surveys were conducted among adult Australians travelers. Information was collected on the travel advice and vaccinations received before departure. Perceptions about, and their potential exposure to, travel-related infections while overseas were also assessed. This paper presents data from the 2003 survey related to travel advice and hepatitis A, while hepatitis B is discussed in the companion article. RESULTS: Only a third of interviewees had sought health advice before travel. Infrequent travelers, those departing for endemic countries or for longer journeys, were more likely to seek medical advice. Overall, 32% of interviewees had been vaccinated against hepatitis A, with travelers to high/medium-hepatitis A endemicity destinations being more likely to be vaccinated than those visiting low-endemicity countries (44% vs 20%). Among the 263 visitors to endemic countries, those who stayed with friends and relatives were least likely to be vaccinated against hepatitis A compared to other styles of accommodation. CONCLUSIONS: Despite government recommendations and industry group campaigns about the need for pretravel advice, the majority of Australians travel overseas without adequate health advice and protection against hepatitis A and other travel-related infectious diseases.

Risk of exposure to hepatitis B and other blood-borne viruses among Australians who travel abroad.

BACKGROUND: European studies indicate that up to 67% of travelers traveling abroad participate in activities that put them at risk of exposure to hepatitis B. Australians are increasingly traveling to destinations where hepatitis B is highly endemic, such as Asia, and are likely to have similar levels of involvement in activities with an associated risk of hepatitis B exposure. METHOD: A series of annual telephone surveys of approximately 500 randomly selected Australian overseas travelers have been conducted under the auspice of the Travel Health Advisory Group over the years 2001 to 2003. The surveys examined the extent to which travelers seek pretravel health advice, what immunizations they receive and what risks they are exposed to during travel including the risk of hepatitis B and other blood-borne virus acquisition. RESULTS: In the 2003 survey, 281 (56%) of the 503 people interviewed had visited at least one country with high or medium hepatitis B endemicity on their most recent overseas trip in the past two years. Approximately a third of travelers undertook one or more activities that were considered to be associated with increased risk of potential hepatitis B exposure. Less than half the travelers (46%) had been vaccinated against hepatitis B. CONCLUSIONS: The results have implications for the individual traveler, as well as to the broader community. Infected travelers can be an important source of hepatitis B into their own home communities. Improved advice and clear recommendations for hepatitis B vaccination are needed to avoid infection.

Treatment of basal cell carcinomas by general practitioners in Australia.

BACKGROUND: Basal cell carcinomas (BCCs) are a relatively common form of skin damage in Australians, involving approximately 1 in 200 general practice encounters per year. AIM: To determine current treatments and the associated healthcare resource costs of BCC therapy in Australia. METHODS: A retrospective survey was undertaken relating to the treatment of patients presenting to their doctor with previously untreated BCCs. Data were collected from a sample of general practitioners who were asked to randomly select two BCC patients from their medical records and complete a questionnaire. Information about treatment types, number of doctor visits, treatment complications, and specialist referrals was extracted from the patient records. RESULTS: One hundred and sixty-four patients were recruited into the study (59% male), who were treated for a total of 244 BCCs (average of 1.5 lesions per patient). Twenty-two per cent of patients were referred to a specialist, most being referred to a general surgeon (45%) or plastic surgeon (25%). Excision was the preferred therapy; second choices were cryosurgery or curettage and cautery. Few adverse events were recorded. The typical number of doctor visits varied from 3.2 to 7.4, with a range of total cost per patient of 146.60-496.20 AUS dollars, depending on complexity and the need for referral. CONCLUSION: With a reported incidence in Australia of approximately 788 per 100,000 persons, BCCs are not inexpensive to treat for such a relatively common condition.

How are solar keratoses treated by general practitioners in Australia?

BACKGROUND: This study aimed to obtain clinical and economic information about patterns of treatment of solar keratoses (SKs) by general practitioners in Australia. The study design was a retrospective survey relating to the treatment of patients presenting to their doctor with previously untreated SKs. METHODS: Data were collected between May and June 2000, from a sample of doctors who were asked to randomly select two SK patients from their medical records and complete a self-administered postal questionnaire. Information about treatment types, number of visits, treatment complications, and specialist referrals were directly extracted from the patient records. RESULTS: A total of 156 patients were recruited to the study (61% male) who had been treated for a total of 251 SKs (average 1.6 lesions/patient). The most common treatment employed was cryotherapy (63%). Excision was also commonly used (18%). Five per cent of patients were treated with a mixture of excision and cryotherapy. Topical agents were not commonly employed. Of those patients who consulted a doctor, 9% were referred to a specialist for diagnosis or treatment, of which 57% were referred to a dermatologist. CONCLUSION: The typical number of doctor visits varied from 1.9 to 4.6 with a range of cost per patient of 55.13-249.70 Australian dollars depending on complexity of the case and the need for referral.

Quality of life and Kaposi sarcoma: using preference techniques to value the health gains from treatment.

The goal of this work was to investigate preference techniques to value potential health gains from treatments of Kaposi sarcoma (KS). The study was designed to take the form of face-to-face interviews with a sample of men with a history of HIV/AIDS ( n=15) or HIV/AIDS and KS ( n=17). The main outcome measure was quality of life (QoL) associated with various KS disease states expressed on a scale from 0 (death) to 1 (perfect health), obtained though time trade-off (TTO) and rating scale techniques. For cutaneous lesions only, the mean TTO preference score value was 0.27. In other words, the men were willing to trade a life expectancy of 5 years for a shorter period (1.4 years) in perfect health. More severe KS health states were rated lower (0.07-0.09). The mean rating scale value for cutaneous lesions only was 0.11 and ranged from -0.10 to -0.04 for the more severe conditions; these values were systematically lower than the TTO ( P=0.014). A large overall potential gain in QoL from treatment (partial response minus stable disease) was found for each condition to be reflected in both the TTO (from 0.31 to 0.55) and the rating scale (from 0.38 to 0.44). Respondents associate KS health states with extremely poor QoL and indicate that large gains are possible through modest treatment effects. While TTO returns higher values than the rating scale, potential gains from treatments were similar. The techniques appear to be suitable for application to QoL and economic evaluation of treatments of KS.